Posted: February 15th, 2023

Week 6: Neurologic and Musculoskeletal Disorders

NURS 6521: Advanced Pharmacology

Week 6: Neurologic and Musculoskeletal Disorders

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In this week’s exploration of neurologic and musculoskeletal disorders, we delve into the case of Sabrina, a 26-year-old woman recently diagnosed with multiple sclerosis. Seeking clarity about her condition, Sabrina turns to the Nurse Helpline for her hospital network. Through her conversation with the advanced practice nurse, Sabrina realizes the comprehensive impact of her diagnosis on both her neurologic and musculoskeletal systems. Although multiple sclerosis primarily manifests as an autoimmune disorder, it exerts diverse adverse effects on these interconnected bodily systems, necessitating vigilant awareness and tailored therapeutic interventions.

As an advanced practice nurse, discerning the most suitable pharmacological interventions to address potential neurologic and musculoskeletal symptoms becomes paramount in Sabrina’s care plan.

This week’s focus entails evaluating patients with neurologic and musculoskeletal disorders through an intricate decision tree exercise utilizing specific patient case studies. By immersing ourselves in these scenarios, we sharpen our ability to analyze and justify the decisions we make throughout the diagnostic and therapeutic journey of individuals grappling with such complex conditions.

Learning Objectives

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Throughout this module, students will:

Assess patients for the treatment of neurologic and musculoskeletal disorders.
Analyze the decision-making process involved in diagnosing and treating patients with these disorders.
Provide evidence-based justifications for the decisions made in the management of neurologic and musculoskeletal disorders.
Learning Resources

Required Word Essay – Readings:

Rosenthal, L. D., & Burchum, J. R. (2018). Lehne’s pharmacotherapeutics for advanced practice providers. St. Louis, MO: Elsevier.

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Chapters covering neuropharmacology, peripheral nervous system physiology, and drug therapies for neurologic and musculoskeletal conditions.

American Academy of Family Physicians. (2019). Dementia. Retrieved from http://www.aafp.org/afp/topicModules/viewTopicModule.htm?topicModuleId=5

A resource providing insights into dementia diagnosis, treatment, and patient education.

Assignment: Decision Tree for Neurological and Musculoskeletal Disorders

For the assignment, each student will be assigned a specific decision tree interactive media piece from the provided resources. By immersing ourselves in these interactive case studies, we prepare to assess and treat patients presenting with symptoms indicative of neurologic and musculoskeletal disorders.

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To Prepare

Review the assigned interactive media piece provided by the instructor.
Reflect on the patient’s symptoms and the nuances of the disorder elucidated in the interactive case study.
Contemplate the assessment and treatment strategies you would employ for patients exhibiting symptoms akin to those presented in your assigned case study.
Consider potential comorbidities and patient-specific factors that might influence the diagnostic and therapeutic approach.
By Day 7 of Week 8

In a succinct 1- to 2-page summary paper, address the following:

Provide a brief overview of the patient case study assigned to you, elucidating each of the three decisions made for the presented patient.
Evaluate whether the decisions you recommended align with evidence-based literature. Substantiate your analysis with concrete examples and references from reputable external sources.
Articulate the objectives underpinning your recommended decisions for the assigned patient case study, supported by pertinent evidence and references.
Reflect on any disparities between your anticipated outcomes for each decision and the actual results gleaned from the exercise. Offer specific instances and elucidate any deviations observed.
This assignment is due in Week 8.

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NURS 6521: Advanced Pharmacology
Week 6 Neurologic and Musculoskeletal Disorders

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This week, you will evaluate patients for the treatment of neurologic and musculoskeletal disorders by focusing on specific patient case studies through a decision tree exercise. You will analyze the decisions you will make in the decision tree exercise and reflect on your experiences in proposing the recommended actions to address the health needs in the patient case study.

Assignment:

In your course resources under week 6 you will find the decision tree under required media.
Choose the case ” Alzheimer’s Disease”, It should be the first one on the list.
This assignment is not due until WEEK 8

Week 6: Neurologic and Musculoskeletal Disorders

Sabrina is a 26 year old female who has just been diagnosed with multiple sclerosis. She has scheduled an appointment for a follow up with her physician but has several questions about her diagnosis and is calling the Nurse Helpline for her hospital network. As she talks with the advanced practice nurse, she learns that her diagnosis also impacts her neurologic and musculoskeletal systems. Although multiple sclerosis is an autoimmune disorder, both the neurologic and musculoskeletal systems will be affected by adverse symptoms that Sabrina needs to be aware of and for which specific drug therapy plans and other treatment options need to be decided on.

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As an advanced practice nurse, what types of drugs will best address potential neurologic and musculoskeletal symptoms Sabrina might experience?

This week, you will evaluate patients for the treatment of neurologic and musculoskeletal disorders by focusing on specific patient case studies through a decision tree exercise. You will analyze the decisions you will make in the decision tree exercise and reflect on your experiences in proposing the recommended actions to address the health needs in the patient case study.
Learning Objectives

Students will:

Evaluate patients for treatment of neurologic and musculoskeletal disorders
Analyze decisions made throughout the diagnosis and treatment of patients with neurologic and musculoskeletal disorders
Justify decisions made throughout the diagnosis and treatment of patients with neurologic and musculoskeletal disorders

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Learning Resources

Required Word Essay – Readings (click to expand/reduce)

Required Media – Help Write An Essay For Me Online! (click to expand/reduce)

Assignment: Decision Tree for Neurological and Musculoskeletal Disorders

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For your Assignment, your Instructor will assign you one of the decision tree interactive media pieces provided in the Resources. As you examine the patient case studies in this module’s Resources, consider how you might assess and treat patients presenting symptoms of neurological and musculoskeletal disorders.

Photo Credit: Getty Images/Science Photo Library RF

To Prepare

Review the interactive media piece assigned by your Instructor.
Reflect on the patient’s symptoms and aspects of the disorder presented in the interactive media piece.
Consider how you might assess and treat patients presenting with the symptoms of the patient case study you were assigned.
You will be asked to make three decisions concerning the diagnosis and treatment for this patient. Reflect on potential co-morbid physical as well as patient factors that might impact the patient’s diagnosis and treatment.

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By Day 7 of Week 8

Write a 1- to 2-page summary paper that addresses the following:

Briefly summarize the patient case study you were assigned, including each of the three decisions you took for the patient presented.
Based on the decisions you recommended for the patient case study, explain whether you believe the decisions provided were supported by the evidence-based literature. Be specific and provide examples. Be sure to support your response with evidence and references from outside resources.
What were you hoping to achieve with the decisions you recommended for the patient case study you were assigned? Support your response with evidence and references from outside resources.
Explain any difference between what you expected to achieve with each of the decisions and the results of the decision in the exercise. Describe whether they were different. Be specific and provide examples.

You will submit this Assignment in Week 8.

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Learning Resources

Required Word Essay – Readings (click to expand/reduce)

Rosenthal, L. D., & Burchum, J. R. (2018). Lehne’s pharmacotherapeutics for advanced practice providers. St. Louis, MO: Elsevier.

Chapter 10, “Basic Principles of Neuropharmacology” (pp. 73–77)
Chapter 11, “Physiology of the Peripheral Nervous System” (pp. 79–90)
Chapter 12, “Muscarinic Agonists and Antagonists” (pp. 91–107)
Chapter 13, “Adrenergic Agonists” (pp. 109–119)
Chapter 14, “Adrenergic Antagonists” (pp. 121–132)
Chapter 15, “Indirect-Acting Antiadrenergic Agents” (pp. 133–137)
Chapter 16, “Introduction to Nervous System Pharmacology” (pp. 139–141)
Chapter 17, “Drugs for Parkinson Disease” (pp. 143–158)
Chapter 18, “Drugs for Alzheimer Disease” (pp. 159–166)
Chapter 19, “Drugs for Epilepsy” (pp. 167–189)
Chapter 20, “Drugs for Muscle Spasm and Spasticity” (pp. 191–201)
Chapter 57, “Drug Therapy of Rheumatoid Arthritis” (pp. 629–641)
Chapter 58, “Drug Therapy of Gout” (pp. 643–651)
Chapter 59, “Drugs Affecting Calcium Levels and Bone Mineralization” (pp. 653–672)

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American Academy of Family Physicians. (2019). Dementia. Retrieved from http://www.aafp.org/afp/topicModules/viewTopicModule.htm?topicModuleId=5

This website provides information relating to the diagnosis, treatment, and patient education of dementia. It also presents information on complications and special cases of dementia.

Document: Mid-Term Summary & Study Guide (PDF)

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Approach to Managing Multiple Sclerosis
Multiple sclerosis (MS) is a chronic autoimmune disease of the central nervous system that results in damage to the protective myelin sheaths surrounding nerve fibers (National Multiple Sclerosis Society, n.d.). This demyelination disrupts communication between the brain and other parts of the body, leading to a wide variety of neurological and musculoskeletal symptoms. While there is no cure for MS, early diagnosis and a comprehensive treatment approach targeting both disease modification and symptom management can help improve quality of life for those living with the condition.
MS most commonly presents between the ages of 20 to 50 and is nearly three times more prevalent in women than men (Wallin et al., 2019). Both genetic and environmental factors are believed to play a role in its development, though the exact cause remains unknown (National Multiple Sclerosis Society, n.d.). The disease follows an unpredictable course, with periods of relapse when new or worsening symptoms occur interspersed with periods of remission (Wallin et al., 2019). During relapses, inflammation and demyelination actively damage the central nervous system (CNS; National Multiple Sclerosis Society, n.d.).
Common neurological symptoms of MS include fatigue, numbness or tingling sensations, vision problems such as optic neuritis, dizziness, and cognitive impairment affecting memory, concentration, and mood (National Multiple Sclerosis Society, n.d.). Musculoskeletal issues involve weakness, spasticity or stiffness of muscles, mobility difficulties, and pain (National Multiple Sclerosis Society, n.d.). Symptoms vary greatly between individuals and even within the same person over time depending on which areas of the CNS are impacted by lesions (Wallin et al., 2019).
First-line disease-modifying therapies for relapsing forms of MS aim to reduce inflammation in the CNS and modify the immune system’s attack on myelin (Wallin et al., 2019). Common options include glatiramer acetate (Copaxone), interferon beta-1a/1b (Avonex, Rebif, Plegridy), teriflunomide (Aubagio), and dimethyl fumarate (Tecfidera; Wallin et al., 2019). These medications have been shown to decrease relapse rates, slow progression of physical disability, and reduce new lesion formation on MRI scans when taken long-term (Wallin et al., 2019).
For acute relapses, corticosteroids like intravenous methylprednisolone (Solu-Medrol) are effective at rapidly reducing inflammation and improving symptoms over the course of several days (Wallin et al., 2019). Additional therapies may be prescribed based on individual symptom assessment task profiles. For example, baclofen, tizanidine, or dantrolene are commonly used to manage spasticity, while duloxetine, pregabalin, or gabapentin help control neuropathic pain (National Multiple Sclerosis Society, n.d.).
Non-pharmacological approaches also play an important role in MS management. Physical and occupational therapy can help preserve mobility and independence through strengthening, stretching, balance training, and adaptive equipment (National Multiple Sclerosis Society, n.d.). Regular aerobic exercise has demonstrated benefits for reducing fatigue, depression, and cognitive issues (Motl & Gosney, 2008). Orthotics, braces, and mobility devices provide support for walking difficulties (National Multiple Sclerosis Society, n.d.). Dietary modifications and stress management techniques may aid symptom control as well (Motl & Gosney, 2008).
In conclusion, a comprehensive treatment approach targeting both disease modification and symptom management through pharmacological and non-pharmacological means can help improve quality of life for those living with MS. Early diagnosis allows for timely initiation of disease-modifying therapies shown to reduce relapses, slow disability progression, and prevent further CNS damage over the long term. Addressing specific neurological and musculoskeletal issues through an individualized regimen tailored for each patient maximizes functioning despite the unpredictable course of this chronic condition. Continued research strives to further advance MS care through new treatment options and a deeper understanding of disease mechanisms.
References
Motl, R. W., & Gosney, J. L. (2008). Effect of exercise training on quality of life in multiple sclerosis: A meta-analysis. Multiple Sclerosis Journal, 14(1), 129–135. https://doi.org/10.1177/1352458507080427
National Multiple Sclerosis Society. (n.d.). What is MS? Retrieved February 15, 2024, from https://www.nationalmssociety.org/What-is-MS
Wallin, M. T., Culpepper, W. J., Nichols, E., Bhutta, Z. A., Gebrehiwot, T. T., Hay, S. I., … & Mokdad, A. H. (2019). Global, regional, and national burden of multiple sclerosis 1990–2016: A systematic analysis for the Global Burden of Disease Study 2016. The Lancet Neurology, 18(3), 269-285. https://doi.org/10.1016/S1474-4422(18)30443-5

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