Management And The Ethical Concerns Related-Myassignmenthelp.Com

Question: Discuss About The Management And The Ethical Concerns Related? Answer: Introduction The case study below shows an illustration of a patient, with external ventricular drain. This reflective essay illustrates on the pathophysiology , nursing intervention and management and the ethical concerns related to the case. The case involves Mr. Knight admitted in the health facility with numerous diagnostics symptoms which is attributed to occurrence of Cerebrospinal fluid. The nursing intervention employed is EVD administration as a way of easing the pressure on the intracranial region. This essay covers the environmental and family issues which affect the nursing intervention and the legal issues pertaining health care delivery. History of the Patient This is a cases study of Mr Knight, aged 35 years old male, who was admitted in the health facility with complains from dysphagia and weakness throughout the body. His medical history is negative with no record of previous surgical procedures. The patient was well till 3 months when he started to develop general weakness and sleep apnea, with dysphagia and experiencing difficulty in swallowing. Upon admission, he was taken through blood investigation, with CBC, ABGs reflecting normal values, the CXR showed no abnormalities. The brain showed mass lesion in the 4th ventricle which was diagnosed with brain tutor. Upon this discovery, the patient underwent craniotomy procedure. Post operation status was that the patient was admitted in the ICU mechanical ventilation, with physical signs showing he was a wake, while spontaneously opening the eyes. The progress was positive on the next day with improvements on the limbs signifying 5/5 limbs. Comprehensive Nursing Assessment Integrating Pathophysiology The patient was taken through physical examination, whereby his head temperature was at 30 degrees, with key vital signs depicting temperature of 95.5degress F, while BP was of 130/79mmHG, pulse of 63, respiratory rate of 25 and oxygen saturation at 97%. His Glasgow coma scale was at 14, with dense left hemi paresis. There was occurrence of generalized symptoms of unconsciousness with mild headache with vomiting. The patient exhibited seizures similar to mild stroke. There was presence of binocular blindness, facial drop and aphasis. Other symptoms depicting subarachnoid haemorrhage included sudden onset of severe headache with vomiting and nausea. The physical signs on vital organs such as the heart, lungs and other extremities showed exacerbation. Altered level of conscious was also evident from the patient with signs of semi coma. This is associated with hemorrhagic stroke, which is often caused by the increased intracranial pressure. Subarachnoid haemorrhage can occur among patie nts without signalling any signs. It has devastating effects on the patient state, (Van, Kerr Rinkel, 2007). The physiological process that the patient exhibited altered levels of blood pressure, body temperature, blood glucose and blood oxygen saturation, (de Rooiji et al., 2007). The impacts this changes have on stroke have an impact on stroke and blood haemorrhage related factors. Thus the limits for offering treatments to these level of treatment incorporate well elaborated physiological variables process. Studies have shown that patients with internal bleeds often correspond to brain damage by the bleeds which lead to rise in intracranial pressure. Often severe headache with vomiting accompanies this condition. Gastrointestinal functions have been shown to have an effect on the patient eating pattern like swallowing and other impairments which often leads to effects on swallowing and impairment factors. Impaired nutritional functionality in brain haemorrhage can lead to reduced functional improvement and increased complication rates. The prevalence of brain haemorrhage is much associated with chronic kidney disease. Thus management of kidney related factors play a critical role in managing the patient. Neurological observation is crucial for early management and caring for complications of subcranoid haemorrhage. At times pain might persist due to intracranial pressure and is often important to make pain relief plan for such patients, (Rodrguez Gregorio, 2005). Evaluation of Nursing intervention/Management Strategy As a practising nursing practitioner, I administered the insertion of external ventricular drain. It is termed as the most common and important lifesaving technique often encountered in the neurological care unit, (Lo et al., 2007). This technique has been applied in brain injury such as intracranial haemorrhage, brain injury and meningitis. These conditions have been closely linked to .intracranial hypertension above 20 mmHg related to the obstruction of cerebrospinal fluid, (CSF) Upon closer examinations, the production of CSF was estimated at higher than 500-6000mL normal levels, (Loiselle et al., 2012). The fluid is often circulated in the ventricular system into the subarachnoid space and then taken into the nerves. There often exists equilibrium between the production and at levels of production and absorption. The disruption of this balance leads to intracranial hypertension with acute hydrocephalus, condition of excess fluid in the part of the CSF space in the brain lobe, (Sl azinski et al., 2011). Thus nursing intervention treatment of EVD, was evident to offer medical help and assistance to this patient. EVD administration aided on reduction of intracranial hypertension through diversion of CSF and the intravenous blood, which allows continuous intracranial pressure which helped in the resuscitation of these patient in the ICU bed, (Sarrafzedeh, Smoll Schaller, 2014). As a medical nurse I used freehand technique on the surface of the land marks as done by the clinicians, (Stanojevic et al., 2008). In this process I preferred the frontal cerebral hemisphere as the right entry for given to non dominance for language function for this patient. I maintained the patient on head of bed elevated at a degree of 45 degrees in the supine mode. I removed the hair using the callipers and the scalp which it was prepared in a sterile function. I placed a burr hole at Kocherr position order to avoid the superior sagittal sinus and the frontal cortex on the motor strip, (Kim et al., 2015). This point can be located through the drawing of the one line along the midpoint from the nasion to appoint of approximately 10 cm back and another from the previous point to a different location. After i had administered anaesthesia, I made linear incision down to the bone and i scrapped the perostema. I made a drill in order to penetrate the cranium in the trajectory area in order to determine the ventricular cannulation . I passed the ventricular catheter entering not more than 7 cm towards the coronal plane into the medical canthus of the eye in the ipsilateral area. Once the CSF flow had visualized, I removed the catheter sty let and trans duced it to obtain an opening in the intracranial pressure. I then tunnelled it down into the skin away from the skin away from the point of entry, (Wong, 2011). As a way of managing the EVD, after insertion, i raised the height of the mean pressure in collections system. While doing this i undertook carefully the pathology displayed by the patient to determine the height of the collecting duct. Using the unsecured aneurismal subarachnoid haemorrhage, the first height of the collecting system is set low so that the CSF was drained quickly to avoid rapid change in the transmural pressure in the aneurysm wall, which can be a factor in bleeding process, (Sheifer , 2010). At this level negative drainage was encountered with these patients with negative pressure placed on the hydrocephalus. When i had determined the needed height of the collection system, the EVD management remained to be a crucial activity. As a effective approaches in nursing management, there is need to adjust the height so that the transducer is nil in the Forameno of Monro. I had to adjust the drip so that it reaches the desired height. This way the CSF will be in a position to drain the intraventricular pressure, (Hunn et al., 2014). As a way of ensuring cleanliness i, ensured that the EVD collection is obtained and rinsed using clean detergents and using sterile technique to avoid risks. As a way of ensuring sober recovery, i ensured the vitals and signs and symptoms are always checked for any intracranial hypertension. Environmental Considerations and Family The environmental surrounding the admission of the patient to the ICU units and the surgical process to be initiated for the patient is often stressful to the patient and the family members, (Benarroch , 2006). Often when admitted to ICU units have always been viewed as crisis moment for both the patient and their families. Thus mental preparedness is always the key aspect in managing the patient affairs. Having loved ones in the intensive care units is often helpful and triggers changes in the family roles and shift in responsibilities roles, (Rincon et al., 2014). Often the fear of death and permanent disability has always been the fears of the family towards managing the patient. In this case study, the family of this patient was so worried and being unsure of what might take place with their patient in the facility upon the EVD process, (Guerra et al., 2017). These feelings of fear can trigger panic among the family members. The family often experiences feelings of high anxiety and insecurity which often leads to increased stressful circumstances. These events lead are catapult by the presence of the huge medical equipments and machines often employed in managing the patients. This scenario often affects the patient recovery process and dampens confidence of easy recovery. Family members have been found to experience difficulty in managing the stress and painful emotions and have often resorted to maladaptive coping strategies. At this juncture the patient family was forced to make decisions regarding the process of treating and managing the patient. This was significant in that it raised the stress levels of the patient. The nurses on the other hand play crucial role in managing the patient. As a nurse my role in being constantly managing the patient, was very crucial. My role in helping the patient was very crucial in helping even the parents to make certain decisions which are not in the capacity. As much as nurses being in a position to help and manage such situations, the needs of the family members are often neglected. The experiences of the nurses on the psychological needs they often encounter are enormous. Nurses and families have different priorities in terms of the needs and the psychological needs of the families are often critical, (Li, Gao, Wei and Wang, 2016). In health care practice, the health professionals are not well conversant with the needs of the patients. The knowledge that most health care professionals are not in a position to ensure that patients outcomes are improved, (Bijitterbier et al., 2001). Health care practitioners, I included as a nurse need to ensure that families are supported during the most needed time especially during the crisis moments. Thus meeting their immediate needs will often reduce the effect of the disease in both families and the health care system. The need to support the family to clarity of roles is essential in helping them gain confidence in the health care system. There is need to be aware of the treatment plan offered to their kin, which may have an effect on enhancing confidence among family members team. As much the anticipation from the family members has often been seen to reduce the tension and stress levels in the early phases of disease prognosis. Legal and Ethical Issues As a way of ensuring that there is informed consent on behalf of the patient, ensure that the family is clearly explained while the use of medical jargon and language. The information given must be in accordance with the patients rights and understanding. While ensuring that there is explanation for the need for the EVD, the reason for the EVD, the procedures it entails and length of EVD if placed. This is crucial in managing and building consensus for easier work during. As a way of ensuring that the patient information is kept in a non disclosed manner, there is need to ensure confidentiality in the nurse-patient relation. Often patients do share their information regularly. Failure to protect this crucial information from the patient will lead to diminish trust on the patient towards patient client relationship. The patient will thus be less likely to share sensitive information regarding this state. Creating an environment of trust among the different levels of care both the patient and nurse ensure the patient seek care and be honest as possible during the process of health. The duty of being confidential in health care practice is meant to ensure that the provider discloses that the information concerning the patient without permission and thus encourages the healt h care team to be more cautious and ensure unauthorised access. When family members seek the program of the patient, the obligality often dictates that they share the information of the patient. However the obligalities for sharing the information may not be met and thus if there is no explicit permission, t is always non ethical and non justifiable to do so, however this is exceptional in cases when the harm is significant and at high risks. Disclosures of patient information are often common and come in various ways. At times health care practitioner can discuss the status of the patient in places such as an elevator or in public. In which the act of maintaining privacy in these case is often hectic. Access to patient medical information by third parties is often prohibited. Thus the nurses have the responsibility of protecting this information in a comprehensive manner as much as possible. At times there comes a situation which you believe that the ethical and legal exception is often exception in confidentiality process. There is need to ensure the disclosure of the patient information can signify potential harm or damage which might be disastrous, thus there is need for critical care for patient privacy information. Avoidance of medical errors are often critical steps in these critical places. Especially when dealing with an EVD case, due diligence is needed as any medical error while facilitating nursing interventions puts the patient at jeopardy of death. There is an urgent need for preventing adverse effects which often include diagnosis, treatment and infection process. Research has put that 1% of hospitals admissions are happening due to adverse effects of negligence. Mistakes have led to immeasurable effects on the patient. The cost of these error management are often highly expensive and thus puts the health care practice of anyone at jeopardy, the impact it has on the nursing practice is so immense in that, there is need to avoid such errors as they are costly and have negative impacts. Thus with this view, there is need for comprehensive approach when dealing with patients. The nursing practice they receive should be geared towards promoting the health and positive outcome. In the case study, that patient diagnosed with EVD, has been successfully been managed to ensure the applied nursing practice management care is essential and productive. The management and intervention of managing the patients is crucial which entails the traits of being diligent and hard working. The environmental factors which surround the patient often play a crucial role in the overall care process for the patient. As a nursing practitioner, there is need to ensure that all guidelines are adhered to and minimising the legal and ethical issues as to pertaining the patients is followed. References Benarroch, E.E., 2006. Basic neurosciences with clinical applications. Elsevier Health Sciences. Bijttebier P., Vanoost, S., Delva, D., Ferdinande, P. and Frans, E., 2001. Needs of relatives of critical care patients: perceptions of relatives, physicians and nurses. Intensive care medicine, 27(1), pp.160-165. Hunn, B.H., Mujic, A., Sher, I., Dubey, A.K., Peters-Willke, J. and Hunn, A.W., 2014. Successful treatment of negative pressure hydrocephalus using timely titrated external ventricular drainage: a case series. 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