The first nursing concern that stands out in the case of the 91-year old is the need to conduct a surgical procedure for a Peripherally Inserted Central Catheter (PICC) line (central line IV catheter) placed to receive antibiotics. This surgical process has the potential of changing the patients body structure and functioning hence the need to obtain her informed consent or that of the close family members in case her psychological status is so low making it impossible to rely on her approval. The rationale behind attaining such informed consent is the fact that the patient and her family needs to have a comprehensive and accurate understanding of any medical process to be undertaken by therapists (Gulanick, & Myers, 2014, 237). Such an elaborate surgical procedure requires that the nurse takes an active role as the patient advocate in reinforcing the explanations provided by the surgeon. The patient is likely to cooperate and embrace self-help mechanisms if she understands the reasons behind such a procedure.
The second issue is frequent bouts of confusion that require ongoing reorientation to her surroundings. As an intervention for this nursing concern, the practitioners should introduce themselves to the patient at every encounter as well as continuously orient the patient to her environment (Gulanick & Myers, 2014, 175). Apart from the two, the patient age is also a vital nursing consideration. The old age means that the patient is likely to encounter falls, and slips easily hence nurses should remove environmental barriers to ensure her safety and avoid making unnecessary changes in the environment that are likely to risk the patients safety (Gulanick & Myers, 2014, 175). Ideally, maintaining a consistent surrounding is essential in ensuring patient continues reinforcing what she has already learnt. Any changes made in the patients surrounding should always be procedural to allow her in systematically adjusting.
Legal or Ethical Considerations that Impact Care of the Client
One clear ethical issue in the given case in informed consent. Medical or nursing practice requires that before the conduct of any procedure that is likely to have far-reaching effects on the normal functioning of an individuals body then the practitioner must not only fully disclose the pros and cons of the process to the patient and family but also make sure that they concede to it. The fact that the 91-year old patient shows emotional instability and the low frequency of a close family member taking care of her complicates the situation. Therefore, it is crucial that before fixing the peripherally inserted central catheter (PICC) line in the patients body to help in receiving antibiotics, the practitioners establish an elaborate mechanism for obtaining the express and informed consent of the closest family members. Ideally, the principles and practice of care restrain practitioners from making unilateral decisions in critical procedures that are likely to affect the patients life in the long term adversely. Failure to practice informed consent exposes nurses to legal and well as professional challenges.
Another ethical issue is non-discrimination of the patient. Ethically, every patient, despite how critical their conditions are required to be attended to by professional caregivers and that their lives are adequately protected in a proper medical environment. In this regard, the 91-year-old needs continued assistance and treatment despite her changing moods including aggressiveness. She should be provided with the best orientation to make her cooperate in the care delivery process. Medical professionalism requires that a medic must do everything possible to relieve the patient of pain and suffering without perceived or actual discrimination.
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References
Gulanick, M., & Myers, J. L. (2014). Nursing care plans: Diagnoses, interventions, and outcomes. Philadelphia: Elsevier/Mosby.
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