Lupus, Lyme Disease, Mononucleosis Diagnostics Sample Assignment

Systemic Lupus Erythematosus (SLE)

The patient could be suffering from SLE as she reported muscle aches without stiffness and a skin rash with an increased photosensitivity. These symptoms are associated with Lupus, the chronic inflammatory condition that is most commonly found in women of childbearing age (Bartels, 2016). The reasonableness of this diagnosis is confirmed by the presence of the shallow bilateral ulcers in the patient’s buccal mucosa.

Lyme Borreliosis (or Lyme Disease)

A skin rash is one of the first symptoms of Lyme disease; the later symptoms include joint pain and fatigue, among others (NHS, n.d.). However, even though the patient seems to display all of these symptoms, their characteristics are different from those typical of Lyme disease. For instance, Lyme disease is known for the bull’s eye-shaped rash and joint pain that goes together with swelling – the signs that Mary does not have. This is why this diagnosis is less likely than the first one. In addition, the patient has mentioned that she had spent a week hiking and camping in the Appalachians; and therefore, it is possible that she could have been bitten by the tick that causes the development of infection leading to Lyme disease.


The patient’s skin rash, fatigue, and a sore throat also match the set of signs associated with mononucleosis (Mayo Clinic, 2017). However, this diagnosis is secondary because Mary does not display fever, swollen lymph nodes and tonsils, and headaches that are the other major symptoms of mononucleosis.

Teaching and Nursing Care Plan

For Systemic Lupus Erythematosus

The additional tests required for the confirmation of this diagnosis include antibody test, urine analysis, and a chest x-ray; also, the patient might be referred to a rheumatologist for the treatment related to joint and muscle pain (Bartels, 2016). Moreover, the patient will be prescribed anti-inflammatory medication for joint aches, a steroid crème to treat the skin lesions, and corticosteroids to control the response of the immune system (Bartels, 2016).

For Lyme Disease

A 2 to 4-week course of antibiotics is required depending on the severity of the condition and its stage. Also, the patient should be referred to a specialist for intravenous antibiotics should her symptoms become especially severe (NHS, n.d.).

In addition, the patient should be educated about the effect some antibiotics may have on her skin. In particular, it can become very sensitive to sunlight; and in that way, the patient should be recommended to stay away from direct sunlight and try to stay inside as much as possible in order to minimize her exposure while the treatment is still in process. The patient has to be informed about the cause of her disease (the infection vectored by a tick) and advised to take all the necessary precautions to avoid exposing herself to a tick bite in the future.

For Mononucleosis

The required tests are antibody test and white blood cell count, they will help to confirm that the patient is suffering from mononucleosis. As for the medication, the patient may need antibiotics in case she has any bacterial infections that accompany her conditions (a sore throat and tonsillitis may be caused by such infections). Other than that, the patient will be advised drinking plenty of fluids (water and fruit juices mainly), have a lot of bed rest, and have wholesome and healthy meals.

Moreover, the patient needs to be educated about the impact mononucleosis produced on spleen and thus be asked to avoid engaging in physical activities to prevent the rupturing of spleen.


Bartels, C. M. (2016). Systemic Lupus Erythematosus (SLE). Web.

Mayo Clinic. (2017). Mononucleosis. Web.

NHS. (n.d.). Lyme disease. Web.

Eight Steps Of Effective Parent Participation

Step one is to communicate with parents frequently. It is important to keep the parents of children who are consistently experiencing difficulties informed. If parents are unaware of how their child is performing at school, a proposition of involving the child in special education may be shocking to them, and a conflict between the parents and the teacher may occur.

Even if a conflict is avoided, it may lead to less developed assistance plans like in Amelia’s case, when ineffective communication led to her parents signing the consent forms without being properly informed. In an effective case, the parents were constantly consulted and involved in the intervention program for their child (Salvia, Ysseldyke, & Witmer, 2012).

Step two is to communicate both the child’s strengths and the child’s weaknesses. One of the more common mistakes for educators of children with special needs is to only communicate the difficulties that the child is experiencing at school. Parents need to be aware of the successes of their children to have a comprehensive idea of their condition. In the ineffective communication case, Amelia’s parents were not informed about her achievements at school, and because of that, they made the decision to switch her to special education without trying to assist her, while in the effective case, they were aware of the issue and attempted to help (Salvia et al., 2012).

Step three is to translate assessment information and team communications as needed. While assessment information is often available to the parents, it may be hard to understand if a lot of jargon is used or if the parents’ primary language is not English. In the ineffective case of Amelia, her parents spoke English but were not familiar with the terminology provided to them. The effective version of the case involved trained professionals that clearly described everything the parents needed to know about the situation, which helped make an informed decision (Salvia et al., 2012).

Step four is to be aware of how cultural differences may impact the understanding of assessment information. The culture of the school may not align with the culture of the family, which could lead to misunderstandings and other issues when communicating with parents. This is why a person who is aware of the student’s culture should be present during meetings with the parents. There were no clear cultural differences mentioned in either Amelia’s case, but it is possible that by not considering the possibility that Amelia’s mother might have time to assist her daughter in reading, they missed an intervention opportunity (Salvia et al., 2012).

Step five is to schedule meetings to facilitate parent attendance. In the modern world, it may be difficult to schedule parent meetings due to a variation in their work schedules. This is why it is important to consider each parent’s availability when scheduling them. Sometimes to facilitate it, the school staff might need to meet at a more convenient location for the parents. The school staff may also need to contact the employer of the parent to make sure they would allow the meeting to happen on a specific date.

In the ineffective communication case, Amelia’s father was not able to attend the meeting because of work, so he was not present during the explanation and signing of papers. In the effective communication case, the meeting occurred on a date favorable to both the school and the parents so that they may be fully informed of the situation (Salvia et al., 2012).

Step six is to clearly explain the purpose of any assessment activities, as well as the potential outcomes. Families of the students may not be aware of what assessment procedures are used to make decisions about the students. To guarantee full understanding, it is important to tell the parents about all the assessment processes and procedures that were performed. It could also be useful to inform parents of the meeting’s contents beforehand so that they may plan accordingly.

In the ineffective communication case, Amelia’s parents were told that they don’t have to come to the meeting despite its importance, which left them uninformed. In the effective communication case, her parents were informed about the contents beforehand, and their presence helped implement an early intervention method that showed that Amelia could improve her reading ability (Salvia et al., 2012).

Step seven is to communicate using as little technical language as possible. Similarly to the earlier step about the importance of choosing the right language during the meeting, it is important to avoid technical terms that are often used in educational circles. Since the parents need to clearly understand the situation, all the terms should be understood (Salvia et al., 2012).

Step eight is to maintain a solution-focused orientation an avoid pointing blame. In some cases, issues that the student experience in the past or errors made by educators become issues that prevent the future solution of the problem from taking place. It is important to be informed by past experiences, but they should not prevent viable solutions from taking place. In the ineffective communication case, Amelia’s mother is dismissively told that the child clearly has a learning disability before any interventions were implemented. In the effective communication case, her issues with reading only serve to attempt additional training before more serious measures are undertaken (Salvia et al., 2012).


Salvia, J., Ysseldyke, J., & Witmer, S. (2012). Assessment in special and inclusive education (12th ed.). Boston, MA: Wadsworth Publishing.

Ethical Dilemmas And Religious Beliefs In Healthcare


The modern healthcare environment could be characterized by numerous challenges specialists should face delivering care. The appearance of these problems is preconditioned by the increased complexity of the majority of health issues and patients diverse needs. The scope of nursing practice includes close cooperation between all actors to acquire an improved understanding of every case and select the most appropriate treatment. However, it also means that numerous ethical dilemmas could occur because of radical differences in peoples mentalities, cultures, and worldviews. The unsolved conflict might have a pernicious impact on results by deteriorating care and decreasing the level of trust between a nurse and a patient. In this regard, the primary aim of this paper is to investigate an ethical dilemma that occurred in the real healthcare setting. The comprehensive analysis of this issue will help to understand the causes of conflicts that might be observed in actual practice. Additionally, the work offers ethical principles, barriers, and theories that could be used when solving the dilemmas of this sort.

Clinical Situation

The hospital environment suggests numerous cases that could be used for the investigation as there are multiple patients with different needs and demands. The following clinical situation is used in the paper. A family addresses a local health care unit because of the significant deterioration of their sons state. A patient, an eight-year male Joshua, has leukemia. He is Caucasian. He has a traditional family. Joshua’s parents are Jehovahs Witnesses. At the moment, the state of the patient’s case is critical. He has already experienced chemotherapy and now suffers from its myelosuppressive effects. The level of blood plates and red blood cells is extremely shallow. Additionally, there is a tendency towards the further deterioration of the situation. Radical alterations of Joshuas blood composition might result in fatal consequences and the patients death. For this reason, a blood transfusion is prescribed as emergent treatment. In general, it remains one of the most frequently used approaches to support patients suffering from this disease and restore the level of blood plastids (Hoffman, 2014).

For this reason, donated blood should be transfused to guarantee the improvement of Joshuas state. The application of this method can guarantee the patients recovery (Adams, 2014). However, the ethical dilemma appears. As stated above, Joshuas parents belong to Jehovah’s Witnesses. The given millenarian restorationist Christian denomination strictly prohibits blood transfusions (Hoffman, 2014). That is why parents do not accept the suggested treatment and insist on looking for alternatives. On the contrary, healthcare specialists insist on using the prescribed treatment as the best and the most efficient method. The given ethical dilemma becomes central to the case as it might result in the further deterioration of the situation and the patients death. The case involves the following actors: an oncologist and a nurse who are responsible for the delivery of care, the patient, and his parents. The situation is complicated because of chemotherapy and its effects. Consequently, Joshua dies from anemia.

Ethical Characteristics

The given case demonstrates the critical importance of ethical dilemmas in the healthcare setting. The inability to make a compromise and find the most appropriate solution results in Joshuas death. Regarding the fatal outcomes of the case, the comprehensive investigation of the central ethical characteristics of the dilemma should be performed. First of all, it could be considered a religious issue. There are numerous cases when Jehovah’s Witnesses refuse from medical treatment and blood transfusions because of the nature of their beliefs (“Leukemia in children, “n.d). A significant number of deaths are preconditioned by this fact. For this reason, the problem remains crucial for healthcare. As for the case, the inability of parties to communicate and make a compromise results in the significant deterioration of the patients state.

That is why it could be considered a communication problem complicated by religious issues. Specialists cannot suggest alternatives because of the complexity of the health issue and disease. Moreover, there is another important factor. Joshua is under age which means that he is not able to make decisions on his own. His parents become responsible for his health as they have the right to accept or refuse the proposed treatment. For this reason, caregivers primary task is to persuade the patients parents and attain their informed consent related to the case. However, they fail to do it.

Ethical Principles

Like other ethical dilemmas, the given case includes several moral principles. First of all, health workers acted in respecting patients’ autonomy. It is one of the leading ethical principles that are used in the healthcare setting. Respect for autonomy means that every individual has the right to act as a free agent (Adams, 2014). People can make decisions related to their lives as long as they do not deteriorate other individuals lives. As for the case, the patients parents can manage their health; however, their right to deprive Joshua of the needed health care remains doubtful. They gave him birth and are responsible for him; however, there is another ethical principle stating that peoples lives are priceless and no one is allowed to harm them. This principle is violated. Joshua dies because his parents are not able to abandon their religious beliefs and save their son. They broke one of the main ethical principles and preferred to ignore the existing threat.


Revolving around the case, it is also possible to note several ethical barriers that appear. The nature of the clinical situation presupposes that the patient is not able to make decisions on his own. For this reason, his parents become the main actors who should be persuaded and demonstrated the fundamental role of the blood transfusion. Specialists are not able to communicate with Joshua directly which means that the life of a patient does not depend on his desires and intentions. Second, the parents religious beliefs become another significant barrier that should be eliminated to deliver the needed care. The fact is that there are numerous cases of refusals to accept the required needed care because of the peculiarities of faith (Adams, 2014). This problem is not new to healthcare and is considered one of the main obstacles a specialist faces.

Ethical Theory

Therefore, several ethical theories could be applied to the case. The parents attitude could be described as a categorical imperative. In other words, their moral rules do not admit exceptions. They are not ready to make terms with specialists and let them perform the blood transfusion. However, this approach preconditions crucial results. For this reason, consequentialism could have served as a guide to a better outcome. It states that the correct moral response is preconditioned by consequences (“Treatment & support,” n.d). In other words, only actions that promote the patients recovery and improvement of his state could be considered moral. Using the given ethical theory, specialists should use blood transfusion and improve Joshuas state. The same could also be applied to his parents point of view on the situation. As far as there are no alternatives, the suggested treatment should be accepted.


In general, recalling this case, I should say that I feel regret because of the outcomes. Unfortunately, religious issues have always been a problem for caregivers as it is almost impossible to provide the needed care because of numerous limits. Joshua dies because of his parents inability to understand the nature of the health problem and follow health workers pieces of advice. The given outcome is not surprising regarding the nature of the disease (Griffiths & Danbury, 2015). However, the use of the blood transfusion demonstrates appropriate results if to initiate treatment in time (Griffiths & Danbury, 2015). That is why I am sure that religious issues should be disregarded when delivering care to patients in critical states. It is crucial to save the life of a person and guarantee his/her recovery. This task acquires the top priority, and if people are not able to understand it, their instructions should be ignored.


Altogether, the given paper provides a detailed description of the ethical dilemma that occurred in the healthcare setting. The patients parents are not able to accept the proposed treatment because of their religious beliefs. That is why their son Joshua dies from anemia which develops after the chemotherapy. There are numerous ethical concerns related to the issue. The adherence to the wrong principles preconditions the disastrous final result. For this reason, it is essential to understand the most important aspects of the case to be able to act under these conditions and make the right decisions.


Adams, R. (2014). Prevention of stroke in sickle cell anemia. The Journal of Law, Medicine & Ethics, 42(2), 135-138. Web.

Griffiths, S., & Danbury, C. (2015). Medico-legal issues for intensivists caring for children in a District General Hospital. Journal of the Intensive Care Society, 16(2), 137-141. Web.

Hoffman, A. (2014). Jehovah’s Witness parents’ refusal of blood transfusions: Ethical considerations for psychologists. Journal of Health Psychology, 21(8), 1556-1565. Web.

Leukemia in children. (n.d.). Web.

Treatment & support. (n.d.). Web.

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