Biological, Psychological, Spiritual, And Cultural Factors

Kristy Parkes has suffered a fracture in her pelvis on the right side after she was thrown from her horse. The first biological factor identified is the pain experienced by the patient following the fracture that might lead to loss of independence and mobility (Nieves et al., 2022). Moreover, Kristy has also experienced a brain injury after the fall, making her more confused. Confusion and pain can affect the mental and physical health of the patient. Severe pain can lead to interference with sleep patterns that can affect her rate of recovery resulting in delay in discharged from the hospital. This can put more pressure on Krsitey’s husband, who will be managing both their children as well as the work in order to meet the healthcare expenses. (Nieves et al., 2022).

The second factor that will be discussed is psychological factors. The patient has suffered a traumatic brain injury that has confused them, affecting her ability to think and respond accurately. I was worried that the patient is shifted to another hospital and seeing new faces might make the patient distressed and develop anxiety. For example, the patient’s husband and her son live in Queensland, and they might be worried and stressed about Kristy and her temper. Being dependent on others for daily tasks might generate a sense of burden and lead to psychological issues like depression (Bhatt, Nagappa & Patil, 2020).  Factors Affecting Patient Care And Consent In Healthcare Essay Paper

Next is the spiritual factor experienced by the patient following her injury, which includes a sense of hopelessness and a loss of faith in God. The patient might feel that her present conditions are an act of God and that he has punished her for the wrong she did. The patient might lose her trust and belief in God. Kristy might question her belief and faith in God’s existence. A sense of spiritual distress might prevail along with intense pain, low satisfaction, and low pain self-efficacy. According to the study, a negative correlation exists between spiritual well-being and pain intensity as well as between spiritual well-being and depression (Wilkinson, Francis & McKenna, 2018). However, a positive correlation can be found among pain self-efficacy, life satisfaction, and spiritual wellbeing.

The next factor is the cultural factor. In the case study, the patient used to live in Queensland; however, after the fracture and brain injury, the patient was shifted to Brisbane Hospital, which is 2 hours away from Queensland (Wilkinson, Francis & McKenna, 2018). The patient might experience a difference in culture, values, and beliefs while being admitted to Brisbane Hospital. There might be language barriers that affect the patient’s ability to express herself and her feelings, together with her needs. This can lead to distress and affect the mental health of the patient (Ali & Watson, 2018). Furthermore, the patient is a female, and she might not be comfortable sharing her experiences and needs with the male healthcare providers. In nursing, it is important to maintain cultural safety, which is the fundamental right of an individual. Cultural safety helps to provide a structure for assisting nurses to administer care such that their identity is protected, values are respected, dignity and beliefs are maintained, together with the wellbeing of the patient (Ali & Watson, 2018). Differences in cultural values and disrespecting the beliefs can result in unwillingness to proceed with the treatment by the patient and their family, which might contribute to a deterioration in the health of the patient.

Informed Consent And Legal Doctrine In Healthcare

“Consent” is a term that is being used when two people agree on something. In healthcare, it is important to obtain consent from the patient before initiating a medical process, which may be implied by the patient’s demeanor (Ploug, 2020). One such consent is informed consent, which is defined as communication between the provider and the patient leading to the permission of services, treatment, or care (Ploug, 2020). Kristey has suffered from a pelvis fracture and requires immediate surgery. However, informed consent has to be taken from her to start the surgical process. But the patient has also suffered from a head injury, confusing, and in such cases, the decision must be made by the patient’s family. Thus, Kristy’s husband can give consent to initiate the process.

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The term “doctrine of necessity” is used to explain the basis on which administrative authority actions are considered constitutional (Ploug, 2020). Medical necessity is a legal doctrine associated with the necessary activities that are appropriate and based on the standards of care. Kristy has suffered from a pelvic fracture, and as a treatment, surgery is vital for improving and facilitating the rate of recovery. “Guardianship” is a term that is used to emphasize the importance of assisting the patient with decisions related to their treatment. In the case study, the patient’s husband can have guardianship and, thus, he can make decisions related to treatment for improving the patient’s overall health (Huber, Aguirrebarrena & Ryan, 2022).

The first nursing goal is to evaluate the cardiovascular function to determine whether there is a preexisting problem like coronary heart disease (Turunen et al., 2017). Reviewing the cardiovascular system may help to find a history of angina, hypertension, heart failure, dysrhythmias, etc. Inquire about the current medication of the patient for any CV condition as well as their level of functioning. A 12-lead electrocardiogram (ECG), as well as coagulation studies, are undertaken and documented on the chart before surgery (Turunen et al., 2017).The CV assessment will help in collecting data on the measures that need to be taken before proceeding with the surgery. For example, if the patient is on diuretic therapy, a serum potassium level needs to be drawn preoperatively (Turunen et al., 2017).

The next step toward that goal is to perform a blood test. Performing a blood test can help to identify the issues that might increase the complexity of the surgery if not treated earlier (Turunen et al., 2017). As Kristy has suffered a pelvic fracture and surgery needs to be done, performing a blood test can help to identify the problem so that the person might not suffer adverse effects while undergoing surgery. A complete blood count, liver function test, pregnancy test, coagulation study, arterial blood gas, and Chem 7 blood chemistry panel (Turunen et al., 2017).

The third nursing action is to know whether the patient has drug allergies or some kind of drug tolerance. Being tolerant to drugs can result in adverse side effects while Having drug allergies can cause anaphylactic reactions, resulting in bronchospasm, hypotension, etc., making the situation worse (Turunen et al., 2017). Knowing about allergies and tolerance can help healthcare providers ensure the safety of their patients. For example, if the patient is allergic to sulfur, it must be documented in the patient’s chart (Turunen et al., 2017). This is because few anesthetic agents have sulfur and administering the same may cause serious complications for the patient. Thus, knowing about the allegations can help in preventing complex situations

Nursing Goals And Actions Before Surgery

The first abnormal finding is that the pain score is 7/10, indicating intense pain that limits her ability to perform daily activities and dominates her senses. Intense pain can limit her ability to maintain social relationships (Small & Laycock, 2020). Severe pain can interfere with the quality and pattern of sleep, resulting in the development of both physical and mental issues. Severe pain is the response to tissue injury resulting in the peripheral pain receptors’ activation and its specific A-delta and C sensory nerve fibers that are nociceptors (Small & Laycock, 2020). Kristy was thrown away by the horse while he was mustering the cattle. She was not wearing a helmet and, as a result, suffered from a brain injury and a pelvis fracture. The patient underwent surgery, resulting in postoperative pain, which is a common symptom after surgery. Severe pain is caused by central and peripheral sensitization as well as humoral factors, resulting in intense pain while resting or moving, slowing the recovery process and impairing functionalities (Li et al., 2019). Sensitization of the peripheral and central neuronal structures amplifies postoperative pain. Though the patient was administered IV fentanyl, resulting in relief from pain for 30 to 60 minutes, the patient’s pain score was 7/10, highlighting the ineffectiveness of the drug in providing relief (Small & Laycock, 2020). This indicates that the patient requires other medication or a modification in the drug dosage to get relief from pain. Studies have shown that the duration of surgery is linked with the intensity of pain, and surgical duration of more than 2 hours can result in moderate to severe postoperative pain (Mitra et al., 2018). The patient’s surgery took three hours to complete, which could be one of the reasons for the patient’s severe pain. acute surgical pain can result in increased postoperative mortality and morbidity, lengthen hospital stays, increase the cost of care, cause needless suffering, etc. (Mitra et al., 2018).

The second abnormal finding is the blood glucose level of the patient falling within the range of prediabetes. The patient’s BGL was 6.5 mmol/L and studies have shown that a BGL of 5.6 to 6.9 mmol/L is identified as prediabetes. Surgical stress is a systemic response that occurs due to a surgical injury, leading to hematopoietic and immunological changes and activation of the sympathetic nervous system and endocrine system (Buysschaert & Bergman, 2011; Tabák et al., 2012). Stress results in the secretion of hormones, resulting in elevated blood glucose levels. As a result, the stress hormones negatively affect the insulin-producing cells, causing a decrease in the level of insulin and, as a result, a patient might develop type 2 diabetes (Buysschaert & Bergman, 2011). In the case study, the patient was given fentanyl while undergoing a surgical procedure, which might cause a decrease in the level of oxygen that reaches the brain and lead to an increased level of blood glucose. Furthermore, Kristy was administered the drugs propofol and midazolam, which are linked with an increased blood glucose level (Buysschaert & Bergman, 2011).

The third cue is that the patient is confused and drowsy after the operation. Postoperative delirium is a temporary condition that leads to confusion, unawareness, issues with memory and attention, disorientation, etc. (Kitsis et al., 2020). Delirium can occur for various reasons, for example, drugs, developing infections, immobilization, and electrolyte imbalance (Rengel, Pandharipande & Hughes, 2018).  Kirsty has been administered the anesthetic agent propofol. Studies have shown that the morning after surgery, about 16% of the patients displayed confusion after receiving light anesthesia. Other side effects include choking, confusion, lightheadedness, dizziness, faintness, etc. when getting up (Rengel, Pandharipande & Hughes, 2018). This can be an issue because confusion and drowsiness can result in feeling weak, tired, and unable to open your eyes. This increases the risk of falls, leading to further progression of the issue. The next drugs, fentanyl, and midazolam can cause drowsiness and confusion, and thus they are the pharmacological factors for developing delirium (Kitsis et al., 2020). The complications associated with delirium include electrolyte abnormalities, malnutrition, decreased mobility, pressure ulcers, aspiration pneumonia, etc.

References

Ali, P. A., & Watson, R. (2018). Language barriers and their impact on provision of care to patients with limited English proficiency: Nurses’ perspectives. Journal of clinical nursing, 27(5-6), e1152-e1160. https://onlinelibrary.wiley.com/doi/abs/10.1111/jocn.14204

Bhatt, S., Nagappa, A. N., & Patil, C. R. (2020). Role of oxidative stress in depression. Drug discovery today, 25(7), 1270-1276. https://www.sciencedirect.com/science/article/pii/S1359644620301926

Buysschaert, M., & Bergman, M. (2011). Definition of prediabetes. Medical Clinics, 95(2), 289-297. https://www.medical.theclinics.com/article/S0025-7125(10)00202-6/abstract

Huber, J., Aguirrebarrena, G., & Ryan, C. J. (2022). Algorithm for the use of the Guardianship Act, the Mental Health Act and the Public Health Act in emergency departments in New South Wales. Emergency Medicine Australasia, 34(1), 34-38. https://onlinelibrary.wiley.com/doi/abs/10.1111/1742-6723.13819

Kitsis, P., Zisimou, T., Gkiatas, I., Kostas-Agnantis, I., Gelalis, I., Korompilias, A., & Pakos, E. (2022). Postoperative Delirium and Postoperative Cognitive Dysfunction in Patients with Elective Hip or Knee Arthroplasty: A Narrative Review of the Literature. Life, 12(2), 314. https://www.mdpi.com/2075-1729/12/2/314

Li, J. W., Ma, Y. S., & Xiao, L. K. (2019). Postoperative pain management in total knee arthroplasty. Orthopaedic surgery, 11(5), 755-761. https://onlinelibrary.wiley.com/doi/abs/10.1111/os.12535

Mitra, S., Carlyle, D., Kodumudi, G., Kodumudi, V., & Vadivelu, N. (2018). New advances in acute postoperative pain management. Current pain and headache reports, 22(5), 1-11. https://link.springer.com/article/10.1007/s11916-018-0690-8

Nieves, J. W., Cosman, F., McMahon, D., Redko, M., Hentschel, I., Bartolotta, R., … & Lane, J. (2022). Teriparatide and pelvic fracture healing: a phase 2 randomized controlled trial. Osteoporosis International, 33(1), 239-250. https://link.springer.com/article/10.1007/s00198-021-06065-4

Ploug, T. (2020). In Defence of informed consent for health record research-why arguments from ‘easy rescue’,‘no harm’and ‘consent bias’ fail. BMC Medical Ethics, 21(1), 1-13. https://link.springer.com/article/10.1186/s12910-020-00519-w

Rengel, K. F., Pandharipande, P. P., & Hughes, C. G. (2018).    Factors Affecting Patient Care And Consent In Healthcare Essay Paper