Identification of the issues
In this case, there are a few concerns related to the case study
Multiple head & neck trauma
It is probable that Mr. Borg’s head was severely hit and his neck got damaged from the accident involving a motor bike. Brain trauma can fuel up a neurological pack of symptoms. Cervical damage could entail the spinal cord, blood vessels, or airway’s tearing. The resulting injuries and conditions, from Mr. Borg’s perspective, could be debilitating and lead to pain, confusion, difficulty in breathing, and altered mental status (Sethi et al., 2014).
Agitated
In Mr. Borg’s case, agitation may be a result of one or more of the problems, like pain, discomfort, confusion, anxiety, or fear. Disquiet is a normal characteristic of patients with acute conditions, such as those who experience pain or psychological complication as a result of a neurological diagnosis.
Disorientated
Mr. Borg’s dizziness might be due to his head injury, sedation, the stress of his medical condition or any combination thereof. Disorientation threatens the safety of patients and its manifestation calls for identifying the cause of it and managing the disturbance in a prompt manner.
Confused
The situation of Mr. Borg might cause his confusion as a result of head injury, dizziness or medication side effects. Confusion tends to intensify agitation and increase the difficulty of, communicating and making any decisions. The main goal of nursing interventions is to pinpoint and eliminate source of the confusions while offering care as far as recovery or cognitive function is concerned.
Aggressive:
For Mr. Borg it is possible that his irritability is connected with his turbulent mental state, disorientation, or his dissatisfaction with his ailment. The nurse’s management of aggression incorporates assessment with identification of triggers, accountable application of de-escalation techniques, and appropriate usage of safety measures including physical restraint or medication, as the last method to for protection of the patient and others.
How is delirium diagnosed?
Diagnosing delirium in the patient uses a detailed mental status and behaviour assessment. Mr. Borg’s abrupt onset of restlessness, disorientation, and confusion should make you consider delirium, particularly in light of the recent traumatic injury and a change in the environment (Pun & Ely, 2007). To diagnose delirium, nurses typically conduct a thorough evaluation, including:
Assessment of Mental Status: This consists mainly of evaluating the level of patients’ consciousness, orientation to time, place and person, attention span, and ability to control simple commands.
Review of Medical History: Nurses collect information about the medical history of the patient, such as whether the patient has any pre-existing conditions, medications, recent surgeries, or trauma in the past, which might be one of the risk factors for the occurrence of delirium (Trzepacz, 1996).
Physical Examination: A medical examination is done to look for possible physical conditions or neurologic disorders that could be causing delirium.
Laboratory and Diagnostic Tests: Nurses can request specific laboratory tests like blood tests or imaging studies to eliminate metabolic or physiological causes of delirium, such as electrolyte imbalances, infections, or brain injuries (Faria & Moreno, 2013).
Assessment of Medication History: Nurses assess patients’ current medication regimes to highlight the medications that may lead to delirium or potential medication interactions.
Observation of Behavior: The patient’s behaviour is carefully observed by the nurses, as would be signs of agitation, restlessness, hallucinations, or variations in consciousness, which are the typical symptoms of delirium.
Delirium usually presents with an acute onset of confusion, cognitive changes, and alterations in the level of consciousness. The recognition of delirium and its prompt diagnosis are significant for the nurses to do the on-time interventions and avoid further complications (Fong et al., 2009). In the case of Mr Borg, delirium has developed, as evidenced by the abrupt onset of his confusion and agitation following the motorbike accident and relocation. The nursing team’s action to employ restraint measures and give antipsychotic medication corresponds to the standard approach in the management of delirium in a bid to secure the safety of the patient. On the other hand, communicating with Mrs Borg about the reasons for these interventions is essential to deal with her concerns and maintain trust in the healthcare team.
Treatment Options
As a nursing student, several treatment alternatives may be considered in the case of Mr. Borg.
Pharmacological Management: Antipsychotics should be administered to Mr. Borg to suppress his agitation and delirium. This group of medications helps to alleviate confusion and aggression that is due to such neurological imbalance. According to research, antipsychotics are often used to treat agitation and delirium in TBI and neurological condition patients. These drugs reduce symptoms by altering brain neurotransmitters (Kupfer, 2005). Continuous monitoring of antipsychotic patients to evaluate treatment response, monitor side effects, and alter drug dose is also recommended by research. To assess side effects and work with the healthcare team to modify dosage when necessary, it is essential for nurses to continually track Mr Borg’s reaction to the the medication.
Non-Pharmacological Interventions: Many non-pharmacological interventions, such as controlling delirium and agitation, would be implemented along with pharmacotherapy. This can only be achieved by creating a serene and peaceful atmosphere to manage pain, such as proper sleep, good hydration, and nutrition. Researchers claim that non-pharmaceutical treatments are central to the management of patients when agitation and delirium occur, especially in those who have devastating injuries (Liao et al., 2021). A quiet and peaceful ambience, pain relief measures, sleep aid, balanced hydration and nutrition bearing in mind the non-pharmacological treatment.
Behavioural Management: To minimize the physical confinements and manage the agitated tendencies of patients with delirium, de-escalation and therapeutic conversation are advisable. Such techniques are doctored to cater for the demands and concerns of patients. Not only this, research also contends that each delirium patient should be involved in care planning processes with a healthcare team to meet their specific needs and preferences (Jayet al, 1985). Nurses can collaborate with healthcare personnel to design individualized care plans peres and demands.
Family Education and Support: Mr Borg’s family, particularly Mrs Borg, should be educated and given exceptional support to fully be enlightened on the the restraint plan and its necessity. Sharing delirium causes, management, and care decision-making are practical steps that nurses should take to make Mrs. Borg and the close family involved in the care discussions. Caring for delirium and agitation calls for information and support from family members. Explaining delirium, its origins, treatment, and care decisions helps calm families and develop confidence in the healthcare staff (Bush et al., 2017). Research emphasizes open discussion and cooperation between healthcare practitioners and families to resolve and include concerns in care.
Regular Assessment and Monitoring: The mental status, behaviour, vital signs, and response to treatment of Mr Borg have to be monitored constantly to evaluate his improvement and to modify interventions if necessary. Delirium patients must be monitored continuously to measure therapy efficacy and detect changes or problems (Gaudreau et al., 2005). Nurses must correctly record observations and communicate with the healthcare team. Researchers stress the necessity of multidisciplinary teamwork and communication in delirium treatment to provide early interventions and optimal patient outcomes.
By complying with the hospital’s policies and procedures, the nurses can protect themselves and the patients from legal disasters. The nurses also authenticate that care is delivered according to ethical and legal standards
Professional & legal guidance to inform the decision-making process and its application to the case?
Some of the recommended measures to be applied in the case of Mr Borg include specialist advice.
Comprehensive Evaluation: The nursing assessment for Mr Borg needs to be mindful of the fact that he was involved in a car accident, had a severe head and neck injury, change of the environment, and a sudden onset of confusion and agitation. In this way, Mr. Borg’s nurses will make a correct treatment plan for him to identify what brings on his symptoms.
Collaborative Care: For Mr. Borg to have a care plan, nurses should join the team and work with other healthcare team members, that is, doctors, psychologists and other professionals. Such management strategies are the best; pharmaceutical or non-pharmaceutical treatments may need some contribution from the nurses and doctors.
Paul’s communication Nurses should remember that being in the hospital is stressful for patients, so sometimes, their relatives and friends are not good at communicating with them. The nurses should help them, too. Open and honest communication creates trust and teamwork in patient care.
Ethical Decision-Making Nurses should be given direction through ethical values like beneficence, nonmaleficence, autonomy and justice. To obtain this aim, it is necessary to seek the golden mean between the hazards and benefits of the treatments, respect Mr Borg’s autonomy and the patient’s rights, and enhance his health.
Professional influence enables nurses to ensure that their actions and decisions come from best practices, ethical principles, and the highest standards of nursing practice. This, in turn, will ultimately lead to the best care and the desired patient results.
Legal advice in the situation of Mr. Borg entails various concerns, including the following.
Legal Regulations The most important laws and regulations that control nursing practice are vital for nurses to know. The issues concerning patient rights, informed consent, and restraints are most important. This group includes federal statutes like the Health Insurance Portability and Accountability Act (HIPAA), which aims at protecting patient privacy and confidentiality, and state legislation governing the use of restraints and administration of medications.
Institutional rules Nurses should also follow the hospital regulations and protocols while providing patient care. This is due to the administration of restraints, policies and procedures issues, and delirium treatment. Another function of these policies is to ensure consistency and high quality of care, and they provide the criteria for appropriate use of interventions.
Documentation: Nurses must record their assessments, interventions, and discussions about Mr. Borg’s care meticulously and precisely. Documentation may be requested during medical or legal investigations since it is a legal record of the care given.
Summary of findings reflecting on learning in terms of clinical practice. What would you have done in this case?
I realized that the main thing is to consider the patients’ safety, ethical aspects, and family participation in the clinical setting. Control and medication are required to control agitation and the safety of the patient. Although the patient and family are involved in such cases, education and support concerning their fears are practical approaches. In this case, I would have taken the following actions: Here, I would have implemented the following actions.
Communication: I would have talked openly with Mrs. Borg sympathetically, relating to her fears and reasons for imposing enslavement and medication. Simple, easy-to-understand communication promotes trust and collaboration between healthcare workers and patients/families.
Education: I should have supplied Mrs Borg with information about delirium, its underlying causes, the virtues and risks associated with restraints and antipsychotic information. Teaching patients and families enables them to be a part of deciding on treatment.
Collaboration: I would have been involved in working with all the healthcare team members, such as doctors and psychologists, in prescribing the other interventions that would help control Mr. Borg’s agitation and delirium. This involves non-pharmacologic strategies of environmental manipulations, therapeutic communication, and behavioural interventions.
Advocacy: I would have championed the rights and welfare of Mr. Borg, ensuring that the interventions were done in a manner that dignified his person and liberty. Patient-focused care must be on the front line, calling for less punitive interventions that suppress the symptoms and lessen risks.
In my clinical practice, I integrate these tenets through the delivery of person-centred care characterized by caring, holistic, and patient-centred approaches, as well as respect for the autonomy and well-being of individuals and their unique needs and contexts.
Reference
Bush, S.H., Tierney, S. and Lawlor, P.G. (2017) ‘Clinical assessment and management of delirium in the palliative care setting’, Drugs, 77(15), pp. 1623–1643. doi:10.1007/s40265-017-0804-3.
Faria, R. da and Moreno, R.P. (2013) ‘Delirium in intensive care: An under-diagnosed reality’, Revista Brasileira de Terapia Intensiva, 25(2), pp. 137–147. doi:10.5935/0103-507x.20130025.
Fong, T.G., Tulebaev, S.R. and Inouye, S.K. (2009) ‘Delirium in elderly adults: Diagnosis, prevention and treatment’, Nature Reviews Neurology, 5(4), pp. 210–220. doi:10.1038/nrneurol.2009.24.
Gaudreau, J.-D. et al. (2005) ‘Fast, systematic, and continuous delirium assessment in hospitalized patients: The nursing delirium screening scale’, Journal of Pain and Symptom Management, 29(4), pp. 368–375. doi:10.1016/j.jpainsymman.2004.07.009.
Jay, S.M. et al. (1985) ‘Behavioral management of children’s distress during painful medical procedures’, Behaviour Research and Therapy, 23(5), pp. 513–520. doi:10.1016/0005-7967(85)90098-1.
Khan, S. et al. (2022) ‘Hand and wrist injuries associated with application of physical restraints: A systematic review’, HAND, 18(8), pp. 1253–1257. doi:10.1177/15589447221105548.
Kupfer, D.J. (2005a) ‘The pharmacological management of Depression’, Dialogues in Clinical Neuroscience, 7(3), pp. 191–205. doi:10.31887/dcns.2005.7.3/dkupfer.
Liao, Y.-J. et al. (2021) ‘Non-pharmacological interventions for pain in people with dementia: A systematic review’, International Journal of Nursing Studies, 124, p. 104082. doi:10.1016/j.ijnurstu.2021.104082.
Pun, B.T. and Ely, E.W. (2007) ‘The importance of diagnosing and managing ICU delirium’, Chest, 132(2), pp. 624–636. doi:10.1378/chest.06-1795.
Sethi, R.K. et al. (2014) ‘Epidemiological survey of head and neck injuries and trauma in the United States’, Otolaryngology–Head and Neck Surgery, 151(5), pp. 776–784. doi:10.1177/0194599814546112.
Trzepacz, P.T. (1996) ‘Delirium’, Psychiatric Clinics of North America, 19(3), pp. 429–448. doi:10.1016/s0193-953x(05)70299-9.
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