A nurse is caring for a client who is dying of metastatic breast cancer. She has a prescription for an opioid pain medication PRN. The nurse is concerned that administering a dose of pain medication might hasten the client's death. Which of the following ethical principles should the nurse use to support the decision not to administer the medication?

Inspection:This is the first step because it allows the nurse to gather information through observation without causing any discomfort to the child. It involves looking at the child's abdomen for any visible abnormalities like distension, asymmetry, masses, or discoloration.

Auscultation:After inspection, the nurse listens to the bowel sounds using a stethoscope. This helps assess peristalsis (movement of food through the intestines) and identify potential problems like bowel obstruction or decreased motility.

Superficial Palpation:This gentle palpation helps assess muscle tone, tenderness, and masses. It's performed after auscultation to avoid altering bowel sounds. Since children are often apprehensive about abdominal exams, starting with a gentler touch can help them feel more comfortable.

Deep Palpation (if necessary):Deep palpation is reserved for last as it can be more uncomfortable for the child. It's used to assess for organomegaly (enlarged organs) or masses that may not be palpable with superficial palpation. It's only performed if there are indications from the first three steps.

Here's a breakdown of why this order is important:

Minimize Discomfort:Starting with non-invasive methods like inspection and auscultation helps establish trust and reduces anxiety in the child, making the overall assessment more cooperative.

Maintain Baseline Bowel Sounds:Palpation can alter bowel sounds, so it's important to listen to them first to get an accurate baseline.

Gradual Progression:Moving from gentle to deeper palpation allows the child to adjust to the sensation and helps the nurse identify potential areas of tenderness before applying deeper pressure.

A. At the beginning: Examining the tympanic membrane at the beginning of the physical examination may not be ideal because it disrupts the flow of the assessment. It's more logical to start with general observations and proceed to more specific areas of assessment.
B. Before auscultating the chest and abdomen: While examining the tympanic membrane before auscultating the chest and abdomen may seem reasonable, it's not the optimal sequence. The nurse should focus on assessing major body systems before proceeding to more specific areas, such as the ears.
C. At the end: This is the correct approach. After completing the assessment of major body systems, such as the cardiovascular, respiratory, and abdominal systems, the nurse can then proceed to examine the ears, including the tympanic membrane. This sequence ensures a systematic and organized assessment.
D. Before examining the head and neck: While examining the tympanic membrane before the head and neck may seem logical due to proximity, it's more practical to conduct a comprehensive head-to-toe assessment first before focusing on specific areas like the ears.