Assignment: Lab Assignment: Ethical Concerns NURS 6512N-32

Assignment Lab Assignment Ethical Concerns NURS 6512N-32

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).

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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.

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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

Various health assessments information, diagnostic tests, evidence-based guidelines and ethical considerations are essential when treating and diagnosing unconscious patients with cardiac arrest. Case study two about a 33-year-old woman who has advanced stage breast cancer and is currently admitted at the emergency room with cardiac arrest. She has been accompanied by her boyfriend in the ambulance and she is not married illustrates how the emergency should be handled by an advanced nurse practitioner (Baker & Marco, 2020).

I will take a number of actions as an advanced nurse practitioner to handle the scenario. First, I will carefully evaluate the patient’s vital signs that include her heart rate, respiration, level of awareness, and blood pressure and are crucial for such a patient in this state, in order to determine how well she is doing. In addition, I would look into her medical background to see if she had ever received breast cancer treatment (Perkins & Nolan, 2022).

She is in cardiac arrest, thus the best course of action would be to start advanced cardiac life support, which includes performing CPR and giving the appropriate drugs, in accordance with current evidence-based guidelines. Evidence for resuscitation has long been compiled using therapeutic and scientific suggestions (Perkins & Nolan, 2022).

Also, I would take the input of the patient’s boyfriend, especially in terms of decision-making. The boyfriend is capable to offer vital information at this stage. Potential questions to ask would include: (Baker & Marco, 2020).

Has she had any previous hospitalizations especially for cardiac arrest? (Baker & Marco, 2020).
Is there next of kin that needs to be contacted to follow up about their condition? (Baker & Marco, 2020).
Previously has she stated any resuscitation or medication preferences if a cardiac arrest occurs? (Baker & Marco, 2020).
Does patient have any cultural, religious or personal beliefs that should be considered during her resuscitation or treatment efforts? (Baker & Marco, 2020).
How long she has been in that state (unconscious and nonresponsive)? (Baker & Marco, 2020).
Does patient have planned advance directive? (Baker & Marco, 2020).
What is the patient’s medical history? Does she have an underlying health risk factor or conditions for cardiac arrest? (Baker & Marco, 2020).
Does she have any adverse reactions or allergies to medication? (Baker & Marco, 2020).

Advanced Practice Nurse Response

In terms of ethics, I would consider the advance decisions that medical

assignment lab assignment ethical concerns nurs 6512n-32 — Assignment Lab Assignment Ethical Concerns NURS 6512N-32

professionals must make for patients who are unconscious or in a vegetative state. As there is no advance directive in this circumstance, I shall consult the medical ethics committee or local regulations and laws to identify the appropriate route of immediate action after establishing if patient had an advance directive intended (Zhang, et al., 2021).

Here, I will take into account the necessity to provide appropriate medical care while simultaneously protecting the patient’s rights and interests. In this situation, beneficence is the most relevant ethical factor to take into account. In this case, the medical staff has a moral duty to provide care that is in the patient’s best interests. If the results of the diagnostic tests indicate that her illness is terminal, it can involve providing therapies that aim to extend her life and provide comfort in this case (Baker & Marco, 2020).

When managing the case, an advanced nurse should follow evidence-based recommendations and nursing practice ethics. Before conducting tests, administering treatments, and making drug recommendations, the nurse will take the necessary precautions. Better outcomes for patient and partner will be made possible by careful adherence to the rules and ethical considerations. However, in the absence of explicit directives, discussing the patient’s condition with ethics committee would indeed be possible (Zhang, et al., 2021).

Legally, let’s say someone who is not the patient’s spouse brings the patient in. The healthcare professional in that situation will only divulge information to individuals who have lawfully gained their consent or to those who are permitted to do so by law. However, after confirming his relationship with the patient, the lover will be treated as a designated representative and permitted to obtain some information about the patient’s condition (Perkins & Nolan, 2022).

References

Zhang, H., Zhang, H., Zhang, Z., & Wang, Y. (2021). Patient privacy and autonomy: A comparative analysis of cases of ethical dilemmas in China and the United States. Links to an external site.BMC Medical Ethics, 22(1). https://doi.org/10.1186/s12910-021- 00579-6

Perkins, G. D., & Nolan, J. P. (2022). Advanced life support update. Critical Care 26(73), https://ccforum.biomedcentral.com/articles/10.1186/s13054-022-03912-6.

Baker, E. F., & Marco, C. A. (2020). Advance directives in the emergency department. J Am CollEmerg Physicians Open 1(3), 270-275

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

It is not uncommon for nurses advanced practice nurses to encounter situations where a patient’s wishes regarded their health are in conflict with the family’s wishes, professional experience, or evidence hence creating ethical dilemmas (Haahr et al., 2020). Therefore, it is important for an advanced practice nurse to make informed decisions that can positively impact the patient’s condition.

The case considered in this assignment is for a 60-year-old man who was diagnosed with inclusive body myositis several years ago and is currently facing a rapid decline in his condition. While the patient prefers to be at home and get end-of-life care from there, the wife is of the opinion that her husband is admitted to the inpatient care setting.

Making a better decision regarding this case requires particular assessment information. Inclusive body myositis exposes the patients to falls; hence this patient is at risk of falling (Weihl, 2019). I would assess the patient’s quality of life and ability to undertake daily life activities. Assessing the proficiency of the home caregiving would be key in determining whether the partner can offer good care and give moral support.

An appropriate response to this scenario requires that I consider ethics as an advanced practice nurse. Guided by nursing ethics, I would strive to educate the family and the patient to ensure that they have sufficient knowledge regarding the condition and how the family can help take care of the patient. After the assessment, I would also collaborate with the patient’s wife and other family members to help come up with an appropriate care plan which is likely to have a better impact on the patient’s condition. These actions are in accordance with the principles of beneficence and nonmaleficence, which involve doing the right and good thing for the patient and doing no harm (McDermott-Levy et al., 2018). I would also ensure that I treat the patient’s medical details with confidentiality.

References

Haahr, A., Norlyk, A., Martinsen, B., & Dreyer, P. (2020). Nurses experiences of ethical dilemmas: A review. Nursing Ethics, 27(1), 258-272. https://doi.org/10.1177%2F0969733019832941

McDermott-Levy, R., Leffers, J., & Mayaka, J. (2018). Ethical principles and guidelines of global health nursing practice. Nursing Outlook, 66(5), 473-481. https://doi.org/10.1016/j.outlook.2018.06.013

Weihl, C. C. (2019). Sporadic inclusion body myositis and other rimmed vacuolar myopathies. CONTINUUM: Lifelong Learning in Neurology, 25(6), 1586-1598. Doi: 10.1212/CON.0000000000000790

Concerns

Photo Credit: Getty Images/Maskot
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 Lab Assignment, you will explore evidence-based practice guidelines and ethical
considerations for specific scenarios.

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:
o Select one scenario, and reflect on the material presented throughout this course.
o What necessary information would need to be obtained about the patient through health
assessments and diagnostic tests?
o 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.

By Day 6 of Week 11

Submit your Assignment.
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To submit your completed Assignment for review and grading, do the following:
 Please save your Assignment using the naming convention “WK11Assgn+last
name+first initial.(extension)” as the name.
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Assignment.
 Click the Week 11 Assignment link. You will also be able to “View Rubric” for grading
criteria from this area.
 Next, from the Attach File area, click on the Browse My Computer button. Find the
document you saved as “WK11Assgn+last name+first initial.(extension)” and
click Open.
 If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit
my paper(s) to the Global Reference Database.
 Click on the Submit button to complete your submission.

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Exam: Week 11 Final Exam

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This exam is a test of your knowledge in preparation for your certification exam. No
outside resources, including books, notes, websites, or any other type of resource, are
to be used to complete this exam. You are expected to comply with Walden
University’s Code of Conduct.
This exam will be on topics covered in weeks 7, 8, 9, 10, and 11. Prior to starting the
exam, you should review all of your materials. This exam is timed with a limit of 2 hours
for completion. When time is up, your exam will automatically submit.

By Day 7 of Week 11

Complete the Final Exam.
Submission and Grading Information
Submit Your Final Exam by Day 7 of Week 11.
To Complete this Exam:
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Learning Resources

Required Readings (click to expand/reduce)
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W.
(2019). Seidel's guide to physical examination: An interprofessional
approach (9th ed.). St. Louis, MO: Elsevier Mosby.

 Chapter 24, “Sports Participation Evaluation”
In this chapter, the authors describe the process of a sports participation
evaluation. The chapter also states the most common conditions
encountered in a sports participation evaluation.

 Chapter 25, “Putting It All Together”
In this chapter, the authors tie together the concepts introduced in

previous chapters. In particular, the chapter has a strong emphasis on the
patient-caregiver relationship.
Tingle, J. & Cribb, A. (2014). Nursing law and ethics (4th ed.). Chichester,
UK: Wiley Blackwell.

Furman , C. D., Earnshaw, L. A., Farrer, L. A. (2014). A case of
inappropriate apolipoprotein E testing in Alzheimer’s disease due to lack
of an informed consent discussion. American Journal of Alzheimer’s
Disease & Other Dementias, 29(7), 590–595.
doi:10.1177/1533317514525829.

Navarro-Illana, P., Aznar, J., & Díez-Domingo, J. (2014). Ethical
considerations of universal vaccination against human papilloma virus.
BMC Medical Ethics, 15(29). doi:10.1186/1472-6939-15-29. Retrieved
from http://www.biomedcentral.com/1472-6939/15/29

Maron , B. J., Friedman, R. A., & Caplan, A. (2015). Ethics of
preparticipation cardiovascular screening for athletes. Nature Reviews
Cardiology, 12(6), 375–378. doi:10.1038/nrcardio.2015.21

May, K. H., Marshall, D. L., Burns, T. G., Popoli, D. M. & Polikandriotis, J.
A. (2014). Pediatric sports specific return to play guidelines following
concussion. The International Journal of Sports Physical Therapy, 9(2),
242–255. PMCID: PMC4004129. Retrieved from
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4004129/
American Academy of Pediatrics. (2008). Recommendations for
preventative pediatric health care (periodicity schedule). Retrieved from
https://www.harmonyhpi.com/WCAssets/illinois/assets/IL_MedicaidProvid
erManual_PEM_AdultPHGsForProviders.pdf

This resource provides recommendations for preventative pediatric
healthcare from infancy through adolescence. The periodicity schedule
covers a variety of areas, from health history to measurements,
developmental/behavioral screenings, physical exams, procedural
screenings, and oral health.
Rourke, L., Leduc, D., & Rourke, J. (2017). Rourke Baby Record.
Retrieved from http://rourkebabyrecord.ca/

This website provides information on the Rourke Baby Record (RBR). The
RBR supplies guidelines on growth and nutrition, developmental
surveillance, physical exam parameters, and immunizations for well-baby
and child care.
Document: Final Exam Review (Word document)

Required Media (click to expand/reduce)

Module 4 Introduction

Dr. Tara Harris reviews the overall expectations for Module 4. Consider
how you will manage your time as you review your media and Learning
Resources for your Case Study Lab Assignment and your Final exam

(3m).

Accessible player

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.

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

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

Assignment: Lab Assignment: Ethical Concerns NURS 6512N-32