Feb 23, 2024 NURS 6512 Lab Assignment Ethical Concerns
NURS 6512 Lab Assignment Ethical Concerns
NURS 6512 Lab Assignment Ethical Concerns
Case Study Assignment
Case Study 1: The Parents of a 5-Year-Old Boy have accompanied their Son for his Required Physical Examination
Nurses often face ethical dilemmas in their practice. Ethical dilemmas predispose nurses to conflicts in the most sound decision that is associated with minimal harm and optimum benefits to those involved. Nurses should have knowledge and skills in addressing ethical dilemmas in their practice. They should utilize models of ethical decision making as well as institutional policies that guide the approaches to addressing ethical dilemmas in practice. Therefore, the purpose of this paper is an examination of a case study of parents who do not want their son to be immunized prior to joining the kindergarten.
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Assessment Information
The selected case study for analysis involves parents of a 5-year-old boy who accompanied their son for his required physical examination before starting kindergarten. The parents are opposed to him receiving any vaccines. Immunizations play an important role in promoting the health of the public. Immunizations prevent the risk of the population being affected by communicable diseases such as polio and tuberculosis. Patients are expected to ensure that children get all the prescribed immunizations to protect them from health problems (Smith et al., 2017). However, the uptake of immunizations may be low in families and communities that do not support the use of immunizations due to effect of cultural values and beliefs.
As an advanced practice nurse, I am expected to perform comprehensive assessment to develop accurate diagnosis. I need to obtain information about the previous immunization history, surgical and medical history and undertake comprehensive physical examination. Obtaining information about immunization history is important to determine whether the parents have been against it since the early childhood or not. It will also be used to determine the vulnerability of the child to infections. History about medical and surgical history is important to determine whether the child has any underlying medical condition or history of surgery. Physical examination should be performed to determine any abnormalities such as injuries, abuse and violence. I also need to obtain information about the religious history of the family, since some religious practices influence the uptake of immunizations in some communities (Quinn et al., 2018).
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Responding to the Scenario
I will respond to the scenario by first educating the parents about the reasons for their decision that their son should not be immunized. Obtaining such information because it will provide insights into whether the parents have an informed basis for their decisions or not. It will also guide the determination of whether their decision is attributed to factors such as religious and cultural beliefs. The other intervention that I will embrace will be educating the parents about the importance of immunizations for their son. Health education may increase their understanding and cause a change in their perception towards immunization (Crocker-Buque et al., 2017; Hui et al., 2018). Resources such as videos and educational brochures may be used to increase their understanding.
Conclusion
Hesitancy to use immunizations is an ethical issue in nursing practice. Individuals may reject immunization services due to the influence of religious and cultural beliefs. Nurse practitioners have a critical role to play in assessing patients to make informed decisions on the uptake of immunization services. They also educate them about the importance of immunizations to facilitate informed decision-making
Photo Credit: Getty Images/Maskot
As an advanced practice nurse, you will encounter situations in which a patient’s health wishes conflict with evidence, your own experience, or the wishes of a family. This could create an ethical quandary. What do you do in these instances?
You will examine evidence-based practice guidelines and ethical considerations for specific scenarios in this Lab Assignment.
To Prepare
Review the scenarios provided by your instructor for this week’s Assignment. Please see the “Course Announcements” section of the classroom for your scenarios.
Based on the scenarios provided:
Select one scenario, 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.
The Lab Assignment
Write a detailed one-page narrative (not a formal paper) explaining the health assessment information required for a diagnosis of your selected patient (include the scenario number). Explain how you would respond to the scenario as an advanced practice nurse using evidence-based practice guidelines and applying ethical considerations. Justify your response using at least three different references from current evidence-based literature.
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Case Study Assignment
Case Study 1: The Parents of a 5-Year-Old Boy have accompanied their Son for his Required Physical Examination
Nurses often face ethical dilemmas in their practice. Ethical dilemmas predispose nurses to conflicts in the most sound decision that is associated with minimal harm and optimum benefits to those involved. Nurses should have knowledge and skills in addressing ethical dilemmas in their practice. They should utilize models of ethical decision making as well as institutional policies that guide the approaches to addressing ethical dilemmas in practice. Therefore, the purpose of this paper is an examination of a case study of parents who do not want their son to be immunized prior to joining the kindergarten.
Assessment Information
The selected case study for analysis involves parents of a 5-year-old boy who accompanied their son for his required physical examination before starting kindergarten. The parents are opposed to him receiving any vaccines. Immunizations play an important role in promoting the health of the public. Immunizations prevent the risk of the population being affected by communicable diseases such as polio and tuberculosis. Patients are expected to ensure that children get all the prescribed immunizations to protect them from health problems (Smith et al., 2017). However, the uptake of immunizations may be low in families and communities that do not support the use of immunizations due to effect of cultural values and beliefs.
As an advanced practice nurse, I am expected to perform comprehensive assessment to develop accurate diagnosis. I need to obtain information about the previous immunization history, surgical and medical history and undertake comprehensive physical examination. Obtaining information about immunization history is important to determine whether the parents have been against it since the early childhood or not. It will also be used to determine the vulnerability of the child to infections. History about medical and surgical history is important to determine whether the child has any underlying medical condition or history of surgery. Physical examination should be performed to determine any abnormalities such as injuries, abuse and violence. I also need to obtain information about the religious history of the family, since some religious practices influence the uptake of immunizations in some communities (Quinn et al., 2018).
Responding to the Scenario
I will respond to the scenario by first educating the parents about the reasons for their decision that their son should not be immunized. Obtaining such information because it will provide insights into whether the parents have an informed basis for their decisions or not. It will also guide the determination of whether their decision is attributed to factors such as religious and cultural beliefs. The other intervention that I will embrace will be educating the parents about the importance of immunizations for their son. Health education may increase their understanding and cause a change in their perception towards immunization (Crocker-Buque et al., 2017; Hui et al., 2018). Resources such as videos and educational brochures may be used to increase their understanding.
Conclusion
Hesitancy to use immunizations is an ethical issue in nursing practice. Individuals may reject immunization services due to the influence of religious and cultural beliefs. Nurse practitioners have a critical role to play in assessing patients to make informed decisions on the uptake of immunization services. They also educate them about the importance of immunizations to facilitate informed decision-making.
References
Crocker-Buque, T., Edelstein, M., & Mounier-Jack, S. (2017). Interventions to reduce inequalities in vaccine uptake in children and adolescents aged <19 years: A systematic review. J Epidemiol Community Health, 71(1), 87–97. https://doi.org/10.1136/jech-2016-207572
Hui, C., Dunn, J., Morton, R., Staub, L. P., Tran, A., Hargreaves, S., Greenaway, C., Biggs, B. A., Christensen, R., & Pottie, K. (2018). Interventions to Improve Vaccination Uptake and Cost Effectiveness of Vaccination Strategies in Newly Arrived Migrants in the EU/EEA: A Systematic Review. International Journal of Environmental Research and Public Health, 15(10), 2065. https://doi.org/10.3390/ijerph15102065
Quinn, S. C., Jamison, A., An, J., Freimuth, V. S., Hancock, G. R., & Musa, D. (2018). Breaking down the monolith: Understanding flu vaccine uptake among African Americans. SSM – Population Health, 4, 25–36. https://doi.org/10.1016/j.ssmph.2017.11.003
Smith, L. E., Amlôt, R., Weinman, J., Yiend, J., & Rubin, G. J. (2017). A systematic review of factors affecting vaccine uptake in young children. Vaccine, 35(45), 6059–6069. https://doi.org/10.1016/j.vaccine.2017.09.046
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
Case study 2 depicts a single father who accompanies his 17-year-old daughter to a women’s health clinic and requests a pregnancy test for his daughter. The daughter does not consent to the test and appears uneasy. Vital health assessment information required to establish if the girl is pregnant includes her menstrual history (Dyer et al., 2018). The nurse should inquire about the date of her last menstrual period (LMP), menstrual pattern, duration of her menses, and frequency. In addition, the nurse should obtain the client’s sexual history, including if she is sexually active, the contraceptives she uses, and the frequency of using contraceptives. The nurse should also gather information on presumptive signs of pregnancy, including amenorrhea, nausea, vomiting, generalized malaise, and breast tenderness (Gadsby et al., 2021).
This case presents an ethical dilemma since the girl’s father insists on a pregnancy test against her wish. The provider also has an ethical duty to promote the confidentiality of the patient’s information. Thus, I would ensure privacy when interviewing the girl in her father’s absence and assure her that the information she gives will be kept confidential. To address this ethical dilemma, I would observe the rule that the patient, in this case, is the girl and not the parent (Larcher & Brierley, 2018). Thus, I would only perform the pregnancy test if the girl consented. This is because conducting the test against the girl’s wish poses the risk of psychological harm.
Sharkey and Griffiths (2019) explain that children above 16 years are considered competent to consent to treatment, including pregnancy testing. Patients should be asked sensitively about the likelihood of pregnancy and offered a pregnancy test with their consent if there is doubt. If the girl continues to decline even after counseling her, I would inform her father that a pregnancy test cannot be conducted against the patient’s wish since it will violate her right to autonomy.
References
Dyer, J., Latendresse, G., Cole, E., Coleman, J., & Rothwell, E. (2018). Content of First Prenatal Visits. Maternal and child health journal, 22(5), 679–684. https://doi.org/10.1007/s10995-018-2436-y
Gadsby, R., Ivanova, D., Trevelyan, E., Hutton, J. L., & Johnson, S. (2021). The onset of nausea and vomiting of pregnancy: a prospective cohort study. BMC pregnancy and childbirth, 21(1), 10. https://doi.org/10.1186/s12884-020-03478-7
Larcher, V., & Brierley, J. (2018). Developing guidance for pregnancy testing of adolescents participating in research: ethical, legal and practical considerations. Archives of disease in childhood, 101(10), 980–983. https://doi.org/10.1136/archdischild-2018-310725
Sharkey, E., & Griffiths, S. (2019). The ethics of pregnancy testing. Anaesthesia & Intensive Care Medicine, 20(9), 511-514.https://doi.org/10.1016/j.mpaic.2019.06.006
Week 4
Skin Comprehensive SOAP Note
Patient Initials: B.B Age: 32 years Gender: Male
SUBJECTIVE DATA:
Chief Complaint (CC): “Red patches on the beard with pus-filled pimples.” (Graphic 3)
History of Present Illness (HPI):
B.B is a 32-year-old White male with chief complaints of having red patches on the beard with pus-filled pimples. He states that the patches are on the left side of the lower beard. The patches started as acne papules about ten days ago, which later turned yellow and pus-filled. The pimples begin as papules and progress to pustules, which have proliferated over the days. The client reports that the part with the red patches is tender to touch. Besides, he experiences a mild itching sensation, and some hair plucks when he scratches the beard. He states that the beard hair on and around the red patch is brittle and lusterless. The patient mentions that he bought OTC Betamethasone cream four days ago to alleviate the itchiness and eliminate the pimples, but it has not had any effect.
Medications: OTC Betamethasone cream.
Allergies: Allergic to Sulphur- causes a rash.
Past Medical History (PMH): History of Asthma- diagnosed at 6 years. Last exacerbation at 25 years.
Past Surgical History (PSH): None
Sexual/Reproductive History: Denies history of STIs.
Personal/Social History:
B.B is married and lives with his spouse and two children aged 5 and 2 years. He has a Bachelor’s in Mass Communication and works as an editor in a publishing company. He reports taking 3-4 glasses of whiskey on his day offs but denies smoking or using drug substances. His hobbies include playing basketball and reading fictional novels. He is the captain of the basketball team in his organization and coaches the basketball team in the local high school in his free time. He reports sleeping 6-7 hours daily and eating 4-5 healthy meals daily.
Health Maintenance: The patient goes to the gym 3-4 days a week. He plays basketball on weekends. He reports attending annual wellness exams.
Immunization History:
Last Tdap- 07/2015
Influenza shot- 06/2022
COVID-19 vaccine- 03/2021 (1st dose) 05/2021 (2nd dose) AstraZeneca
Significant Family History:
The paternal great-grandfather had HTN and died from stroke at 92 years. His maternal grandmother has DM and rheumatoid arthritis. His Father has controlled HTN, diagnosed at 54 years. Siblings and children are alive and well.
Review of Systems:
General: Negative for weight changes, fever, chills, or fatigue.
HEENT: Negative for headache, double/blurred vision, excessive lacrimation, ear pain/discharge, hearing loss, nasal secretions, sneezing, or throat pain.
Respiratory: Denies cough, sputum, chest pain, or breathing difficulties.
Cardiovascular/Peripheral Vascular: Negative for lower limbs edema, palpitations, chest pain, increased fatigue, or dyspnea on exertion.
Gastrointestinal: Negative for nausea, vomiting, regurgitation, epigastric/abdominal pain, rectal bleeding, or diarrhea/constipation.
Genitourinary: Negative for blood in urine, dysuria, urinary frequency, or urgency.
Musculoskeletal: Negative for joint pain/stiffness, muscle pain, or lower back pain.
Neurological: Denies headaches, dizziness, black spells, or tingling sensations.
Psychiatric: Denies having depressive, anxiety, obsessive symptoms, or suicidal thoughts.
Skin/hair/nails: Positive for mild itching on the lower left beard area. Pus-filled pimples on the beard and red skin patches. Brittle beard hair.
OBJECTIVE DATA:
Physical Exam:
Vital signs: BP-110/68; HR- 72; RR- 16; Temp-98.2 Ht-5’7; Wt-171 lbs.
General: The client is calm, alert, and oriented. He is well-groomed and displays positive body language. He maintains eye contact and has a positive attitude towards the clinician.
HEENT: Head is symmetrical and normocephalic. Eyes: Sclera is white, and conjunctiva is pink, PERRLA. Ears: Tympanic membranes are shiny and intact. Nose: The nasal septum is intact. Throat- Tongue is pink and midline; No tooth cavities, and the Tonsillar gland is non-erythematous.
Neck: Full ROM; Trachea is well-aligned.
Chest/Lungs: Uniform and smooth respirations. The chest is clear.
Heart/Peripheral Vascular: No edema or jugular vein distention. S1 and S2 are present. No gallop sound or systolic murmur.
Abdomen: The abdomen is flat and moves with respirations. Bowel sounds are normoactive. No abdominal tenderness, masses, organomegaly, or guarding.
Genital/Rectal: Normal male genitalia. Rectal sphincter is intact.
Musculoskeletal: Full ROM in all joints; No fractures, enlarged joints, or joint tenderness/stiffness.
Neurological: Muscle strength- 5/5. Normal gait, balance, and posture.
Skin: Fair, warm, and dry skin with normal turgor. The skin at the lower left beard is inflamed with red lumpy patches. Yellow pustules and crusting on the beard involve the hair root and follicle. Broken beard hairs on the red patches.
Diagnostic results: No diagnostic results are available.
ASSESSMENT:
Tinea Barbae: Tinea barbae is a dermatophyte infection occurring in the beard area. It is characterized by superficial annular lesions. However, some patients can present with a deeper infection that resembles folliculitis (Walkty et al., 2020). Tinea barbae can also be an inflammatory kerion that causes scarring hair loss. It is typically inflamed with red lumpy areas, pustules, and crusting around the hairs. The hairs can be plucked out easily. Mild itching, irritation, or pain is often present (Walkty et al., 2020). Tinea barbae is the primary diagnosis based on positive findings of patchy red areas in the beard area with pustules and mild irritation. The brittle and easily plucked-out beard hairs also support the diagnosis.
Pseudofolliculitis Barbae: This is an irritation of the skin caused by hairs that penetrate the skin before coming out of the hair follicle or come out of the follicle and curve back into the skin, resulting in a foreign-body reaction (Ogunbiyi, 2019). Pseudofolliculitis barbae mostly occurs around the beard and neck. Clinical manifestations include an erythematous papule with a hair shaft at the center (Ogunbiyi, 2019). Pseudofolliculitis barbae is a differential diagnosis based on the pustule and erythematous patches in the patient’s lower beard.
Bacterial Folliculitis: This is a bacterial infection of hair follicles. It is mostly caused by Staphylococcus aureus, but occasionally Pseudomonas aeruginosa. Clinical manifestations include mild pruritus, pain, or irritation (Jappa & Sameer, 2018). Physical findings include a superficial pustule or inflammatory nodule around a hair follicle. The infected hairs fall out or are plucked by the patient, but new papules develop (Jappa & Sameer, 2018). The growth of stiff hairs into the skin may result in chronic low-grade inflammation or irritation. Bacterial Folliculitis is a differential based on positive symptoms of mild pruritus, papules that progress to pustules on the beard area, and beard hair that easily plucks off.
PLAN: This section is not required for the assignments in this course (NURS 6512) but will be required for future courses.
References
Jappa, L. S., & Sameer, R. K. (2018). A clinical and bacteriological study of bacterial folliculitis. Panacea Journal of Medical Sciences, 8(2), 54-58. https://doi.org/10.18231/2348-7682.2018.0014
Ogunbiyi, A. (2019). Pseudofolliculitis barbae; current treatment options. Clinical, cosmetic and investigational dermatology, pp. 12, 241–247. https://doi.org/10.2147/CCID.S149250
Walkty, A., Elgheriani, A., Silver, S., Pieroni, P., & Embil, J. (2020). Tinea barbae presenting as a kerion. Postgraduate Medical Journal, 96(1137), 441-441. http://dx.doi.org/10.1136/postgradmedj-2020-137609
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