Signs, Symptoms and the Pathophysiology - Case Study Example

Case Study Care Plan on Sciatic Nerve Injury Affiliation Disorder analysis Management of this kind of nerve injury is based on the cause. The initial steps are geared towards management of pain first then work on curbing the origin of the injury. From the case study, the patient is suffering from compression at the spinal cord which has affected the sciatic nerve (Navarro, Vivó, & Valero-Cabré, 2007). Thus, apart from management of the pain by use of non-steroidal anti-inflammatory drugs, the patient has to be observed on the status of the spinal cord. In such a case, surgical intervention can be utilized to bring back the vertebrae in line and relieve the pressure exerted on the sciatic nerve. Coupling the surgical repair with regular exercising and nursing care, the patient is likely to recover well over time. Lastly, on the management, patients are advised to have an application of ice or heat at the painful area interchangeably. The recommendation is ice application for the first 48 to 72 hours then followed by heat compressions (Menorca, Fussell, & Elfar, 2013). The prognosis depends on the extent of nerve injury. Most of the times with advanced nerve injury, there is permanent damage to the nerve hence impairing it completely, in such a case patients sometimes have to use wheelchairs L5-S1 is significant for the fact one branch of the sciatic nerve originates from this point. Thus, compression at this point means that the sciatic nerve will be injured hence releasing the symptoms down the lower limb where it supplies. The L5-S1 height drop is caused by compression of the spinal code. Compression of the vertebral discs is a medical condition usually referred to as lumbar spinal stenosis. As the spinal cord narrows, it presses on the nerves located on the level hence eliciting a series of symptoms on the sites where the nerves supply. From the case study, there is a clear indication that the sciatic nerve is injured, and the injury is caused by the compressed vertebrae. There are various causes of compressed vertebrae. First, the compression can be as a result of ankolysing spondlitis that is a chronic disease that is characterized by inflammation of the axial skeleton; there is variable involvement of both the non-articular structures and the peripheral joints. It is among the spondyloarthropathies that have a strong genetic predisposition. Mainly, it affects joints in the sacroiliac, spine and the pelvis. In some severe cases, the condition can lead to complete spinal discs fusion. The prevalence of the syndrome is about 12 % of older community-dwelling men while those in retirement communities add up to about 21 % (Li et al., 2011). Signs, symptoms and the pathophysiology In cases of ankolysing spondlitis, the symptoms occur gradually and begin from the age of 15 to 45 years. Inflammation of the sacrum manifests as the initial symptom of this disease. It is characterized initially by chronic dull pain that is sinister at the beginning; the pain is felt at the gluteal region and the lower lumber region accompanied by stiffness at the low back. The pain can occur in the entire spine or at the middle of the spine, most often; the pain is referred to one side of the buttock or at the back of a thigh and originates from the sacroiliac joint (Abe & Cavalli, 2008) The symptom of lumbar spinal stenosis on the sciatic nerve that are referred to the leg includes pain, leg tingling and weakness. Additionally the legs may experience cramps, numbness or prickling, tingling sensation, heaviness, fatigue and sometimes bladder symptoms as well. The symptoms may be bilateral and symmetrical; however sometimes they may be unilateral with leg pain being more troubling that that of the back in most instances (Ichihara, Inada, & Nakamura, 2008). Degenerative spondylolisthesis is one of the other main causes of the lumber spinal stenosis there is forward displacement of the vertebra in relation with the adjacent vertebra in association with an intact neural arch. It narrows the spinal canal hence showing the symptoms of spinal stenosis with many effects of the nervous system. In the patient’s case, there is injury of the sciatic nerve at the point of exit between L5 and S1. Thus, these areas of the body supplied by the branch of the sciatic nerve feel the full effect of the injury. The signs and symptoms of the patient are as a result of the impaired functionality of the sciatic nerve orchestrated by the fact there is a vertebral injury at the point of exit from the spinal cord. Management and prognosis To determine the diagnosis, first, there is needed to take into the historical account of the patient. It is of essence determining whether the cause is related to injury or the patient’s lifestyle. After predetermining the probable cause, there must be confirmatory diagnostic. There are various diagnostics tests performed to determine the patients status. For example, x-ray, CT scan or the MRI of the spinal cord that will locate the exact point of damage and at the same time show the extent of damage. The diagnostic tests are very important for they guide on the type of care to be given. At the same time form the observation of the extent of damage, the physician can be able to predetermine the prognoses hence prepare the patient and the family psychologically so that they can accept the outcome of the patient ultimately (Navarro et al., 2007). The disorder from normal development Normally the degenerative disorder of the spinal cords vertebrae that can lead to the spinal cord compression ensures much later at the age of about sixty years. Unlike the normal degenerative disorder that comes with age, this patient has been suffering from the on and off symptoms of this condition at the age of about 37 years. The causative agents for this condition can be attributed to heavy duties that the patient is involved in that have led to the destabilization of the spinal cord hence compression at the l5 and s1 vertebrae. Physical and psychological demands the disorder places on the patient and family. The condition so far has compromised the physical ability of the patient to perform the daily activities. At the same time, the patient is disturbed psychologically for the fact the he will no longer be in a position to make money to take care of his bills, a situation that affected his first relationship. For the fact that the parents live nearby and are able to meet with him at least each week, they are likely to be psychologically affected since their son is now ailing and not able to perform the daily activities of living. Thus causing psychological trauma that may pose a great threat to the well-being of the patient’s nuclear family. Key concepts shared with the patient and family. For adequate family coping with the situation, a couple of issues have to be clarified to allay the unnecessary anxiety on both the patient and the family. In the first case, the patient is affected psychologically since he feels like is the cause of his breakup with his wife, thus counseling is paramount before initiating other talks on the current illness. After the patients’ conscious has been cleared on the misfortunes, then the nurse should engage on explaining the current condition (Campbell, 2009). Among the information that should be provided to the client is on the causes, management, treatment options and the prognosis. With adequate information on the same, both the patient and their family will consequently have that peace of mind with adequate knowledge on what is going to happen next. Interdisciplinary team personnel needed. Management of the family and patient disorders has to be collaborative for optimal results. The professionals involved in patient care have to play a role in restoring the psychological status of the patient. Physician, psychologist, nurse and the psychotherapist have both very crucial role in ensuring the patient and the families are stable psychologically. The physician, who provides the diagnosis and prescribes the treatment modalities of the patient, has the role of explaining to the patient on the mode of treatment chosen and the expected outcome. The physician has to share with the patient on the side effects of the drugs and the effect they have towards healing the condition. Physiotherapists too work with the physicians in the management of patients. Thus, they also have to chip in explaining to the client on the activities they can engage in and project the outcome of the activities that they are involved in. The psychologist and a nurse have a critical role too. They spend quite a lot of time with the patient and families hence are in a position to not the reaction of the patients and the difficulties they have while coping with the situation. At the same time, nurses have the vital role of ensuring the patients copes with the daily activities. They play the great role of ensuring that the patient access activities of daily living that are essential for survival (Neal & Fields, 2010) Facilitators and barriers to optimal disorder management and outcomes The major barrier to elimination of the disorder is the financial incapability of the patient. First, the client does not have a medical cover, and secondly the annual earning of the patient is slightly above the minimum wages. Hence managing the patient with sophisticated equipment is not possible for they will require a lot of money. The close care of the health care professionals will not be provided because of the same reasons that the patients will not be able to pay. Secondly, the patients have psychological disturbance that is drawn from the past relationship that he had. Psychologically instability will impair caring of the current condition. Compliance with the current care will largely depend on the patients coping with the past psychological disturbance. Strategies to overcome the identified barriers First to ensure adequate care of the patients, there is a need to provide the services that are optimal in curing the condition, but at the same time not very expensive for the client. The less sophisticated machines and equipment can be used to care for the patients, of essence is to see the patient get the adequate care that will see the patient recover from the condition. Moreover, there is a need to stabilize the patient psychologically before initiating care of the current situation. That can be managed by using the nurses who also double up as psychologists. The nurses will be the most appropriate first choice in providing counseling to the patients for the fact that will reduces the patient’s bills since they do not have an adequate financial ability to carry out the functions. Comprehensive plan of care with a comprehensive approach on disorder management Plan Rationale Expected outcome Historical Data collection and conducting of tests The initial data collection provides some knowledge on the extent of the disease. The diagnostics tests are important in confirming the exact extent of the disorder, which is important for staging and deciding on the modality of care. Information will be obtained that will be able to predetermine causes of the disorder and the same time provide a baseline to start with while taking care of the patient Psychological care The patient’s previous divorce has a great impact on his psychological status. With that in mind, the patient has to be provided with the adequate psychological support to help in the healing process and awareness of the current situation The patient is expected to cope with the divorces and be ready to handle the current disorder. Care of the current condition by the physician, nurse’s psychotherapist and maybe the psychologist. The current condition of the patient distressing sand needs sift action to deter the further psychological tortures and pain the patient is going through. Concisely the patient has to receive the collaborative care that will see him go through the condition The patient will recover from the condition ultimately with adequate care form the appropriate groups. Social cultural impact In the Jewish culture, the sciatic nerve is important since it is used to commemorate Jacobs’s victory over the angel. Therefore, depending on the patient’s faith, there can be limitations on the sciatic nerve care for the fact the patients believes and culture has to be respected in the process of patient care which is upheld by the medical practitioners (Auyong & Le, 2011). Evidence-based approach to address key issues identified in the case study. Some of the key issues that have been raised in the case study include, drug and substance abuse, psychological trauma and misuse of drugs form over the counter and using drugs prescribed for other patients. Use of drugs that have not been recommended patients doctor can lead to various complications. In the recent past, sharing of drugs has been a major cause of drug resistance more so for the antibiotics (Burnett & Zager, 2004) and increased tolerance for other drugs. Concisely, there is still need to create awareness on the effects of sharing drugs that have not been prescribed on a particular patient. At the same time drugs cause also of interactions in the body, that why before a drug is prescribed, the doctor must first assess the effect of the drug on the patient. Psychological trauma has been seen to slow down healing process as observed by Chunzheng, Shengzhong, Yinglian, Ji-e, & Jianmin (2008) Marijuana is a strong psycostimulant that can affect the threshold of functionality of ibuprofen. Thus, the patient has to taper off the intake of marijuana, which is at the same time illegal. Conclusion Patients with sciatic nerve injury have to be taken care of with optimal care. With proper management, the patients will have to resume their daily activities in due course. On the other hand, with poor management of these patients, they will continue to deteriorate which will even have them in wheel chairs hence compromising the quality of life ultimately. Lastly, holistic care of patients is very crucial for accelerated healing process. It is important, to access the patient wholesomely to reach the optimal healthy status of the patient. References Abe, N., & Cavalli, V. (2008). Nerve injury signaling. Current Opinion in Neurobiology. doi:10.1016/j.conb.2008.06.005 Auyong, T. G., & Le, A. (2011). Dentoalveolar Nerve Injury. Oral and Maxillofacial Surgery Clinics of North America. doi:10.1016/j.coms.2011.05.001 Burnett, M. G., & Zager, E. L. (2004). Pathophysiology of peripheral nerve injury: a brief review. Neurosurgical Focus, 16, E1. doi:10.3171/foc.2004.16.5.2 Campbell, W. W. (2009). Evaluation of peripheral nerve injury. European Journal of Pain Supplements, 3, 37–40. doi:10.1016/j.eujps.2009.08.007 Chunzheng, G., Shengzhong, M., Yinglian, J., Ji-e, W., & Jianmin, L. (2008). Siatic nerve regeneration in rats stimulated by fibrin glue containing nerve growth factor: An experimental study. Injury, 39, 1414–1420. doi:10.1016/j.injury.2008.05.010 Ichihara, S., Inada, Y., & Nakamura, T. (2008). Artificial nerve tubes and their application for repair of peripheral nerve injury: an update of current concepts. Injury, 39, 29–39. doi:10.1016/j.injury.2008.08.029 Li, N., Downey, J. E., Bar-Shir, A., Gilad, A. A., Walczak, P., Kim, H., … Pelled, G. (2011). Optogenetic-guided cortical plasticity after nerve injury. Proceedings of the National Academy of Sciences of the United States of America, 108, 8838–8843. doi:10.1073/pnas.1100815108 Menorca, R. M. G., Fussell, T. S., & Elfar, J. C. (2013). Nerve physiology. Mechanisms of injury and recovery. Hand Clinics. doi:10.1016/j.hcl.2013.04.002 Navarro, X., Vivó, M., & Valero-Cabré, A. (2007). Neural plasticity after peripheral nerve injury and regeneration. Progress in Neurobiology. doi:10.1016/j.pneurobio.2007.06.005 Neal, S., & Fields, K. B. (2010). Peripheral nerve entrapment and injury in the upper extremity. American Family Physician, 81, 147–155.  Read More