You are to write a 3 000 word (+/- 10% excluding reference list) essay reflecting on the decision making involved in the assessment and delivery of care related to the scenario below. In your work you need to draw on the theoretical perspectives explored during the module so that the learning outcomes are met. The nurse’s role will be an important focus but you need to demonstrate understanding of the importance of shared decision making in the assessment, planning, implementation and evaluation of care.
In addition to symptom management you will consider psychological factors, which can influence coping, and reflect on how policy in terms of service delivery can promote client centered care. In your care study you will reflect on your own practice experience where appropriate and support your account with evidence. You are to write a 3 000 word (+/- 10% excluding reference list) essay reflecting on the decision making involved in the assessment and delivery of care related to the scenario below.
In your work you need to draw on the theoretical perspectives explored during the module so that the learning outcomes are met. The nurse’s role will be an important focus but you need to demonstrate understanding of the importance of shared decision making in the assessment, planning, implementation and evaluation of care. In addition to symptom management you will consider psychological factors, which can influence coping, and reflect on how policy in terms of service delivery can promote client centered care.
In your care study you will reflect on your own practice experience where appropriate and support your account with evidence. Complex health needs Patient: Peter Johnson is 15 years old, and has Down’s syndrome learning disability. Peter has complex health needs, which include congenital heart defect, eczema, and ganglionic mega colon (Hirschsprung’s disease). Present situation While at a party last night, Peter was encouraged by his friends to drink a mixture of vodka and rum shots. Although Peter can’t remember much about the party, he thinks he also took some white tablets that John offered him.
However, Peter is refusing to discuss this with anyone. During the night Peter suffered a series of tonic-clonic seizures (status epilepticus) resulting in him being taken by ambulance to the local Accident and Emergency (A&E) department where he was stabilised before being admitted due to concerns about his breathlessness. He has had 1 tonic-clonic seizure since admission. The nurses have noticed that his blood glucose level is above normal. Peter is also becoming increasingly breathless. Personal and social history
Peter receives support from the school nurse, and more recently, a community learning disability nurse from the local Child and Adolescent Mental Health (CAMHs) team. He lives with his parents and twin brothers, Jack and Sam, who are 10 years old, in a small three bedroomed end of terrace house. Peter used to be the center of attention in his family, particularly after his epilepsy was diagnosed. However, recently it is the twins who have been the focus of his parents’ attention, as they are aware that the boys have been bullied and are anxious about changing schools in September.
For the past 7 months, there has been lots of rows between Peter and his parents. He has been staying over at his elderly grandparents’ house once or twice a week, ‘just to have some space’. His grandfather has recently been diagnosed with terminal lung cancer and becoming increasingly forgetful. His latest school report highlights that he is not doing as well this year as his teacher had predicted, and he has had a lot of absences. When he is at home he spends most of the time in his room, and he is increasingly neglecting himself.
His parents are shocked and have tried to discuss this with Peter, but these discussions always end in rows, with Peter storming to his room, shouting that they only care about the boys. Peter’s parents are even more anxious when his teacher suggests that Peter’s friend Jodie may not be a good influence on him. Medical history Peter has had epilepsy since the age of 11 years. He suffers from frequent tonic-clonic seizures. However, he has been maintained successfully on Sodium valproate 200mg twice a day.
He has been free of seizures for 3 years, but has recently been having on average 1 tonic-clonic seizure per week. Peter is overweight and has recently been diagnosed with type 2 diabetes mellitus, for, which he is being treated with Metformin 500mg twice daily, and a ‘healthy diet’, which Peter finds difficult to adhere to. Peter was diagnosed with asthma when he was 10 years old. Peter is prescribed Salmeterol and Fluticasone for which he self-medicates with inhalers. However recently he has been having intermittent episodes of acute dyspnea. What needs to be considered for Peter’s plan of care?