Introduction
This essay provides a critical reflection on my role as a nurse managing a 25-year-old adult patient, referred to here as Dick, who presented with complex care needs following a cardiac arrest. Diagnosed with Lance-Adams syndrome, characterised by myoclonic movements secondary to hypoxic brain injury (HBI), Dick’s medical history includes type 1 diabetes mellitus (T1DM) with previous diabetic ketoacidosis (DKA), diabetic neuropathy, anaemia, asthma, nephrotic syndrome, and hypertension (HTN). Drawing from nursing principles at undergraduate level 6, this reflection examines my responsibilities in assessment, care planning, and interdisciplinary collaboration, while critically evaluating challenges and evidence-based practices. The essay highlights the nurse’s pivotal role in holistic care, supported by relevant literature, and considers limitations in applying knowledge to such multifaceted cases.
Patient Assessment and Initial Management
As the managing nurse, my primary role involved comprehensive assessment to address Dick’s immediate and ongoing needs. Following his cardiac arrest, which led to HBI and subsequent Lance-Adams syndrome, I prioritised stabilising vital signs and monitoring neurological status. Lance-Adams syndrome, a form of action myoclonus post-hypoxia, requires vigilant observation for involuntary movements that can impair daily functions (Frucht and Fahn, 2000). Indeed, Dick’s myoclonic jerks complicated mobility and self-care, necessitating assistive devices and pharmacological interventions like clonazepam, as recommended in neurological guidelines.
Furthermore, his comorbidities added layers of complexity. For instance, T1DM with a history of DKA demanded strict blood glucose monitoring to prevent recurrent episodes, particularly amid stress from HBI (NICE, 2015). I implemented a personalised care plan, including insulin adjustments and neuropathy assessments to mitigate pain and sensory loss. Anaemia required haematological monitoring, while asthma and HTN called for respiratory checks and antihypertensive therapy. This holistic approach aligned with the Nursing and Midwifery Council (NMC) standards, emphasising patient-centred care (NMC, 2018). However, a limitation was my awareness that while I could identify key problems, resource constraints in the ward sometimes delayed specialist input, highlighting the need for better interdisciplinary integration.
Challenges in Managing Complex Comorbidities
Managing Dick’s overlapping conditions presented significant challenges, requiring a critical approach to problem-solving. Nephrotic syndrome, compounded by HTN, increased risks of fluid overload and renal deterioration, so I monitored proteinuria and adjusted diuretics accordingly (Kidney Disease: Improving Global Outcomes, 2012). Asthma exacerbations were a concern, especially with myoclonic interference in inhaler use, prompting education on adaptive techniques.
Critically reflecting, I recognised that while evidence supports multidisciplinary teams for complex cases (Reeves et al., 2017), coordination was occasionally fragmented. For example, balancing T1DM control with anaemia treatment involved consulting endocrinologists and haematologists, but delays in communication affected timely interventions. This underscores a limitation in nursing knowledge application: although I drew on forefront research, such as studies on post-cardiac arrest care (Callaway et al., 2015), real-world applicability was hindered by systemic barriers. Arguably, this experience enhanced my specialist skills in prioritising care, yet it revealed the need for more robust protocols to address such intersections.
Ethical and Reflective Considerations
Ethically, my role extended to advocating for Dick’s autonomy, particularly given his young age and potential for rehabilitation. Lance-Adams syndrome can lead to psychological distress, so I incorporated mental health support, aligning with holistic nursing models (Royal College of Nursing, 2019). Reflecting critically, I evaluated diverse perspectives, such as family involvement in decision-making, which sometimes conflicted with clinical priorities. This process demonstrated my ability to interpret complex scenarios, though with limited depth compared to advanced practitioners.
Conclusion
In summary, managing Dick’s complex needs as a nurse involved thorough assessment, tailored interventions, and ethical advocacy, informed by evidence like NMC standards and NICE guidelines. Key arguments highlight the strengths in holistic care but also limitations, such as interdisciplinary challenges and resource constraints. Implications for practice include advocating for enhanced training in complex case management to improve outcomes. This reflection underscores the nurse’s essential role in navigating multifaceted health issues, fostering better patient-centred care in similar scenarios. Overall, it has deepened my understanding of nursing’s applicability and boundaries in dynamic clinical environments.
References
- Callaway, C.W., Donnino, M.W., Fink, E.L., Geocadin, R.G., Golan, E., Kern, K.B., Leary, M., Meurer, W.J., Peberdy, M.A., Thompson, T.M. and Zimmerman, J.L. (2015) Part 8: Post-cardiac arrest care: 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation, 132(18_suppl_2), pp.S465-S482.
- Frucht, S. and Fahn, S. (2000) The clinical spectrum of posthypoxic myoclonus. Movement Disorders, 15(S1), pp.2-7.
- Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group (2012) KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney International Supplements, 3(1), pp.1-150.
- NICE (2015) Type 1 diabetes in adults: diagnosis and management. National Institute for Health and Care Excellence.
- NMC (2018) The Code: Professional standards of practice and behaviour for nurses, midwives and nursing associates. Nursing and Midwifery Council.
- Reeves, S., Pelone, F., Harrison, R., Goldman, J. and Zwarenstein, M. (2017) Interprofessional collaboration to improve professional practice and healthcare outcomes. Cochrane Database of Systematic Reviews, (6).
- Royal College of Nursing (2019) Holistic needs assessment and care planning. RCN.
