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Case Study Discussion: Working Through Ethical Dilemmas and Other Issues in Advanced Nursing Practice

Case Study Discussion: Working Through Ethical Dilemmas and Other Issues in Advanced Nursing Practice Case Study Discussion: Working Through Ethical Dilemmas and Other Issues in Advanced Nursing PracticeThe Discussion for this week is to provide you an opportunity to discuss with your colleagues the case studies presented in the interactive media program. These case studies involve ethical dilemmas or other issues encountered in advanced nursing practice.Photo Credit: WavebreakmediaMicro / Adobe StockBy Day 3To prepare:Review the interactive case studies in this week’s Learning Resources. Select one of the cases to prepare your discussion post. Do not post a SOAP note though your post should address the following:Summary of your chosen case studyWhat is your differential diagnosis?Why did you make this diagnosis decision?What is your treatment plan?What evidence-based research can you provide to support your decision (choice for differential diagnosis and plan/intervention)?Case Study Discussion: Working Through Ethical Dilemmas and Other Issues in Advanced Nursing PracticeWhat resources did you use to meet your best practice guidelines?Address the ethical dilemmas and/or other issues for your case study:Ethical issuesPsychological issuesPhysical issuesFinancial issuesORDER A PLAGIARISM-FREE PAPER HEREBy Day 6Respond to at least two of your colleagues’ posts (from a different group) on two different days and provide additional insight that might be useful and appropriate for the issue addressed. Use your learning resources and/or evidence from the literature to support your position.Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit! Rubric Detail Select Grid View or List View to change the rubric’s layout.ContentName: NRNP_6552_Week9_Case_Study_Discussion_RubricCase Study Discussion: Working Through Ethical Dilemmas and Other Issues in Advanced Nursing PracticeGrid ViewList ViewExcellentPoint range: 90–100GoodPoint range: 80–89FairPoint range: 70–79PoorPoint range: 0–69Main Posting:Response to the case study discussion questions includes appropriate diagnoses with explanations of appropriate diagnostic tests and treatment options as directed, is based on evidence-based research where appropriate, and is incorporates syntheses representative of knowledge gained from the course readings for the module and current credible sources.Points Range: 40 (40%) – 44 (44%)Thoroughly responds to the discussion question(s).Post includes approprite diagnoses including explanations of appropriate diagnostic tests and treatment options.Incorporates syntheses representative of knowledge gained from the course readings for the module and current credible sources, with no less than 75% of post the post having exceptional depth and breadth.Case Study Discussion: Working Through Ethical Dilemmas and Other Issues in Advanced Nursing PracticeSupported by at least 3 current credible sources.Points Range: 35 (35%) – 39 (39%)Responds to most of the discussion question(s)Post includes approprite diagnoses with explanations of appropriate diagnostic tests and treatment options.Case Study Discussion: Working Through Ethical Dilemmas and Other Issues in Advanced Nursing PracticeSomewhat incorporates syntheses representative of knowledge gained from the course readings for the module and current credible sources with no less than 50% of the post having exceptional depth and breadth.Supported by at least 3 credible references.Points Range: 31 (31%) – 34 (34%)Responds to some of the discussion question(s).Post contains incomplete or vague diagnoses or explanations of appropriate diagnostic tests and treatment options.Is somewhat lacking in synthesis of knowledge gained from the course readings for the module and current credible sources.Post is cited with fewer than 2 credible references.Points Range: 0 (0%) – 30 (30%)Does not respond to the discussion question(s).Post contains incomplete diagnoses or explanations of appropriate diagnostic tests and treatment options, or diagnoses and/or explanations are missing.Lacks synthesis gained from the course readings for the module and current credible sources.Contains only 1 or no credible references.Main Posting:WritingPoints Range: 6 (6%) – 6 (6%)Written clearly and concisely.Contains no grammatical or spelling errors.Further adheres to current APA manual writing rules and style.Points Range: 5 (5%) – 5 (5%)Written concisely.May contain one to two grammatical or spelling errors.Adheres to current APA manual writing rules and style.Points Range: 4 (4%) – 4 (4%)Written somewhat concisely.May contain more than two spelling or grammatical errors.Contains some APA formatting errors.Points Range: 0 (0%) – 3 (3%)Not written clearly or concisely.Contains more than two spelling or grammatical errors.Does not adhere to current APA manual writing rules and style.Main Posting:Timely and full participationPoints Range: 9 (9%) – 10 (10%)Meets requirements for timely, full, and active participation.Posts main discussion by due date.Points Range: 8 (8%) – 8 (8%)Posts main discussion by due date.Meets requirements for full participation.Points Range: 7 (7%) – 7 (7%)Posts main discussion by due date.Points Range: 0 (0%) – 6 (6%)Does not meet requirements for full participation.Does not post main discussion by due date.First Response:Post to colleague’s main post that is reflective and justified with credible sources.Points Range: 9 (9%) – 9 (9%)Case Study Discussion: Working Through Ethical Dilemmas and Other Issues in Advanced Nursing PracticeResponse exhibits critical thinking and application to practice settings.Responds to questions posed by faculty.The use of scholarly sources to support ideas demonstrates synthesis and understanding of learning objectives.Points Range: 8 (8%) – 8 (8%)Response has some depth and may exhibit critical thinking or application to practice setting.Points Range: 7 (7%) – 7 (7%)Response is on topic, may have some depth.Points Range: 0 (0%) – 6 (6%)Response may not be on topic, lacks depth.First Response:WritingPoints Range: 6 (6%) – 6 (6%)Communication is professional and respectful to colleagues. Case Study Discussion: Working Through Ethical Dilemmas and Other Issues in Advanced Nursing PracticeResponse to faculty questions are fully answered, if posed.Provides clear, concise opinions and ideas that are supported by two or more credible sources.Response is effectively written in Standard, Edited English.Points Range: 5 (5%) – 5 (5%)Communication is mostly professional and respectful to colleagues.Response to faculty questions are mostly answered, if posed.Provides opinions and ideas that are supported by few credible sources.Response is written in Standard, Edited English.Points Range: 4 (4%) – 4 (4%)Response posed in the discussion may lack effective professional communication.Response to faculty questions are somewhat answered, if posed.Few or no credible sources are cited.Points Range: 0 (0%) – 3 (3%)Responses posted in the discussion lack effective communication.Response to faculty questions are missing.No credible sources are cited.First Response:Timely and full participationPoints Range: 5 (5%) – 5 (5%)Meets requirements for timely, full, and active participation.Posts by due date.Points Range: 4 (4%) – 4 (4%)Meets requirements for full participation.Posts by due date.Case Study Discussion: Working Through Ethical Dilemmas and Other Issues in Advanced Nursing PracticePoints Range: 3 (3%) – 3 (3%)Posts by due date.Points Range: 0 (0%) – 2 (2%)Does not meet requirements for full participation.Does not post by due date.Second Response:Post to colleague’s main post that is reflective and justified with credible sources.Points Range: 9 (9%) – 9 (9%)Response exhibits critical thinking and application to practice settings.Responds to questions posed by faculty.The use of scholarly sources to support ideas demonstrates synthesis and understanding of learning objectives.Case Study Discussion: Working Through Ethical Dilemmas and Other Issues in Advanced Nursing PracticePoints Range: 8 (8%) – 8 (8%)Response has some depth and may exhibit critical thinking or application to practice setting.Points Range: 7 (7%) – 7 (7%)Response is on topic, may have some depth.Points Range: 0 (0%) – 6 (6%)Response may not be on topic, lacks depth.Second Response:WritingPoints Range: 6 (6%) – 6 (6%)Communication is professional and respectful to colleagues.Response to faculty questions are fully answered, if posed.Provides clear, concise opinions and ideas that are supported by two or more credible sources.Response is effectively written in Standard, Edited English.Points Range: 5 (5%) – 5 (5%)Communication is mostly professional and respectful to colleagues.Response to faculty questions are mostly answered, if posed.Provides opinions and ideas that are supported by few credible sources.Response is written in Standard, Edited English.Points Range: 4 (4%) – 4 (4%)Response posed in the discussion may lack effective professional communication.Response to faculty questions are somewhat answered, if posed.Few or no credible sources are cited.Points Range: 0 (0%) – 3 (3%)Responses posted in the discussion lack effective communication.Response to faculty questions are missing.No credible sources are cited.Second Response:Timely and full participationPoints Range: 5 (5%) – 5 (5%)Meets requirements for timely, full, and active participation.Posts by due date.Points Range: 4 (4%) – 4 (4%)Meets requirements for full participation.Posts by due date.Points Range: 3 (3%) – 3 (3%)Posts by due date.Points Range: 0 (0%) – 2 (2%)Does not meet requirements for full participation.Does not post by due date. Total Points: 100Name: NRNP_6552_Week9_Case_Study_Discussion_RubricCase Study Discussion: Working Through Ethical Dilemmas and Other Issues in Advanced Nursing PracticeUnfolding Case Study 2:Ethical Dilemmas in Advanced Nursing Practice  14 year old femaleA) Summary of your chosen case studyBackgroundFelicia Walker is a 14-year-old female who presents to your school-based teen clinic. She is complaining of daily stomachaches for the past several weeks. She states that she has been complaining about them but everyone tells her it’s just stress from moving and it will get better after she makes some friends. Felicia is new to your school this year and her record notes that she frequently misses her first class of the day. She lives with her aunt and uncle, who are her legal guardians. (Your clinic has private rooms that each person goes into; so there is no waiting room but they are assured privacy).Case Study Discussion: Working Through Ethical Dilemmas and Other Issues in Advanced Nursing Practice1) What information do you need?More information about her stomachaches, such as where they are, what makes it better or worse, and any other symptoms.Although the other answers are getting at important information, this is your first time with Felicia, and starting off just addressing the problem is preferable. It is important to establish a rapport with her first. Additionally, she sees that you are listening to her.Felicia states that if she eats something it is better, but if she gets hungry it’s worse. As you discuss her symptoms more, she relates that she is often late in the morning because she’s been so tired recently. She states she’s feeling better and doesn’t want to miss her next class.2)You tell her that:Have her come back at another time.You are letting her know that you are interested and listening. She appears to be starting to open up a little. Additionally, there are more assessments that need to be done.Case Study Discussion: Working Through Ethical Dilemmas and Other Issues in Advanced Nursing PracticeFelicia comes back during her lunch break. You find out that she is also worried because she has not had her period since moving in with her aunt and uncle 3 months ago. She likes living with them but they are very religious and are at church three or four times a week.As you talk with her more, you find she was removed from her mother’s care due to drug use, and her mother’s boyfriend was found to have drugs in the home. She says she’s glad to be away from him because he’s a “pig.”3)Where would you go with your next questions?Why do you call him a “pig”?Although the other questions are good ones, Felicia may be giving you an opening to something she needs to tell someone.She says he’s a pig because he smells like one. Upon further discussion, she tells you that he would come into her room at night and touch her. She is reluctant to go further with this conversation and starts crying.4)Your next step is to:Reflect on and clarify what she has told you, and ask if this is one reason she is concerned about stomachaches and missed periods.Although the second two answers also are things you can do, you need to address what she has told you so far and clarify it.Case Study Discussion: Working Through Ethical Dilemmas and Other Issues in Advanced Nursing PracticeUpon additional questioning, Felicia says she is concerned that’s why she hasn’t gotten her period and just thinking about it makes her nauseous. She says she can’t sleep at night because she thinks her aunt and uncle won’t want her if they know. You do a urine pregnancy test and the result comes back positive. She states she doesn’t want this baby in her. You find out that the mother’s boyfriend is 40 years old, and Felicia feels safer now that she’s in a different city than him.You are aware of your particular state’s regulations and are aware that the age of consent is 12 unless there is coercion or if the other party is more than 5 years older. As in all states, you are a mandated reporter if abuse, rape, or coercion are involved. According to reproductive laws in your state, anyone 12 years of age or older can seek reproductive health care (i.e., contraception, screening, and treatment for STIs, and counseling) and psychiatric care without the consent of a parent or guardian. Teens younger than 18 years of age cannot sign for any other medical or surgical treatment for themselves however, they can sign for treatment of their child.5)Next, you tell Felicia that:You are a mandated reporter and need to report the sexual assault. Additionally, you bring in the school counselor/social worker (with Felicia’s permission) to help her with the next steps as she chooses what she wants to do and how she wants to tell her aunt and uncle.Felicia needs to be aware that you are a mandated reporter. Additionally, she needs unbiased assistance in helping her make her next choices.B) What is your differential diagnosis? (American College of Obstetricians and Gynecologists (ACOG).Case Study Discussion: Working Through Ethical Dilemmas and Other Issues in Advanced Nursing Practice1) ICD-10-CM 09.619 Supervision of young primigravida(2) ICD-10-CM T76.22XA Child sex abuse(3) ICD-10-CM R10.9 Abdominal pain(4) ICD-10-CM F40.248 SITUATIONAL ANXIETY/PHOBIA(5) ICD-10-CM  R11.0 NASUEA (6) ICD-10 CM Z60.9 PROBLEM RELATED TO SOCIAL ENVIORNMENTWhy did you make this diagnosis decision?Our teen patient is a victim of child rape and poor social background. She needs help right away. This is a crisis situation. (Schuiling, K. D., & Likis, F. E. )What is your treatment plan?(Centers for Disease Control and Prevention. (CDC) AND (American College of Obstetricians and Gynecologists (ACOG) And (  American Nurses Association (ANA).1) ENSURE SAFE ENVIRONMENT AT HOME-CONTACT SOCIAL SERVICES/DCFS2)MEDICALY SCREEN PATIENT-ADMIT TO HOSPITAL SO COMPREHENSIVE WORK UP CAN OCCUR AND PATIENT SAFTEY CAN BE ESTABLISHED3)NOTIFY LAW ENFORCEMENT4) EDUCATE PATIENT ON CAREPLAN, INVOLVE HER IN HER CARE5) PART OF HOSPITAL ADMIT PLAN WILL BE CONSULT WITH OB-GYN, FETAL WORK UP6) NOTIFY MOM/GRANDPARENTS PER LEGAL CHANNELS-LAW ENFORCEMENT7) PART OF HOSPITAL ADMIT TO TO CONNECT WITH MEDIAID FOR KIDS AND ENSURE FINANCIAL RESOURCES NEED TO PROVIDE FOR MEDICAL CARE, EMOTIONAL CARE, LEGAL CARE, HOUSING AND SHELTER CARE, LIVING AND EDUCATION ASSISISTANCE . CARE FOR PATIENT AND HER BABY.What evidence-based research can you provide to support your decision (choice for differential diagnosis and plan/intervention)?BASED ON LATEST RECOMMENDATIONS BY CITED SOURCESWhat resources did you use to meet your best practice guidelines?Case Study Discussion: Working Through Ethical Dilemmas and Other Issues in Advanced Nursing PracticeEVIDENCE BASED CARE RECOMMENDATIONS BY CITES SOURCESAddress the ethical dilemmas and/or other issues for your case study:Ethical issues-RIGHT TO CARE FOR PATIENTS OWN BODY. RIGHT TO GET ABORTION FOR UNWANTED PREGNANCY-GRANDPARENTS VERY RELIGIOUS AND MAY OPPOSE IT. WILL SHE NEED TO BE PLACED IN SHELTER FOR HER PROTECTION FROM HER FAMILY OR THE BOYFRIEND OF MOM. (Schuiling, K. D., & Likis, F. E. ) (Centers for Disease Control and Prevention. (CDC)Psychological issues-TRAUMA OF CHILDHOOD RAPE AND SEX ABUSE, TRAUMA OF NOT HAVING A SUPPORTIVE HOME ENVIORNMENT, TRAUMA OF POSSIBLY BEING A TEEN PARENT OF UNWANTED PREGNANCY DUE TO RAPE. TRAUMA OF NOT MHAVING ANY RESOURCES TO DEAL WITH SUCH A MAJOR LIFE EVENT. (Schuiling, K. D., & Likis, F. E. )(Centers for Disease Control and Prevention. (CDC)Physical issues-TEEN PREGNANCY, BODY NOT FULLY ABLE TO CARRY OR DELEIVER BABY SAFLEY. NEED FOR PHYSICAL SAFTEY FROM FAMILY (Schuiling, K. D., & Likis, F. E. )( Centers for Disease Control and Prevention. (CDC)Financial issues-NEED HEALTH INSURANCE, NEED RESOURCES TO PAY FOR HOUSING IF NEEDED, SHELTER IF NEEDED, LEGAL EXPENSES RELATED TO GOING AFTER THE MOM’S BOYFRIEND AND PROVIDE SAFE HOME ENVIRNMENT, CONSULING FOR PATIENT AND FAMILY, FOOD AND EDUCATION EXPENSES FOR PATIENT AS NEEDED (Schuiling, K. D., & Likis, F. E. ) (Centers for Disease Control and Prevention. (CDC)Resources:American College of Obstetricians and Gynecologists (ACOG). (2020).  https://www.acog.org/American Nurses Association (ANA). (n.d.). Lead the profession to share the future of nursing and health care. https://www.nursingworld.org/  Case Study Discussion: Working Through Ethical Dilemmas and Other Issues in Advanced Nursing PracticeCenters for Disease Control and Prevention. (CDC). (n.d.). CDC in action. https://www.cdc.gov/  HealthyPeople 2030. (2020).Healthy People 2030 Framework.  https://www.healthypeople.gov/2020/About-Healthy-People/Development-Healthy-People-2030/Frameworks://www.acog.org/Schuiling, K. D., & Likis, F. E. (2022). Gynecologic health care (4th ed.). Jones and Bartlett Learning.Chapter 3,” Women’s Growth and Development Across the Life Spans) pp. 39–49)Chapter 13, “Contraception” (pp. 236–266)Summary: Gloria Smart is a 55-year-old female G0P0 who is 3 years post-menopausal who present to the clinic for family counseling. Patient and her partner will be getting married in 2 months and would like to have a family together.Differential Diagnose:Family Planning, V25.09This can include, adoption, surrogate, fosteringTreatment Plan, depends on patient and her partner and how they want to proceed. As the provider you need to make sure the patient understands, once you reach menopause, your LH and FSH levels remain high and your estrogen and progestogen remain low. You no longer ovulate and cannot conceive a child (Mirsafi & Attarha, 2020). If a patient has postmenopausal vaginal bleeding and is sexually active, pregnancy could occur, but should not be relied on (Mirsafi & Attarha, 2020). Case Study Discussion: Working Through Ethical Dilemmas and Other Issues in Advanced Nursing PracticeIf patient is interested in adoption, surrogacy, family fostering, or other option, further education and support can be provided. Also, a referral to a family planning navigator, who can help provide resources, education, and support as needed.ReferencesMirsafi, R., & Attarha, M. (2020). Postmenopausal Pregnancy: A Case Report. Iranian journal of nursing and midwifery research, 25(3), 260–262. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7299412/Case Study    This week’s case study 1 describes a case about patient, Gloria Smart, who is a 75-year-old woman who presents to the office for regular gynecology care. She has a history of mild hypertension, cardiac stent at age 55, and a surgical history of tonsil surgery and bunion surgery. The medications she currently takes are Zocor, Plavix, and lisinopril, and she is up to date on all her screenings with normal results. She has never been married and has never had children, and comes into the office inquiring about having a child with her current fiancé. She references a 78-year-old and an 80-year female in other countries who were both successful in having children at their age. She comes into the office seeking guidance and referral for her plans.Case Study Discussion: Working Through Ethical Dilemmas and Other Issues in Advanced Nursing PracticeDifferential Diagnosis, Treatment, and Plan            Differential diagnosis for this patient is pregnancy at advanced maternal age, which is defined as pregnancy after age 35 years which puts the patient at higher risks for complications (Mayo Clinic, 2020). Maternal health problems can also contribute to risk factors such as high blood pressure, diabetes, heart or blood disorders, epilepsy, and thyroid disease (Mayo Clinic, 2020). This diagnosis was made because this patient is at an advanced age and due to her cardiac history this puts her more at risk for a pregnancy complication along with her advanced maternal age. In this case study scenario, the patient did suffer from complications of preeclampsia. She abrupted late and went on to deliver a male baby who lived for 20 minutes. Women who are at risk for hypertensive disorders during pregnancy have risk factors such as age greater than 35 years, nulliparity, African American ethnicity, history of vascular disease, or family history of preeclampsia (Schuiling & Likis, 2017). This patient, Gloria Smart, had some of these risk factors as noted in the case study.Case Study Discussion: Working Through Ethical Dilemmas and Other Issues in Advanced Nursing Practice            Treatment plan would include close monitoring of this patient, education on prenatal care and the risks of a pregnancy at advanced maternal age, specialized or targeted ultrasound to target any abnormal development, prenatal cell-free DNA testing to screen for certain chromosome problems, and invasive genetic testing (Mayo Clinic, 2020). This patient is at a greater risk due to her age being advanced more than 35 years of age, and should be educated on the importance of following all health care, education, and pregnancy guidelines during her high-risk pregnancy. Research provided to support this decision shows that pregnancy in older women contributes to high-risk pregnancies with complications such as, difficult labors, ruptured uterus, low birth weight or preterm birth, and chorio-amnionitis (Olamide, Omowaleola & Abosede, 2021). Preeclampsia is another health risk complication attributed to advanced maternal age along with history of high blood pressure, kidney disease, first pregnancy, African American ethnicity, obesity, and blood vessel problems (U.S. National Library of Medicine, 2021). Resources used to meet best practice guidelines include Mayo Clinic, U.S. National Library of Medicine, International Journal of Caring Sciences, and our current course book Women’s Gynecologic Health.Case Study Discussion: Working Through Ethical Dilemmas and Other Issues in Advanced Nursing PracticeEthical Dilemmas/Issues            Some ethical issues for this case include ethical dilemmas concerning the patients even more advanced age over 35 and concerns of whether the mother can have a safe delivery for herself and her baby. Some health care providers may not agree with this patient’s choice to try and have a child at the age of 75 along with her cardiac history. Many ethical questions may arise such as, is this safe for the mother and baby? Will two elderly parents be able to care for physically and financially for a newborn baby until adulthood? What will happen to the child if the parents do not live much longer due to already advanced age? At what age do we decide that a mother is too old to try and have a baby? These are all questions that may contribute to a healthcare provider seeing this case as an ethical dilemma. Psychological issues for the parents should also be considered as they will be older parents, which may cause psychological issues for them as well as possibly for their child due to this case being out of the norm by societies standards. Physical issues are also a concern due to the patient being older, and the possibility of the pregnancy taking a physical toll on her body. Pregnancy can be a physical challenge to a young and healthy female, therefore, this patient may have more physical issues due to her advanced age and advanced aging body. Financial issues are a possible concern as well. The elderly who may be retired or on a fixed income may struggle with the financial commitment that is required in caring for a baby through their lifetime. If the parents are no longer able to work much longer, then providing for the baby’s future may be a concern if there are no other resources to the parents that are available to them. Like any pregnancy, there may be many factors that need to be addressed and the patient educated on in order to ensure best patient outcomes for the mother and the baby.Case Study Discussion: Working Through Ethical Dilemmas and Other Issues in Advanced Nursing PracticeReferencesMayo Clinic. (2020). Pregnancy week by week. High-risk pregnancy: Know what to Expect. Retrieved on July 28,2021 from https://www.mayoclinic.org/healthy-lifestyle/pregnancy-week-by-week/in-depth/high-risk-pregnancy/art-20047012Olamide, O.D., Omowaleola, A.M., & Abosede, E.N. (2021). Pregnancy Outcomes and  Associated Factors among Older Women in Adeoyo Maternity Hospital, Ibadan Nigeria. International Journal of Caring Sciences. Vol 14. Retrieved on July 28, 2021from https://web-b-ebscohost-com.ezp.waldenulibrary.org/ehost/pdfviewer/pdfviewer?vid=4&sid=b4832f58-d391-4dbc-a0da-e15084cc27c8%40pdc-v-sessmgr02Schuiling, K.D., & Likis, F.E. (2017). Women’s gynecological health (3rd ed.). Jones and  Bartlett Publishers.U.S. National Library of Medicine. (2021). Medline Plus. Preeclampsia. Retrieved on July 28, 2021 from https://medlineplus.gov/ency/article/000898.htmCase Study Discussion: Working Through Ethical Dilemmas and Other Issues in Advanced Nursing Practice

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