Pick Any Case Study 1a: 27-Year-Old Man With Crohn's Disease

Pick Any Case Studycase 1a 27 Year Old Man With Crohns Disease Has B

Pick any Case Study Case 1a 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. Case 2: A single mother has accompanied her two daughters, aged 15 and 13, to a women’s health clinic and has requested that the girls receive a pelvic examination and be put on birth control. The girls have consented to the exam but seem unsettled. Case 3: A 17-year-old boy has come in for a check-up after a head injury during a football game. He has indicated that he would like to be able to play in the next game, which is in 3 days. Write a detailed max of 2-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.

Paper For Above instruction

Scenario 1: A 27-year-old man with Crohn’s disease experiencing an extreme flare-up after missing medication due to financial constraints.

As an advanced practice nurse (APN) approaching this case, the initial step involves conducting a comprehensive health assessment to gather pertinent data for diagnosis and management. With Crohn’s disease, a chronic inflammatory bowel disease, the assessment includes understanding the patient’s current symptoms, medical history, medication adherence, nutritional status, psychosocial factors, and potential complications. The patient’s recent exacerbation indicates a possible worsening of inflammation, requiring rapid yet thorough evaluation.

Health Assessment Information Needed

Primary assessment should focus on the gastrointestinal system, emphasizing symptoms such as abdominal pain, diarrhea, blood in stool, weight loss, and fatigue. A detailed symptom history should include onset, duration, severity, and any factors that alleviate or worsen symptoms. Physical examination should evaluate vital signs—especially temperature, heart rate, blood pressure, and hydration status—as dehydration can be significant in Crohn’s disease flare-ups (Gondalia et al., 2020). Abdominal examination should assess for tenderness, guarding, masses, or signs of peritonitis.

Laboratory investigations are vital to confirm active inflammation and screen for complications. These include complete blood count (CBC) to evaluate anemia or infection, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) as markers of inflammation, electrolyte panels, and nutritional markers like albumin. Stool studies, including fecal calprotectin, can help differentiate active disease from other gastrointestinal pathologies (Lao et al., 2021).

Imaging studies, such as abdominal ultrasound or magnetic resonance enterography (MRE), provide detailed visualization of bowel inflammation, strictures, fistulas, and abscesses—common complications of Crohn’s disease (Khan et al., 2019). Endoscopy might be considered if necessary for direct visualization and biopsy to assess mucosal inflammation and exclude cytomegalovirus or other superimposed infections, especially in severe flare-ups (Hanauer, 2020).

Response as an Advanced Practice Nurse

Responding to this scenario requires balancing evidence-based guidelines and ethical principles, particularly beneficence, non-maleficence, justice, and respect for patient autonomy. Recognizing that the patient cannot afford medication access, I would first explore options for financial assistance programs through pharmaceutical companies or community health resources (McGowan et al., 2019). Education about the importance of medication adherence and disease management would be prioritized, emphasizing the risks of untreated Crohn’s disease, such as strictures, fistulas, and nutritional deficiencies.

Pain management and hydration support are essential. I would implement supportive care to stabilize the patient, including IV fluids if dehydrated, and prescribe medications aligned with current guidelines—such as corticosteroids for acute exacerbations, while planning for tapering and transition to maintenance therapies (Lichtenstein et al., 2021). Additionally, I would coordinate referrals to a gastroenterologist and dietitian to optimize long-term management and nutritional support.

Ethically, it is crucial to respect the patient’s dignity, address socioeconomic barriers, and promote shared decision-making. I would inform the patient about available resources and involve him in developing a feasible treatment plan, considering his financial limitations without compromising care quality. Documentation and multidisciplinary collaboration are essential to ensure continuity of care and address the psychosocial aspects associated with chronic disease management.

Conclusion

Effective management of a Crohn’s disease flare-up in a financially disadvantaged patient hinges on comprehensive assessment, evidence-based interventions, and ethical practice. By integrating clinical data with empathetic patient-centered care, the APN can facilitate better health outcomes while respecting the patient’s circumstances and choices (Walker & Royle, 2019; Shaikh et al., 2022).

References

• Gondalia, R., et al. (2020). Management strategies for Crohn's disease: A review. Journal of Gastroenterology & Hepatology, 35(4), 587-599.
• Khan, N., et al. (2019). Imaging modalities in Crohn's disease: A comprehensive overview. European Journal of Radiology, 115, 222-231.
• Lao, W., et al. (2021). Diagnostic utility of fecal calprotectin in inflammatory bowel disease. World Journal of Gastroenterology, 27(20), 2582-2593.
• Lichtenstein, G., et al. (2021). Management of Crohn's disease: Recommendations for best practices. Clinical Gastroenterology and Hepatology, 19(2), 263-283.
• McGowan, M. L., et al. (2019). Addressing financial barriers to medication adherence in chronic diseases. Journal of Health Care for the Poor and Underserved, 30(1), 123-136.
• Hanauer, S. B. (2020). Crohn's disease: Pathogenesis and management. New England Journal of Medicine, 382(9), 855-865.
• Shaikh, M., et al. (2022). Ethical considerations in managing chronic illnesses: A clinical perspective. Journal of Medical Ethics, 48(3), 175-180.
• Walker, E., & Royle, J. (2019). Patient-centered care in inflammatory bowel disease. Nursing Clinics of North America, 54(4), 523-533.