Answer To: An excerpt of clinical notes and charts are provided in the NRSG258 LEO site to provide the clinical...
Robert answered on Mar 28 2023
2
A Case Study
Contents
Background 3
Pre-surgical Risks and Intervention 3
Legal Consent 4
Medications 5
Biopsychosocial factors 8
Biological factors: 8
Psychological factors: 9
Social factors: 9
Conclusion 10
References 12
Background
The case study of Maisie highlights the complexities involved in providing healthcare services to individuals with multiple pre-existing medical conditions. In this case, Maisie, a 72-year-old woman, presented to the emergency department with severe abdominal pain. As a result, she underwent a complex surgical procedure, which required administering various medications and interventions to manage her pain, nausea, and other associated symptoms.
This case study explores the medical, legal, ethical, and social factors involved in Maisie's care and highlights the need for a holistic and patient-centered approach to healthcare delivery.
Pre-surgical Risks and Intervention
Maisie's pre-surgical risks include hypertension, type 2 diabetes, asthma, obesity, smoking, and a history of deep vein thrombosis (DVT). These risks are linked to an increased risk of complications during and after surgery (Janiak et al., 2022).
Hypertension, or high blood pressure, can cause damage to the heart, kidneys, and blood vessels. This can lead to a higher risk of heart attack, stroke, and other cardiovascular events during and after surgery. Therefore, controlling Maisie's blood pressure before surgery is essential through medication and lifestyle changes such as diet and exercise (Breyre et al., 2021). Type 2 diabetes, a condition where the body does not produce enough insulin or does not use insulin effectively, can cause nerve and blood vessel damage. This can lead to poor wound healing, infections, and other complications during and after surgery. To manage Maisie's diabetes, she will need to monitor her blood sugar levels and adjust her medication as needed (Janiak et al., 2022).
Asthma, a chronic lung condition that causes inflammation and narrowing of the airways, can increase the risk of breathing problems during and after surgery. To reduce this risk, Maisie may need to use her inhaler more frequently prior to surgery and have her lung function monitored.
Obesity, defined as having a body mass index (BMI) of 30 or higher, can increase the risk of surgical complications such as infections, blood clots, and breathing problems. To reduce this risk, Maisie may need to lose weight before surgery through a combination of diet and exercise (Jarman et al., 2021).
Smoking, which can cause damage to the lungs and blood vessels, can increase the risk of complications during and after surgery. To reduce this risk, Maisie should quit smoking before surgery and refrain from smoking during her recovery period. Finally, Maisie's history of deep vein thrombosis (DVT), a blood clot in a deep vein, increases her risk of developing a blood clot during and after surgery. To reduce this risk, she may need to take blood-thinning medication and wear compression stockings during and after surgery (Kiepura et al., 2019).
To address these pre-surgical risks and reduce Maisie's overall surgical risk, she will need a comprehensive preoperative evaluation and management plan. This plan may include medication adjustments, lifestyle modifications, and other interventions tailored to her specific needs and medical history. By proactively managing these risks, Maisie can increase her chances of successful surgery and recovery (Maxwell et al., 2019).
Legal Consent
Legal consent refers to the agreement given by an individual to undergo medical treatment after being informed of the potential benefits, risks, and alternative options. To provide valid legal consent, the individual must have the capacity to make informed decisions, be provided with adequate information, and give voluntary consent without any undue influence or coercion.
In many countries, including Australia, the law recognizes the principle of informed consent and requires healthcare providers to obtain it before providing treatment. However, the specific requirements for informed consent may vary by jurisdiction and depend on the type of treatment and the individual's capacity to provide consent (Okamoto et al., 2018).
In Maisie's case, whether she can provide legal consent depends on her capacity to make informed decisions. As noted earlier, Maisie has an intellectual disability that affects her cognitive functioning and ability to understand complex information. This may impact her capacity to provide valid legal consent, and healthcare providers must assess her decision-making capacity (Oleck et al., 2019).
Based on the information provided, it is unclear whether Maisie can consent to the surgery. Her pre-surgical risks, such as her history of cognitive impairment and delirium, suggest that she may not be able to make decisions about her own medical treatment. As a result, it may be necessary to involve a substitute decision-maker, such as a guardian or next of kin, to make decisions on her behalf. The relevant legislation, in this case, will also depend on the jurisdiction, but it is likely to require that the substitute decision-maker act in Maisie's best interests and make decisions that Maisie would have made if she could do so (Scotti et al., 2019).
Medications
Morphine and ondansetron are two medications that were used in Maisie's case. Both medications have distinct mechanisms of action, side effects, correct dosage, and contraindications.
Morphine is a powerful opioid pain medication used to treat severe pain that is not responsive to other pain medications. It binds to opioid receptors in the brain, spinal cord, and other parts of the body, leading to the inhibition of pain transmission and the activation of the reward center in the brain (Beedham et al., 2019). Morphine works by mimicking the actions of endogenous...