Testicular Cancer Case Studies A 21-year-old male noted pain in his right testicle while studying hard for his midterm college examinations. On self-examination, he noted a “grape sized” mass in the right testicle. This finding was corroborated by his healthcare provider. This young man had a history of delayed descent of his right testicle until the age of 1 year old. Studies Results Routine laboratory studies Within normal limits (WNL) Ultrasound the testicle Solid mass, right testicle associated with calcifications HCG (human chorionic gonadotropin) 550mIU/mL (normal: <5) CT scan of the abdomen Enlarged retroperitoneal lymph nodes CT scan of the chest Multiple pulmonary nodules Diagnostic Analysis At semester break, this young man underwent right orchiectomy. Pathology was compatible with embryonal cell carcinoma. CT directed biopsy of the most prominent pulmonary nodule indicated embryonal cell carcinoma, compatible with metastatic testicular carcinoma. During a leave of absence from college, and after banking his sperm, this young man underwent aggressive chemotherapy. Repeat testing 12 weeks after chemotherapy showed complete resolution of the pulmonary nodules and enlarged retroperitoneal lymph nodes. Critical Thinking Questions 1. What impact did an undescended testicle have on this young man’s risk for developing testicular cancer? 2. What might be the side effects of cytotoxic chemotherapy? 3. What was the purpose of preserving his sperm before chemotherapy? 4. Is this young man’s age typical for the development of testicular carcinoma? 

Formulate one new comment of your own. It must be a logical and thoughtful response that synthesizes the comments of at least 3 classmates into one comment. Be sure to synthesize; do not simply reply to each of the 3 classmates.

1. Gatekeepers are primary care physicians.  They serve as the first contact in healthcare, so they can control utilization. (Module- 2 Home Managed Care, 2019).  If patients were able to self-refer for expensive exams, it would be chaotic.  Not to mention the expense for both the patient and insurance companies.  There are steps when ordering diagnostic testing for patients.  For example, breast imaging starts with an X-Ray (mammogram). If the radiologist sees something that requires further testing, he/she will order an ultrasound, and then a biopsy.  If a patient went straight for the biopsy they don’t need, they’d be putting themselves through unnecessary trauma and costs.  Some insurance companies will not cover expensive imaging without documentation that the proper steps were taken. Medicaid won’t cover a PET/CT scan if there is not a cancer diagnosis.  I worked at a PET/CT imaging center. We had to have documentation and prior imaging results before submitting the patient’s packet for Medicaid approval.  It’s an expensive exam and insurance companies do not want to pay for something they don’t have to. We had patients pay out of pocket because they thought for sure something was wrong with them that their doctor could not find. Even then, they still need a doctor’s order before they can get a nuclear med imaging test. 

2. The gatekeeper approach is exactly what patients need. Reminder, that the patients must come first, and must be respected within the healthcare process. The most important thing to keep in mind as healthcare professionals, is that if they’re going to take care of the patients, they must abide with the core ethical principles such as beneficence, nonmaleficence, autonomy, and justice (Flite, Harman, 2013). One that pops the most is beneficence, which is defined as “providing benefits and balancing benefits and risks/harm” (Chiropr, 2011). The care should start with the general practitioner or primary care providers, where their roles are to “collaborate with other healthcare providers, such as other specialists and therapists, to ensure the patient has all of their needs met” (Fritzel, 2019). In addition, they must educate patients and have an oversight of their entire healthcare needs. This not only provides the needs of the patients, but benefits them by avoiding unnecessary cost and harm to the patients who decide to take matters into their own hands.  

3.   As a Primary Care Provider (PCP) they have been given the title of gatekeeper. This means they delegate the path a patient must take to return them to a healthier state if capable. I do believe that the gatekeeper system has achieved its purpose. The gatekeepers can have positive attributes. For example, children have been known to see their pediatrician for 15 years before they age out. So a well established rapport is built and the physician has an understanding of what treatments work whether that be holistic, conventional medicine, or alternative medicine for the patient. Unlike an adult in certain medical systems may see several PCP’s within a timeframe due to the shortage of physicians. Meaning, your PCP has become unavailable for whatever reason, so another physician must cover down on the patient load. Weinstein (2001) commented, “Physicians, each acting in the best interests of their own patients, collectively reach the limits of health care resources, with the result that access to care and quality of care are compromised” (p. 268).  Where the negative aspect comes into play as a gatekeeper would be going to the dentist and finding a mass in the annual panorama x-ray. The patient must go though the gatekeeper in order to be seen by an ENT physician which prolongs their treatment. This example seems very minuet, but take for instance a single mom, the finances, time off work, and dragging kids along just to get the gatekeeper to write the consult for ENT. This becomes an extra hurdle just to achieve the end result.  

PICOT Question and Literature Search

The first step of the evidence-based practice process is to evaluate a nursing practice environment to identify a nursing problem in the clinical area. When a nursing problem is discovered, the nurse researcher develops a clinical guiding question to address that nursing practice problem.

For this assignment, you will create a clinical guiding question know as a PICOT question. The PICOT question must be relevant to a nursing practice problem. To support your PICOT question, identify six supporting peer-revised research articles, as indicated below. The PICOT question and six peer-reviewed research articles you choose will be utilized for subsequent assignments.

Use the “Literature Evaluation Table” to complete this assignment.

1. Select a nursing practice problem of interest to use as the focus of your research. Start with the patient population and identify a clinical problem or issue that arises from the patient population. In 200–250 words, provide a summary of the clinical issue.
2. Following the PICOT format, write a PICOT question in your selected nursing practice problem area of interest. The PICOT question should be applicable to your proposed capstone project (the project students must complete during their final course in the RN-BSN program of study).
3. The PICOT question will provide a framework for your capstone project.
4. Conduct a literature search to locate six research articles focused on your selected nursing practice problem of interest. This literature search should include three quantitative and three qualitative peer-reviewed research articles to support your nursing practice problem.

Note: To assist in your search, remove the words qualitative and quantitative and include words that narrow or broaden your main topic. For example: Search for diabetes and pediatric and dialysis. To determine what research design was used in the articles the search produced, review the abstract and the methods section of the article. The author will provide a description of data collection using qualitative or quantitative methods. Systematic Reviews, Literature Reviews, and Metanalysis articles are good resources and provide a strong level of evidence but are not considered primary research articles.  Therefore, they should not be included in this assignment.

While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting guidelines, which can be found in the APA Style Guide, located in the Student Success Center. 

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are not required to submit this assignment to LopesWrite.

PICOT Question and Literature Search

The first step of the evidence-based practice process is to evaluate a nursing practice environment to identify a nursing problem in the clinical area. When a nursing problem is discovered, the nurse researcher develops a clinical guiding question to address that nursing practice problem.

For this assignment, you will create a clinical guiding question know as a PICOT question. The PICOT question must be relevant to a nursing practice problem. To support your PICOT question, identify six supporting peer-revised research articles, as indicated below. The PICOT question and six peer-reviewed research articles you choose will be utilized for subsequent assignments.

Use the “Literature Evaluation Table” to complete this assignment.

1. Select a nursing practice problem of interest to use as the focus of your research. Start with the patient population and identify a clinical problem or issue that arises from the patient population. In 200–250 words, provide a summary of the clinical issue.
2. Following the PICOT format, write a PICOT question in your selected nursing practice problem area of interest. The PICOT question should be applicable to your proposed capstone project (the project students must complete during their final course in the RN-BSN program of study).
3. The PICOT question will provide a framework for your capstone project.
4. Conduct a literature search to locate six research articles focused on your selected nursing practice problem of interest. This literature search should include three quantitative and three qualitative peer-reviewed research articles to support your nursing practice problem.

Note: To assist in your search, remove the words qualitative and quantitative and include words that narrow or broaden your main topic. For example: Search for diabetes and pediatric and dialysis. To determine what research design was used in the articles the search produced, review the abstract and the methods section of the article. The author will provide a description of data collection using qualitative or quantitative methods. Systematic Reviews, Literature Reviews, and Metanalysis articles are good resources and provide a strong level of evidence but are not considered primary research articles.  Therefore, they should not be included in this assignment.

While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting guidelines, which can be found in the APA Style Guide, located in the Student Success Center. 

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are not required to submit this assignment to LopesWrite.