How integration of objective and subjective signs and symptoms and medications impact care

How the integration of subjective and objective signs and Symptoms and Medications impact on the Care provided to the Patient.

Critical reflection pertaining to nursing practice is a systematic and logical process of thinking and reflecting on own practice in order to highlight the aspects of own practice requiring further development. Research has indicated critical reflection as a professional practice skill that aids in the professional development of nurses. Critical reflection skills hold much value in the nursing field since they help in prioritizing major decisions and achieving better patient outcomes. Further, it can be referred to as an extension of critical thinking through which helps the nurse to solve queries by probing questions. In addition, it moves beyond examining the past experiences and focuses on applying the gained knowledge in the future (Mill et al. 2016).

The present paper is a critical reflection written on the basis of a nursing patient care case study that aims to demonstrate critical ability. The paper focuses on four major aspects of nursing care for demonstrating critical reflection. First, it discusses how the integration of subjective and objective signs and symptoms and medications impact on the care provided to the patient. Secondly, it identifies the elements of care that are required due to the events in the simulation scenario. Further, it highlights the role of inter professional collaboration in this case study, lastly, it discusses the particular psychosocial issues arising in the case. The case study selected, from Case World, for the present critical reflection focuses on the patient named Adam Knight, a 20-year-old man who has suffered acquired brain injury after a car accident. The patient has deficits related to mobility, memory loss and the ability to engage in a social interaction with the peers. He is in need of an effective community based long term support services as he is suffering from isolation. The focus of the case study analysis is acute pain and management strategies for the same would be highlighted in the paper (School of Nursing & Midwifery 2014).

How integration of objective and subjective signs and symptoms and medications impact care

According to Morton et al. (2017), nursing care delivery is influenced to a significant extent by the integration of objective and subjective signs and symptoms and medications provided. From the case study and simulation, it has been found that Adam has undergone an acute injury in his head and fractures as a result of the accident and is awaiting CT scan. He is found to be in a drowsy state though the ICP is normal. As highlighted by Wintermark et al. (2015) a head injury is suffered by a patient due to trauma to the skull, brain or scalp. Such injuries might be either penetrating, in which the bone or skin can be broken, or closed, in which there is no cut to the skin. Head injuries lead to different symptoms whose cause is dependent upon the impact of the injury. Such symptoms might be developing immediately after the trauma or gradually afterwards.

Elements of care due to events of simulation scenario

Head injuries are treated depending upon the type of injury suffered by the patient. The condition of the patient also influences the type of treatment that is to be decided on. It is crucial that an appropriate diagnosis tool is used for assessing the severity of he injury suffered to the head. From the widely used examination tools available for neurologic and physical testing, the commonly used test is CT scan. Computed Tomography (CT) scan of the head utilises special X-ray equipment for producing multiple images of the brain nd the head. This is done for detection of any brain swelling, bleeding, brain injury or skull fractures (Levin and Diaz-Arrastia 2015). The authors point out that CT scans are valuable under conditions when the patient is found to have loss of consciousness. In the present case, Adam has been found to be in a drowsy state. Following a head injury, there might be a damage suffered to the blood vessels besides the brain or to the brain itself. In case a blood vessel is damaged, there are high chances that blood is supplied into the brain. The most common feature of such a condition is drowsiness.

The patient has undergone surgery to remove the left subdural haematoma and for repairing the right fractured tibia and fibula. The patient has been in much pain after he has regained consciousness and subsequently an increased dose of 4/24 analgesia has been ordered. Analgesia is used for relieving patients from pain. Pain management forms an integral element of patient care with the prime objective of the care plan to reduce pain level. The rationale for this is the fact that effective pain management ensures that associated patient complications are also handled in an effective manner (Song et al. 2015). The patient is also found to have right hemiparesis (School of Nursing & Midwifery 2014). Hemiparesis is the condition wherein the patient has weakness on one particular side of the body due to medical complications such as trauma or injury as he has suffered vehicle injury. This condition needs to be looked into by the nurse for preventing further impairment to the body part (Mark and Taub 2017).

The nursing practice elements that would be considered for the reflection paper are acute adult injuries, acute pain and medication reaction. The patient has suffered acute injuries to his head. As highlighted by Morton et al. (2017) acute injuries to the head leads to frequent death or disability at large. Acute pain management is an essential component of nursing care services. Pain is a complex, subjective, and multidimensional concept which is referred to as a highly unpleasant experience (Lehne and Rosenthal 2014). Analgesia is commonly administered to the patients for relieving them from the pain, suffering and alleviating them form adverse psychological and physiological issues. In the present case, Adam has been having altered levels of consciousness, and thus acute pain management is imperative. From the case study, it is found that Glasgow Coma Scale (GSC) had dropped as per the handover and his RR is 8. The medication had been changed from subcutaneous morphine to fentanyl 500 mircograms/mizadolam 50 mgs in a 50 mls syringe infusion. Subcutaneous morphine injections are more acceptable and comfortable as compared to intramuscular ones. Boluses of subcutaneous morphine are often more effective for acute severe pain than commencing an infusion.  In addition, he had been administered Naloxone.

Role of interprofessional collaboration

In the present case, the GCS  had dropped, indicating that the patient had been suffering from severe head injuries. As pointed out by Adams and Urban (2015) fentanyl is an excellent analgesic that acts as a local anaesthesia and has been proved to give better patient outcomes as compared to morphine. It is for patients who are tolerant to opioids. Naloxone is a drug used for reversing or blocking the actions of opioid medications that include loss of consciousness, slowed breathing and drowsiness. This medication was, therefore, suitable for Adam as he had been suffering from all these three symptoms. The low readings in RR are due to injuries in the lungs shortly after the injury to the brain and subsequent damage. The mechanisms include inflammation, pulmonary oedema and autonomic system dysfunction (Lehne and Rosenthal 2014).

The role of a multidimensional team is extremely important in such a scenario as Adam requires more than one type of treatment. Here, the diagnosis and treatment suggestion of the doctor as well as the therapeutic treatment of the nurses will not provide him with enough chance to get back into the normal life because of the different effects the brain injury had on the different aspects of his life. Besides, he also had surgery in his tibia and fibula which had also affected in his mobility. Moreover, the brain injury had resulted in his memory loss incidences and also in social exclusion. All these had to be correctly figured out by the different professionals of the multidisciplinary team as the doctor and nurses will not be able to handle each and every symptom with equal expertise than the experts in each field can do (Bosch et al. 2016). In such a scenario, effective teamwork is essential so that every professional in the team communicate with each other about Adam’s present health, their observation as well as their suggestions for proceeding with the care. Every member should conduct meetinhs and update their observations at a frequent rate so that the response observed from Adam in each of the interventions form different professionals can be jotted down and a comprehensive monitoring of his recovery of health can be measured. Each and every member should involve in effective teamwork and proper communication with each other. These would ensure that every of Adam’s symptoms are noted and acted upon after a group meeting and taking suggestions from every members of the team. A team where members are united and more connected to each other regarding updates of patients will be able to handle cases more efficiently.

The multidisciplinary team who will help the patient to overcome all his negative symptoms and come back to a normal life will be comprised of the doctor (Dr), nurses, physiotherapist (PT), occupational therapist (OT), speech pathologist (SP), neuropsychologist, and social worker (SW). The Doctor who will be assisting his case will be mainly responsible for diagnosing the different symptoms faced by Adam and will eventually plan and prescribe medications. He will be in discussion with the pharmacist about the medications whether those would bring the best result for adults.  He will also be interactive with the nurses to design her care plan for Adam as his guidance would be helpful for the nurse’s treatment to be more effective. Moreover, he can also take part in the allocation of members of the multidisciplinary team as he is the primary individual who is aware of the different initiatives that would make Adam’s treatment more fruitful (Dharm-Dutta et al. 2015). Moreover, association of the nurse with the other specialist are also necessary so that the nurse can develop her intervention accordingly depending on the reports of all the specialists.

He is also having severe pain from his surgery of the limbs and therefore proper pain management is extremely important. Here nurses require to properly taking interventions which would be managing his pain properly. They need to develop a proper therapeutic relationship with the patient so that they can also help him to overcome their frustrations he is having by striking the right conversation and providing a good guidance to tackle the present situation (Bosch et al., 2016). The better the patient feels under their care, there would be more chance of his fast recovery. The nurses should properly communicate with the other profession also and set up a treatment plan where each of the professional will have allocated time for providing their treatment and here is no clash of timing or power. Besides, they would be also responsible for providing correct medication administration (Cassidy et al., 2014). The nurse should regularly measure the vital signs, hemodynamic variables, specific gravity and others. She should administer IV fluids to maintain hydration. Providing him assistance in turning, coughing and deep breathing will prevent pooling of secretions. The nurse should also communicate to understand whether he is having any anxiety or not which affect him (Karch & Karch, 2016).

Physiotherapists would be mainly responsible for improving his balance and walking with increased ability to retain normal patterns of movement, increase affected leg function, decrease the risk of falls and to increase energy levels. The speech therapists will mainly help the patient to live independently by developing his cognitive problems and also helping him in his communication issues (Sutter and Harvey 2016). The neuropsychologists are mainly helpful in conducting various tests and differential diagnosis which help them to understand the parts of the brain that are affected and hence the various symptoms that are visible. This explanation is provided to doctors and nurses so that they can prepare their treatment plan accordingly. Social workers will mainly help to make the life of Adam better by providing him support to every aspect of his life by helping him to conduct his activities independently, collaborating with family members and educating them for better support to Adam (Fernandez et al. 2013). They also help Adam to develop his skills and performances in everyday life gradually making him cope up with his condition and try his best to overcome challenges. All these would assure him to come back to his normal life. Nurses are one of the most important professionals as they remain associated with the patient’s overall care. They also communicate with the entire specialist individually as well as in comprehensively so that they can prepare interventions which are in accordance to the current needs of patient. In case of Adam, nurse would play a crucial role by maintaining communication among all members and also providing a compassionate and empathetic care for the patient.

A number of psychosocial issues arise from the case. It is seen that due to brain injury, Adam is suffering from frequent incidences of memory losses and is also suffering from social exclusion. As he is not being able to properly communicate with his peers, he is experiencing a sense of uneasiness that is causing him to be socially excluded. Social exclusion, at such a tender age of adulthood, when persons try to make friends and new relationships and enjoy life has made him frustrated (Morton et al. 2017). Due to difficulty in the patient’s communication methods, he might not be able to express his pain concerns pt the nurse which might affect his health in a negative way. The nurse should make sure that she measures his pain score assessment in a proper manner. She should also educate Adam about how he can easily communicate or call nurses when he needs assistance or needs pain management. The nurse would conduct PCA by setting up alarms, being alert for his summons, being steady and so on.

Development of a sense of depression may act a as a potential issue due to being dependent on other for daily activities of life.  For this in future, he may be facing difficulty in maintaining social relationships which also may affect his emotional well being. This could lead to potential issue of the present condition of the patient. Moreover, this sudden change of life styles which are making him compromise many favourite activities of him is also affecting him mentally (Arcinieges and Wortzel 2014). All these will lead him to depression which might cause him to either withdraw himself completely or will make him aggressive hence, correct treatment and companionship are very necessary now to give him a proper quality life.

Critically reflecting on the care process delivered to a patient is useful in understanding the means of delivering a comprehensive care. A comprehensive assessment would enure that all patient problems are highlighted adequately. Advanced medical diagnosis is the key to outline a  suitable nursing care plan aligned with the needs of the patient. The prime nursing care elements arising form the case study are acute injuries, acute pain and oversedation. Acute injuries are associated with a trauma suffered by the individual wherein the body undergoes a negative change in the concerned area, leading ot multiple adverse reactions. In the present case, the patient had suffered acute injuries to his head. Acute pain is the prime nursing diagnosis as it is a protective function acting to inform the patient about the injury suffered. Medication reaction is a valuable care aspect since medications doses and administration route are to be modified as per the need of the patient. Safe and effective care of patients needs to include maintaining a balance between the provision of pain relief, monitoring for appropriate use of prescribed medications and other substances, and recommendations for viable treatment alternatives. 

Rehabilitation would be the key nursing approach for Adam. The nurse would need to assist Adam in adopting an altered lifestyle and provide him with appropriate resources to develop and implement a proper discharge plan. Coordination of nursing care activities in collaboration with other members of the interdisciplinary rehabilitation team to facilitate achievement of overall goals is important. A holistic approach is needed in this case. A multidisciplinary team aids in the complete and comprehensive care plan for the patient. After analysisng the treatment options and the results of the assessment done, it had been highlighted that the primary goal for the patient would be maximising his abilities to lead to a normal life. Each professional from the team would deliver care in a manner that addresses different issues the patient has been suffering from. The professionals involved in the care plan of Adam were doctor nurses, physiotherapist, occupational therapist, speech pathologist, neuropsychologist, and social worker. There are a number of psychosocial issues arising in the case study. Inability to communicate with peers lead to isolation and frustration that the patient might find difficult to handle. This can be aggravated by the fact that Adam is struggling to become independent. A sudden change of lifestyle affects the emotional well being of the patient as well. Nursing care for the patient must, therefore, include this aspect of care in order to provide a comprehensive care service. The goal of rehabilitation for the patient would be to assist him to overcome his disability in mobility for maintaining maximum functioning.

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