Comprehensive Nursing Care For Inez: Analysis And Interventions

Introduction

The nursing care is important to effectively treat physical alignments of the patients as well as their emotional needs to ensure they lead a healthy life. The nurses when show empathetic care they are able to develop a collaborative relationship with the patients that helps in understanding the key causes and symptoms of the health issues as well as the explanations of the results regarding treatment and diagnosis. In this assignment, the health condition of Inez is to be analysed and the pathophysiology of the health issue is to be discussed. On the basis of the facts, the way nursing interventions may be able to influence the health of Inez is to be explained. The legal, ethical and professionals issues to be faced in the nursing interventions for Inez are to be critically discussed. Lastly, the sources of evidence are to be evaluated and their impact on the health outcome for Inez is to be discussed.

LO1 Identifying one health condition of Inez and explaining the pathophysiology of the health issue

The brain and the spinal cord are the key parts which form the central nervous system (CNS) in humans and the vital parts of the brain are protected by the cranium. The brain contains mainly four structures which are the cerebrum, the cerebellum, the medulla and the Pons (Peate, 2017). The cerebrum is the upper part of the brain and has the function to control the mental processes of humans (Peate, 2017). The cerebral hemisphere is divided into four sections which are the frontal lobe that has the role of making judgements, decisions and planning; the parietal lobe that has the function for body orientation, spatial computation and attention; the temporal love that has the role of managing hearing, memory storage and language and the occipital love that has the role for managing visual processing (Shah and Jeyaretna, 2018). The cerebellum is located at between the back of cerebrum and the brain stem where it is responsible for managing muscle coordination and maintaining equilibrium of the body (Shah and Jeyaretna, 2018). The Pons is present in the front of the cerebellum and it has the responsibility to coordinate activities in the cerebellum and cerebrum by sending and receiving signals from them to the spinal cord. The medulla is regarded as part of the brainstem and has the role of controlling heartbeat, breathing and vomiting (Shah and Jeyaretna, 2018).

In the given case study, it is mentioned that Inez is showing confusion which is evident as she feels uncertainty about the fuss created by repeat perception for her existing health condition that is type-2 diabetes and high blood pressure. In addition, Inez is seen to show decline in organising thoughts which are evident as she is reported to say that she at times feel lost and unable to control things in her mind. Moreover, she is feeling trouble in paying attention to details as even though she tried to get back to sewing that she previously used to do but she could not. Inez also revealed that she experiences issues with memorising things and relation which is evident as she struggles to remember the names of her grandchildren. The study by D'Onofrio et al. (2015) informs that individuals suffering from vascular dementia often show symptoms of problem with memorising things, decline ability to analyse, reduced ability to concentrate and organise things, confusion and others. In the case of Inez, it is seen most of the symptoms mentioned for vascular dementia are being shown by her which indicate that she might be suffering from vascular dementia.

The pathophysiology of vascular dementia mentions that it is not normal pathogenetic entity and mainly occurs when the blood vessels that supply blood to the brain are narrowed or blocked. The situation occurs due to multiple numbers of small thromboembolic stroke in the areas in brain such as the frontal or temporal lobe, thalamus and others that results vessels supplying oxygen to the brain are suddenly cut off leading the person show declined brain activity (T O'Brien and Thomas, 2015). One of the pathological mechanisms of vascular dementia mentions that alternation of the small blood vessels in the brain play a key role in damaging the cerebral tissues and is potentially responsible for subsequent formation of alteration in cognitive ability seen in the disorder. The development of small vessel lesions are found to b related with deep lacunar infracts and changes in the white mater which are mainly observed alterations in the subcortical nature of vascular dementia (Smith, 2017). Another mechanism of vascular dementia mentions that small vessels changes can be observed as a result of incomplete ischemia and selective necrosis of tissues in the brain which cause selective neuronal necrosis along with sparing of the microvessels and glial cells. These results to hinder the normal blood supply to the brain area making individuals show symptoms of vascular dementia (Hatanaka et al. 2015).

There are several risk factors involves that leads individual to develop vascular dementia. The history of heart attack and mini-strokes acts as risk for vascular dementia as they cause damage to the brain by limiting the proper supply of blood to cells in the brains (Baumgart et al. 2015). The atherosclerosis in which deposition of cholesterol is seen in arteries that narrows the flow of blood through the vessels creates risk for the development of vascular dementia. This is because the amount of blood required for proper nourishment of the brain cannot be reached in turn lowering the function of the brain (Song et al. 2018). The presence of diabetes, obesity, atrial fibrillation and others creates risk for the development of vascular dementia among individuals (Heiss and Goldberg, 2015). In the case of Inez, it is seen that she already has type-2 diabetes along with high blood pressure as long-term condition and these may have contributed to the rise of vascular dementia in the patient.

LO2 Applying relevant evidence for justifying the way and reason behind nursing intervention may influence health of the individual

The nursing intervention is referred to as the treatment and therapeutic actions to be performed for assisting the patient to reach care goals set for them to help them lead a better and healthy life. In the case of Inez, it is seen that she is currently suffering from vascular dementia with the presence of type-2 diabetes and high blood pressure. The pharmacological intervention taken by nurses for vascular dementia informs that medications are used in the disorder to lower the progress of loss of cognitive ability and not for modification of the disease to be cured (Chen et al. 2016). The common medication used in nursing intervention for vascular dementia is Rivastigmine. This is because it offers sustained as well as brain-selective inhibition of acetylcholinesterase and butyrylcholinesterase that helps in improving the functional abilities, behavioural symptoms and reduces stress among the patients. It is evident from the study of Battle et al. (2019) where it is mentioned that inhibition of the acetylcholinesterase leads to increase the acetylcholine levels that helps in lowering the rate at which the cholinergic cells in the brain among the vascular dementia patients are being broken down. Thus, the Rivastigmine is to be provided to Inez by the nurses to help in controlling the degradation of cells in the brain slowing and controlling the progress of vascular dementia.

The medication such as Atenolol and Gliclazide is to be ensured to be continuously taken by Inez in the nursing intervention for vascular dementia for the patient. This is because Atenolol is the medication which helps in controlling high blood pressure level and Gliclazide is the medication which is provided in controlling type-2 diabetes (Monzón et al. 2016; Anitha et al. 2019). The presence of type-2 diabetes, as well as high blood pressure, acts as risk factors in progressing the development of vascular dementia and both the health issues are present in Inez which might lead her to develop more progressive symptoms of vascular dementia if the vitals are not controlled. This is evident as in the study of Flores et al. (2016), it is mentioned that high blood pressure is prone to result the individual experience stroke in the heart and brain that may reduce proper blood supply to brain region making the individuals suffering from mental health issues such as vascular dementia. In addition, the study by Davis et al. (2017) mentions that type-2 diabetes contributes to the rise in blood pressure that may lead to stroke in the brain as well as due to increased sugar in the blood may damage the brain cells leading the person to develop vascular dementia. The nursing intervention for Inez also required ensuring that she intakes healthy foods and the level of salt in the diet is lowered. This is required so that blood pressure remains controlled which acts as one of the key risk factors for the development of vascular dementia.

LO3 Critically discussing the ethical, legal and professional issues which underpin the nursing intervention for Inez

The ethical issue which may occur in the case of Inez during nursing intervention is the inability to access informed consent and develop conflict of interest. The NMC Code mentions that nurses are to access informed consent from the patients while offering them care by including them in making care decision (NMC, 2018). However, inability of Inez to make proper analysis of situation and developing conflicting ideas that she no more requires Gliclazide and Atenolol as it is some nature of poison added to the body would result the nurses face ethical issues in offering her care. This is because the nurses may have to force her to take medication irrespective of her wish and might require making decisions of care on her behalf as she has hindered cognitive ability, in turn, creating ethical issues in care. It would make the nurses unable to respect the autonomy of the patients as well as violate NMC code of practice resulting to raise professional issues in care. The NMC Code of Conduct informs that nurses are to act in the best interest of the patient to ensure their well-being (NMC, 2018). In the case of Inez, the nurses by ensuring the patients take medications such as Atenolol, Gliclazide and Rivastigmine irrespective of her wish would be able to follow proper professional code. However, it would violate the rights of Inez being to take own decision leading the nurses to face the ethical dilemma of whether to allow the patient take personal decision or act in their best interest to force her to take the medication.

LO4 Evaluating the sources of evidence and their effect on health as well as health outcomes

The sources of evidence used in supporting nursing intervention for vascular dementia of Inez included medical journals and articles that support medication like Rivastigmine is effective medication to control dementia symptoms. The use of information as evidence from the published medical journals and articles in caring for the patients helps the nurses to understand to what extent the intervention to be delivered would be effective for improving the health of the patient as well as the way it is to be delivered (Scales et al. 2018). This would affect the nurses to avoid error in care in turn leading them to ensure effective health outcome for Inez where she would show controlled behaviour and attitude even with the presence of vascular dementia.

The previous treatment records of the patients suffering from vascular dementia are used as sources of evidence for gathering care intervention to be provided to Inez to control her symptoms related o vascular dementia. The use of patient records as a source of evidence to care for patients lead to significant healthcare as the information in the records mentions the nurses about the probable error in care to be faced and the way they are to manage it to ensure effective well-being of the patient. Moreover, the records inform about the way certain complex care intervention and therapies are provided helping the nurses in understand skills to be used and role to be performed to ensure error-free care to the patient (Laver et al. 2017). Thus, use of patient records as reference and source of evidence to care for individuals like Inez helps the nurses to offer high-quality care as well as ensure speedy recovery of patients from health issues as health outcome.

Conclusion

The above discussion informs that the brain is mainly made up of four parts and the frontal and temporal lobe are the key areas affected during vascular dementia. The case study of Inez informs that she is suffering from vascular dementia as she is found to show many symptoms such as confusing behaviour, memory issues, inability to analyse situations and others which are similar to vascular dementia. The nursing interventions to be taken for Inez is that she is to be made to take Rivastigmine along with continue use of Atenolol and Gliclazide. The nurses are going to face ethical issues such as informed consent gathering and others along with professional issues related to violation of NMC code while caring for Inez. The sources of evidence used for caring of Inez are medical journal and articles along with patient records.

References

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