FNP 591 Discussion 1

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United States University *

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591

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Nursing

Date

Apr 29, 2024

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docx

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Uploaded by BrigadierQuetzal2508

1. Discuss the appropriate differential diagnoses for this patient. 2. Is the provider legally liable to explain to the patient the diagnostics that they are ordering? Why? 3. How many missed opportunities did Esteban have? 4. Should Esteban be sued? Why or why not? According to the story of the discussion post, there are a couple of differential diagnoses that can be established for Mr. Shien. Three differential diagnoses that can be made upon Mr. Shien’s clinical presentation may include deep vein thrombosis (ICD-10-I82.40), cellulitis (ICD- 10-L03.90), and thigh mass compressing venous outflow of the leg (ICD-10-R22.40) (Stevens et al., 2023). The primary diagnosis would be deep vein thrombosis. A deep-vein thrombosis (DVT) is a type of blood clot that typically develops in the leg but can also happen in the arms, mesenteric, and cerebral veins (Waheed et al., 2023). Complications for DVT include pulmonary embolism, a clot that travels to the lungs and potentially causes respiratory complications. Most pulmonary embolism instances are caused by a serious medical condition called deep-vein thrombosis. Reducing morbidity requires early diagnosis and treatment. A second differential diagnosis includes cellulitis. Cellulitis is diagnosed clinically when there is localized skin erythema and edema, as well as irritation and warmth (Bystritsky, 2021). A common complication of cellulitis is sepsis where the infection travels in the bloodstream causing detrimental effects on major organs such as the kidney, heart, and lungs. Thigh mass compressing the leg's venous outflow is the final differential diagnosis that should be considered the least likely but possible diagnosis. Thigh masses are often soft tissue sarcoma. Malignant neoplasms known as soft tissue sarcomas usually manifest in an extremity and need to be closely monitored to evaluate metastasis and potential resection, among other treatment options (Rometti

& Bryczkowski, 2022). Complications of thigh mass can result in functional loss of the extremity and lead to necessary amputation of the limb. The clinical provider is legally bound to explain to the patient the diagnostics that they are ordering. Patient communication is key in medical decision-making. A patient must be informed about the potential risks, advantages, and available options before giving their consent for a particular diagnostic order, treatment, or intervention. Medical professionals are required by 45 CFR part 46 regulations of the U.S. Department of Health and Human Services (HHS) to obtain their patients' legal consent, either verbally or in writing, or both (HHS.gov, 2023). The main reason why it is imperative to legally explain medical decision-making is to obtain informed consent for the protection of the patient. The concept of respect for persons states that people must be viewed as autonomous agents and that those with restricted autonomy have their rights and welfare appropriately protected. According to Esteban’s story, he had more than three opportunities missed to help Mr. Shien with his medical complaint. Esteban disregarded Mr. Shien’s initial complaint about his leg and utilized the gout history to make a clinical decision. There is no recollection of an appropriate physical assessment of Mr. Shien’s leg. The second encounter was when Mr. Shien came back to the office three weeks later and disregarded the possibility of a deep vein thrombosis without ruling it out with a venous ultrasound. Esteban then failed to explain to Mr. Shien the significance of ordering and completing the venous ultrasound to rule out DVT. Esteban ordered the venous ultrasound the next day and not a stat order despite the presenting assessment of Mr. Shien’s leg. Another opportunity for Esteban was when the venous ultrasound result came positive for a DVT. Esteban proceeded to tell the patient to come back to the office

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