1. Introduction
The paper presents the case of Akmal Muhammad, a 15-year-old Afghan refugee, who was admitted to Flinders University Paediatric Ward with severe asthma precipitated by an attack of panic. Akmal is a young boy with two serious chronic diseases of asthma and Type 1 Diabetes Mellitus and considerable psychosocial adversity in the setting of his traumatic experiences as a survivor of war. His medication so far includes intravenous hydrocortisone and inhaled bronchodilators (White et al., 2024). The paper focuses on the detailed health needs of Akmal, where asthma management, pharmacological incidence, and legal and ethical concerns in the nursing of a young refugee with a history of trauma are critically discussed. It also brings into light critical thinking and decision-making in nursing for medication safety and effective management of his complex needs. Furthermore, comprehensive nursing care for Akmal will be called upon to understand the interplay of medical and psychosocial issues as they relate to areas concerning emotional support, cultural understanding, and health education (Suk, 2024).
2. Evaluation of Complex Health Care Needs
2.1. Pathophysiology: Asthma
Asthma is defined as a chronic inflammatory airway disorder, essentially characterized by hyperresponsiveness, together with airflow limitation and recurrent respiratory symptoms manifesting as wheezing, shortness of breath, chest tightness, and cough. The genetic predispositions, combined with environmental triggers and inflammatory mediators, form the interlinking basis of the underpinning pathology (Mackie et al., 2024). In Akmal's case, his asthma exacerbation is compounded with a psychological component in that the panic attack itself may serve to further constrict the airways and provoke respiratory distress. In asthma, inflammation is primarily mediated by immune cells, particularly eosinophils and mast cells. These cells mediate the inflammatory reaction, causing bronchoconstriction and excessive production of mucus (Narendra &Khurana, 2024). The relationship between stress and asthma exacerbation is highly relevant in Akmal's case, especially given his PTSD diagnosis from traumatic experiences related to the loss of his family in the war (Al-Jabr et al., 2024). The psychological distress he is exposed to can result in increasing airway responsiveness, thus further deteriorating the patient's asthma symptoms and engendering a vicious circle of respiratory distress and anxiety.
2.2. Pharmacology: IV Hydrocortisone
Hydrocortisone is a medication classified under glucocorticoid corticosteroids. This medication is indicated in the treatment of acute asthma exacerbation due to its strong anti-inflammatory action. Akmal receives 100 mg of IV hydrocortisone every six hours. Corticosteroids, through this pathway, decrease airway inflammation, which helps in advancing the bronchodilation effect, thus making breathing easier (Bartziokas et al., 2024). Given Akmal's diagnosis of Type 1 Diabetes Mellitus, the administration of hydrocortisone complicates his glycemic control; therefore, close monitoring of blood glucose and possible adjustments in insulin will be necessary (Rao et al., 2024).
The pharmacokinetics of hydrocortisone involve rapid absorption and distribution throughout the body, with the onset of its action usually after 1-2 hours from the time of its administration. Its half-life is variable, lying in the range between 8 and 12 hours, so frequent dosing is often required to maintain levels which are associated with therapeutic benefits. Nursing staff must monitor Akmal's response to hydrocortisone for evidence of adrenal insufficiency, especially if it has to be continued over a long period (Coumans&Wark, 2024). Basic education on the importance of adherence to the prescribed regimen is also necessary for Akmal to understand, and his mother, Asal, needs to be aware of medication as a way of controlling his acute asthma exacerbation.
2.3. Ethical and Legal Considerations
Care for a refugee like Akmal requires the application of ethical and legal frameworks in nursing. The principle of beneficence would ensure interventions that promote his physical and psychological well-being, while justice ensures access to service delivery is culturally competent and delivered equitably. Disclosure of Akmal's history would have to be done with consideration to confidentiality to facilitate coordination of care. Informed consent would be obtained by discussing treatment options with Akmal and Asal (Peprah et al., 2024). The legal requirement for nurses while administering medications is about appropriateness of dosages and monitoring for adverse effects, as well as proper documentation (Kirkbride et al., 2024). A nurse must be vigilant in the practice related to safety medications and frequent audits to avoid the risks that may lead to a legal case.
2.4. Social Determinants of Health
Akmal's status as a refugee significantly impacts his healthcare needs. Major social leading determinants in his health outcomes include access to health care, socioeconomic status, and social support networks. It is also required on the part of the nursing team that the patient Akmal's social support systems, in particular the mother Asal, are evaluated in terms of managing his healthcare requirements (Kanengoni-Nyatara et al., 2024). Akmal and his sister Asal should be provided with resources that include access to mental health services, diabetes education, and asthma management to enhance their overall well-being (Peprah et al., 2024).
Culturally sensitive care is paramount when addressing the needs of refugees. Care must acknowledge and respect the underpinning cultural beliefs and practices of health care. For instance, undeniably, understanding the role of Akmal's religion, Islam, in his life will help the nursing team provide care that acknowledges his values (White et al., 2024). This aspect can be incorporated into the care plan to help Akmal feel more comfortable and thus become involved with his treatment, yielding positive health outcomes.
3. Anticipated Nursing Care
3.1. Fundamentals of Care
Nursing care for Akmal involves several fundamentals: respiratory support, management of diabetes, and psychological support. Given Akmal's current condition, the top priority is stabilizing his respiratory status by continuously monitoring his oxygen saturation, and the rate of his respirations, and using bronchodilators. For the management of Akmal's diabetes, nurses should monitor his blood glucose regularly, considering his higher readings over the past few days (Suk, 2024). His Humalog insulin pump settings should be reviewed and changed as necessary, notably during his time on corticosteroids, which raise blood glucose levels (Mackie et al., 2024). Education of Akmal and Asal is paramount, using the rationale for routine glucose checking and the signs and symptoms associated with hypo- or hyperglycemia.
It is important to provide regular assessment of Akmal's respiratory status through auscultation of lung sounds, assessing respiratory effort, and monitoring of vital signs. Moreover, the use of a structured approach to asthma management like an asthma action plan empowers Akmal and Asal to identify onsets of exacerbations earlier with the appropriate response. The treatment plan should include clear instructions on when to use the rescue medications when to seek medical help, and what constitutes the early warning signs of worsening asthma (Narendra &Khurana, 2024). For instance, some methods like guided breathing exercises or mindfulness practices could be taught to him for better handling of stress and, consequently, reduction of episodes of panic attacks (Al-Jabr et al., 2024). A respiratory therapist could also be approached to provide information on the proper inhalation techniques and use of spacer devices to enhance the effectiveness of the bronchodilator therapy.
Diabetes nursing care includes monitoring and the appropriate management of Akmal's insulin pump. The nursing staff should provide a thorough assessment of his current pump settings, including his carbohydrate intake, activity levels, and recent blood glucose levels. His infusion site should be checked regularly to ensure that no problems are occurring to affect insulin delivery such as site infections or kinks in the tube. This will include education on the signs and symptoms of hypoglycemia and hyperglycemia, proper nutrition, and the effects that stress has on blood glucose levels (Bartziokas et al., 2024). A diabetes educator can be brought in for Akmal to further his support and resources for his specific needs.
3.2. Psychological Support
Based on Akmal's diagnosis of PTSD, The nursing team should provide psychological support by creating a safe and comfortable environment that promotes open communication and the expression of feelings. Nurses can also collaborate with other mental health professionals to ensure that Akmal receives appropriate interventions to address his trauma. Trauma-informed care involves a concept that would enable the nursing team to bring Akmal's psychological needs into line. The major core principles of trauma-informed care are understanding trauma, its causes, and pathways into health; safety; trustworthiness; collaboration with choice; empowerment; and cultural issues (Rao et al., 2024). These can be furthered through active listening, feelings validation, and also through creating a sense of control to improve Akmal's care experience and malt such positive health outcomes.
4. Conclusion
In Akmal Muhammad's case, medical and psychosocial factors interplay vastly in the management of healthcare needs for a young refugee with chronic health conditions. Effective nursing requires knowledge of the pathophysiology of asthma and diabetes, besides the legal, ethical, and cultural complexities of his care. Incorporating respect for Akmal's cultural background into a patient-centred approach will facilitate a focus on respiratory management, diabetes education, and psychological support for his unmet healthcare needs, thus encouraging Akmal and his mother to take an active role in the establishment of a therapeutic relationship as far as his nursing is concerned. Continued collaboration with interdisciplinary team members and utilizing best practices in medication safety will further improve Akmal's quality of care. The presented case discloses one of the significant contributions made by nursing to overcome the challenges of vulnerable populations with equitability, compassion, and support of health and well-being.