NURS 6512: Advanced Health Assessment and Diagnostic Reasoning
Sample Answer for NURS 6512: Advanced Health Assessment and Diagnostic Reasoning Included After Question
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.
A Sample Answer For the Assignment: NURS 6512: Advanced Health Assessment and Diagnostic Reasoning
Title: NURS 6512: Advanced Health Assessment and Diagnostic Reasoning
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
A Sample Answer 2 For the Assignment: NURS 6512: Advanced Health Assessment and Diagnostic Reasoning
Title: NURS 6512: Advanced Health Assessment and Diagnostic Reasoning
The patient is in advanced-stage cancer, and the effective discussion should be on life care and discussion of wishes and needs. In the case presented, the patient has tested positive for advanced-stage cancer and is presented in the emergency unit for cardiac arrest. In this write-up, I will provide a detailed narrative explaining the health assessment information required for a diagnosis regarding the presented case.
I would determine the cardiac arrest using an ECG and the life-saving measures as defined in the ACL protocols (Nelson & Lewis, 2017). Once I am able to stabilize the patient, I would ask the boyfriend if the patient has an advanced directive or will concerning the resuscitation status. The advanced directive is a legal document relaying more information on the life savings of the patient (Rossetti, 2017). In this case, I would ask the boyfriend who can connect to the next of kin in case the boyfriend is not the next of kin. This would happen if the patient is unconscious or does not have the mental capacity to make important decisions. Effective decisions for resuscitation would wait, but until then, I will make every attempt to stabilize the patient.
I will respect the wish of the patient and the family. If the patient and the family agree that they need all interventions and the patient is stable on life support machines, then further investigation into brain function and viability will be conducted (Ozmen et al., 2019). Diagnostic testing would reveal the extent of brain damage and cardiopulmonary stability that would aid in determining the status of my patient and viability. I will then discuss the patient’s condition with the family to get ready for any result that would come from the treatment offered to the patient.
A confirmation that the brain cells of the patient are dead and the family is not ready to stop the life support measures, the hospital can change the status of the patient to “do not resuscitate” with approval from two physicians (Nelson & Lewis, 2017). However, providers will ensure that the family confirms the decision. This would be important in avoiding ethical dilemmas.
References
Nelson, A., & Lewis, A. (2017). Determining brain death: basic approach and controversial issues. American Journal of Critical Care, 26(6), 496-500. https://doi.org/10.4037/ajcc2017540
Ozmen, O., Aksoy, M., Atalay, C., Aydin, M. D., Dostbil, A., Ince, I., & Sener, E. (2019). Are unresponsive dilated pupils an indicator for brain death? an evaluation of Edinger Westphal nucleus in rabbits with brain death. Annals of Medical Research, 26(10), 2376-2381. https://annalsmedres.org/index.php/aomr/article/view/3711
Rossetti, A. O. (2017). Clinical neurophysiology for neurological prognostication of comatose patients after cardiac arrest. Clinical Neurophysiology Practice, 2, 76-80. https://doi.org/10.1016/j.cnp.2017.03.001