Reference no: EM133320894

Assignment:

Twenty-seven-year-old female presents at provider's office complaining of increasing multiple sclerosis symptoms. Use the chart to answer the questions. The chart may update as the scenario progresses.

History and Physical Assessment Medical/Surgical history: Diagnosed with MS 9 years ago. First MS attack at age 18, with initial complaints of blurred vision and balance problems. Next MS attack 2 years later with main complaint of numbness and tingling beginning in distal right arm, progressing proximally. MS attacks at age 22 and 24 years with balance and vision problems as primary complaints.

Social history: Laboratory technician in research science laboratory. Denies alcohol, tobacco, drug usage.

Family history: Mother suffers from rheumatoid arthritis. Father in good health after suffering myocardial infarction (5 years ago). Great-grandmother is believed to have had scleroderma.

Physical Assessment: Patient appears underweight and ashen. Pulses are normal. Eye exam reveals pain with eye movement. Lungs are clear. Breath sounds are normal. Abdomen is slightly descended with hypoactive bowel sounds. Normal range of movement in extremities with weakness noted in right arm. Patient says arm feels as if it is numb and "tingling." She struggles to get the sensation to stop.

Medications: Corticosteroids during MS attack, acetaminophen (over the counter) for general "aches".

Question

The nurse also reviews the patient information to determine if the patient is experiencing any affective or cognitive symptoms. Select to highlight findings that may indicate affective and/or cognitive developments.

Patient appears underweight and ashen. Patient says she has been depressed lately and is discouraged because "symptoms are back." Patient states she is having difficulty focusing eyes at work. She also reports having to navigate very slowly the walkways and stairways to and from her work. She feels work is becoming more difficult due to her inability to maintain concentration.

Patient moves slowly when asked to change position. Patient uses examining table for balance.

Patient reports not eating normally, as she feels bloated and uncomfortable after eating. She also reports urinary incontinence that is becoming more problematic.