Health Assessment Information Essay Paper

CASE STUDY 3

A 47-year-old man with Ulcerative Colitis has been admitted to the emergency room with an extreme abdominal pain. He explains that he has not taken his medications for the last few months and does not have any medical or prescription insurance.

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)Health Assessment Information Essay Paper. 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.

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In case study 3, the patient with Ulcerative Colitis presented to the emergency room with extreme abdominal pain. As an advanced practice nurse dealing with this scenario, the main focus would be on carrying out a comprehensive health assessment to collect pertinent information to make an accurate diagnosis and develop a tailored treatment plan. According to Govender et al. (2021), a “PHRASED” approach would be essential in providing relevant health assessment information such as the patient’s problem, history of the presenting problem, medical history, possible allergies, family history, and substance use. I would first obtain a detailed history from the patient. This will provide subjective data such as the onset, duration, and characteristics of the abdominal pain. I would also enquire about other associated symptoms such as diarrhea, rectal bleeding, weight loss, and changes in bowel movement (Dunlap & Patterson, 2020)Health Assessment Information Essay Paper.

The other health assessment required for the diagnosis would be acquired through a comprehensive physical examination, especially on the abdomen. Dunlap and Patterson (2020) emphasize that a thorough physical examination should be carried out when a complaint of abdominal pain has been made. The examination would involve assessment for tenderness, distension, palpable masses, and possible signs of peritoneal irritation. Based on the severity of the abdominal pain and the patient’s history of noncompliance with medications, laboratory tests would be ordered. These tests include a complete blood count, which will be essential in assessing for anemia or infection, inflammatory markers, and electrolyte levels. Imaging and endoscopic studies would be guided based on the signs and symptoms of abdominal pain. Dunlap and Patterson (2020) emphasize that laboratory and imaging studies should be used to help in confirming or ruling out possible diagnoses or reasonable differential diagnoses, as informed by the patient’s history, relevant family history, and objective data from physical examination. In dealing with this scenario, among the ethical considerations that I would consider is autonomy, which involves respecting a patient’s right to make informed decisions about their care. According to Varkey (2021)Health Assessment Information Essay Paper, respecting the principle of autonomy requires an advanced practice nurse to disclose relevant medical information and treatment options necessary to assist the patient in exercising self-determination and facilitating making an informed decision. Another ethical consideration is the ethical principle of justice, where it is expected that the patient should get fair and equitable access to care, irrespective of their ability to pay.

References

Dunlap, J. J., & Patterson, S. (2020). ASSESSING ABDOMINAL PAIN. Gastroenterology Nursing, 43(3), 267-270. https://doi.org/10.1097/SGA.0000000000000531

Govender, I., Rangiah, S., Bongongo, T., & Mahuma, P. (2021). A primary care approach to abdominal pain in adults. South African Family Practice, 63(1). https://doi.org/10.4102/safp.v63i1.5280

Varkey, B. (2021). Principles of clinical ethics and their application to practice. Medical Principles and Practice, 30(1), 17–28. https://doi.org/10.1159/000509119 Health Assessment Information Essay Paper