Assignment Lab Assignment: Ethical Concerns 

Assignment Lab Assignment: Ethical Concerns 

Assignment Lab Assignment: Ethical Concerns 

Breast cancer is a common malignancy in women. In some cases, patients present at advanced stages (Andersen et al., 2019). The purpose of this paper is to define the assessment of a patient with advanced breast cancer who presented to the emergency department and elaborate on the approach to this patient.

Information to be Obtained

Patient information to be obtained includes signs and symptoms of the presenting complaint (Glynn, 2022). This includes ruling out symptoms such as chest pain, shortness of breath, palpitations, easy fatigability, syncope, nocturnal cough and paroxysmal nocturnal dyspnea (Jameson, 2018). Moreover, the onset, timing, alleviating factors and relieving factors of the presenting symptoms need to be evaluated. The location, severity and character of the presenting symptom should also be evaluated (Cydulka, 2018). The patient’s current medications, last meal and history of the circumstances surrounding the onset of symptoms should be obtained (Walls et al., 2018). The patient should be assessed for the presence of allergies and any relevant medical and surgical history such as prior cardiovascular interventions. Further history to be probed include any family history of cardiac disease (Cydulka, 2018). The signs to be assessed during physical examination include oedema, pallor, pulses and temperature gradient (Glynn, 2022). A thorough cardiovascular exam which entails inspection of the precordium, auscultation of heart to rule out murmurs and palpation for heaves or thrills should also be performed. Various tests such as cardiac enzymes (troponin I and T, creatine kinases, myoglobin), complete blood count, complete metabolic profile, electrolytes, EKG and chest x-ray should be performed to aid in diagnosis.

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Approach to the Patient

Emergency patients require an ABCs approach (Walls et al., 2018). I would inform the patient about my intended approach and obtain informed consent. I would then assess the patient’s airway, circulation, and breathing and rule out any neurological abnormalities (Walls et al., 2018). I would intervene as appropriate in each stage. I would then place the patient on an EKG and observe any anomalies. I would then administer oxygen and step up as appropriate and administer chewable aspirin (Jameson, 2018). I would also administer sublingual nitroglycerin while monitoring the patient’s blood pressure (Cydulka, 2018). I would also provide the patient with analgesics such as morphine sulphate (Jameson, 2018). If the patient had presented within 2 hours of the onset of her symptoms, I would recommend primary percutaneous coronary intervention (angioplasty and stenting) to manage the condition (Jameson, 2018). These may relieve the symptoms of cardiac arrest. 

Conclusion

Patient evaluation includes a thorough history and physical examination. Additionally, laboratory tests such as blood tests and radiological investigations such as x-rays can also be performed. These may help in establishing diagnoses to help in planning appropriate interventions.

References

Andersen, D. K., Billiar, T. R., F Charles Brunicardi, Dunn, D. L., Hunter, J. G., Kao, L. S., Matthews, J. B., & Pollock, R. E. (2019). Schwartz’s principles of surgery. Mcgraw-Hill.

Cydulka, R. K. (2018). Tintinalli’s emergency medicine manual. Mcgraw-Hill Education.

Glynn, M. (2022). Hutchison’s Clinical Methods : An Integrated Approach to Clinical Practice, 23/e. Elsevier India.

Jameson, J. L. (2018). Harrison’s principles of internal medicine (20th ed.). New York Mcgraw-Hill Education.

Walls, R. M., Hockberger, R. S., Gausche-Hill, M., & Bakes, K. M. (2018). Rosen’s emergency medicine : concepts and clinical practice (9th ed.). Elsevier.

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Choose one of the cases listed below to write about for the week 11 assignment.

Case 1

A 60-year-old man who was diagnosed with inclusive body myositis several years ago is experiencing a rapid decline in his condition. He prefers to be stay home with hospice relief to receive end-of-life care, but his wife wants him to be admitted to an inpatient setting.

Case 2

A 19-year-old girl has come in for a routine check-up and has not yet received the Covid vaccine. Her family is very religious and believes that they are covered by their faith.

Case 3

A 33-year-old woman with advanced stage breast cancer has been admitted to the emergency room with cardiac arrest. She is not married and her boyfriend accompanies her in the ambulance.

Based on the scenarios provided:
1. Select one scenario, and reflect on the material presented throughout this course.
2. What necessary information would need to be obtained about the patient through health assessments and diagnostic tests?
3. Consider how you would respond as an advanced practice nurse. Review evidence-based practice guidelines and ethical considerations applicable to the scenarios you selected.
4. Justify your response using at least three different references from current evidence-based literature.