David’s history and client records indicate that he was born prematurely. He required incubation after birth suffered from anoxia, massive intraventricular hemorrhage, developmental delays, brain damage, cerebral palsy, and two cardiac arrests. He later underwent shunt surgery to ease pressure on the brain with the approval of his parents. After nine months of intensive intervention, David experienced intracranial pressure, refusal to suckle, leading to the insertion of a G-tube for feeding. His parents work full-time, have two other dependents, and this strains their finances and emotions. David has experienced seizure disorders, contracture of his extremities, and scoliosis. He also suffers from pressure ulcers, is irritable, and cries as if in pain when touched.
The birth of David preterm indicates that he is at an increased risk of developing congenital abnormalities. Vogel et al. (2018) discovered that children born preterm are highly likely to develop multiple congenital anomalies in many body systems such as the cardiovascular and nervous systems. Anoxia, massive intraventricular hemorrhage, and cardiac arrests indicate that David has congenital heart diseases that include atrial septal defects and ventricular septal defects (Kelly et al., 2017). Symptoms of developmental delays, brain damage, cerebral palsy, and seizure disorders point to congenital nervous diseases such as hydrocephalus (Dewan et al., 2018). In addition, David is at an increased risk of injury due to increased intracranial pressure, infection due to the shunt he has, delayed growth and development, and risk of impaired skin integrity.
The goals of care for David include averting injury, ensuring skin integrity is assured, and avoiding infections due to the shunt. Additional goals include guaranteeing that growth and development are sustained and reducing unease in the family. Plans for ensuring that the cardiovascular system is well cared for revolve around monitoring activity intolerance and decreased cardiac output. Additional plans involve making sure that David is comfortable and experiences minimal pain.
The implementation stage of the nursing process would involve preventing injury by monitoring the level of consciousness regularly. Examining the pupils for equality and response, monitoring the neurological status of the child is also crucial. I would ensure that the integrity of the skin is maintained by repositioning the child regularly while he is admitted and ensuring that his head is turned away from the operative site where the shunt was previously inserted. I would ensure that I observe for any infections and promptly report them while administering the required antibodies. I would ensure that the family is adequately informed of David’s state to relieve them of anxiety. I would encourage them to ask questions for clarification and respond to all their concerns accurately. I would provide teachings to the family on the severe symptoms and signs they need to be observant of to be provided with care promptly.
I would assess the efficiency of the measures implemented if the child has no recurring infections. The maintenance of skin integrity would also be a crucial marker to indicate that the efforts were successful. The ability of the family to report to the healthcare facility whenever the child has any worrying signs would be proof of the efficiency of the family education measures. The absence of injuries in David after the interventions would indicate the efficiency of injury prevention initiatives. Minimal occurrence s in injuries would prompt an evaluation of the prevention measures to make adjustments. Reduced worry amongst the family members would indicate reduced anxiety and efficiency of the anxiety reduction intervention.
Ethical Theory Used
The ethical theory used to determine whether David would be accorded care as per the family’s requests or terminate care based on the team’s recommendation is the non-maleficence theory. The non-maleficence approach provides that patients have the right to no harm (Haddad & Geiger, 2020). This theory requires nurses to avoid causing damage to their patients. Non-maleficence in nursing practice can arise through acts of commission or omission. Commission occurs when a nurse may carry out an activity that harms a patient or omission where a nurse does not carry out an activity that may save a patient (Haddad & Geiger, 2020). Non-maleficence is considerable negligence that needlessly harms a patient.
Non-maleficence is applicable as the child has the right to life, and withdrawing treatment violates this right. Withdrawing treatment for the child is backed by the financial and emotional challenges the family encounters. The probability of the child living for more years is also low given the severity of their condition and the developmental delays. David is likely to die in the next few years from his condition that continues to worsen. The grief of losing the boy is inevitable for the parents, and offering him additional treatment is only likely to delay his demise.
On the other hand, the non-maleficence principle requires a medical practitioner to provide comfort and minimal pain to the patient despite their inevitable death (Massie, 2021). Withdrawing treatment for the child would be equivalent to causing harm by subjecting him to pain, while I could provide medications to reduce the pain. Letting the child die without any medical interventions would also make me responsible for their demise to some degree due to negligence (Smithard et al., 2019). Non-maleficence would guide me to provide pain medication and observation of David’s condition to the best of my abilities.
Dewan, M. C., Rattani, A., Mekary, R., Glancz, L. J., Yunusa, I., Baticulon, R. E., Fieggen, G., Wellons, J. C., Park, K. B., & Warf, B. C. (2018). Global hydrocephalus epidemiology and incidence: systematic review and meta-analysis. Journal of Neurosurgery, 130(4), 1–15. Web.
Haddad LM, Geiger RA. Nursing Ethical Considerations. 2020. StatPearls Publishing. PMID: 30252310.
Kelly, C. J., Makropoulos, A., Cordero-Grande, L., Hutter, J., Price, A., Hughes, E., Murgasova, M., Teixeira, R. P. A. G., Steinweg, J. K., Kulkarni, S., Rahman, L., Zhang, H., Alexander, D. C., Pushparajah, K., Rueckert, D., Hajnal, J. V., Simpson, J., Edwards, A. D., Rutherford, M. A., & Counsell, S. J. (2017). Impaired development of the cerebral cortex in infants with congenital heart disease is correlated to reduced cerebral oxygen delivery. Scientific Reports, 7(1), 15088. Web.
Massie, J. (2021). Suffering and the end of life. Journal of Paediatrics and Child Health. Web.
Smithard, D., Mitchell, L., & Patel, F. (2019). Ethical considerations of care towards the end of life. Nursing and Residential Care, 21(3), 146–150. Web.
Vogel, J. P., Chawanpaiboon, S., Moller, A.-B., Watananirun, K., Bonet, M., & Lumbiganon, P. (2018). The global epidemiology of preterm birth. Best Practice & Research. Clinical Obstetrics & Gynaecology, 52, 3–12. Web.