solved

Adolescent Case study Scenario:
Jackson is a 18-year-old high school senior, who is being evaluated for neurological changes. Jackson’s parents provide a prior history of Chiari Malformation type 1, but indicate it was an incidental finding in early childhood following imaging after a motor vehicle accident. Jackson was referred to a neurologist and no interventions were taken since Jackson had no symptoms that consistently interfered with life or activity. Jackson’s parents report that the neurologist did note that sometimes this condition has an onset of symptoms in late adolescence, highlighting their concern at this visit and citing information on a public patient information page as consistent with Jackson’s current presentation. Other notable medical history includes 2 prior knee surgeries following an injury in soccer with outpatient physical therapy with ongoing narcotic pain management occurring over 2.5 years.
Upon initial history, Jackson is somnolent and not very responsive to inquiry. When inquiring about the specific signs and symptoms Jackson is currently experiencing, his parents state that he has been complaining of ongoing headaches and increasing sleepiness, sometimes for seemingly for multiple days at a time and that he can be hard to rouse at times. Jackson’s mom reports that sometimes his pupils change in size and he has sometimes experienced syncope or near syncopal episodes and change in coordination. Jackson remains somnolent during much of the assessment and parents further state that his recent health issues have caused depression and he has been very withdrawn recently. Parents further state that he has recently completed PT and weaned off his prescription pain medication which they thought would improve his mood and social involvement. Instead Jackson has exhibited changes in mood and personality and his parents are concerned that he is falling behind in school and they are concerned this will impact graduation. They also note that he had to stop playing soccer after his injuries, and developed new social circles, but in general does not participate in social activity. They also state that he has continued to have pain following the weaning of his narcotic pain management and tends to take ibuprofen and tylenol chronically, taking his most recent dose just before entering the facility.
Jackson’s level of consciousness continues to decline, on initial assessment include:
Temp: 37.3
Pulse: 50
Resp: 10
Blood Pressure: 100/60.
The nurse observes that Jackson continues to grow somnolent and verbal responses decline. Jackson appears to have constricted pupils and his breathing is becoming increasingly shallow, he is exhibiting pallor and clamminess to the touch.

Analyze and synthesize the above case study presentation above to answer the following questions :
What is the primary concern for Jackson based on this initial information and what indicators and evidence support your assessment?
What are the immediate nursing interventions for this scenario and what further assessment or information should be considered?
What are the potential ethical considerations in this scenario?
What are the potential family centered interventions?

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