NURS 6512: Advanced Health Assessment and Diagnostic Reasoning INITIAL POST Ethical Concerns Scenario 1 – A five year old boy comes in for his physical assessment before the start of kindergarten. Both of his parents come to the appointment and voice that they are opposed to their son receiving any immunizations. A comprehensive history and physical examination is essential for all well-child visits allowing for minor variations based on the patient’s age (Sullivan, 2012). Addressing any new issues if present would be the first step. Since the child would have been coming to the office since birth, past medical, family, and social history should be updated. A review of systems and comprehensive physical exam should also be completed. The health assessment should include growth and developmental screenings to determine if the patient is following a healthy growth and developmental trajectory (Sullivan, 2012). Establishing if the patient has received any immunizations from birth until now should also be included particularly due to parental opposition to immunizations and the likelihood that the patient has not received any. Assessment of attention span and ability to separate from parents is important for school readiness (Sullivan, 2012). Patient safety such as seat belts, booster seats, street safety should be determined while discussing anticipatory guidance. Laboratory data is not necessary at this age unless it is required for a new onset issue. Lastly, discussing other topics anticipatory for this age include knowing full name, address, and phone number; sexual curiosity; household chore participation; and no playing with match (Sullivan, 2016). Evidence-based Practice Guidelines and Ethical Considerations It is most important to address the parent’s opposition to immunizations. The first step as an advanced practice nurse is to establish why the
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