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.
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.
Scenario: 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.
To effectively respond to this scenario as an advanced practice nurse, I would need to gather essential health assessment information and perform diagnostic tests to make a comprehensive diagnosis and develop an appropriate treatment plan. Here are the necessary steps and considerations:
- Health Assessment: a. Medical History: Obtain a detailed medical history, including the duration and severity of the patient’s Crohn’s disease, prior treatments, and medication history. b. Current Symptoms: Assess the patient’s current symptoms, including abdominal pain, diarrhea, weight loss, fatigue, and any extraintestinal manifestations. c. Nutritional Status: Evaluate the patient’s nutritional status and dietary habits, as malnutrition is common in Crohn’s disease. d. Medication History: Explore the reasons for the patient’s inability to afford medications and inquire about any adverse effects experienced due to medication use. e. Psychosocial Assessment: Consider the patient’s psychosocial factors, such as stressors, social support, and coping mechanisms.
- Diagnostic Tests: a. Laboratory Tests: Perform blood tests, including complete blood count (CBC), C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) to assess inflammation and anemia. b. Imaging Studies: Conduct imaging studies such as abdominal ultrasound, CT scan, or MRI to visualize the extent of inflammation, strictures, and complications in the gastrointestinal tract. c. Endoscopy: Perform colonoscopy or upper endoscopy to directly visualize the affected areas and obtain biopsy samples for histological assessment. d. Stool Studies: Consider fecal calprotectin or lactoferrin tests to assess inflammation in the gut and exclude infectious causes of symptoms.
In response to the scenario, I would prioritize relieving the patient’s acute symptoms and stabilizing his condition. I would collaborate with the healthcare team to provide immediate treatment, including intravenous fluids, pain management, and corticosteroids to reduce inflammation. Additionally, I would consult a gastroenterologist to assess the need for surgery or other advanced interventions.
I would educate the patient about the importance of adhering to his treatment plan and explore available options to address the cost concerns. This may involve discussing financial assistance programs, alternative medications, or exploring insurance options.
Ethically, I would ensure that the patient’s autonomy and right to informed decision-making are respected. I would also consider the principles of beneficence and non-maleficence by providing the best available evidence-based care while minimizing harm.
In conclusion, the management of this patient with Crohn’s disease involves a thorough health assessment, diagnostic tests, and a holistic approach to address not only the medical aspects but also the financial and psychosocial challenges. Evidence-based practice and ethical considerations play a crucial role in ensuring the patient receives the best possible care while respecting his autonomy and well-being.