NR603 iHuman Reflection Week 4

iHuman Reflection Week 4: Diagnostic Decision-Making in Advanced Clinical Practice

In the realm of advanced clinical practice, the decision-making process regarding diagnostic testing is crucial for accurate patient assessment and management. The iHuman case scenario involving Kailey Simpson presents an opportunity to explore the diagnostic tools necessary for determining the appropriate clinical course. In this case, I selected a range of diagnostic tests, including Complete Blood Count (CBC), Brain Natriuretic Peptide (BNP), Chest X-ray, Electrocardiogram (ECG), Transesophageal Echocardiogram (TEE), and Pulmonary Function Test (PFT). Each test was chosen with the specific goal of evaluating the patient’s cardiovascular and respiratory status, thereby informing the diagnosis and subsequent treatment plan.

Diagnostic Tests and Rationale

The selection of diagnostic tests was based on the presenting symptoms and the potential underlying conditions that needed to be ruled out or confirmed. The CBC was chosen to assess the patient’s overall health and to detect any abnormalities such as anemia, infection, or inflammation that could contribute to her symptoms (Hoffbrand & Moss, 2016). Although a CBC is a routine test, it is not the most critical for the suspected diagnosis of aortic stenosis in this scenario. Similarly, the BNP test was selected to evaluate the possibility of heart failure, as elevated levels of BNP can indicate increased pressure in the heart due to heart failure or other cardiac conditions (Wang et al., 2021).

The Chest X-ray was ordered to visualize the heart, lungs, and chest structure, providing essential information on the presence of heart enlargement, fluid buildup, or other pulmonary issues that could be contributing to the patient’s symptoms (Collins et al., 2018). The ECG was included to detect any arrhythmias or other electrical abnormalities in the heart that might be associated with her condition.

The TEE emerged as the most critical and costliest diagnostic procedure in this case, estimated at $1,775 (MDsave, n.d.). TEE provides detailed images of the heart’s structure and function, making it indispensable for diagnosing conditions like aortic stenosis, where a clear view of the heart valves and blood flow is essential (Otto & Cooper, 2022). Finally, the PFT was selected to assess lung function, particularly to rule out any respiratory causes of her symptoms. However, given the suspected diagnosis of aortic stenosis, the PFT, along with the CBC and ECG, could be considered less pertinent in this context.

Cost Considerations in Diagnostic Testing

The total estimated cost of the selected diagnostic tests is approximately $3,254 (MDsave, n.d.). In the current healthcare environment, cost considerations are increasingly relevant, especially in cases where the patient may not have adequate health insurance coverage. The high cost of diagnostic testing necessitates careful consideration of the value and necessity of each test. In this scenario, while the TEE is expensive, it is a necessary test for diagnosing aortic stenosis, a condition that, if left untreated, can lead to severe complications or death (Otto & Cooper, 2022). On the other hand, less pertinent tests such as the CBC, ECG, or PFT could be deferred or omitted, particularly in uninsured patients, to reduce the financial burden.

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This financial aspect highlights the importance of cost-effective care in advanced practice nursing. Practitioners must balance the need for comprehensive diagnostic evaluation with the economic realities faced by patients. This balance ensures that patients receive the necessary care without incurring prohibitive costs that could limit their access to further treatment.

Ethical Considerations in Diagnostic Testing

Beyond the financial implications, the selection of diagnostic tests also involves ethical considerations. As healthcare providers, it is our duty to ensure that the tests ordered are not only clinically relevant but also ethically justified. This means avoiding unnecessary tests that could cause undue financial or emotional stress to the patient. In Kailey Simpson’s case, the ethical decision would involve focusing on the tests that directly impact the diagnosis and management of her suspected condition— aortic stenosis.

Ethical decision-making in diagnostic testing also requires transparency with the patient. Patients should be informed about the costs, benefits, and risks of each diagnostic test. This transparency allows patients to participate in the decision-making process, thereby respecting their autonomy and ensuring that they are fully aware of the implications of the proposed diagnostic plan (Beauchamp & Childress, 2019).

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Conclusion

The iHuman case scenario involving Kailey Simpson provides a valuable opportunity to reflect on the complexities of diagnostic decision-making in advanced clinical practice. The selection of diagnostic tests—CBC, BNP, Chest X-ray, ECG, TEE, and PFT—was guided by the need to obtain a comprehensive understanding of the patient’s cardiovascular and respiratory status. However, the high cost associated with these tests, particularly the TEE, necessitates a careful consideration of their necessity, especially in cases where the patient may lack adequate health insurance coverage.

Ethical considerations also play a crucial role in the decision-making process, ensuring that the tests ordered are both clinically relevant and ethically justified. As advanced practice nurses, it is our responsibility to balance the need for thorough diagnostic evaluation with the economic and ethical implications of our decisions. By doing so, we can provide high-quality, patient-centered care that is both effective and respectful of the patient’s circumstances.

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References

Beauchamp, T. L., & Childress, J. F. (2019). Principles of biomedical ethics (8th ed.). Oxford University Press. https://global.oup.com/academic/product/principles-of-biomedical-ethics-9780190640873

Collins, J., Stern, E. J., & Fligner, C. L. (2018). Chest radiology: The essentials (4th ed.). Lippincott Williams & Wilkins. https://shop.lww.com/Chest-Radiology/p/9781496396355

Hoffbrand, A. V., & Moss, P. A. H. (2016). Hoffbrand’s essential haematology (7th ed.). Wiley Blackwell. https://www.wiley.com/en-us/Hoffbrand%27s+Essential+Haematology%2C+7th+Edition-p-9781118408674

MDsave. (n.d.). Procedure pricing. Retrieved from https://www.mdsave.com/

Otto, C. M., & Cooper, L. T. (2022). Valvular heart disease: A companion to Braunwald’s heart disease (5th ed.). Elsevier. https://www.elsevier.com/books/valvular-heart-disease/otto/978-0-323-69187-7

Wang, C., Yang, Y., Zhu, L., Ma, J., & Li, M. (2021). BNP levels in patients with heart failure and their relationship with prognosis: A systematic review and meta-analysis. Journal of Cardiovascular Nursing, 36(3), 215-222. https://journals.lww.com/jcnjournal/Abstract/2021/03000/BNP_Levels_in_Patients_With_Heart_Failure_and_Their.2.aspx