NURS 6512: Advanced Health Assessment and Diagnostic Reasoning
WEEK 11 Assignment 1: Lab Assignment: Case Study 3
Ethical Concerns
As an advanced practice nurse, you will run into situations where a patient’s wishes about his or her health conflict with evidence, your own experience, or a family’s wishes. This may create an ethical dilemma. What do you do when these situations occur?
In this Discussion, you will explore evidence-based practice guidelines and ethical considerations for specific scenarios.
Scenario 3:
A 27-year-old man with Crohn’s disease has been admitted to the emergency room with an extreme flare-up of his condition. He explains that he has not been able to afford his medications for the last few months and is concerned about the costs he may incur for treatment.
To prepare:
Select three scenarios, and reflect on the material presented throughout this course.
What necessary information would need to be obtained about the patient through health assessments and diagnostic tests?
Consider how you would respond as an advanced practice nurse. Review evidence-based practice guidelines and ethical considerations applicable to the scenarios you selected.
By Day 3
Post the explanation of the health assessment information required for a diagnosis of your selected patients (include the scenario numbers). Explain how you would respond to the scenario as an advanced practice nurse using evidence-based practice guidelines and applying ethical considerations. Justify your responses.
Read a selection of your colleagues’ responses.
By Day 6
Respond to at least two of your colleagues on two different days who selected different scenarios than you, using one or more of the following approaches:
Suggest additional health assessment information that would be necessary to collect from the patient
Critique your colleague’s response, and explain alternative approaches to the situation.
Validate an idea with your own experience and additional research.
WEEK 11 Assignment 1: Lab Assignment: Case Study 3
The case concerns a 27-year-old male admitted to the ED due to an extreme Crohn’s disease (CD) flare-up. He mentions that he could not afford his medications in the last couple of months and is worried about the costs of this treatment. The health assessment information needed to diagnose a CD flare-up includes the presence of fever, abdominal pain, flatulence or bloating, diarrhea, or weight loss. These symptoms are characteristic of CD flare-ups. Physical assessment data needed to diagnose this condition include the patient’s temperature, nutritional status, presence of abdominal mass or tenderness, and perianal and rectal exam findings (Gade et al., 2020). The clinician should assess if the patient has a fullness or a discrete mass, usually in the right lower abdominal quadrant, or look out for a mass usually felt due to thickened loops of the inflamed bowel.
As an APN, I would respond to this situation by first managing the patient’s pain using anti-inflammatory drugs to promote comfort. I would prescribe a short course of intravenous corticosteroids to treat the active CD episode. Corticosteroids are the cornerstone of CD flare therapy (De Simone et al., 2021). I would also prescribe an immunosuppressant, particularly Methotrexate. The drug is recommended primarily for maintaining remission in patients with moderate to severe or steroid-dependent CD.
The APN must apply ethical considerations when addressing this patient’s case to ensure the greater good. The APN should respect the patient’s right to autonomy by including him in decision-making and obtaining his consent before initiating treatment. In addition, the APN should provide high-quality care to promote the best outcomes without compromising his safety despite his inability to afford treatment (Varkey, 2021). I would involve a social worker to help the patient identify the options he has regarding his financial status.
References
De Simone, B., Davies, J., Chouillard, E., Di Saverio, S., Hoentjen, F., Tarasconi, A., … & Catena, F. (2021). WSES-AAST guidelines: management of inflammatory bowel disease in the emergency setting. World Journal of Emergency Surgery, 16(1), 1-27. https://doi.org/10.1186/s13017-021-00362-3
Gade, A. K., Douthit, N. T., & Townsley, E. (2020). Medical Management of Crohn’s Disease. Cureus, 12(5), e8351. https://doi.org/10.7759/cureus.8351
Varkey, B. (2021). Principles of clinical ethics and their application to practice. Medical Principles and Practice, 30(1), 17-28. https://doi.org/10.1159/000509119
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