Promoting Recovery Working with Complex Needs - Essay Example

? Promoting Recovery Working with Complex Needs Number and Number Number of Words: 2,076 Table of Contents I. Introduction ………………………………………………………. 3 II. Complexity of the Problem and How this Imparts on the Illness of the Patient and the Service Providers ...................... 3 III. Patient’s Health Problems including Its Causative Factors .... 4 IV. Assessment, Care and Medical Intervention Given to Save the Life of Patient X ........................................................ 4 V. Evaluation of Assessment and Medical Intervention Based on Published Literature, Policy and Legislation ........... 5 VI. Lessons Learned from Working with Patient X ....................... 7 References ……………………………………………………………... 9 – 11 Introduction Patient X is 70 years old male patient with dementia who was unconscious at the time he was admitted to NHS hospital because of drug overdose (substance misuse). The patient’s neighbour reported that an empty bottle of benzodiazepines. Since the patient was living on his own, it was his neighbour who brought him to the hospital when he saw patient X lying unconsciously on the floor. Upon describing the assessment and care given to patient X, this study will demonstrate the complexity of the problem and how this imparts on the illness of the patient and the service providers. As part of the main discussion, the patient’s health problems including the possible causative factors, how the patient was assessed, and the medical intervention used to save the life of the patient will be described in details. In line with this, the effectiveness of these assessment and medical intervention will be evaluated based on published literature, policy and legislation. After going through reflection with regards to the process of care, lessons learned from working with patient X will be provided. Complexity of the Problem and How this Imparts on the Illness of the Patient and the Service Providers Patient X has a complex health care needs because of his severe dementia, drug overdose and serious eating problem. The fact that the patient was admitted to the hospital unconscious increases the complexity of the patient’s health problem. Benzodiazepine is a sedative drug that is commonly used to induce sleep or lessen the levels of anxiety. To avoid coma, respiratory depression, central nervous system depression or untimely death caused by drug overdose on benzodiazepines (Ngo et al. 2007; Dart 2003, p. 811), it is important to assess and provide care and treatment to the patient without further agitating the patient’s health condition. Since the patient is already old, there is a high risk that patient X is suffering from other diseases like diabetes or heart-related problems. For this reason, wrong treatment given to the patient could cause patient X to suffer from cardiac-arrest including other kinds of health problems such as respiratory depression. On the part of the service provider, the case of patient X is sensitive since wrong decisions made with regards to the patient’s assessment and care could endanger the life of patient X. Given that patient X have family members who would claim for his body, there is a strong possibility that medical professionals working in the service provider could face legal issues related to medical ethics and negligence. Patient’s Health Problems including Its Causative Factors Dementia can occur because of ageing or excessive intake of alcohol. In line with this, several studies explained that excessive drinking of alcohol could cause serious neurological damage on the brain (Mak 2008; Kapaki 2006). Because of patient’s old age, mental health problem and poor social life, the patient’s quality of living was badly affected. Dementia is a serious health condition since the patient has loss his cognitive ability which makes the patient suffer from disorientation (Lamont 2004). Since the patient is having problem with mental recognition, it is possible that the patient was unaware that he was already taking his medication more than the safe dosage. Considering that the patient was living on his own, it is possible that he has been skipping meals most of the time. Assessment, Care and Medical Intervention Given to Save the Life of Patient X Patients with dementia are often experiencing high levels of anxiety and depression (Calleo and Stanley 2008; Peters et al. 2008). Aside from explaining that Patient X is suffering from dementia, the patient’s neighbour reported that an empty bottle of benzodiazepines was seen in the site where patient X was seen unconscious. As soon as the patient was admitted to the hospital, the patient’s vital signs were taken and recorded as this information will serve as a basis in determining the existing health condition of the patient at the time of admission. Based on the patient’s vital signs record, the patient’s blood pressure, heart rate, respiratory rate, and temperature were significantly lower than the normal levels. In the study of Goldfrank (1998), it was explained that the intake of excessive benzodiazepines could make the patient’s blood pressure, heart rate, respiratory rate, and temperature significantly lower than the normal levels. This is the main reason why patient X’s blood pressure was 70/40, heart rate of 45 beats per minute, respiratory rate of 13 breaths per minute, and temperature of 35oC. Other than the abnormal vital signs, the physician noted that the patient may have serious eating disorders because of his bony body structure and below average weight. Immediately after taking the patient’s vital signs, IV line with dextrose solution was provided in order to rehydrate the patient. Likewise, artificial ventilation was given to the patient to minimize the risk of respiratory depression (Whyte 2004, pp. 811 – 822). As soon as the patient’s vital signs were normalized, the patient’s urine output, electrocardiography (ECG) and O2 saturation were taken and recorded (Murray et al. 2007). Since the patient is suffering from serious cognitive loss, all objects or things that could cause further harm on the part of the patient were removed. This strategy is effective in terms of preventing the risk wherein the patient will make use of available medicine or any forms of sharp objects to harm himself. Evaluation of Assessment and Medical Intervention Based on Published Literature, Policy and Legislation As soon as the patient was admitted to the hospital, the patient’s vital signs were taken and recorded. This particular patient assessment method is very important since the information related to the patient’s blood pressure, heart rate, respiratory rate, and temperature can be use in determining whether or not the patient is biologically unstable. In line with this, Goldfrank (1998) reported that the intake of excessive benzodiazepines could make the patient’s blood pressure, heart rate, respiratory rate, and temperature significantly lower than the normal levels. Since the patient’s vital signs at the time of admission was 70/40 (blood pressure), heart rate of 45 beats per minute, respiratory rate of 13 breaths per minute, and temperature of 35oC, this figures confirm the possibility that the patient is suffering from a drug overdose. Beneficence means that health care professionals should decide only what is best for the patient (Bailey 2007). It means that health care professionals should do good actions which are beneficial on the part of the patient. In line with this, it was necessary for the health care team to provide immediate health care and treatment which is for the best interest of the patient (Mental Capacity Act 2005 2007; Department of Health 2001, p. 9). Since patient X was admitted to the hospital unconsciously because of drug overdose, it is just right on the part of the health care professionals to provide immediate health care intervention which could save the patient from coma, respiratory depression, central nervous system depression or untimely death (Ngo et al. 2007; Dart 2003, p. 811). Likewise, it was a good decision to remove all objects or things that could cause further physical harm or injury on the part of the patient. The use of activated charcoal, gastric lavage and whole bowel irrigation could only cause further harm on the patient’s health condition (Whyte 2004, pp. 811 – 822; el-Khordagui, Saleh and KhalIl 1987). Therefore, it was good that activated charcoal was not given to the patient. Although activated charcoal is often use in absorbing drug overdose, this strategy aside from gastric lavage and whole bowel irrigation does not necessarily apply in the case of patient under benzodiazepine overdose because the use of activated charcoal could only cause more negative effects unless drug overdose with benzodiazepine is taken together with other drugs (Whyte 2004, pp. 811 – 822; el-Khordagui, Saleh and KhalIl 1987). Rather than the use of activated charcoal, gastric lavage or whole bowel irrigation, it was a good choice that medical professionals maintained the patient’s airway patency and administered IV since fluid replacement through IV route could treat hypotension (Gaudreault et al. 1991). In relation to patient’s drug overdose, there is a strong possibility for the patient to show signs of bradycardia or hypotension. In line with this, Gaudreault et al. (1991) revealed that it is best to treat the patient with atropine for bradycardia and catecholamines like dopamine to increase the patient’s blood pressure. Since the patient physically shows signs of malnutrition, it was a good step that IV insertion with dextrose solution was provided to the patient. This strategy is good in terms of preventing dehydration which could further complicate the patient’s existing health situation. It is common for patients with nutritional problems to rely on the use of tube feeding devices (National Institute for Health and Clinical Excellence, 2006; Department of Health 2001, p. 2). Aside from the fact that several studies revealed that the use of tube feeding devices is not effective in terms of providing the patient with his nutritional requirements (Chernoff 2006; Fine 2006), the use of this device could shorten the life of the patients because of possible internal infection caused by the presence of invasive foreign objects inside the human body (Fine 2006; Skelly 2002). For this reason, health care professionals should be honest when telling the patient and patient’s family members or relatives about the advantage and disadvantages of using tube feeding in terms of improving the patient’s nutrients requirements and improvements in weight. Because of the negative health consequence of using tube feeing, health care professionals should advice the patient’s family member or relatives (if any) to simply take time to spoon feed the patient. Lessons Learned from Working with Patient X Upon reflecting on the case of patient X, I have learned that health care professionals should always do things that are for the best interest of the patient. When providing necessary care and treatment, health care professionals should always consider the ethical issues on beneficence, autonomy, law of confidentiality, and informed consent to avoid the risk of facing legal issues in the future. There are some guidelines that health care professionals should follow when caring for patients with dementia. Autonomy and informed consent to health care treatment should be carefully observed when health care professionals provide care to patients who are mentally incapacitated. Since patient X was unable to decide for his preferred care and treatment, it is essential for health care professionals to follow the guidelines as published by the Department of Health entitled “Reference Guide to Consent for Examination or Treatment” (Department of Health 2009) and “Seeking Consent: Working with Older People” (Department of Health 2001). Informed consent is considered as a standard health care procedure before starting the provision of the patient’s required health care treatment (Department of Health 2009, p. 1; Department of Health 2001, p. 1). Although patient X was unconscious at the time he was admitted to the hospital, health care professionals should refrain from assuming that the patient is not capable of communicating their preferred care and treatment (Department of Health 2001, p. 9). In line with this, it is a challenge on the part of the health care professionals to avoid making unnecessary decisions over the patient’s health care treatment without any clinical evidences that could prove that patient X is not physically or mentally fit to make any decisions. Since it was impossible on the part of the health care professionals to seek informed consent directly from patient X, decisions made by health care professionals for patient’s assessment, care and treatment methods should consider and observe the law of beneficence. Aside from the ethical and legal consideration when providing care and treatment for patient X, I have learned that equality and diversity is very important in the profession of health care professionals. Since patient X has a complex health situation, health care professionals who are specializing in different fields should work together to deliver the best life-saving intervention at the time the patient was admitted to the hospital. It is equally important for health care professionals to immediately take and record the patient’s vital signs as this information will be use by the physicians in terms of monitoring any signs of progress and development with regards to the patient’s health condition. In line with this, vital signs are commonly used when determining whether or not the patient is at risk of developing further health complications as a result of excessive intake of benzodiazepine. *** End *** References Mental Capacity Act 2005, 2007, April 23. [online] Available at: [Accessed 4th January 2011]. Bailey, G., 2007. National Association of Social Workers. NASW Standards for Social Work Practice in Palliative and End of Life Care. [online] Available at: [Accessed 4th January 2011]. Calleo, J. and Stanley, M., 2008. Anxiety Disorders in Later Life Differentiated Diagnosis and Treatment Strategies. Psychiatric Times , 25(8). Chernoff, R., 2006. Tube Feeding Patients with Dementia. In Hoffer, L.J. (ed) "Analysis and Comment: Tube Feeding in Advanced Dementia. The Metabolic Perspective" . British Medical Journal , 333, pp. 1214-1215. Dart, R., 2003. Medical Toxicology. 3rd edition. USA: Lippincott Williams & Wilkins. Department of Health, 2001, November. Seeking Consent: Working with Older People. [online] Available at: [Accessed 4th January 2011]. Department of Health, 2009. Reference Guide to Consent for Examination or Treatment. 2nd Edition. [online] Available at: [Accessed 4th January 2011]. el-Khordagui, L., Saleh, A. and KhalIl, S., 1987. Adsorption of benzodiazepines on charcoal and its correlation with in vitro and in vivo data. Pharm Acta Helv , 62(1), pp. 28–32. Fine, R., 2006. Ethical Issues in Artificial Nutrition and Hydration. In Hoffer, L.J. (ed) "Analysis and Comment: Tube Feeding in Advanced Dementia. The Metabolic Perspective". British Medical Journal , 333, pp. 1214-1215. Gaudreault, P., Guay, J., Thivierge, R. and Verdy, I., 1991. Benzodiazepine poisoning. 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