Case study on Delirium Syndrome

The immediate action that Mary Jo should take is to call for assistance and take care not to be injured. She should then asses and maintain Mr. Johns’ airway by position in a lateral or semi prone position. If possible, Mary Jo can administer supplemental oxygen as ordered. These will be followed by application of pulse oximetry, cardiac monitoring and cerebral oximetry if available. Mary Jo should then ensure that the Mr. Johns’ fluid balance is maintained by assessing his hydration status and taking necessary remedy for example starting IV line or NG tube placement. Then, she needs to take care of her patient’s incontinence using a condom catheter. The healthcare giver should also support the patient’s family by educating Mr. Johns’ wife of his needs.

The guidelines on restraint procedures include all the precautions taken to ensure that the restraint achieves its significant roles. First, it is required that the skin should be examined before applying a restraint to avoid applying it over the wounds or restrictive clothes. Second, for elbow restraints, an appropriate size elbow restraint should be used to keep the arms straight. Applying restraints that are too small can be ineffective or they can break and the oversize restraints may slip. Third, gauze padding should be done under the restraint to prevent skin irritation. The next guideline would require securing the restraint using ties to maintain circulation and prevent the associated complications. Last, regular checking of the skin should be carried out to provide an early detection of complications (Bowden, & Greenberg, 2012).

Haloperidol has a high protein binding capacity in humans and 90% of it is bound to the blood plasma. The free action accounts for only 7.5% – 11.6%. The drug undergoes extensive metabolism in the liver and only 1% of is excreted (Incayawar, & Todd, 2013). On the other hand, benzodiazepines are a class of drugs that act upon the nervous system. The drugs are usually administered in clinics as sedatives-anxiolytic drugs, therapy for epilepsies, panic disorders among other disorders. Benzodiazepines rapidly cross the blood-brain barrier and then equilibrate with the brain tissue (Mozayani, & Raymon, 2012).

The decision of the night nurse to avoid call Mrs. Johns is important and well thought. This is because she could have created tensions and inconveniences in the process of attending to the emergency. The nurse’s decision validity can be illustrated from her behavior in the early days of Mr. Johns’ admission. Even though there it is possible that she could have been controlled, it could have not been appropriate in this emergency. However, it is recommendable that the night nurse should have called Mrs. Johns in.

The nursing student should first take precautions when interacting with a patient. Such precautions may consist of the general monitoring of the patient’s reactions before getting any closer. This can help in reducing the risk of the student being injured or even getting the patient injured in such an event. The student should also learn to call for assistance before getting much involved in some of such situations.

It is the responsibility of the injured nurse to enlighten other nurses on how Mr. Johns behaved, what might have led to his behavior and also what could have been done to prevent his actions from harming others. She can be supported by the hospital for her to regain from her injury and get mental and moral support from her colleagues. The assumptions made by the student are due to the fear of getting attacked just like the nurse left to take care of Mr. Johns. However, these assumptions might be true because it could have been her first encounter and the patients vary or may resemble in their ailments. Based on the situation of Mr. Johns and the medication that he is put under, it is possible that he was experiencing a nightmare. He is actually fighting for his life in his hospital bed. As such, his thinking and experience might have triggered the nightmares.

This hospital should incorporate patient-centered care model in its health care services. They should fully involve their patients during their health care assessments for better outcomes. Patient assessment without the patient being unaware as in the case where Mary Jo assesses Mr. Johns while sleeping should be discouraged. Because Mr. Johns is in an acute condition, Mrs. Johns needs to be provided with clinical patient education to enable her understand the processes and necessity of patient assessment, diagnosis, evaluation, and individual needs in relation to these interventions (Jones, & Bartlet Learning, 2010).

References

Bowden, V. R., & Greenberg, C. S. (2012). Pediatric nursing procedures. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.
Incayawar, M., & Todd, K. H. (2013). Culture, brain, and analgesia: understanding and managing pain in diverse populations. Oxford: Oxford University Press.
Jones & Bartlet Learning. (2010). Basic concepts of patient education. Boston: Jones and Bartlet Publishers.
Mozayani, A., & Raymon, L. P. (2012). Handbook of drug interactions a clinical and forensic guide. New York: Humana Press.