Case Study 3 A 27-year-old man with Crohns disease – Ethical considerations Case Study Solution

CASE STUDY 3 A 27-year-old man with Crohn’s disease has been admitted to the emergency room with an extreme flare-up of his condition. He explains that he has not been able to afford his medications for the last few months and is concerned about the costs he may incur for treatment.

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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.

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CASE STUDY 3

A 27-year-old man with Crohn’s disease has been admitted to the emergency room with an extreme flare-up of his condition. He explains that he has not been able to afford his medications for the last few months and is concerned about the costs he may incur for treatment.

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The case I selected is of a 27-year-old man with Crohn’s disease admitted to the ER with an extreme flare-up of his condition. From the outset, it is essential to note that Crohn’s disease is a long term inflammatory condition where the gastrointestinal system gets inflamed at any point, starting with the mouth and to the rectum. It is one of the three non-infectious chronic inflammation of the GI system medically referred to as Inflammatory Bowel Disease (IBD) (Alatab et al., 2020). The other two are Ulcerative Colitis (UC) which attacks colonic mucosa and indeterminate colitis. These researchers note that in 2017 there were about 6.8 cases of IBD worldwide, with the USA reporting the highest age-standardized prevalence rate of 464.5 per 100 000 population. Like UC, Crohn’s disease presents with diarrhea and abdominal pain hence the need for detailed health assessment information that an APRN would require to diagnose Crohn’s disease, as in Case Study #3.

The Health Assessment Information Required For A Diagnosis Of Case Study #3

The clinical manifestations of Crohn’s Disease are fever and fatigue accompanied by abdominal pain, diarrhea, GI bleeding, and weight loss (Veauthier & Hornecker, 2018). The health assessment information as captured in the HPI should address the symptoms onset, their severity, and pattern. The provider should focus more on the bowel movements frequency and consistency. There should also be specific questions targeting the risk factors and likely alternative diagnoses like a family history of IBD, food intolerance, medications, smoking, and recent travel. Other questions address extra-intestinal symptoms like eyes, joint problems, and symptoms of anemia. A comprehensive physical evaluation must account for the patient’s vitals, such as blood pressure, temperature, body weight, and heart rate. An abdominal examination could reveal tenderness, masses or distention while performing an anorectal examination is a priority because a significant number of patients will have either fistula, fissure or perirectal abscess at some point during the illness. While there is no single laboratory test that, if performed alone, can help confirm Crohn’s disease, colonoscopy has been proved significant in determining occurrence (Masser et al., 2019). Taking levels of vitamins B12, vitamin D and folate, amongst others, helps establish the patient’s nutritional status while CBC can detect infection and anemia.

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How As an APRN I Would Respond To the Scenario Using Evidence-Based Practice Guidelines and Applying Ethical Considerations

De Baros et al. (2021) the two main aims in managing Crohn’s disease is to treat the inflammatory process and the complications that appear in these patients like intestinal obstructions, fistula, strictures and abscesses, while the second one is to lower negative health impact of this Crohn’s disease itself and the medications used in its treatment. The pharmacological interventions treatment decision points must consider the location of the disease, age, presence of comorbidities, flaring symptoms, and inflammation status. Veauthier et al. (2018) opine that more severe forms of Crohn’s disease and the presence of risk factors suggest a poor prognosis and hence may justify the use of high-risk medications. Similarly, the nursing and medical interventions should address the conflict of ethical principles because of my dual role of being a clinician (healer) and clinical investigator (research scientist). Suffice to say that as a clinician, I will have to utilize knowledge and experience to offer the patient the best available treatment, which is a corticosteroid like prednisone 40mg PO daily.

As a clinical investigator, the APRN is duty-bound to apply scientific methods to diagnose better and treat a particular disease affecting many patients. The ethical conflicts in Crohn’s disease patients become complicated due to the victims’ young age at onset and an almost lifespan and new technologies in the disease’s diagnosis and treatment. As the patient’s advocate, I will petition the patient’s payer cover for off-label use of a medication found to be effective. As far as the clinical goal to heal the patient is concerned. As a clinical investigator, the goal is to advance science and identify safer and more effective treatments. Here, the researcher is to seek the best interests of the target population of patients (those diagnosed with Crohn’s disease). The nursing intervention measures identifying and restricting foods and fluids that precipitate diarrhea to avoid intestinal irritants, promote intestinal rest, and reduce intestinal workload will also involve measures to reduce therapeutic misconception (namely the misunderstanding of the difference between clinical care and research).

 Lastly, if the interventions in the treatment plan are ineffective, recommending the patient to take part in clinical trials will be solely based on the practicability of the principle of clinical equipoise. This narrows down to comparing two or more treatments ethically, provided the medical fraternity has not agreed that one of the options available is superior (Rooshenas et al., 2016). In using evidence-based practice, a clinician should consider it ethical to randomize the participating patients to a study unproven treatment versus a placebo or another equally unproven intervention even if the clinical investigator is biased towards one of the treatments over the other in standard nursing practice.

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References

Alatab, S., Sepanlou, S. G., Ikuta, K., Vahedi, H., Bisignano, C., Safiri, S., … & Naghavi, M. (2020). The global, regional, and national burden of inflammatory bowel disease in 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. The Lancet Gastroenterology & Hepatology, 5(1), 17-30.

de Barros, J. R., Herrerias, G. S. P., Ramdeen, M., Saad-Hossne, R., Alencar, R. A., & Sassaki, L. Y. (2021). Nursing Process in a Patient with Crohn’s Disease: Case Report. Open Journal of Nursing, 11(04), 258.

Maaser, C., Sturm, A., Vavricka, S. R., Kucharzik, T., Fiorino, G., Annese, V., … & European Crohn’s and Colitis Organisation [ECCO] and the European Society of Gastrointestinal and Abdominal Radiology [ESGAR]. (2019). ECCO-ESGAR Guideline for Diagnostic Assessment in IBD Part 1: Initial diagnosis, monitoring of known IBD, detection of complications. Journal of Crohn’s and Colitis, 13(2), 144-164K.

Rooshenas, L., Elliott, D., Wade, J., Jepson, M., Paramasivan, S., Strong, S., … & POUT study group. (2016). Conveying equipoise during recruitment for clinical trials: a qualitative synthesis of clinicians’ practices across six randomized controlled trials. PLoS medicine, 13(10), e1002147.

 Pro-essays.com has the top and most qualified writers to help with any of your assignments. All you need to do is place an order with us (CASE STUDY 3 A 27-year-old man with Crohn’s disease – Ethical considerations Solution)

Veauthier, B., & Hornecker, J. R. (2018). Crohn’s disease: diagnosis and management. American family physician, 98(11), 661-669.

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