A 49-year-old woman with advanced stage cancer has been admitted to the emergency room with cardiac arrest. Her husband and one of her children accompanied the ambulance.
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.
A 17-year-old boy has come in for a check-up after a head injury during a football game. He has indicated that he would like to be able to play in the next game, which is in 3 days.
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 three scenarios.
Write an explanation of the health assessment information required for a diagnosis of all three selected patients (include the scenario numbers). Explain how you would respond to the three scenarios as an advanced practice nurse using evidence-based practice guidelines and applying ethical considerations. Justify your responses.
Use current references less than five years old.
Health assessment information for diagnosis
The nurse should ask the family members about the medications the patient has been on. The nurse should check for unresponsiveness and ability to breath normally. She should also establish the time the cardiac arrest occurred. The nurse should ask about the immediate interventions the family members took after the cardiac arrest (Eyal, 2013).
- The advanced practice nurse should establish if the patient has recently been experiencing feelings of sadness as well as thoughts of worthlessness, hopelessness, and helplessness.
- What symptoms have you been experiencing?
- When did you stop taking the medications and after how long did the flare-up occur?
- Have you been taking any antibiotic or nonsteroidal anti-inflammatory drugs? (Eyal, 2013).
- Have you been on a well-balanced diet?
- What kinds of food have you been taking?
- Have you been experiencing rectal bleeding, diarrhea, fever, or abdominal pain?
- Did you lose consciousness after the head injury?
- Were you putting on a helmet when the injury occurred?
- What are you feeling right now?
- Have you experienced any concussion in the recent past?
- Have you taking illicit drugs, alcohol, natural remedies, over-the-counter, or prescription medications?
- Are you taking aspirin or blood thinners? (Eyal, 2013).
- Have you been vomiting repeatedly after the injury?
- Did you experience numbness, weakness, or reduced coordination after the injury?
Evidence-based practice guidelines and ethical considerations
The nurse should discuss the nutrition support options with the family members and patient in advance, and they should be presented with information on nutritional choices and the consequences they have. The artificial nutrition support’s potential benefits should be weighed against the burden on the family and patient for medical procedures and additional hospitalizations, potential complications, and financial cost (Department, 2013). The nurse should also consider if resuscitating the patient will be ineffective or medically futile before administering it. The nurse should also seek if the patient and family agrees to resuscitation. In the case, if there directives regarding ventilator withdrawal are inadequately communicated or not available, there may be intubation although the likelihood for survival may be low. If ventilator support no longer agrees with the goals of care or is medically futile, the ventilator may be withdrawn to allow natural death.
Regardless of the fact that the basic principles of justice, autonomy, nonmaleficence, and beneficence are accepted across cultures, their priority varies among various cultures. The nurse, therefore, has an obligation in decision making in regard to resuscitation. Societal values and scientifically proven data should guide the resuscitative efforts while striving to promote cultural autonomy at the same time.
Due to medical costs, some patients may be willing to forgo potent life-saving treatments. Patients struggling with huge medical debt may skip important treatments or quit the prescribed medications (Department, 2013). Often, medical debts result to diminished life quality as well as high psychological distress levels for families and the patient. To the advanced practitioner nurse, this case will evoke concerns of denial of care, rationing and cheaper healthcare among insurance companies. The nurse has an ethical obligation of advocating for the best treatment possible for this patient irrespective of the price. The patient should rely on this philosophy to guide his decisions (Eyal, 2013).
Head injuries usually lead to a concussion or brain injury. Considering that the brain is extremely complicated, each brain injury differs. While some symptoms show right away, others appear weeks or days following the concussion. At times, the injury hinders people from recognizing or admitting that they are experiencing problems (Department, 2013). Hence, the advanced practice nurse should not allow the patient to play in three days. The patient should have diagnostic tests (brain CT scan) carried out on him and he should be monitored closely overnight. If an athlete experiences a concussion, the brain requires time to heal (Eyal, 2013). If there is another brain injury before the first one recovers, recovery is slowed and long-term problems’ chances are increased. Repeat concussions lead to permanent brain damage or welling.
Department, B. M. A. M. E. (2013). Everyday Medical Ethics and Law. Hoboken: Wiley.
Eyal, N. M. (2013). Inequalities in health: Concepts, measures, and ethics. Oxford: Oxford University Press.