NURS3013 Nursing Practice and Professional Placement Case Study 3 Sample

NURS3013 Nursing Practice and Professional Placement

In 1500 words (+/- 10%) select one of the case studies (as featured below) and provide the following:

• An introduction to the paper and person.

• Evaluation of the patient’s complex health care needs, demonstrating the ability to apply theoretical concepts of pathophysiology (to ONE complex health condition);
pharmacology (to ONE regular medication), explore ethical and legal considerations and social determinants of health.

• Demonstration of critical thinking and decision making when evaluating the anticipated nursing care required to safely manage the fundamentals of care for this person, including evaluation of the risks to medication safety.

• Conclusion

Solution

Introduction

Pediatric palliative care is exhaustive, mainly in the case of young patients. Such is the case of Sam Preston, an 8-year-old boy who has just been diagnosed with Stage 4 Glioblastoma, considered one of the most aggressive forms of brain tumors with very limited treatment options and poor prognosis. The challenge for MBA Assignment Expert in Sam's condition is that he moved straight from curative care to palliative care, meaning that his needs will have to be addressed holistically: physical, emotional, and social. This report assesses the complex condition of Sam using theoretical concepts of pathophysiology, pharmacology, and ethical and legal issues in addition to social determinants of health. Moreover, this report demonstrates critical thinking and decision-making skills in evaluating the expected nursing care to be instituted, particularly with respect to medication safety.

Assessment of Complex Health Care Needs of Sam

A. Glioblastoma GBM Pathophysiology

GBM is the most common and deadly primary malignant brain tumour in childhood, accounting for about 45% of the malignant brain tumours in children. This tumour arises from the glial cells-supporting cells in the brain. GBM is fast-growing, very invasive, and completely resistant to standard chemotherapy and radiotherapy (Alexandra Dumitru et al., 2024, p. 3).

In the case of Sam, the tumor was diagnosed after repeated headaches and an inability to concentrate in school. Aggressive treatments of surgery, chemotherapy, and radiotherapy were administered to him. At this stage, the tumor has grown bigger and is currently inoperable, thus he reached the point of palliative care. Neurologically, the deficits caused by GBM can be profound at its progression and could have dysphagia or paresthesia as in the case of Sam. The most complicating symptom will be the increased size of his tumor, which will seriously affect the further course of his motor and sensitive functions due to serious headaches and seizures.

Central to its pathophysiology, GBM invades healthy brain tissue, which disrupts the normal functioning of the neurological system (Seker-Polat et al., 2022, p. 5). Many times, the tumor invades regions responsible for motor control, cognition, and even basic life functions, complicating treatment. As GBM progresses, there is an increase in intracranial pressure, thereby worsening symptoms including nausea, vomiting, and changes in consciousness that Sam could face during the terminally ill stages of the disease.

B. Pharmacology: Levetiracetam

Currently, Sam is on various symptom management medications. The most critical drug includes the medication cycle of Levetiracetam at 230mg BD. It is an antiepileptic medication that is used in seizure control. Seizures are very common complications in tumor patients because of disturbed electrical activity in the cerebrum (Catibusic et al., 2024, p. 124).

Levetiracetam exerts its action by inhibiting abnormal neuronal firing through modulation of synaptic neurotransmitter release. It does so by highly binding to synaptic vesicle protein 2A, which appears to regulate neurotransmitter release and prevent neuronal hyperexcitability. This action helps in preventing seizures, which in his case are most likely to occur due to the tumor affecting critical brain areas (Catibusic et al., 2024, p. 125).

Pharmacologically, Levetiracetam is generally well-tolerated but has the possibility of side effects such as dizziness, somnolence, and irritability (Beschi et al., 2024, p. 4). These will need to be managed appropriately in a palliative setting to maximize the quality of life that remains for Sam. There is also the risk of drug interaction, particularly with Morphine and Dexamethasone being administered. This medication, combined with others, raises the risk of certain side effects, including sedation or respiratory depression, which could complicate the care of Sam further.

C. Ethical and Legal Considerations

There are significant ethical and legal considerations in Sam's care plan, mainly with regard to transitioning from a curative approach to palliative care. The ethical principle of autonomy would dictate the need for decision-making based on the family's determinations of what is in the best interest of Sam, supported by medical advice and any expressed wishes of Sam himself. However, the concept of autonomy is complicated in pediatric patients due to their potential inability to understand or express informed preferences. At the same time, however, all decisions taken so far have involved Sam's parents, Olivia and Henry, in collaboration with the medical team, to maintain respect for their values and wishes.

Another ethical principle involved in the case of Sam is beneficence, the duty to act always in the best interest of the patient by providing maximum benefit care with minimum harm. It includes the decision of stopping the aggressive treatments when these are unlikely to prolong life and in concentrating on increasing comfort through the palliative care.

Medications such as Morphine and Midazolam, in a legal sense, have to strictly follow policies and protocols since these medications have potential abuse and complications such as causing respiratory depression. It is also necessary that the informed consent about palliative care and use of the medications be obtained and documented, indicating that Sam's parents understand risks and benefits involved and are aware of treatments such as Morphine for the alleviation of pain and Midazolam in seizure control (Preuss et al., 2023). Moreover, healthcare professionals should follow legal requirements concerning controlled substances in order to provide medications responsibly and ethically.

D. Social Determinants of Health

Social determinants of health, too, play an important role in the case of Sam. The mother has taken unpaid leave from work to take care of Sam full-time, while the father works casually as an IT specialist. This puts the family under financial stress that might undermine their potential to access resource and support services.
While the principal focus of palliative care is symptom management of the patient, it also includes addressing specific needs the family may have. For Sam, there is a significant psychosocial impact on Olivia and Henry. They require emotional support, respite care, and practical facilitation through a complex health service, with retention of other supportive children such as Thomas and Luke. The availability of the Flinders University Community Palliative care team pertains to the support of medication management, emotional counseling, and helping the family cope with the impending loss of their child.

Economic constraints may limit access to services such as in-home nursing care that could alleviate some of the caregiving burdens on Olivia. A very important social safety net concerning community resources and governmental support, such as subsidized care or financial assistance, plays a very vital role in enabling the family to give Sam the best possible care during his final stages.

Nursing Care and Medication Safety

A. Fundamentals of Care

Nursing care focuses on the symptoms of pain, seizures, and dysphagia that Sam is experiencing. His needs are complex; therefore, a holistic approach is necessary in which nurses address not only the medical aspects of his care but also the emotional and psychological support needed by the family.

1. Physical Care: Nursing actually involves some interventions, such as pain management for Sam with Morphine PRN. Family teaching by the nurses on PRN medication should also involve safety measures while administering to Sam, recognizing when pain escalates, when to use medications like Morphine and Midazolam, and preventing suffering (Pérez-Toribio et al., 2024, p. 5).

2. Seizure Management: Anticonvulsant therapy is the cornerstone for seizure management, and Levetiracetam is one of the mainstays in his seizure management. Breakthrough seizures should be monitored by the nurses, and during seizures, Midazolam is utilized because it acts very quickly as a sedative (Hakyemez Toptan et al., 2024). Families should be educated regarding seizure onset and drug rescue medication.

3. Psychosocial Support: It is within the nurses' domain to support Sam's family emotionally through various means to enable them to cope with the emotional burden that goes along with palliative care. This also means that nurses can provide information related to different support groups, counseling services, and how to deal with anticipatory grief.

B. Evaluation of Risks to Medication Safety

Thus, a very important aspect in the care of Sam will involve safe drug administration. Combination drugs like Levetiracetam, Dexamethasone, Morphine, and Midazolam pose potential risks such as drug interaction and adverse side effects: sedation, respiratory depression, and dizziness. It is, therefore, an important concern for the nurses to closely monitor Sam for any signs of adverse drug reactions and dose adjustment according to symptoms and tolerance manifested by Sam.

PRN, in order to manage Sam's seizures, Midazolam is given, which must be accurately timed and dosed to evade prolonged seizures. Medication safety includes double-checking doses and educating the family about recognizing side effects of medications to avoid complications.

Conclusion

The Sam Preston case is, in fact, illustrative of the complexities going from curative treatment to comfort care in a child with a terminal diagnosis. This report has discussed the pathophysiology of GBM, the pharmacology of Levetiracetam, ethical and legal consideration, and the impact of social determinants of health on the care provided to Sam. In this context, the nursing care requires the ability for critical thinking and decision-making, mainly for medication safety management and provision of the necessary support to the family. Health caregivers address both the physical and psychosocial needs of Sam and his family in order to make the client's remaining months comfortable and meaningful.

References

Alexandra Dumitru, C., Walter, N., Ludwig, C., Schäfer, A., Rashidi, A., Belal Neyazi, Stein, K.-P., Mawrin, C., & Ibrahim Erol Sandalcioglu. (2024). The Roles of AGTRAP, ALKBH3, DIVERSIN, NEDD8 and RRM1 in Glioblastoma Pathophysiology and Prognosis. Biomedicines, 12(4), 1-16. https://doi.org/10.3390/biomedicines12040926

Beschi, F., Hughes, R., & Schneider, J. (2024). Administration of Levetiracetam via Subcutaneous Infusion for Seizure Control in the Palliative Care Setting: A Narrative Review. Pharmacy, 12(4), 1-9. https://doi.org/10.3390/pharmacy12040125

Catibusic, F., Uzicanin, S., Salihbegovic, E., & Huseinbegovic, Z. (2024). Efficacy and Safety of Levetiracetam for Childhood Epilepsies. Medicinski Arhiv, 78(2), 122–126. https://doi.org/10.5455/medarh.2024.78.122-126

Hakyemez Toptan, H., Nilgun Karadag, N., Topcuoglu, S., Ozalkaya, E., Dincer, E., Cakir, H., Asli Okbay Gunes, & Guner Karatekin. (2024). Comparative Outcomes of Levetiracetam and Phenobarbital Usage in the Treatment of Neonatal Seizures: A Retrospective Analysis. Healthcare, 12(7), 1-12 https://doi.org/10.3390/healthcare12070800

Pérez-Toribio, A., Moreno-Poyato, A. R., Lluch-Canut, M. T., El-Abidi, K., Rubia-Ruiz, G., Ana María Rodríguez-López, Pérez-Moreno, J. J., Marcelino Vicente Pastor-Bernabeu, Sánchez-Balcells, S., Ventosa-Ruiz, A., Montserrat Puig-Llobet, & Roldán-Merino, J. F. (2024). The Nurse-Patient Relationship in Nursing Documentation: The Scope and Quality of Interactions and Prevalent Interventions in Inpatient Mental Health Units. Journal of Nursing Management, 2024, 1–8. https://doi.org/10.1155/2024/7392388

Preuss, C. V., Kalava, A., & King, K. C. (2023, April 29). Prescription of Controlled Substances: Benefits and Risks. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK537318/

Seker-Polat, F., Pinarbasi Degirmenci, N., Solaroglu, I., & Bagci-Onder, T. (2022). Tumor Cell Infiltration into the Brain in Glioblastoma: From Mechanisms to Clinical Perspectives. Cancers, 14(2), 1-24. https://doi.org/10.3390/cancers14020443