NURS 6512 Assignment 1 Week 11: Lab Assignment: Ethical Concerns

Walden University NURS 6512 Assignment 1 Week 11: Lab Assignment: Ethical Concerns-Step-By-Step Guide

 

This guide will demonstrate how to complete the Walden University NURS 6512 Assignment 1 Week 11: Lab Assignment: Ethical Concerns assignment based on general principles of academic writing. Here, we will show you the A, B, Cs of completing an academic paper, irrespective of the instructions. After guiding you through what to do, the guide will leave one or two sample essays at the end to highlight the various sections discussed below.

 

How to Research and Prepare for NURS 6512 Assignment 1 Week 11: Lab Assignment: Ethical Concerns                     

 

Whether one passes or fails an academic assignment such as the Walden University NURS 6512 Assignment 1 Week 11: Lab Assignment: Ethical Concerns depends on the preparation done beforehand. The first thing to do once you receive an assignment is to quickly skim through the requirements. Once that is done, start going through the instructions one by one to clearly understand what the instructor wants. The most important thing here is to understand the required format—whether it is APA, MLA, Chicago, etc.

 

After understanding the requirements of the paper, the next phase is to gather relevant materials. The first place to start the research process is the weekly resources. Go through the resources provided in the instructions to determine which ones fit the assignment. After reviewing the provided resources, use the university library to search for additional resources. After gathering sufficient and necessary resources, you are now ready to start drafting your paper.

 

How to Write the Introduction for NURS 6512 Assignment 1 Week 11: Lab Assignment: Ethical Concerns                     

The introduction for the Walden University NURS 6512 Assignment 1 Week 11: Lab Assignment: Ethical Concerns is where you tell the instructor what your paper will encompass. In three to four statements, highlight the important points that will form the basis of your paper. Here, you can include statistics to show the importance of the topic you will be discussing. At the end of the introduction, write a clear purpose statement outlining what exactly will be contained in the paper. This statement will start with “The purpose of this paper…” and then proceed to outline the various sections of the instructions.

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How to Write the Body for NURS 6512 Assignment 1 Week 11: Lab Assignment: Ethical Concerns                     

 

After the introduction, move into the main part of the NURS 6512 Assignment 1 Week 11: Lab Assignment: Ethical Concerns assignment, which is the body. Given that the paper you will be writing is not experimental, the way you organize the headings and subheadings of your paper is critically important. In some cases, you might have to use more subheadings to properly organize the assignment. The organization will depend on the rubric provided. Carefully examine the rubric, as it will contain all the detailed requirements of the assignment. Sometimes, the rubric will have information that the normal instructions lack.

 

Another important factor to consider at this point is how to do citations. In-text citations are fundamental as they support the arguments and points you make in the paper. At this point, the resources gathered at the beginning will come in handy. Integrating the ideas of the authors with your own will ensure that you produce a comprehensive paper. Also, follow the given citation format. In most cases, APA 7 is the preferred format for nursing assignments.

 

How to Write the Conclusion for NURS 6512 Assignment 1 Week 11: Lab Assignment: Ethical Concerns                     

 

After completing the main sections, write the conclusion of your paper. The conclusion is a summary of the main points you made in your paper. However, you need to rewrite the points and not simply copy and paste them. By restating the points from each subheading, you will provide a nuanced overview of the assignment to the reader.

 

How to Format the References List for NURS 6512 Assignment 1 Week 11: Lab Assignment: Ethical Concerns                     

 

The very last part of your paper involves listing the sources used in your paper. These sources should be listed in alphabetical order and double-spaced. Additionally, use a hanging indent for each source that appears in this list. Lastly, only the sources cited within the body of the paper should appear here.

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NURS 6512 Assignment 1 Week 11: Lab Assignment: Ethical Concerns

NURS 6512 Assignment 1 Week 11: Lab Assignment: Ethical Concerns

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 Care26(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 Research26(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 Practice2, 76-80. https://doi.org/10.1016/j.cnp.2017.03.001

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).

  1. Has she had any previous hospitalizations especially for cardiac arrest? (Baker & Marco, 2020).
  2. Is there next of kin that needs to be contacted to follow up about their condition? (Baker & Marco, 2020).
  3. Previously has she stated any resuscitation or medication preferences if a cardiac arrest occurs? (Baker & Marco, 2020).
  4. Does patient have any cultural, religious or personal beliefs that should be considered during her resuscitation or treatment efforts? (Baker & Marco, 2020).
  5. How long she has been in that state (unconscious and nonresponsive)? (Baker & Marco, 2020).
  6. Does patient have planned advance directive? (Baker & Marco, 2020).
  7. What is the patient’s medical history? Does she have an underlying health risk factor or conditions for cardiac arrest? (Baker & Marco, 2020).
  8. 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 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 Care26(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 Research26(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 Practice2, 76-80. https://doi.org/10.1016/j.cnp.2017.03.001

Assignment 1: Lab Assignment: Ethical 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:
    • Select one scenario, and reflect on the material presented throughout this course.
    • What necessary information would need to be obtained about the patient through health assessments and diagnostic tests?
    • Consider how you would respond as an advanced practice nurse. Review evidence-based practice guidelines and ethical considerations applicable to the scenarios you selected.

The Lab Assignment

Write a detailed one-page narrative (not a formal paper) explaining the health assessment information required for a diagnosis of your selected patient (include the scenario number). Explain how you would respond to the scenario as an advanced practice nurse using evidence-based practice guidelines and applying ethical considerations. Justify your response using at least three different references from current evidence-based literature.

By Day 6 of Week 11

Submit your Assignment.

Submission and Grading Information

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.
  • Click the Week 11 Assignment Rubric to review the Grading Criteria for the 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.

Grading Criteria

To access your rubric:

Week 11 Assignment Rubric

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Week 11 Assignment

Case study 2 depicts a single father who accompanies his 17-year-old daughter to a women’s health clinic and requests a pregnancy test for his daughter. The daughter does not consent to the test and appears uneasy. Vital health assessment information required to establish if the girl is pregnant includes her menstrual history (Dyer et al., 2018). The nurse should inquire about the date of her last menstrual period (LMP), menstrual pattern, duration of her menses, and frequency. In addition, the nurse should obtain the client’s sexual history, including if she is sexually active, the contraceptives she uses, and the frequency of using contraceptives. The nurse should also gather information on presumptive signs of pregnancy, including amenorrhea, nausea, vomiting, generalized malaise, and breast tenderness (Gadsby et al., 2021).

This case presents an ethical dilemma since the girl’s father insists on a pregnancy test against her wish. The provider also has an ethical duty to promote the confidentiality of the patient’s information. Thus, I would ensure privacy when interviewing the girl in her father’s absence and assure her that the information she gives will be kept confidential. To address this ethical dilemma, I would observe the rule that the patient, in this case, is the girl and not the parent (Larcher & Brierley, 2018). Thus, I would only perform the pregnancy test if the girl consented. This is because conducting the test against the girl’s wish poses the risk of psychological harm.

Sharkey and Griffiths (2019) explain that children above 16 years are considered competent to consent to treatment, including pregnancy testing. Patients should be asked sensitively about the likelihood of pregnancy and offered a pregnancy test with their consent if there is doubt. If the girl continues to decline even after counseling her, I would inform her father that a pregnancy test cannot be conducted against the patient’s wish since it will violate her right to autonomy.

References

Dyer, J., Latendresse, G., Cole, E., Coleman, J., & Rothwell, E. (2018). Content of First Prenatal Visits. Maternal and child health journal22(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 childbirth21(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 childhood101(10), 980–983. https://doi.org/10.1136/archdischild-2018-310725

Sharkey, E., & Griffiths, S. (2019). The ethics of pregnancy testing. Anaesthesia & Intensive Care Medicine20(9), 511-514.https://doi.org/10.1016/j.mpaic.2019.06.006

NURS_6512_Week_11_Assignment_1_Rubric

  Excellent Good Fair Poor
Using the SOAP (Subjective, Objective, Assessment, and Plan) note format:
·  Create documentation, following SOAP format, of your assignment to choose one skin condition graphic (identify by number in your Chief Complaint). ·   Use clinical terminologies to explain the physical characteristics featured in the graphic.
Points Range: 30 (30%) – 35 (35%) 

The response clearly, accurately, and thoroughly follows the SOAP format to document one skin condition graphic and accurately identifies the graphic by number in the Chief Complaint. The response clearly and thoroughly explains all physical characteristics featured in the graphic using accurate terminologies.

Points Range: 24 (24%) – 29 (29%) 

The response accurately follows the SOAP format to document one skin condition graphic and accurately identifies the graphic by number in the Chief Complaint. The response explains most physical characteristics featured in the graphic using accurate terminologies.

Points Range: 18 (18%) – 23 (23%) 

The response follows the SOAP format, with vagueness and some inaccuracy in documenting one skin condition graphic, and accurately identifies the graphic by number in the Chief Complaint. The response explains some physical characteristics featured in the graphic using mostly accurate terminologies.

Points Range: 0 (0%) – 17 (17%) 

The response inaccurately follows the SOAP format or is missing documentation for one skin condition graphic and is missing or inaccurately identifies the graphic by number in the Chief Complaint. The response explains some or few physical characteristics featured in the graphic using terminologies with multiple inaccuracies.

·   Formulate a different diagnosis of three to five possible considerations for the skin graphic.    ·   Determine which is most likely to be the correct diagnosis, and explain your reasoning using at least three different references from current evidence-based literature. Points Range: 45 (45%) – 50 (50%) 

The response clearly, thoroughly, and accurately formulates a different diagnosis of five possible considerations for the skin graphic. The response determines the most likely correct diagnosis with reasoning that is explained clearly, accurately, and thoroughly using three or more different references from current evidence-based literature.

Points Range: 39 (39%) – 44 (44%) 

The response accurately formulates a different diagnosis of three to five possible considerations for the skin graphic. The response determines the most likely correct diagnosis with reasoning that is explained accurately using at least three different references from current evidence-based literature.

Points Range: 33 (33%) – 38 (38%) 

The response vaguely or with some inaccuracy formulates a different diagnosis of three possible considerations for the skin graphic. The response determines the most likely correct diagnosis with reasoning that is explained vaguely and with some inaccuracy using three different references from current evidence-based literature.

Points Range: 0 (0%) – 32 (32%) 

The response formulates inaccurately, incompletely, or is missing a different diagnosis of possible considerations for the skin graphic, with two or fewer possible considerations provided. The response vaguely, inaccurately, or incompletely determines the most likely correct diagnosis with reasoning that is missing or explained using two or fewer different references from current evidence-based literature.

Written Expression and Formatting – Paragraph Development and Organization:
Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused–neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria.
Points Range: 5 (5%) – 5 (5%) 

Paragraphs and sentences follow writing standards for flow, continuity, and clarity. A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria.

Points Range: 4 (4%) – 4 (4%) 

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time. Purpose, introduction, and conclusion of the assignment are stated, yet are brief and not descriptive.

Points Range: 3 (3%) – 3 (3%) 

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time. Purpose, introduction, and conclusion of the assignment are vague or off topic.

Points Range: 0 (0%) – 2 (2%) 

Paragraphs and sentences follow writing standards for flow, continuity, and clarity < 60% of the time. No purpose statement, introduction, or conclusion were provided.

Written Expression and Formatting – English writing standards:
Correct grammar, mechanics, and proper punctuation
Points Range: 5 (5%) – 5 (5%) 

Uses correct grammar, spelling, and punctuation with no errors.

Points Range: 4 (4%) – 4 (4%) 

Contains a few (1 or 2) grammar, spelling, and punctuation errors.

Points Range: 3 (3%) – 3 (3%) 

Contains several (3 or 4) grammar, spelling, and punctuation errors.

Points Range: 0 (0%) – 2 (2%) 

Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.

Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, running heads, parenthetical/in-text citations, and reference list. Points Range: 5 (5%) – 5 (5%) 

Uses correct APA format with no errors.

Points Range: 4 (4%) – 4 (4%) 

Contains a few (1 or 2) APA format errors.

Points Range: 3 (3%) – 3 (3%) 

Contains several (3 or 4) APA format errors.

Points Range: 0 (0%) – 2 (2%) 

Contains many (≥ 5) APA format errors.

Total Points: 100  
           

Name: NURS_6512_Week_11_Assignment_1_Rubric

Lab Assignment: Ethical Concerns

            Looking at case scenario 2, the 49-year-old female patient with a history of advanced-stage cancer was admitted to the emergency room due to cardiac arrest. Studies show that advanced-stage cancer patients with cardiac arrest usually have a survival rate of less than 10% hence the need for collecting appropriate health assessment information to promote accurate diagnosis and management of the patient (Stoltzfus et al., 2020). The diagnostic process will mainly focus on the relationship between the patient’s advanced cancer state and the causes of sudden cardiac arrest such as neoplasm or antineoplastic therapy among other causes (Cushman et al., 2021). As such, it will be necessary to first utilize the tumor, nodes, and metastasis system to confirm the staging of the patient’s cancer. For the diagnosis of cardiovascular arrest, the patient must report symptoms of sudden collapse, chest discomfort, no pulse, loss of consciousness, and no breathing (Holmes et al., 2020). With these symptoms, it will be necessary to obtain the patient’s electrocardiogram (ECG), and a blood test to check for magnesium, potassium, and hormone levels among other chemicals which affect the functioning of the heart. Imaging studies will also be necessary including chest X-ray and echocardiogram to promote accurate diagnosis.

Evidence-based practice guidelines recommend the administration of oxygen alongside medication therapy to relieve the symptoms of patients with cardiac arrest (Holmberg et al., 2020). Routine monitoring of the patient’s vitals including ECG, blood pressure, respiratory status, and urinary output is crucial to promote positive outcomes (Stoltzfus et al., 2020). Since the patient is in palliative care, with advanced-stage cancer, the clinician needs to ensure that the patient’s personal beliefs and values are respected (Cushman et al., 2021). Ethical principles such as beneficence, non-maleficence, respecting the patient’s autonomy, justice, and observing the patient’s right to consent are also important (Holmes et al., 2020).

 

 

References

Cushman, M., Shay, C. M., Howard, V. J., Jiménez, M. C., Lewey, J., McSweeney, J. C., … & American Heart Association. (2021). Ten-year differences in women’s awareness related to coronary heart disease: results of the 2019 American Heart Association National Survey: a special report from the American Heart Association. Circulation143(7), e239-e248. https://doi.org/10.1161/CIR.0000000000000907

Holmberg, M. J., Nicholson, T., Nolan, J. P., Schexnayder, S., Reynolds, J., Nation, K., … & Berg, K. M. (2020). Oxygenation and ventilation targets after cardiac arrest: a systematic review and meta-analysis. Resuscitation152, 107-115. https://doi.org/10.1016/j.resuscitation.2020.04.031

Holmes, J. L., Brake, S., Docherty, M., Lilford, R., & Watson, S. (2020). Emergency ambulance services for heart attack and stroke during UK’s COVID-19 lockdown. The Lancet395(10237), e93-e94. https://doi.org/10.1016/S0140-6736(20)31031-X

Stoltzfus, K. C., Zhang, Y., Sturgeon, K., Sinoway, L. I., Trifiletti, D. M., Chinchilli, V. M., & Zaorsky, N. G. (2020). Fatal heart disease among cancer patients. Nature communications11(1), 1-8. https://doi.org/10.1038/s41467-020-15639-5

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 Care26(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 Research26(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 Practice2, 76-80. https://doi.org/10.1016/j.cnp.2017.03.001

Case study 2 depicts a single father who accompanies his 17-year-old daughter to a women’s health clinic and requests a pregnancy test for his daughter. The daughter does not consent to the test and appears uneasy. Vital health assessment information required to establish if the girl is pregnant includes her menstrual history (Dyer et al., 2018). The nurse should inquire about the date of her last menstrual period (LMP), menstrual pattern, duration of her menses, and frequency. In addition, the nurse should obtain the client’s sexual history, including if she is sexually active, the contraceptives she uses, and the frequency of using contraceptives. The nurse should also gather information on presumptive signs of pregnancy, including amenorrhea, nausea, vomiting, generalized malaise, and breast tenderness (Gadsby et al., 2021).

This case presents an ethical dilemma since the girl’s father insists on a pregnancy test against her wish. The provider also has an ethical duty to promote the confidentiality of the patient’s information. Thus, I would ensure privacy when interviewing the girl in her father’s absence and assure her that the information she gives will be kept confidential. To address this ethical dilemma, I would observe the rule that the patient, in this case, is the girl and not the parent (Larcher & Brierley, 2018). Thus, I would only perform the pregnancy test if the girl consented. This is because conducting the test against the girl’s wish poses the risk of psychological harm.

Sharkey and Griffiths (2019) explain that children above 16 years are considered competent to consent to treatment, including pregnancy testing. Patients should be asked sensitively about the likelihood of pregnancy and offered a pregnancy test with their consent if there is doubt. If the girl continues to decline even after counseling her, I would inform her father that a pregnancy test cannot be conducted against the patient’s wish since it will violate her right to autonomy.

References

Dyer, J., Latendresse, G., Cole, E., Coleman, J., & Rothwell, E. (2018). Content of First Prenatal Visits. Maternal and child health journal22(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 childbirth21(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 childhood101(10), 980–983. https://doi.org/10.1136/archdischild-2018-310725

Sharkey, E., & Griffiths, S. (2019). The ethics of pregnancy testing. Anaesthesia & Intensive Care Medicine20(9), 511-514.https://doi.org/10.1016/j.mpaic.2019.06.006

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