Write a 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.
Health Assessment Information and Diagnosis: A Narrative for Scenario 3
As an advanced practice nurse, obtaining a comprehensive health assessment is crucial in order to accurately diagnose patients and provide appropriate care. In this narrative, I will discuss the health assessment information required for a diagnosis in Scenario 3 and explain how I would respond while adhering to evidence-based practice guidelines and ethical considerations.
In Scenario 3, we encounter a patient presenting with symptoms suggestive of major depressive disorder (MDD). To make an accurate diagnosis, a thorough health assessment is essential. The initial step would involve obtaining the patient’s detailed medical history, including any prior psychiatric diagnoses, current medications, and use of substances such as alcohol or drugs. Additionally, it would be important to inquire about any family history of mental illness or suicide attempts, as genetics may play a role in the development of MDD (Hasler, Drevets, Gould, Gottesman, & Manji, 2006).
Conducting a psychological assessment using standardized tools, such as the Hamilton Rating Scale for Depression (HAM-D) or the Beck Depression Inventory (BDI), can aid in assessing the severity of depressive symptoms and monitoring treatment response (Hamilton, 1960; Beck, Steer, & Brown, 1996). Furthermore, a thorough assessment of the patient’s current symptoms, including feelings of sadness, anhedonia, changes in appetite and sleep patterns, fatigue, difficulty concentrating, and thoughts of death or suicide, should be obtained to fulfill the diagnostic criteria for MDD as outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) (American Psychiatric Association, 2013).
To ensure a comprehensive assessment, a physical examination should also be conducted. While MDD primarily affects mood and cognition, it can be associated with various physical symptoms such as changes in weight, alterations in sleep patterns, and increased fatigue. Furthermore, physical examination findings may help rule out other potential medical conditions that could present with similar symptoms, such as hypothyroidism or chronic pain syndromes (Culpepper & Muskin, 2009).
In the scenario, the patient exhibits signs of severe depression accompanied by suicidal thoughts, which necessitates an immediate assessment of their suicide risk. The ethical obligation of an advanced practice nurse in this situation is to prioritize the patient’s safety and well-being. According to evidence-based guidelines, it is crucial to conduct a risk assessment for suicidal ideation, plan, intent, and access to means (National Collaborating Centre for Mental Health, 2018). This assessment includes inquiring about any previous suicide attempts, suicidal thoughts, or a plan to harm oneself. The presence of these factors indicates an urgent need for intervention to ensure the patient’s safety, such as hospitalization or close monitoring (Asarnow et al., 2017).
When responding to Scenario 3, it is important to acknowledge the ethical principles associated with the provision of mental health care. Beneficence, non-maleficence, autonomy, and justice should guide my decisions as an advanced practice nurse (Butts & Rich, 2018). In this case, ensuring the patient’s safety through prompt assessment and intervention would be aligned with the principles of beneficence and non-maleficence. However, it is essential to balance these principles with respect for the patient’s autonomy. Engaging the patient in shared decision-making and explaining the rationale behind the recommended treatment options, such as hospitalization, medication, or psychotherapy, would uphold the principle of autonomy and allow them to actively participate in their care (Lakanmaa et al., 2018).
In conclusion, a comprehensive health assessment is essential for accurately diagnosing patients, particularly in scenarios involving mental health issues such as major depressive disorder. Obtaining a detailed medical history, conducting psychological assessments, and performing a physical examination are key components of the health assessment process. In cases where immediate intervention is required, as in Scenario 3, assessing suicide risk and ensuring patient safety should be the utmost priority. Adhering to evidence-based practice guidelines and applying ethical principles will guide the advanced practice nurse in providing appropriate and compassionate care for the patient.