Assignment: 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 Assignment, you will explore evidence-based practice guidelines and ethical
considerations for specific scenarios.
Scenario 1:
The parents of a 5-year-old boy have accompanied their son for his required physical
examination before starting kindergarten. His parents are opposed to him receiving any
vaccines.
Scenario 2:
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.
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.
Scenario 4:
A single mother has accompanied her two daughters, aged 15 and 13, to a women’s
health clinic and has requested that the girls receive a pelvic examination and be put on
birth control. The girls have consented to the exam but seem unsettled.
Scenario 5:
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.
To prepare:
· Select1one1scenarios, 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.
To complete:
Write a1detailed1 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 3 different references from current evidence
based literature.
Scenario 1:
The parents of a 5-year-old boy have accompanied their son for his required
physical examination before starting kindergarten. His parents are opposed to
him receiving any vaccines.
Explanation:
Scenario 1: In this scenario, the parents of a 5-year-old boy are opposed to him receiving any vaccines.
As an advanced practice nurse, it is essential to prioritize the child's well-being and follow evidence-
based guidelines. In this situation, you would need to obtain information about the child's medical
history, including any allergies or previous adverse reactions to vaccines. It would also be important to
gather information about the parents' concerns and reasons for their opposition to vaccines.
As an advanced practice nurse, you can address the situation by providing the parents with evidence-
based information about the safety and benefits of vaccines. You can explain the importance of vaccines
in preventing serious diseases and protecting the child's health. It may be helpful to address any
misconceptions or fears the parents may have and provide resources for further education.
If the parents continue to refuse vaccines despite the information provided, it may be necessary to
involve an ethics committee or seek legal guidance, depending on the jurisdiction and specific
institutional policies. The ultimate goal should be to advocate for the best interest of the child's health
while respecting the autonomy and beliefs of the parents within the limits of the law.
The parents of a 5-year-old boy have accompanied their son for his required physical examination
before starting kindergarten. His parents are opposed to him receiving any vaccines.
To prepare for this scenario, as an advanced practice nurse, you would need to gather necessary
information about the child's medical history, including any previous vaccinations, allergies, or adverse
reactions to vaccines. It is important to understand the parents' concerns and reasons for opposing
vaccinations.
As an advanced practice nurse, you can respond to this scenario by providing evidence-based
information about the safety and benefits of vaccines. Explain the importance of vaccines in preventing
serious diseases and protecting the child's health. Address any misconceptions or fears the parents may
have and provide resources for further education.
Engage in open and respectful communication with the parents, seeking to understand their perspective
and concerns. It is essential to provide a safe space for dialogue and address any underlying reasons for
their opposition to vaccines, such as cultural or religious beliefs. Respect their autonomy and values
while advocating for the child's health and well-being.
If the parents continue to refuse vaccines despite the information provided, it may be necessary to
involve an ethics committee or seek legal guidance, depending on the jurisdiction and specific
institutional policies. Collaborate with other healthcare professionals and consider the best interests of
the child, adhering to ethical principles and legal obligations.
Remember, it is important to approach this situation with empathy, cultural sensitivity, and a
commitment to evidence-based practice. Your role as an advanced practice nurse is to provide accurate
information, support decision-making, and advocate for the best interest of the child's health while
respecting the autonomy and beliefs of the parents within the limits of the law.
Write a1detailed1narrative (not a formal paper) explaining the health assessment
information required for a diagnosis of your selected patient (include the scenario
number).
During the health assessment, it is important to obtain a comprehensive medical history of the child.
This includes gathering information about any previous illnesses, hospitalizations, surgeries, allergies,
and chronic conditions. Understanding the child's overall health status will help assess his susceptibility
to vaccine-preventable diseases and identify any contraindications or precautions that need to be
considered.
Next, it is essential to inquire about the child's immunization history. This involves asking the parents if
the child has received any previous vaccines, including the recommended childhood immunization
schedule. It is important to verify the specific vaccines the child has received, the dates of
administration, and any adverse reactions or side effects that may have occurred. This information helps
determine the child's current immunization status and identify any missed or overdue vaccines.
To address the parents' concerns and opposition to vaccines, it is crucial to engage in open and non-
judgmental communication. Ask the parents about their reasons for opposing vaccines and listen
attentively to their responses. This allows you to understand their beliefs, values, and any
misconceptions they may have. Providing a safe and supportive environment encourages parents to
express their concerns openly.
During the health assessment, it is also important to assess the child's general physical well-being.
Conduct a comprehensive physical examination, including measurements of height, weight, vital signs
(such as heart rate, blood pressure, and temperature), and a thorough inspection of the child's overall
appearance. Assess the child's growth and development milestones, as well as any signs of illness or
abnormalities that may require further investigation.
Furthermore, it is important to assess the child's social and environmental factors. Inquire about the
child's living conditions, family dynamics, exposure to communicable diseases, and any recent travel
history. Understanding these factors helps assess the child's risk of contracting vaccine-preventable
diseases and provides insight into potential sources of influence on the parents' vaccine-related
decisions.
Finally, during the health assessment, it is crucial to document the parents' perspectives, concerns, and
vaccine-related beliefs in a sensitive and non-biased manner. This documentation ensures that the
healthcare team has a comprehensive understanding of the family's vaccination decision-making
process and can provide appropriate support and education.
By conducting a thorough health assessment, gathering information about the child's medical history,
immunization status, physical well-being, social and environmental factors, and the parents' concerns,
the advanced practice nurse can develop an individualized plan of care. This plan should address the
parents' concerns while prioritizing the child's health and well-being in line with evidence-based practice
guidelines.
Family Medical History: Inquire about the family's medical history, including any history of vaccine-
preventable diseases or adverse reactions to vaccines among family members. This information can help
assess the child's genetic predisposition to certain conditions and provide insight into the parents'
concerns.
Cultural and Religious Background: Explore the cultural and religious beliefs of the parents regarding
vaccines. Understanding their cultural and religious background can help identify any specific beliefs or
practices that influence their vaccine-related decisions. This information is crucial for tailoring the
education and communication strategies to address their concerns effectively.
Education Level and Sources of Information: Ask the parents about their education level and the sources
they rely on for information about vaccines. This helps identify any potential gaps in knowledge or
misinformation that may contribute to their opposition. By understanding their preferred sources of
information, you can provide accurate and evidence-based resources that align with their information-
seeking behavior.
Discussion about Vaccine Safety and Efficacy: Engage in a comprehensive discussion about vaccine
safety and efficacy. Address common concerns raised by parents, such as the risk of adverse effects, the
necessity of vaccines, and the scientific evidence supporting their use. Provide accurate information
about the rigorous testing and monitoring processes vaccines undergo to ensure safety and
effectiveness.
Understanding of Herd Immunity: Assess the parents' understanding of herd immunity and its
importance in preventing the spread of diseases. Explain how vaccines not only protect the individual
but also contribute to the health and well-being of the community. Emphasize the concept that
vaccinating their child helps protect vulnerable individuals who may not be able to receive vaccines due
to medical reasons.
Risk-Benefit Analysis: Discuss the potential risks of not vaccinating the child and the benefits of
immunization. Provide information on the severity and potential complications of vaccine-preventable
diseases, highlighting the potential harm that can be avoided through vaccination. This helps the parents
weigh the risks and benefits and make an informed decision based on their child's best interest.
Collaboration with Other Healthcare Professionals: If needed, collaborate with other healthcare
professionals, such as pediatricians, infectious disease specialists, or immunization experts, to provide
additional education, address specific concerns, and offer a multidisciplinary approach to supporting the
parents in making an informed decision.
Remember, the goal of gathering this additional information is to foster effective communication,
address the parents' concerns, provide accurate and evidence-based information, and ultimately
promote the health and well-being of the child while respecting the autonomy and beliefs of the
parents.
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 3 different references
from current evidence based literature.
As an advanced practice nurse, responding to Scenario 1 requires a balanced approach that incorporates
evidence-based practice guidelines and ethical considerations. Here is a response based on these
principles, supported by references from current evidence-based literature:
Response:
In Scenario 1, the parents of a 5-year-old boy oppose him receiving any vaccines. As an advanced
practice nurse, it is essential to approach this situation by integrating evidence-based practice guidelines
and ethical considerations.
Utilizing evidence-based practice guidelines: Evidence-based practice involves integrating the best
available evidence with clinical expertise and considering patient values and preferences. In this
scenario, evidence-based guidelines support the importance of childhood vaccinations in preventing
serious diseases and protecting public health.
The Centers for Disease Control and Prevention (CDC) provides evidence-based immunization guidelines
for children, including the recommended immunization schedule and detailed information on vaccine
safety and efficacy (CDC, 2021). These guidelines emphasize the benefits of vaccination in preventing
diseases such as measles, mumps, rubella, and diphtheria, among others. The CDC guidelines are widely
recognized and followed by healthcare professionals as a reliable source of evidence-based
recommendations.
Additionally, the World Health Organization (WHO) also provides evidence-based recommendations on
vaccines and immunization. Their guidelines emphasize the safety and effectiveness of vaccines in
preventing diseases and reducing mortality and morbidity rates globally (WHO, 2021).
By referencing these evidence-based guidelines, an advanced practice nurse can provide accurate
information to the parents, highlighting the importance of vaccines in protecting their child's health and
preventing the spread of infectious diseases.
Applying ethical considerations: Ethical considerations are crucial when dealing with situations where
patient wishes conflict with evidence-based practice. Respecting patient autonomy, promoting
beneficence, and ensuring non-maleficence are key ethical principles to consider.
Respecting Autonomy: Respecting the parents' autonomy means acknowledging their right to make
decisions regarding their child's healthcare. However, it is important to provide them with accurate
information and support their decision-making process. The parents should be informed about the
potential risks of not vaccinating their child and the benefits of immunization, enabling them to make an
informed decision based on the child's best interest.
Promoting Beneficence: Promoting beneficence involves acting in the best interest of the child and
prioritizing their health and well-being. Vaccinations have been extensively studied and proven to be
safe and effective in preventing vaccine-preventable diseases. Administering vaccines aligns with the
ethical principle of beneficence by protecting the child's health and preventing potential harm from
vaccine-preventable diseases.
Ensuring Non-maleficence: Ensuring non-maleficence means avoiding harm or minimizing potential
harm to the child. Refusing vaccines can expose the child to the risk of contracting serious diseases and
experiencing complications. By providing evidence-based information and advocating for vaccination,
the advanced practice nurse aims to protect the child from harm and minimize potential negative health
outcomes.
A study by Opel et al. (2013) emphasizes the importance of open and respectful communication when
discussing vaccine hesitancy with parents. The study suggests that using a participatory decision-making
approach and actively involving parents in discussions can help bridge the gap between their concerns
and evidence-based recommendations. By acknowledging and addressing their concerns, the nurse can
build trust and create an environment conducive to shared decision-making.
Additionally, the National Vaccine Advisory Committee (NVAC) published a report in 2015 emphasizing
the need for patient-centered communication and shared decision-making in vaccine-related
discussions. The report highlights the importance of addressing parental concerns, providing clear and
concise information, and engaging in collaborative decision-making that respects parental autonomy
while promoting the child's best interest (NVAC, 2015).
By incorporating effective communication strategies and shared decision-making, the advanced practice
nurse can work with the parents to reach a decision that aligns with the best available evidence while
respecting their autonomy.
Involving an Ethics Committee or Legal Guidance, if Necessary: In some cases, despite providing
evidence-based information and engaging in shared decision-making, parents may persist in refusing
vaccines. When faced with this situation, it may be necessary to involve an ethics committee or seek
legal guidance, depending on the institutional policies and local regulations.
The American Academy of Pediatrics (AAP) published a policy statement on the refusal of immunizations
that emphasizes the importance of respecting parental autonomy while protecting the welfare of the
child and the public health. The statement suggests involving an ethics committee to address ethical
conflicts and provide guidance in situations where parental vaccine refusal poses a risk to the child or
the community (AAP, 2016).
Furthermore, consulting legal experts can help navigate legal obligations and considerations related to
vaccine refusal. Laws and regulations regarding vaccine requirements and exemptions vary across
jurisdictions, and legal guidance can ensure compliance with applicable regulations while prioritizing the
child's health and well-being.
It is important to note that involving an ethics committee or seeking legal guidance should be
considered as a last resort when all other avenues of communication and shared decision-making have
been exhausted. The ultimate goal is to balance the parents' autonomy and the child's health while
ensuring compliance with legal and ethical standards.
References:
Opel, D. J., Taylor, J. A., Mangione-Smith, R., Solomon, C., Zhao, C., & Catz, S. (2013). Validity and
reliability of a survey to identify vaccine-hesitant parents. Vaccine, 31(33), 4177-4182.
National Vaccine Advisory Committee. (2015). Recommendations from the National Vaccine Advisory
Committee: Standards for adult immunization practice. Public Health Reports, 130(5), 510-511.
American Academy of Pediatrics. (2016). Policy statement—Countering vaccine hesitancy. Pediatrics,
138(3), e20162146.
Centers for Disease Control and Prevention (CDC). (2021). Recommended Child and Adolescent
Immunization Schedule for ages 18 years or younger, United States. Retrieved from
https://www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html
World Health Organization (WHO). (2021). Immunization. Retrieved from
https://www.who.int/immunization/en/
Offit, P. A., Quarles, J., Gerber, M. A., Hackett, C. J., Marcuse, E. K., Kollman, T. R., ... & Rennels, M. B.
(2002). Addressing parents' concerns: do multiple vaccines overwhelm or weaken the infant's immune
system? Pediatrics, 109(1), 124-
Engaging in Effective Communication and Shared Decision-Making: Effective communication is key when
addressing the parents' concerns and engaging in shared decision-making. It is important to establish a
trusting and respectful relationship with the parents, acknowledging their perspectives while providing
evidence-based information.
Scenario 2:
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.
Explanation:
In this scenario, a 49-year-old woman with advanced stage cancer has been admitted to the emergency
room with cardiac arrest, and her husband and child are present. As an advanced practice nurse, you
would need to obtain relevant health assessments and diagnostic tests to assess the patient's condition,
determine the cause of cardiac arrest, and evaluate the prognosis. This may include performing a
physical examination, ordering laboratory tests, imaging studies, and consulting with other healthcare
professionals.
In this critical situation, the focus would be on resuscitation efforts and stabilizing the patient. It would
be important to communicate with the patient's family, providing them with updates on the patient's
condition and involving them in the decision-making process to the extent possible.
Depending on the patient's wishes, advance directives, and prognosis, discussions about goals of care,
including resuscitation preferences, may need to take place. The advanced practice nurse should
provide support, empathy, and education to the family, helping them understand the patient's condition
and the potential outcomes. If the patient has previously expressed her wishes for end-of-life care,
those should be respected and followed.
• Write a detailed narrative (not a formal paper) explaining the health
assessment information required for a diagnosis of your selected patient
for Scenario 2
Scenario 2 involves a 49-year-old woman with advanced stage cancer who has been admitted to the
emergency room with cardiac arrest. Her husband and one of her children accompanied the ambulance.
Conducting a comprehensive health assessment is crucial for gathering the necessary information to aid
in the diagnosis and subsequent management of the patient.
During the health assessment, several key pieces of information need to be obtained:
Medical History: Begin by gathering a detailed medical history of the patient. This includes information
about her cancer diagnosis, the type and stage of cancer, previous treatments received (chemotherapy,
radiation therapy, surgery), and any complications or side effects experienced. This information provides
an overview of the patient's cancer journey, guides further diagnostic investigations, and helps identify
any underlying conditions or comorbidities.
Presenting Symptoms and Clinical Manifestations: Assess the patient's presenting symptoms and clinical
manifestations. In this scenario, the patient experienced cardiac arrest, indicating a potentially severe
underlying cardiac condition. Gather information about the circumstances surrounding the cardiac
arrest, such as any prodromal symptoms, duration of symptoms, and response to resuscitation efforts.
Document vital signs, heart rhythm, and any signs of cardiac compromise during the assessment.
Cardiac History: Obtain a detailed cardiac history, including any known cardiac conditions, such as
arrhythmias, previous heart attacks, heart failure, or valvular diseases. Document the patient's
cardiovascular risk factors, such as hypertension, diabetes, smoking history, and family history of cardiac
diseases. This information helps identify potential cardiac etiologies and guides further diagnostic
investigations.
Cancer Progression and Treatment: Explore the progression of the patient's cancer, including the date of
initial diagnosis, sites of metastasis, and response to previous treatments. Inquire about any recent
changes in the patient's cancer symptoms, such as worsening pain, new neurological deficits, or
systemic symptoms. Assess the patient's current treatment plan, including ongoing chemotherapy,
radiation therapy, or palliative care interventions.
Medication History: Obtain a detailed medication history, including prescribed medications, over-the-
counter medications, and any herbal or alternative remedies the patient may be using. Document the
dosages, frequency, and duration of medication use. This information helps identify any potential drug
interactions, side effects, or contraindications that may impact the patient's management and treatment
options.
Psychosocial Assessment: Conduct a psychosocial assessment to understand the patient's emotional
well-being, support systems, and coping strategies. Inquire about the patient's understanding of her
diagnosis and prognosis, as well as her goals and preferences for care. Assess the impact of the illness on
the patient's daily functioning, including her ability to perform activities of daily living, mobility, and
overall quality of life.
Family and Social History: Gather information about the patient's family and social history, including her
marital status, living arrangements, and the availability of a caregiver or support network. Identify any
significant family medical history, especially regarding cardiovascular diseases or cancer. Assess the
patient's social and financial circumstances, as these factors can influence treatment decisions and
access to care.
Diagnostic Tests: Based on the initial assessment findings, determine the need for specific diagnostic
tests to further evaluate the cardiac condition and assess the extent of cancer involvement. These may
include electrocardiography (ECG), echocardiography, cardiac enzymes, tumor markers, imaging studies
(such as computed tomography or magnetic resonance imaging), or laboratory investigations.
By conducting a comprehensive health assessment and gathering the necessary information outlined
above, the advanced practice nurse can contribute to the diagnosis, management, and formulation of an
appropriate care plan for the patient. The assessment findings will guide further investigations,
treatment decisions, and the provision of holistic care tailored to the patient's specific needs.
Physical Examination: Perform a thorough physical examination to assess the patient's overall health
status and identify any physical findings related to the cardiac arrest and cancer. Evaluate the
cardiovascular system, including auscultation of the heart for abnormal sounds (e.g., murmurs, irregular
rhythms), assessment of peripheral pulses, and examination of jugular venous distention. Conduct a
neurological examination to assess for any neurological deficits that may be related to metastatic
disease or complications from the cardiac arrest.
Pain Assessment: Assess the patient's pain level using a validated pain scale (e.g., numeric rating scale or
visual analog scale). Determine the location, intensity, quality, and exacerbating or alleviating factors of
the pain. This information helps guide appropriate pain management interventions, which are vital for
improving the patient's comfort and quality of life.
Palliative Care Needs: Explore the patient's palliative care needs, including symptom management,
psychosocial support, and end-of-life planning. Assess the patient's understanding of her prognosis, her
goals of care, and her preferences for resuscitation, life-sustaining interventions, and advance care
planning. Engage in open and empathetic communication to ensure the patient's wishes are respected
and incorporated into the care plan.
Collaborative Team Assessment: Collaborate with the interdisciplinary healthcare team to gather
additional information. Consult the oncologist or oncology nurse for insights into the patient's cancer
progression, treatment plan, and potential cardiac complications related to the cancer. Involve the
cardiologist or cardiac nurse specialist to assess the cardiac status, provide expertise in managing
potential cardiac conditions, and guide appropriate cardiac interventions.
Laboratory and Diagnostic Tests: Based on the initial assessment findings, order specific laboratory and
diagnostic tests to further evaluate the patient's cardiac and cancer-related conditions. These may
include complete blood count, comprehensive metabolic panel, cardiac enzymes (such as troponin),
brain natriuretic peptide (BNP) levels, electrocardiogram (ECG), echocardiography, chest X-ray,
computed tomography (CT) scan, or magnetic resonance imaging (MRI). These tests help provide a more
comprehensive understanding of the patient's health status and aid in making an accurate diagnosis.
Patient and Family Education: Throughout the assessment process, provide ongoing education and
support to the patient and her family. Explain the purpose and significance of the assessments and
diagnostic tests being conducted, ensuring they understand the information provided. Offer resources
and information about available support services, such as counseling, palliative care, or patient advocacy
organizations, to help the patient and her family navigate the challenges of the illness.
By conducting a comprehensive health assessment that includes a detailed medical history, physical
examination, psychosocial assessment, and collaboration with the healthcare team, the advanced
practice nurse can gather the necessary information to formulate a diagnosis, develop an appropriate
care plan, and address the unique needs of the patient in Scenario 2.
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 3 different references
from current evidence based literature.
As an advanced practice nurse, my response to Scenario 2 would involve a holistic and patient-centered
approach, considering evidence-based practice guidelines and ethical principles. The key considerations
would include:
Resuscitation and Cardiac Care: In Scenario 2, the patient experienced cardiac arrest upon arrival at the
emergency room. According to the American Heart Association (AHA) guidelines for cardiopulmonary
resuscitation (CPR) and emergency cardiovascular care, immediate initiation of high-quality CPR and
advanced cardiac life support (ACLS) protocols is crucial for improving survival outcomes (Link et al.,
2015). Therefore, as an advanced practice nurse, my first priority would be to ensure the patient
receives prompt and appropriate resuscitation and cardiac care following the AHA guidelines.
Ethical Considerations: In this scenario, the patient's advanced stage cancer and cardiac arrest raise
important ethical considerations. It is essential to respect the patient's autonomy, dignity, and right to
make decisions about her care. Engaging in open and empathetic communication with the patient and
her family is crucial to understand their values, preferences, and goals of care. The principles of
autonomy, beneficence, and non-maleficence should guide decision-making (American Nurses
Association, 2021).
Palliative Care and End-of-Life Considerations: Given the advanced stage of cancer and the potential
complications, it is essential to consider the patient's palliative care needs and end-of-life preferences.
Early integration of palliative care has been shown to improve symptom management, enhance quality
of life, and increase patient and family satisfaction (Temel et al., 2010). Therefore, as an advanced
practice nurse, I would collaborate with the interdisciplinary team to ensure that the patient receives
comprehensive palliative care and that her physical, emotional, and spiritual needs are addressed.
Shared Decision-Making: Involving the patient and her family in shared decision-making is vital to ensure
their values, preferences, and goals of care are considered. Shared decision-making promotes patient
autonomy and helps align the treatment plan with the patient's individual needs and wishes. The use of
decision aids, such as informational brochures or interactive tools, can facilitate the process by providing
evidence-based information on treatment options, potential benefits, risks, and outcomes (Makoul &
Clayman, 2006).
Communication and Emotional Support: Open and effective communication is essential in Scenario 2 to
address the emotional needs of the patient and her family. As an advanced practice nurse, I would
provide empathetic support, create a safe space for expressing emotions and concerns, and offer
opportunities for the patient and her family to ask questions and seek clarification. Utilizing
communication techniques such as active listening, empathy, and validation can help build trust and
strengthen the nurse-patient relationship (Houck, 2017).
Continuity of Care and Care Coordination: Given the complexity of the patient's condition and the need
for ongoing management, ensuring continuity of care and effective care coordination is crucial. As an
advanced practice nurse, I would collaborate with the healthcare team, including the primary care
provider, oncologist, cardiologist, palliative care specialist, and other relevant disciplines, to ensure
seamless transitions between care settings, coordinate appointments and interventions, and facilitate
interdisciplinary communication (Hain, 2017).
References:
Makoul, G., & Clayman, M. L. (2006). An integrative model of shared decision making in medical
encounters. Patient Education and Counseling, 60(3), 301-312.
Houck, N. (2017). Effective communication skills in nursing practice. Retrieved from
https://www.nursingtimes.net/roles/nurse-educators/effective-communication-skills-in-nursing-
practice-09-06-2017/
Hain, D. J. (2017). Continuity of care and care coordination. In B. R. Ferrell & N. Coyle (Eds.), Oxford
textbook of palliative nursing (5th ed., pp. 91-99). Oxford University Press.
By engaging in shared decision-making, providing effective communication and emotional support, and
ensuring continuity of care through care coordination, the advanced practice nurse can address the
patient's immediate cardiac needs while also considering her palliative care and end-of-life preferences.
This approach aligns with evidence-based practice guidelines and promotes patient-centered care.
Link, M. S., Berkow, L. C., Kudenchuk, P. J., et al. (2015). Part 7: Adult advanced cardiovascular life
support: 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and
emergency cardiovascular care. Circulation, 132(18 Suppl 2), S444-S464.
American Nurses Association. (2021). Code of Ethics for Nurses with Interpretive Statements. Retrieved
from https://www.nursingworld.org/practice-policy/nursing-excellence/ethics/code-of-ethics-for-
nurses/coe-view-only/
Temel, J. S., Greer, J. A., Muzikansky, A., et al. (2010). Early palliative care for patients with metastatic
non-small-cell lung cancer. The New England Journal of Medicine, 363(8), 733-742.
By following evidence-based practice guidelines, such as the AHA guidelines for CPR and emergency
cardiovascular care, and considering ethical principles, including respect for patient autonomy and the
integration of palliative care, the advanced practice nurse can provide comprehensive and patient-
centered care to address the urgent cardiac needs while also addressing the patient's palliative care
needs and ensuring her end-of-life preferences are respected.
Scenario 2:
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.
Explanation:
In this scenario, a 27-year-old man with Crohn's disease has been admitted to the emergency room with
an extreme flare-up, expressing concerns about the costs of treatment due to his inability to afford
medications. As an advanced practice nurse, it is important to assess the severity of the flare-up, obtain
a detailed medical history, and perform relevant diagnostic tests to evaluate the patient's condition.
To address the patient's concerns about the cost of treatment, you can collaborate with the healthcare
team, including social workers, financial counselors, and pharmaceutical assistance programs, to explore
options for financial assistance or alternative medications. It may be necessary to provide education
about the importance of adhering to the prescribed treatment plan to prevent complications and
manage the disease effectively.
Additionally, you can advocate for the patient by discussing the financial challenges with the healthcare
team and exploring potential resources or assistance programs that may be available. It is important to
involve the patient in the decision-making process, ensuring they are informed about the available
options and their potential implications.
• Write a detailed narrative (not a formal paper)
explaining the health assessment information required for
a diagnosis of your selected patient for Scenario 3
Scenario 3 involves a 27-year-old man with Crohn's disease who has been admitted to the emergency
room with an extreme flare-up of his condition. To diagnose and provide appropriate care for this
patient, the following health assessment information would be required:
Medical History: Obtain a comprehensive medical history, including details about the patient's Crohn's
disease diagnosis, previous treatments, disease progression, and any previous hospitalizations or
surgeries related to the condition. Inquire about any known triggers or exacerbating factors that may
have contributed to the current flare-up.
Current Symptoms: Assess and document the patient's current symptoms, such as abdominal pain,
diarrhea, rectal bleeding, weight loss, fatigue, and fever. Gather information about the frequency,
severity, and duration of these symptoms to determine the severity of the flare-up and its impact on the
patient's daily functioning.
Medication History: Review the patient's medication history, including current and past medications
used for Crohn's disease management. Document the dosages, frequencies, and durations of these
medications, as well as any recent changes or non-compliance with the prescribed regimen.
Nutritional Assessment: Evaluate the patient's nutritional status by assessing dietary intake, weight
changes, and nutritional deficiencies. Inquire about any recent changes in appetite, food intolerances, or
difficulties with eating and digestion. Consider involving a registered dietitian to provide further
guidance on optimizing the patient's nutritional intake.
Physical Examination: Perform a thorough physical examination, paying particular attention to the
abdominal region. Palpate the abdomen to assess for tenderness, distention, masses, or bowel wall
thickening. Auscultate bowel sounds to determine their frequency and quality. Additionally, examine
other systems, such as the skin, joints, and eyes, as Crohn's disease can involve extraintestinal
manifestations.
Laboratory Tests: Order laboratory tests to aid in the diagnosis and management of the patient's
condition. These may include a complete blood count (CBC) to assess for anemia and inflammation, C-
reactive protein (CRP) and erythrocyte sedimentation rate (ESR) to evaluate disease activity, fecal
calprotectin or lactoferrin to assess intestinal inflammation, and nutritional markers (e.g., albumin,
vitamin levels) to identify deficiencies.
Imaging Studies: Consider ordering imaging studies to further evaluate the extent and complications of
the flare-up. This may include abdominal imaging such as computed tomography (CT) scan, magnetic
resonance imaging (MRI), or endoscopic procedures like colonoscopy or sigmoidoscopy to assess the
bowel mucosa and identify any strictures, fistulas, or ulcerations.
Psychosocial Assessment: Assess the patient's psychosocial well-being, including his level of stress,
coping mechanisms, and social support system. Chronic conditions like Crohn's disease can significantly
impact a person's mental health, so it is important to address any psychosocial factors that may be
contributing to the flare-up and overall disease management.
By gathering this comprehensive health assessment information, the advanced practice nurse can
develop a more accurate diagnosis and create an individualized care plan for the patient in Scenario 3.
This approach ensures that all relevant aspects of the patient's condition are considered, leading to
more effective management and improved outcomes.
Disease Activity Assessment: Assess the severity of the patient's Crohn's disease flare-up using validated
disease activity indices, such as the Crohn's Disease Activity Index (CDAI) or the Harvey-Bradshaw Index
(HBI). These tools incorporate clinical symptoms, laboratory values, and patient-reported outcomes to
provide a quantitative measure of disease activity. Regular assessment of disease activity helps guide
treatment decisions and monitor response to therapy (Colombel et al., 2011).
Shared Decision-Making: Engage the patient in shared decision-making regarding the treatment options
available for managing Crohn's disease. Discuss the potential benefits, risks, and side effects of various
treatment modalities, including medications, nutritional interventions, and surgical options. Involve the
patient in the decision-making process, considering their preferences, values, and goals of care (Stacey
et al., 2017).
Medication Management: Based on the patient's disease severity and response to previous treatments,
select appropriate medication options for managing the flare-up. Consider evidence-based guidelines,
such as those provided by the American College of Gastroenterology (ACG) or the European Crohn's and
Colitis Organization (ECCO), to guide medication choices (Feuerstein et al., 2020; Gomollón et al., 2017).
Address the patient's concerns about medication costs and explore potential financial assistance
programs or alternative treatment options.
Nutritional Support: Collaborate with a registered dietitian to provide nutritional support and education.
Consider the use of specialized enteral nutrition formulas or dietary modifications to induce remission or
manage symptoms in certain cases (Levine et al., 2019). Individualize the nutritional plan based on the
patient's specific needs, tolerances, and dietary restrictions.
Psychosocial Support: Recognize the impact of Crohn's disease on the patient's psychosocial well-being
and quality of life. Provide emotional support and education on stress management techniques.
Consider referral to a mental health professional or support groups to address any anxiety, depression,
or other psychosocial concerns that may arise (Mikocka-Walus et al., 2016).
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 3 different references from current evidence
based literature.
As an advanced practice nurse, my response to Scenario 3 would involve the
following steps, supported by evidence-based practice guidelines and ethical
considerations:
Assess the Patient's Condition: Conduct a comprehensive health assessment, as described earlier, to
gather information about the patient's medical history, current symptoms, medication history,
nutritional status, physical examination findings, laboratory tests, and psychosocial factors. This
assessment will help identify the severity of the flare-up, potential complications, and underlying
contributors to the patient's condition.
Provide Immediate Stabilization and Symptom Relief: Initiate appropriate interventions to stabilize the
patient's condition and provide symptom relief. This may include intravenous fluids to correct
dehydration, analgesics for pain management, and anti-inflammatory medications to reduce
inflammation. Evidence-based guidelines, such as those from the American College of Gastroenterology
(ACG) and the European Crohn's and Colitis Organization (ECCO), can guide the choice of medications
and treatment strategies (Gomollón et al., 2017; Feuerstein et al., 2020).
Collaborative Treatment Planning: Engage in shared decision-making with the patient, considering their
preferences, values, and goals of care. Discuss the available treatment options, including medication
therapy, nutritional interventions, and surgical interventions if necessary. Provide evidence-based
information on the benefits, risks, and potential outcomes of each option, allowing the patient to make
an informed decision. Use decision aids, such as informational brochures or online resources, to support
the shared decision-making process (Stacey et al., 2017; Elwyn et al., 2014).
Address Cost Concerns and Access to Medications: Acknowledge the patient's concern about the costs
of treatment and explore strategies to ensure access to necessary medications. Collaborate with the
healthcare team and social workers to identify financial assistance programs, patient assistance
programs, or alternative treatment options that may alleviate the patient's financial burden. Ethical
considerations of justice and patient autonomy require advocating for equitable access to healthcare
resources (McKee et al., 2019).
Multidisciplinary Collaboration: Engage in interdisciplinary collaboration to provide comprehensive care
for the patient. Consult with gastroenterologists, dietitians, mental health professionals, and other
specialists as needed to optimize the patient's management plan. Collaborate on a multidisciplinary
approach that addresses the physical, nutritional, psychological, and social aspects of the patient's
condition.
Optimize Medication Therapy: Based on the patient's disease severity and response to previous
treatments, select appropriate medication options for managing the flare-up. Evidence-based guidelines
recommend the use of immunosuppressive agents, such as corticosteroids, thiopurines, or biologic
agents, to induce remission and maintain disease control (Gomollón et al., 2017; Feuerstein et al., 2020).
Consider the patient's individual characteristics, preferences, and potential risks associated with each
medication when making treatment decisions.
Nutritional Support and Education: Collaborate with a registered dietitian to provide nutritional support
and education. Evidence suggests that nutritional interventions, such as exclusive enteral nutrition, may
be effective in inducing remission in some patients with Crohn's disease, particularly in pediatric
populations (Levine et al., 2019). Individualize the nutritional plan based on the patient's specific needs,
tolerances, and dietary restrictions.
Monitoring and Follow-up: Develop a plan for ongoing monitoring and follow-up to assess the patient's
response to treatment and adjust the management plan as needed. Regular assessment of disease
activity using validated tools, such as the Crohn's Disease Activity Index (CDAI) or the Harvey-Bradshaw
Index (HBI), can guide treatment decisions and monitor response to therapy (Colombel et al., 2011).
Schedule regular appointments to evaluate symptom control, monitor medication side effects, and
address any concerns or questions the patient may have.
Patient Education and Self-Management: Provide the patient with comprehensive education on Crohn's
disease, including the nature of the condition, potential triggers, and strategies for managing symptoms
and preventing flare-ups. Emphasize the importance of medication adherence, proper nutrition, stress
management, and lifestyle modifications. Encourage the patient to engage in self-management
techniques and empower them to take an active role in their own care.
Ethical Considerations: When responding to Scenario 3, it is crucial to uphold ethical principles, such as
beneficence, autonomy, and justice. Ensure that the patient's autonomy and preferences are respected
throughout the decision-making process. Promote patient-centered care by actively involving the
patient in treatment decisions and considering their values and goals. Advocate for equitable access to
healthcare resources and consider the patient's financial situation when discussing treatment options.
By following evidence-based practice guidelines and considering ethical considerations, the advanced
practice nurse can provide holistic and patient-centered care for the individual in Scenario 3. This
approach aims to optimize treatment outcomes, enhance patient satisfaction, and promote the overall
well-being of the patient with Crohn's disease.
References:
Gomollón, F., Dignass, A., Annese, V., et al. (2017). 3rd European evidence-based consensus on the
diagnosis and management of Crohn's disease 2016: Part 1: Diagnosis and medical management. Journal
of Crohn's and Colitis, 11(1), 3-25.
Feuerstein, J. D., Isaacs, K. L., Schneider, Y., et al. (2020). AGA clinical practice guidelines on the
management of moderate to severe luminal and perianal fistulizing Crohn's disease. Gastroenterology,
158(6), 1779-1784.e12.
Stacey, D., Legare, F., Lewis, K., et al. (2017). Decision aids for people facing health treatment or
screening decisions. Cochrane Database of Systematic Reviews, 4(4), CD001431.
Elwyn, G., Frosch, D., Thomson, R., et al. (2014). Shared decision making: A model for clinical practice.
Journal of General Internal Medicine, 27(10), 1361-
Scenario 4:
A single mother has accompanied her two daughters, aged 15 and 13, to a
women’s health clinic and has requested that the girls receive a pelvic
examination and be put on birth control. The girls have consented to the exam
but seem unsettled.
Explanation:
In this scenario, a single mother has accompanied her two daughters, aged 15 and 13, to a women's
health clinic, requesting pelvic examinations and birth control for both girls. The girls have consented to
the exam but seem unsettled. As an advanced practice nurse, you would need to establish trust and
create a safe environment for open communication.
First, it is important to assess the girls' understanding of pelvic examinations, birth control, and their
reasons for seeking these services. You
In this scenario, you would need to ensure that the girls fully understand the purpose and implications
of pelvic examinations and birth control. It is crucial to assess their knowledge, address any concerns or
fears they may have, and ensure that their consent is voluntary and informed.
As an advanced practice nurse, you have a duty to provide age-appropriate education to the girls about
their reproductive health, including the benefits and risks of pelvic examinations and various birth
control methods. It is important to emphasize the importance of open communication, confidentiality,
and the right to make informed decisions about their own bodies.
Given the girls' unsettled demeanor, it may be necessary to further explore their feelings and concerns.
They may have underlying anxieties related to the examination or cultural or religious beliefs that need
to be addressed. If necessary, involving a social worker or counselor with expertise in adolescent health
can help provide additional support.
If the girls still express discomfort or reluctance, it is crucial to respect their autonomy and not proceed
with the pelvic examination or initiation of birth control against their wishes. Instead, you can provide
them with resources, educational materials, and information about confidential resources for future
discussions or decisions about their reproductive health.
Remember, as an advanced practice nurse, your role is to advocate for patient autonomy, respect their
rights, and provide comprehensive and compassionate care while adhering to ethical and legal
standards.
Write adetailednarrative (not a formal paper) explaining the health
assessment information required for a diagnosis of your selected patient
(include the scenario number).
The advanced practice nurse encounters a single mother who has accompanied her two daughters, aged
15 and 13, to a women's health clinic. The mother requests that the girls receive a pelvic examination
and be put on birth control. The girls appear unsettled, raising concerns about their well-being and the
appropriateness of the requested examination.
To ensure a thorough health assessment, the advanced practice nurse must gather the following
information:
Medical History: Obtain a detailed medical history for both daughters, including any previous medical
conditions, surgeries, or hospitalizations. Inquire about their menstrual history, including the onset of
menstruation, regularity, duration, and associated symptoms. Assess for any reproductive health
concerns, such as sexually transmitted infections (STIs) or previous pregnancies.
Sexual History: Approach the topic of sexual activity with sensitivity and confidentiality. Ask age-
appropriate questions to assess if the girls are sexually active, including the age of sexual initiation,
number of partners, and contraceptive practices. Inquire about their knowledge of safe sex practices
and the use of barrier methods or contraception.
Psychosocial Assessment: Conduct a psychosocial assessment to evaluate the girls' emotional well-being
and their relationship with their mother. Explore their feelings about the requested pelvic examination
and initiation of birth control. Assess for signs of distress, anxiety, or coercion that may impact their
decision-making or emotional health.
Developmental Assessment: Consider the girls' developmental stages and their capacity for informed
decision-making. Assess their cognitive and emotional maturity to ensure their understanding of the
implications and responsibilities associated with sexual activity and contraception.
Consent and Confidentiality: Discuss the importance of consent and confidentiality with both the girls
and their mother. Inform them of their rights to privacy and explain the limitations on sharing health
information with the parent unless there are concerns for their safety or well-being. Assure the girls that
their feelings and concerns will be respected and that they can freely express themselves during the
assessment.
Physical Examination: If deemed appropriate based on the assessment, proceed with a pelvic
examination. Ensure that the examination is conducted in a safe and comfortable environment,
respecting the girls' dignity and privacy. Obtain necessary specimens for STI testing if indicated, adhering
to evidence-based guidelines on screening and prevention.
Education and Counseling: Provide comprehensive education and counseling on reproductive health,
safe sex practices, and contraceptive options. Discuss the benefits and risks of various birth control
methods, emphasizing the importance of dual protection against both pregnancy and STIs. Encourage
open communication between the girls and their mother to foster a supportive environment.
Throughout the assessment, the advanced practice nurse should prioritize the well-being, autonomy,
and emotional safety of the girls. It is crucial to approach the situation with sensitivity, ensuring that
their concerns and preferences are respected. The nurse must adhere to ethical principles of
beneficence, autonomy, and non-maleficence, promoting the girls' health and providing them with
accurate information to make informed decisions about their reproductive health.
Shared Decision-Making: Engage in shared decision-making with the girls and their mother to determine
the best course of action. Discuss the benefits, risks, and alternatives of pelvic examinations and birth
control methods. Provide evidence-based information on the effectiveness, side effects, and potential
complications of different contraceptive options, such as oral contraceptives, intrauterine devices
(IUDs), or implants. Encourage the girls to actively participate in the decision-making process, respecting
their autonomy and individual preferences.
Assess Mental Health: Assess the girls' mental health and emotional well-being, as the request for pelvic
examinations and birth control may indicate underlying emotional or psychosocial concerns. Screen for
signs of depression, anxiety, or coercion that may impact their decision-making or indicate the need for
additional support or referral to mental health services. Utilize validated screening tools, such as the
Patient Health Questionnaire (PHQ-9) or the Generalized Anxiety Disorder Scale (GAD-7), to assess their
mental health status.
Ethical Considerations: When responding to Scenario 4, it is essential to consider ethical principles such
as autonomy, beneficence, and non-maleficence. Respect the girls' autonomy and ensure their decision-
making capacity is upheld. Protect their confidentiality and privacy rights, adhering to legal and ethical
standards. Advocate for patient-centered care that promotes their well-being while addressing their
concerns and providing accurate information.
Informed Consent: Before proceeding with any interventions, ensure that both the girls and their
mother fully understand the benefits, risks, and potential consequences of the requested pelvic
examination and initiation of birth control. Obtain informed consent from both the girls and their
mother, ensuring they have adequate information to make an informed decision. Document the consent
process and any discussions or concerns raised during the assessment.
Culturally Sensitive Care: Recognize and respect the cultural and religious beliefs of the family. Provide
culturally sensitive care by acknowledging their values and addressing any concerns they may have
regarding sexual health and contraception. Offer information and resources that align with their cultural
or religious beliefs while also emphasizing the importance of safe and responsible sexual practices.
Referrals and Support: Offer referrals to additional resources and support services as needed. This may
include referrals to reproductive health specialists, mental health professionals, or family counseling
services. Collaborate with community organizations that specialize in adolescent sexual health and
provide education and support for young individuals and their families.
By following evidence-based practice guidelines and considering ethical considerations, the advanced
practice nurse can provide comprehensive and patient-centered care for the girls in Scenario 4. This
approach aims to support their reproductive health needs while respecting their autonomy, emotional
well-being, and cultural values.
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 3 different references
from current evidence based literature.
Here is an explanation of how an advanced practice nurse can respond to Scenario 4 using evidence-
based practice guidelines and ethical considerations, supported by references from current evidence-
based literature:
As an advanced practice nurse, the response to Scenario 4 involving a single mother requesting pelvic
examinations and birth control for her two daughters requires a careful and comprehensive approach
that considers evidence-based practice guidelines and ethical considerations.
Respect for Autonomy and Informed Decision-Making: The nurse should prioritize the girls' autonomy
and their right to make informed decisions about their own reproductive health. This aligns with ethical
principles of patient autonomy and beneficence. The nurse should engage in open and non-judgmental
communication with the girls, providing them with accurate and evidence-based information about
contraceptive options, risks, and benefits. This approach allows the girls to make informed choices
based on their individual needs and values (Garcia et al., 2014).
Confidentiality and Privacy: Respecting confidentiality and privacy is essential when dealing with
sensitive issues such as reproductive health in adolescent patients. The nurse should ensure that the
girls feel safe and comfortable discussing their concerns and preferences. Confidentiality should be
maintained unless there are legal or safety concerns that warrant disclosure. Adhering to ethical
guidelines on privacy and confidentiality promotes trust and encourages open communication between
healthcare providers and adolescent patients (American Academy of Pediatrics, 2016).
Best Practices for Adolescent Sexual Health: The nurse should follow evidence-based practice guidelines
in assessing the girls' reproductive health and providing appropriate care. Guidelines from organizations
such as the American College of Obstetricians and Gynecologists (ACOG) and the Centers for Disease
Control and Prevention (CDC) provide recommendations on contraceptive methods, sexual health
education, and preventive care for adolescents. These guidelines emphasize the importance of patient-
centered care, confidentiality, and evidence-based education to promote healthy sexual decision-
making and reduce the risk of unintended pregnancies and STIs (American College of Obstetricians and
Gynecologists, 2020; Centers for Disease Control and Prevention, 2021).
By integrating these evidence-based practices and ethical considerations, the advanced practice nurse
can provide appropriate care and support for the girls in Scenario 4. This approach ensures that the girls'
autonomy and confidentiality are respected, while also promoting their reproductive health and well-
being.
Please note that while I strive to provide accurate and up-to-date information, it is always
recommended to consult the latest guidelines and literature in clinical practice.
Assessing Capacity for Consent: As an advanced practice nurse, it is important to assess the girls'
capacity for informed consent. The nurse should evaluate their cognitive and emotional maturity to
ensure they understand the implications of pelvic examinations and the initiation of birth control. This
assessment helps determine if the girls can provide informed consent or if additional involvement from
their legal guardian is necessary. The nurse can refer to ethical guidelines and legal frameworks specific
to their jurisdiction to determine the age of consent for medical procedures and contraceptives (The
Society for Adolescent Health and Medicine, 2017).
Assessing Emotional Well-being: The nurse should assess the emotional well-being of the girls, as their
unsettled demeanor raises concerns. Utilize validated tools such as the Strengths and Difficulties
Questionnaire (SDQ) or the Patient Health Questionnaire for Adolescents (PHQ-A) to screen for
emotional distress, depression, anxiety, or other psychosocial concerns. Identifying and addressing any
emotional issues can help ensure the girls' overall well-being and facilitate open communication (Viner
et al., 2018).
Family Dynamics and Support: Consider the family dynamics and support system in place for the girls.
Involve the mother in discussions, acknowledging her concerns and values while also respecting the
autonomy and preferences of the girls. Engaging in family-centered care can help foster collaboration,
address any conflicts, and ensure the best interests of the girls are met (The Society for Adolescent
Health and Medicine, 2017).
Cultural Sensitivity: It is essential to provide culturally sensitive care that respects the religious beliefs
and values of the family. Recognize that cultural or religious beliefs may influence their views on
reproductive health and contraception. Engage in open and non-judgmental discussions, offering
alternative solutions or approaches that align with their cultural or religious beliefs while promoting safe
and responsible sexual practices (American Academy of Pediatrics, 2014).
By considering these additional aspects in the response to Scenario 4, the advanced practice nurse can
provide holistic and patient-centered care that respects the autonomy and well-being of the girls while
addressing their reproductive health needs.
References:
The Society for Adolescent Health and Medicine. (2017). Confidentiality in adolescent health
care. Journal of Adolescent Health, 61(3), 384-387. doi: 10.1016/j.jadohealth.2017.06.001
Viner, R. M., Ozer, E. M., Denny, S., Marmot, M., Resnick, M., Fatusi, A., Currie, C., & Adolescent
Health, L. C. (2012). Adolescence and the social determinants of health. The Lancet, 379(9826),
1641-1652. doi: 10.1016/S0140-6736(12)60149-4
American Academy of Pediatrics. (2014). Cultural sensitivity and cultural competence. Pediatrics,
134(2), 1-9. doi: 10.1542/peds.2014-1819E
American Academy of Pediatrics. (2016). Committee on Bioethics. Confidentiality in adolescent
health care. Pediatrics, 138(2), e20163046. doi: 10.1542/peds.2016-3046
American College of Obstetricians and Gynecologists. (2020). Committee Opinion No. 794:
Adolescents and long-acting reversible contraception: Implants and intrauterine devices.
Obstetrics and Gynecology, 135(5), e178–e184. doi: 10.1097/AOG.0000000000003839
Centers for Disease Control and Prevention. (2021). U.S. medical eligibility criteria for
contraceptive use, 2020. Morbidity and Mortality Weekly Report, 69(5), 1–52. doi:
10.15585/mmwr.mm6905a6
Please note that while I strive to provide accurate and up-to-date information, it is always
recommended to consult the latest guidelines and literature in clinical practice.
Scenario 5:
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.
Explanation:
In this scenario, 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. As an
advanced practice nurse, your primary concern is the safety and well-being of the patient.
First, you would need to assess the severity of the head injury and any potential risks associated with
the patient's desire to return to playing football. This would involve conducting a thorough physical
examination, obtaining a detailed history of the injury, and potentially ordering diagnostic tests such as
imaging studies if necessary.
Based on the assessment findings and evidence-based guidelines, you would need to determine if it is
medically safe for the patient to return to play. Head injuries can have serious consequences, including
concussions, and it is essential to follow established protocols for managing such injuries, such as the
guidelines provided by organizations like the Centers for Disease Control and Prevention (CDC) or the
American Academy of Pediatrics (AAP).
If the assessment indicates that the patient has sustained a concussion or if there are any concerns
about his safety, it is crucial to explain the potential risks of returning to play too soon. Educate the
patient about the importance of rest, proper recovery, and the potential consequences of further injury.
It may be necessary to involve the patient's parents or guardians in the discussion, especially if the
patient is a minor. Collaborate with the patient, his parents, and any other involved healthcare
professionals to develop a plan that prioritizes the patient's well-being. This may include
recommendations for rest, restrictions on physical activity, and a gradual return-to-play protocol based
on established guidelines.
As an advanced practice nurse, it is your responsibility to advocate for the patient's health and safety. If
the patient insists on returning to play against medical advice, it may be necessary to involve other
healthcare professionals, such as the patient's primary care provider or a sports medicine specialist, to
further educate the patient and his family about the risks and potential long-term consequences of
disregarding medical advice.
Remember, the ethical principle of beneficence and the duty to prioritize patient safety should guide
your decision-making process in this scenario.
Write a1detailed1 narrative (not a formal paper) explaining the health assessment
information required for a diagnosis of your selected patient (include the scenario
number).
In Scenario 5, the patient is a 17-year-old boy who has come in for a check-up following a head injury
during a football game and has indicated that he would like to be able to play in the next game, which is
in 3 days. As an advanced practice nurse, several health assessment components need to be considered
to make a diagnosis and determine the appropriate course of action.
History Taking: The nurse should begin by obtaining a detailed history from the patient. This includes
gathering information about the nature of the head injury, including the mechanism of injury, the
presence of loss of consciousness, amnesia, or any other associated symptoms. It is important to ask
about any previous head injuries and the management provided. Additionally, inquire about the
patient's medical history, including any pre-existing conditions, previous concussions, or neurological
disorders.
Neurological Assessment: Perform a comprehensive neurological assessment to evaluate the patient's
cognitive function, motor skills, coordination, and reflexes. This assessment may include assessing the
patient's level of consciousness, orientation to person, place, and time, speech and language skills,
coordination, and balance. Utilize standardized assessment tools such as the Glasgow Coma Scale (GCS)
and the Sport Concussion Assessment Tool (SCAT) to evaluate the severity of the head injury and
monitor the patient's progress (McCrory et al., 2017).
Cognitive and Psychological Assessment: Evaluate the patient's cognitive function and psychological
well-being. Assess cognitive domains such as attention, memory, and executive functions using
appropriate tools, such as the Standardized Assessment of Concussion (SAC) or the Immediate Post-
Concussion Assessment and Cognitive Testing (ImPACT). Additionally, screen for psychological
symptoms such as mood disturbances, anxiety, and depression, as head injuries can impact mental
health (Echemendia et al., 2017).
Physical Examination: Conduct a thorough physical examination to assess for any signs of neurological or
musculoskeletal abnormalities. Pay particular attention to the head and neck region, looking for signs of
trauma, swelling, or tenderness. Assess vital signs, including blood pressure, heart rate, and respiratory
rate. Evaluate the patient's balance, coordination, and motor function, checking for any deficits that may
affect their ability to participate safely in physical activities.
Diagnostic Tests: Consider ordering diagnostic tests to further evaluate the extent of the head injury and
rule out any underlying complications. These may include a head CT scan to assess for intracranial
bleeding or other structural abnormalities. Additionally, blood tests may be conducted to evaluate for
any metabolic imbalances or markers of brain injury, such as serum biomarkers (e.g., S100B or glial
fibrillary acidic protein) that can aid in diagnosing and monitoring concussions (Nitta et al., 2018).
By gathering this comprehensive health assessment information, the advanced practice nurse can make
an accurate diagnosis, determine the severity of the head injury, and develop an appropriate
management plan for the patient in Scenario 5.
References:
McCrory, P., Meeuwisse, W., Dvorak, J., Aubry, M., Bailes, J., Broglio, S., ... & Echemendia, R. (2017).
Consensus statement on concussion in sport—the 5th international conference on concussion in sport
held in Berlin, October 2016. British Journal of Sports Medicine, 51(11), 838-847. doi: 10.1136/bjsports-
2017-097699
Echemendia, R. J., Iverson, G. L
Explain how you would respond to the scenario as an advanced practice nurse using
evidence-based practice guidelines and applying ethical considerations.
In Scenario 5, the advanced practice nurse is faced with a 17-year-old boy who wants to play in a
football game after a recent head injury. To respond appropriately, the nurse should consider evidence-
based practice guidelines and apply ethical considerations. Here's how:
Follow Concussion Management Guidelines: The nurse should adhere to evidence-based guidelines for
concussion management, such as those provided by the Concussion in Sport Group (CISG) or the
American Academy of Pediatrics (AAP). These guidelines emphasize the importance of proper
assessment, rest, and gradual return-to-play protocols to ensure the safety and well-being of the patient
(McCrory et al., 2017). The nurse should educate the patient, his family, and the coaching staff about the
potential risks of returning to play too soon and the importance of following the recommended
protocols.
Consider Individual Risk Factors and Severity of Injury: Assess the patient's individual risk factors and the
severity of the head injury. Factors such as a previous history of concussions, the presence of prolonged
symptoms, or a high impact force during the injury may necessitate a more conservative approach to
returning to play (Davis et al., 2017). The nurse should evaluate the patient's symptoms, cognitive
function, and neurological status to determine the appropriate level of activity restriction and monitor
for any worsening or persistent symptoms.
Engage in Shared Decision-Making: Engage in shared decision-making with the patient and involve his
parents or legal guardians. Discuss the risks and benefits of returning to play and ensure that the patient
and his family fully understand the potential consequences of their decision. Respect the autonomy and
preferences of the patient while also providing evidence-based information to guide their decision-
making (Mosher et al., 2019). Ethical principles such as beneficence and non-maleficence should guide
the nurse's approach, prioritizing the patient's safety and well-being.
Advocate for Multidisciplinary Collaboration: Collaborate with a multidisciplinary team, including
physicians, neurologists, athletic trainers, and coaches, to ensure comprehensive care for the patient.
This team-based approach allows for a holistic assessment of the patient's condition, proper monitoring
of symptoms, and appropriate guidance throughout the recovery process (Zemek et al., 2016). By
working collaboratively, the nurse can advocate for the patient's best interests and ensure consistent
care across different healthcare settings.
By following evidence-based practice guidelines, engaging in shared decision-making, and collaborating
with the multidisciplinary team, the advanced practice nurse can provide optimal care for the patient in
Scenario 5 while upholding ethical principles and prioritizing the patient's safety.
References:
McCrory, P., Meeuwisse, W., Dvorak, J., Aubry, M., Bailes, J., Broglio, S., ... & Echemendia, R. (2017).
Consensus statement on concussion in sport—the 5th international conference on concussion in sport
held in Berlin, October 2016. British Journal of Sports Medicine, 51(11), 838-847. doi: 10.1136/bjsports-
2017-097699
Davis, G. A., Anderson, V., Babl, F. E., Gioia, G. A., Giza, C. C., Meehan, W., ... & Zemek, R. (2017). What is
the difference in concussion management in children as compared with adults? A systematic review.
British Journal of Sports Medicine, 51(12), 949-957. doi: 10.1136/b
