The Neurological Issues - Essay Example

Part A Patient assessment starts with the physical appearance of the patient and this will depends in the way you communicate the patient. This will assess cognitive power, psychosocial, logic and the general demeanour. It also involves putting in consideration of the patient history and lab assessment of the intravenous, oral and output fluids. ‘This is necessary to provide the vital signs and also show the pains of the patients head to toe’ (Riccio, Sullivan et al, 2010, pp142). This is a patient focuses approach necessary to establish an environmental safety of the patient. It is important to consult other professionals for support to keep abreast with the assessment procedure and also ensure professionalism in the assessment. This has to be done after winning the patient confidence and having informed consent on whatever kind of assessment you will want to carry out. Confusion is not a normal state in the aging process especially for him at around sixty five years. ‘This can be associated with several factors and hence an immediate assessment will need to be conducted to find out what exactly the patient could be suffering from’ (Boldy, Homer, Crouchley & Davey, 2005, pp321). Vital signs measurements are the first in assessments and involve determining the temperature, blood pressure, pulse rate and finally the respiratory rate. Pain is also mainly said to a fifth sign in patient assessment and considered a subjective symptom, because pain can also result from oxygen saturation. The patient safety is the next concerns because he already seems to have fallen several times. This is very dangerous and it therefore will be expected that essential safety measures be put in place to ensure that he does not fall as it may lead to serious accidents. This starts by looking after his body by making him clean because he seems not to have washed for some time and his ADL is not in order. Thereafter, ‘the most important role of a registered nurse in the assessment for this patient is the falling risk assessment because confusion and cognitive impairment are well recognized risk factors for falls in a hospital environment’ (Bond, 2001, pp56). So fall assessment is to decide which urgent intervention needs to be put in place to reduce the probability of another fall. In his case, he is confused man so the use of a low bed, one to one supervision will be required to guard against unsafe bed exits and fall. ‘A follow up strategy will also need to be put in place conducted twice per day to ensure that he is fully constituted and recovered and will not fall again’ (Ricker, 2004, pp320). Danger Response for the ABC assessment will then follow now that he has been secured for the safety against falling. This involves the assessment of the airways, breathing and the circulatory system. ‘It is often used for unresponsive patients especially in hypoxia and it can also be used as a priority for assessment and treatment of patients having a blockage of pharynx’ (D’ Amato & Hartlage, 2008, pp49) Breathing is the next after airways opening to ensure that patient is making normal respiratory efforts. This can be assessed by checking for the general respiratory distress using the accessory muscles to breath, abdominal breathing, and the position of the patient. Assessing the respiratory rate, depth and rhythm will also be essential. ‘Circulation checks is the final stage after breathing assessment, observe the colour and temperature of the hands and the fingers’ (Haerer, 1992, pp53). Cold, blue, pink, and pale can be indication of poor circulation, pulse check is also conducted both centrally and peripherally to confirm regularity, strength and the equality of each different pulse. Blood pressure measurements can also be done to check for indications of shock. This will require assessment based on instrumental techniques that are precise in providing information of the patient assessment. ‘The neurological assessment will thus need to be done and this will involve determination of the Mini mental state examination to measure cognitive status and Glassgow coma scale’ (Lezak, 2004, pp61). GCS is a reliable method for monitoring level of consciousness and it also give more information about neuron system and it includes three measures eye opening, motor response and verbal response to find out whether the nervous system is impaired. ‘The initial assessment should be structured to provide baseline data of the neurological status and information needed in order to design a realistic individualised care plan’ (Hebben & Milberg, 2009, pp114). ‘This assessment will have to be performed either every second or hourly even more often until the patient’s condition is stabilised’ (Jones, 2011, pp35). Protecting the patient from self harm is an important part of nursing care. All initial data should be accurately recorded to provide a baseline for comparison to determine whether the patient’s condition is improving or deteriorating. He has also indicated that he repeatedly want to pass urine which means that he most likely is suffering from diabetes of which passing excess urine is the major symptom. ‘This is also associated with Diabetic keto-acidosis (DKA) which is associated with two types of Diabetes that results from defects in the metabolism of proteins, carbohydrates and fats. This can be confirmed by the Blood Sugar Test (BST) using the Glucometer and other test that can be applicable. DKA has adverse effects of creating hyperglycaemia, hyperosmolality, ketoacidosis and the volume depletion which involves polyuria the loss of large volumes of urine. This patient thus will need to be assessed for Glycosuria, ketonuria and the reduction of blood of blood pressure. Insulin defiecieny prevent the use of normal serum glucose creating starvation, this stimulates gluconeogenesis through the release of hormones. Acetoacetic acids are released which are broken down further to form acetone that come as a sweet tasting odour from the patient’ (Massey, Pleet & Scherokman, 2003, pp72). The rationale is that assessment and treatment should be able to reduce the serum glucose, correct the dehydration, metabolic acidosis, regain the electrolyte imbalance and should be able to identify the precipitating causes. This will need to be performed every 15-30 minutes depending on of the patient’s condition. This is because the patients with severe DKA are mainly semi conscious with marked hypotension, severe acidosis and electrolyte imbalance and which need to be handled within the first 24 hours. Part B Code of conduct has been the basis for professionalism and acts as guiding principles in the manner in which one has to behave and act within the professional capacity. This conduct must always be held with exemplary standards of conduct. ‘The code of professional ethics in Australia provides the minimum standards that the nurses are expected to uphold both outside and within the professional domain’ (Melia, 2007, pp65). This serve as the basis for decision making, competency standards, policy frame works that will provide legal and professional accountability. ‘This has otherwise been referred to as the ethics of works to reduce the cases of negligence for the patients as their health is more of the priority’ (Kerridge & Lowe, 2005, pp42). The case at the handover to a colleague is totally out of order and shows a well rooted cause of negligence that should not be condoned. The health professionals have sidelined the elderly in the society for the ills they are suffering. This has been partly due to the growing trend in the development of the retrogressive attitudes and believes about the elderly. ‘The aged have been referred to by several names such as; smelly, senile, feeble, stupid and decrepit’ (Hart, A. (2002, pp15). Others have come to believe that taking care of the elderly is of a low status work. ‘In other places outside Australia, they have been recognised as the neediest and disadvantaged group of the patients and hence generally most nurses are not willing to work in the areas involving the elderly’ (McCaffery, Ferrell & Pasero, 2000, pp 84). The impact of this is that they have greatly increased the rate of negligence among the elderly in the society and that the elderly really feel dejected by the society that sees them as worthless due to their age. ‘Ageing has been used as a kind of a chronological marker that determines their ability and function to contribute to the society’ (Bonnie & Wallace, 2003, pp49). This is quite unprofessional especially because it denies the focus on the patients needs but favour the patient’s status as in this scenario. This has influenced the attitudes of the healthcare professionals towards the aggressiveness of providing the diagnosis and treatment to this elderly patient. The nurse to hand over has to emphasize on the code of ethics as a response to the nurse. This is what brings all the nurses together. ‘The Australian nursing and midwifery council has code of ethics that insist that the nursing practise has to be done in a safe and competent manner’ (CRACS, 2002, pp72). This should also be done in accordance with the professional standards and the broader health system. ‘In addition, the nurses need to conduct themselves in accordance with the laws that are relevant to their profession, more especially in the practice of nursing’ (Hart, 2002, pp75). The dignity, culture and the ethnicity of the people will also need to be upheld while the values and the beliefs of the people receiving care and treatment will need to be given priority, this will help reduces the cases of negligence. ‘It is also very important to consider the confidentiality of personal information of the patient one is handling’ (Staunton & Chiarella, 2008, pp72). More so, they need to work with impartiality, honesty, and provide accurate information relating to the nursing care and the health care products. All their functions will need to work objectively and promote communities trust and confidence in the nursing profession’ (Twycross, 2002, pp709). This will need to be done reflectively and ethically. It is completely out of the code of conduct for her to say that she cannot move closer to the patients because he is old, senile and stinks. He even calls him a dirty old nutter. ‘This also falls short of the fact that nurses should support the health of their patient’s’ (Johnstone & Kanitsaki, 2001, pp27). The comments of the nurses ought to be impartial, honest and accurate relating to the care and not abuses as she has done. Above all, even if the patient is stinking or smelly, that information should be treated as private and confidential. This serves as the measure for competency and we have a justification to conduct a legal probe over her conduct that is quite unprofessional in attribute and practice. It is basically the aspect of negligence that is being contested. Professionalism will divert the nurse’s way of treating patients with negligence and avoid discrimination of the patients so that due attention can be given to all patients equally without prejudice and favours. Socialisation has been a major factor that has contributed to this short coming of the nurses. ‘It can be understood as a complex process through which the professional roles of the nurses involving their skills, knowledge, and behaviour can be learned and the values, goals and attitudes integrated to the profession and as an occupational identity’ (Wilson & Startup, 2005, pp1480). This is a special way through which an individual has to fit into the system and comply at the same time for it to gain acceptance. ‘For this to take full effect, the process needs to be internalised and the nurses at this point will need to be take individual characters, attitudes and values of their profession which should be recognised as their own’ (Forrester & Griffiths, 2005, pp 87). Socialisation can have both positive and negative impact on the nursing care. It has been the main cause of lack of the critical awareness of their practice, the common trends and believes have been absorbed continued as ritualised practices against the demands of the code of ethics. In conclusion, the rational is that such like belief and values have led to negligence of the patients and hence some patients have not been able to receive good care because of the failure of the nurses to uphold the code of ethics that is supposed to regulate their service to patients. The overall objective of care is to ensure that the patients regain their status of good health and this should be done while observing the professional codes of conduct. This will require frequent assessment to mark the development of the patient till full recovery. This will ensure that the patient’s is placed under very close monitoring that will ensure safety of the patient. Read More