Assignment: Dilemmas and Problem Solving
As nurses we will be faced with dilemmas and problem solving on a daily basis. Our own personal beliefs can also affect how we may treat or even care for a patient. It shouldn’t but it could possibly happen. If you see that happening, ask the nurse manager to switch with another nurse as that patient deserves proper care without judgment. If you were against a certain vaccination and you had to provide that vaccination and patient education to a patient, you must provide them with accurate information, side effects, statistics all while you put your beliefs behind.
I personally experienced an ethical dilemma at work when I was scheduled to give a patient an injection. This patient had his blood work drawn and saw the doctor and was waiting for me to give him the injection. In the chart, the doctor had approved the treatment however based on the orders and the guidelines this patient was to not get the injection. I went looking for the doctor in the clinic and of course, he is with the next patient which can take about 20 minutes. So while waiting I asked one of our experienced RN’s what she feels I should do and to look into the chart more closely just in case I missed something. She reviews it and says to give it but upon asking why she said the doctor-approved it so it’s fine. I knew that something didn’t seem right so I had to continue to wait and explain to the patient that I was waiting for the doctor to review the treatment again.
The 57-year-old patient noted urinary hesitancy and a decrease in the force of his urinary
stream for several months. Both had progressively become worse. His physical examination
was essentially negative except for an enlarged prostate, which was bulky and soft.
Routine laboratory studies Within normal limits (WNL)
Intravenous pyelogram (IVP) Mild indentation of the interior aspect of the bladder,
indicating an enlarged prostate
Uroflowmetry with total voided
flow of 225 mL
8 mL/sec (normal: >12 mL/sec)
Cystometry Resting bladder pressure: 35 cm H2O (normal: <40 cm H2O)
Peak bladder pressure: 50 cm H2O (normal: 40-90 cm H2O)
Electromyography of the pelvic
Normal resting bladder with a positive tonus limb
Cystoscopy Benign prostatic hypertrophy (BPH)
Prostatic acid phosphatase
0.5 units/L (normal: 0.11-0.60 units/L)
Prostate specific antigen (PSA) 1.0 ng/mL (normal: <4 ng/mL)
Prostate ultrasound Diffusely enlarged prostate; no localized tumor
Because of the patient’s symptoms, bladder outlet obstruction was highly suspected.
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