ANSWER
This Week’s Clinical Experience Reflection
Overview of Clinical Experience
The clinical experience for this week entailed caring for a wide range of individuals with different medical issues. One noteworthy instance was a 45-year-old woman who complained of periodic chest pain, shortness of breath, and exhaustion. I was able to improve my diagnostic abilities and use evidence-based practice in patient care because of this instance.
Obstacles and Achievements
The inability to differentiate between cardiac and non-cardiac causes of chest pain is one of the challenges.
coordinating treatment with the cardiology team as a result of diagnostic test scheduling delays.
Achievements: To rule out life-threatening diseases, the patient’s symptoms were successfully recognized and prioritized.
built a solid therapeutic alliance with the patient by attending to her worries and anxiety around her symptoms.
Subjective Data from the Patient Assessment:
“I feel exhausted all the time and occasionally have chest pain,” is the Chief Complaint (CC).
Present Illness History (HPI):
Onset: Three weeks ago, symptoms began to appear.
Location: The middle region of the chest is the site of chest discomfort.
Quality: described as being heavy and tight.
Mild to moderate (5/10 on the pain scale) is the severity.
Timing: sporadic, lasting 10 to 15 minutes, usually following physical activity.
Modifying Factors: Rest helps to alleviate symptoms.
Breathlessness, exhaustion, and sporadic palpitations are associated symptoms.
Objective Information:
Vital signs: BMI 28; SpO2 96%; RR 20; HR 92 bpm; BP 138/84 mmHg.
Physical Examination:
Heart: No gallops or murmurs, regular beat.
Lungs: Both sides are clear.
Extremities: No cyanosis or edema.
Abdomen: Organomegaly absent, soft, and non-tender.
Labs:
Troponin: Typical.
LDL was elevated at 150 mg/dL in the lipid panel.
110 mg/dL of glucose when fasting.
ECG: No ischemia alterations, normal sinus rhythm.
Assessment of the Plan of Care: The symptoms of the patient point to stable angina, which is most likely caused by coronary artery disease (CAD). On the other hand, additional possible disorders like anxiety or GERD must be taken into account.
Differential Diagnosis:
The rationale behind stable angina is that its symptoms are exertional, alleviated by rest, and linked to risk factors including high LDL cholesterol and being overweight.
Reasons for Anxiety Disorder: Particularly in people who have had stressful life events or have elevated anxiety levels, palpitations and chest tightness might resemble cardiac symptoms.
GERD: Justification: Esophageal irritation may be the cause of chest pain, especially if it is made worse by eating or sleeping.
Plan of Management:
Laboratory and Diagnostic Testing: To assess heart function, order echocardiography and stress testing.
If GERD symptoms continue, have an upper GI endoscopy performed.
Pharmacological Intervention:
Give 81 mg of aspirin per day as a low-dose prescription to avoid cardiovascular disease.
Start taking 10 mg of atorvastatin per day to treat high LDL.
If GERD is suspected, think about trying ranitidine or a proton pump inhibitor (PPI).
Non-Medical Intervention:
Encourage dietary changes (low-fat diet, stay away from trigger foods).
Promote moderate activity for 30 minutes each day, based on tolerance.
Predictive Advice:
Teach the patient to seek medical attention right away if their symptoms increase (such as persistent chest discomfort or dyspnea).
Plan of Follow-Up:
Set up a follow-up appointment in two weeks to go over test findings and reevaluate symptoms.
Intervention for Health Promotion
The patient received lifestyle advice on how to control CAD risk factors:
Diet: Focus on a Mediterranean diet that is high in lean proteins, whole grains, fruits, and vegetables.
Exercise: Increasing physical activity gradually while maintaining safety and comfort.
Smoking Cessation: If necessary, cessation resources were supplied.
Stress management: Suggested mindfulness exercises or, in the event that anxiety continues, a therapy referral.
Knowledge Acquired
The clinical experience this week made clear how crucial it is to assess patients with complex symptoms using a comprehensive approach. Important lessons learned include:
Getting a thorough history is essential for distinguishing between similar clinical presentations.
the importance of following clinical recommendations for cardiovascular risk management, such as those made by the American Heart Association.
the necessity of open communication with patients in order to foster confidence and guarantee that the treatment plan is followed.
Support Based on Evidence
(2019) American Heart Association. Clinical recommendations for the primary prevention of cardiovascular disease. e596–e646 in Circulation, 140(11). 10.1161/CIR.0000000000000678 https://doi.org
Berry, C., and T. J. Ford (2020). The pathophysiology, advancements in diagnosis, and need for treatment of stable coronary syndromes. 106(7), 468–477; Heart. 10.1136/heartjnl-2019-315669 https://doi.org
In 2021, Patel, H. J., and Patel, H. J. Distinguishing between cardiac and non-cardiac chest pain disorders. Internal Medicine Journal, 289(3), 363-374. Joim.13234 https://doi.org/10.1111
Managing complicated patient presentations, incorporating evidence-based care, and targeting modifiable risk factors to stop the progression of the disease were all made easier by this example.
QUESTION
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.