Case Study: Ethical Concern Essay

Case Study: Ethical Concern Essay

Case Study: Ethical Concern Essay

Health Assessment Information Required

The case concerns a 33-year-old patient with advanced breast cancer who has been admitted to the emergency department (ED) with cardiac arrest. To make the correct diagnosis, a comprehensive health assessment is necessary. According to Toney-Butler & Unison-Pace, (2022), comprehensive health assessment involves taking a complete medical history and examination. In taking the medical history, a medical history should be taken and find out the current medications the patient is currently taking, any allergies, and history of surgical interventions.

Regarding family history, it is vital to find out any family history of breast cancer or any heart disorder. A social history should also be evaluated and determine her smoking and alcohol consumption history, dietary intake, and physical exercise patterns. A proper history may help the nurses determine the correlation between advanced breast cancer and the susceptibility to developing cardiac arrest (Sharabi & Singh, 2021). Cardiovascular disease and breast malignancy share common risk factors, such as smoking, alcohol intake, fatty diet, obesity, and sedentary lifestyles (Cardiol, 2021).

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            A detailed physical examination should be conducted on the patient. Components of the physical examination include vital signs (blood pressure, temperature, heart rate, respiratory rate, oxygen saturation, and body mass index), general examination, and systemic examination (Toney-Butler & Unison-Pace, 2022). In a general examination, the elements evaluated include jaundice, pallor, cyanosis, edema, lymphadenopathy, and dehydration. In a patient with cardiac arrest and breast cancer, the systems that will be of the essence to evaluate include the respiratory and cardiovascular systems. By doing a proper general and systemic examination, it will help to determine what is responsible for her cardiac arrest. According to Durila (2018), causes of cardiac arrest include hypokalemia/hyperkalemia, hypoxia, hypoglycemia, acidosis, toxins, tamponade, and tension pneumothorax. Therefore, to finish her health assessment, baseline investigations must be considered once resuscitation has been concluded.

Advanced Practice Nurse (APN) Response to the Scenario

As an APN, applying evidence-based guidelines in approaching a patient with cardiac arrest is necessary. Since the cardiac arrest has already been identified, starting the patient on chest compressions while connecting the patient to the monitor immediately to determine if she has a shockable on non-shockable rhythm is crucial. Shockable rhythms include ventricular tachycardia and ventricular fibrillation, while non-shockable rhythms include pulseless electrical activity and asystole (Cheskes et al., 2022). During this time, the patient should have intravenous access and be on oxygen supplementation. If the patient has a shockable rhythm, early defibrillation should be done using an automated external defibrillator (AED) (Resuscitation Council UK, 2021).

Murphy et al. (2022) suggest that cardiopulmonary resuscitation (CPR) should be conducted for about two minutes after defibrillation. Other options at this point include giving epinephrine after checking for her pulse rate, if rapid. According to Sharabi & Singh (2021), using AED and CPR concurrently in patients with cardiac arrest helps restore the heart’s normal rhythm. The pathology of cardiac arrest is an abrupt cessation of heart activity that results in cardiovascular collapse (Sharabi & Singh, 2021). While managing patients with cardiac arrest, the ethical principles of nursing should be applied.

Patients with cardiac arrest will present unconscious, therefore, the principles of beneficence and non-maleficence should be considered. Since she is not married and is in the company of her boyfriend, as an APN, I will act for the good of the patient and proceed to do the AED and CPR without having to seek consent from the boyfriend, as he does not meet the criteria for providing consent regarding the patient’s management. After completion of resuscitation and the patient is back to life, baseline investigations such as glucose levels, urea/electrolytes/creatinine, arterial blood gases, chest X-ray, and complete blood count should be conducted to determine the cause of her cardiac arrest.

References

Cardiol, P. (2021). Ten things to know about ten cardiovascular disease risk factors. American Journal of Preventive Cardiology, 5, 100149. https://doi.org/10.1016/j.ajpc.2021.100149

Cheskes, S., Verbeek, P. R., Drennan, I. R., McLeod, S. L., Turner, L., Pinto, R., Feldman, M., Davis, M., Vaillancourt, C., Morrison, L. J., Dorian, P., & Scales, D. C. (2022). Defibrillation Strategies for Refractory Ventricular Fibrillation. New England Journal of Medicine, 387. https://doi.org/10.1056/nejmoa2207304

Durila, M. (2018). Reversible causes of cardiac arrest 4 “Ts” and 4 “Hs” can be easily diagnosed and remembered following general ABC rule, Motol University Hospital approach. Resuscitation, 126, e7. https://doi.org/10.1016/j.resuscitation.2018.03.013

Murphy, T. W., Cohen, S. A., Hwang, C. W., Avery, K. L., Balakrishnan, M. P., Balu, R., Chowdhury, M. A. B., Crabb, D. B., Elmelige, Y., Maciel, C. B., Gul, S. S., Han, F., & Becker, T. K. (2022). Cardiac arrest: An interdisciplinary scoping review of clinical literature from 2020. Journal of the American College of Emergency Physicians Open, 3(4). https://doi.org/10.1002/emp2.12773

Resuscitation Council UK. (2021). 2021 Resuscitation Guidelines. Resuscitation Council UK. https://www.resus.org.uk/library/2021-resuscitation-guidelines

Sharabi, A. F., & Singh, A. (2021). Cardiopulmonary Arrest In Adults. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK563231/

Toney-Butler, T. J., & Unison-Pace, W. J. (2022). Nursing Admission Assessment and Examination. Nih.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK493211/

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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.

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.

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.

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.

Do not submit more than 2 pages, this is a 1-page assignment. Points will be deducted for 3 or more pages.