Weekly Clinical Experience 1
Describe your clinical experience for this week.
- Did you face any challenges, any success? If so, what were they?
- Describe the assessment of a patient, detailing the signs and symptoms (S&S), assessment, plan of care, and at least 3 possible differential diagnosis with rationales.
- Mention the health promotion intervention for this patient.
- What did you learn from this week’s clinical experience that can beneficial for you as an advanced practice nurse?
- Support your plan of care with the current peer-reviewed research guideline.
Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources.
The following nursing essay sample is in APA 7th edition.
Weekly Clinical Experience 1
Student’s Name
Institutional Affiliation
Course Number and Name
Instructor
Due Date
Weekly Clinical Experience 1
This week’s clinical experience was both challenging and insightful. My primary focus was on assessing and managing a 65-year-old female patient who presented with shortness of breath, fatigue, and chest discomfort. These symptoms prompted me to delve deeper into both physical and psychosocial assessments, providing me with hands-on experience in managing complex cases that require attention to both chronic conditions and potential comorbidities.
Challenges Faced:
One of the major challenges I encountered was related to differential diagnosis. The patient’s symptoms were indicative of multiple conditions, making it essential to conduct a thorough assessment to rule out various possible diagnoses. Additionally, communicating effectively with the patient, who was quite anxious about her condition, required me to demonstrate empathy while also ensuring that I obtained accurate information to inform her care.
Successes:
On the other hand, I felt successful in managing the patient’s anxiety by employing therapeutic communication techniques, which helped her feel more comfortable during the assessment. My ability to coordinate with other healthcare professionals, such as respiratory therapists and cardiologists, also improved my understanding of interdisciplinary care.
Patient Assessment:
Signs & Symptoms (S&S):
- Shortness of breath (dyspnea)
- Fatigue
- Chest discomfort
- Mild peripheral edema
- Decreased exercise tolerance
Assessment:
Upon initial assessment, I noted that the patient had a history of hypertension and diabetes, both of which are risk factors for cardiovascular complications. A physical examination revealed bilateral crackles upon auscultation of the lungs, which could indicate fluid overload. Her heart rate was regular, but she exhibited mild tachypnea. The patient reported worsening shortness of breath over the past two weeks, particularly when lying down, which raised concerns about heart failure.
Plan of Care:
The plan of care focused on stabilizing the patient’s respiratory status while evaluating and managing potential underlying causes.
- Diagnostic Tests:
- Chest X-ray to assess for pulmonary congestion or infection.
- Echocardiogram to evaluate heart function and rule out heart failure.
- Blood tests, including BNP (B-type natriuretic peptide), to assess for heart failure.
- Electrolytes and glucose levels to monitor for diabetic complications.
- Interventions:
- Administer diuretics to manage fluid overload.
- Oxygen therapy to improve oxygen saturation.
- Initiate dietary consultation to manage sodium and fluid intake.
- Monitor blood glucose and adjust insulin as necessary to control diabetes.
- Follow-Up:
- Cardiology and endocrinology consultations to manage comorbid conditions.
- Educate the patient on lifestyle modifications, including diet, exercise, and smoking cessation.
Differential Diagnoses:
- Congestive Heart Failure (CHF):
Rationale: The patient’s dyspnea, peripheral edema, and crackles on lung auscultation are classic signs of CHF. Her history of hypertension and diabetes increases her risk for developing heart failure. - Chronic Obstructive Pulmonary Disease (COPD):
Rationale: While the patient did not have a significant history of smoking, the chronic shortness of breath and decreased exercise tolerance could be indicative of COPD. Pulmonary function tests would help confirm or rule out this diagnosis. - Pulmonary Embolism (PE):
Rationale: Given the patient’s symptoms of acute dyspnea and chest discomfort, PE could be a potential diagnosis. Although her clinical presentation was more gradual, ruling out this condition through diagnostic imaging is essential due to its life-threatening nature.
Health Promotion Interventions:
For this patient, the health promotion interventions include educating her about lifestyle changes to manage her chronic conditions and prevent complications. This includes:
- Dietary Management: A low-sodium diet to prevent fluid retention and control blood pressure, alongside proper diabetes management through a balanced diet.
- Exercise: Encouraging low-impact exercises such as walking to improve cardiovascular health while considering her exercise tolerance.
- Smoking Cessation (if applicable): As smoking can exacerbate both cardiovascular and pulmonary issues, advising the patient to avoid tobacco use.
Learning Reflection:
This week’s experience reinforced the importance of a holistic approach in patient assessment, particularly for patients with multiple chronic conditions. As an advanced practice nurse, I learned the critical role that differential diagnosis plays in guiding appropriate care plans. I also realized the importance of educating patients on lifestyle interventions that support long-term health, which aligns with the principles of preventive medicine.
Supporting Research:
Heart failure management guidelines recommend a multidisciplinary approach, including medication, lifestyle modifications, and patient education, which can significantly improve outcomes (McDonagh et al., 2021). Research also emphasizes the role of patient self-management in reducing hospital readmissions for heart failure patients (Jaarsma et al., 2021).
In conclusion, this clinical experience has strengthened my assessment skills, improved my ability to manage complex cases, and emphasized the need for continuous learning, especially regarding evidence-based practice in managing chronic conditions like heart failure.
References:
Jaarsma, T., Hill, L., Bayes-Genis, A., et al. (2021). Self-care of heart failure patients. European Journal of Heart Failure, 23(2), 178-198.
McDonagh, T. A., Metra, M., Adamo, M., et al. (2021). 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. European Heart Journal, 42(36), 3599-3726.