ANSWER
Clinical Experience Every Week 6. Overview of Clinical Experience
During my clinical experience this week, I came across a variety of patients, from acute problems to managing chronic diseases. One instance in particular caught our attention: a middle-aged man who presented with exhaustion and dyspnea, necessitating a thorough evaluation and differential diagnosis.
Obstacles and Achievement Obstacles:
Managing the patient’s worry regarding their symptoms while performing a comprehensive evaluation was one of the difficulties I encountered. The potential for a severe ailment such as heart failure worried the patient.
Additionally, it took sensitivity and precise wording to convey the significance of lifestyle modifications and diagnostic tests without overwhelming the patient.
Achievement:
A highlight was effectively establishing a rapport and making sure the patient felt heard. This enhanced their participation in the care plan and enabled me to get a thorough history.
Presentation for Patient Assessment:
Signs and Symptoms (S&S): The patient complained of periodic lightheadedness, slight chest pain, exhaustion, and shortness of breath when exerting themselves. He denied experiencing chills, fever, or noticeable weight loss. He had a history of high blood pressure and high cholesterol.
Vital Signs: BMI: 30, respiratory rate: 18 breaths per minute, heart rate: 88 beats per minute, blood pressure: 148/92 mmHg, and oxygen saturation: 96% on room air.
Physical Examination: A slight systolic murmur was detected by auscultation. Peripheral edoema and jugular vein distension were not present. Bilateral lung noises were audible.
Care Plan:
Diagnostics:
To rule out arrhythmias or ischemia alterations, get an ECG.
Purchase basic laboratory tests, such as a B-type natriuretic peptide (BNP) test, thyroid function tests, a complete blood count (CBC), and a comprehensive metabolic panel (CMP).
Make an appointment for a chest X-ray to check for pulmonary congestion or heart enlargement.
If preliminary findings justify it, consider echocardiography for a more thorough cardiac evaluation.
Administration:
Start a lifestyle counselling programme that emphasises a low-sodium diet, exercise based on the patient’s tolerance, and weight control.
Modify antihypertensive medication to improve blood pressure management.
Follow-up:
In two weeks, schedule a follow-up to discuss the diagnostic findings and modify the treatment plan as necessary.
Congestive heart failure (CHF) is one of the differential diagnoses.
Justification: The presence of a systolic murmur, fatigue, and dyspnea upon exertion are suggestive. Echocardiography and BNP are two further tests that can either confirm or rule out CHF.
Anaemia
Justification: Anaemia may be the cause of fatigue and lightheadedness, particularly in people who have underlying chronic illnesses. Finding anomalies in haemoglobin or hematocrit levels would be aided by a CBC.
CAD, or coronary artery disease:
Justification: Age, hypertension, and hyperlipidemia are important risk factors for the patient. Assessing for ischemia alterations may be aided by stress tests and an ECG.
Intervention for Health Promotion
Lifestyle changes aimed at lowering cardiovascular risk were the focus of health promotion:
Nutrition: Stress the need of eating a heart-healthy diet that is low in salt and saturated fats and high in vegetables, lean protein, and whole grains.
Physical Activity: After being cleared from diagnostic evaluations, gradually introduce aerobic activity, such as walking for 30 minutes most days of the week.
Quitting Smoking: Offer resources and counselling if necessary.
Medication Adherence: Stress the value of taking lipid-lowering and antihypertensive drugs as directed.
Reflection on Learning
The event this week served as a reminder of the value of treating patients holistically. I discovered that:
In order to address patient problems and establish confidence, patient-centered communication and active listening are essential.
Making a list of differential diagnoses aids in methodically excluding possible explanations and guiding the right tests.
Adapting health promotion tactics to each patient’s particular situation enhances long-term results and adherence.
Maintaining empathy and using evidence-based recommendations in patient care can greatly improve patient outcomes for advanced practice nurses.
Support Based on Evidence
The treatment plan complies with the most recent recommendations for controlling hypertension and lowering cardiovascular risk from the American Heart Association (AHA) and the American College of Cardiology (ACC). For example:
To lower cardiovascular risks, the American Heart Association advises lowering blood pressure to less than 130/80 mmHg (Whelton et al., 2018).
The cornerstone of treating people with obesity and hypertension is lifestyle modifications, such as a low-sodium DASH diet and consistent exercise (Lichtenstein et al., 2021).
Citations
Appel, L. J., Vadiveloo, M., Hu, F. B., Allison, M. A., de Jesus, J. M., Appel, A. H., & Van Horn, L. (2021). Dietary recommendations for cardiovascular health improvement in 2021: An American Heart Association scientific statement. e472-e487 in Circulation, 144(23). 10.1161/CIR.0000000000001031 https://doi.org
Wright, J. T., Collins, K. J., Himmelfarb, C. D., Aronow, W. S., Casey, D. E., Whelton, P. K., Carey, R. M., & Wright, J. T. (2018). ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASPC/NMA/PCNA 2017 guideline for the prevention, identification, assessment, and treatment of adult hypertension. e127–e248 in Journal of the American College of Cardiology, 71(19). 10.1016/j.jacc.2017.11.006 https://doi.org
Please let me know if you require any modifications or additional help!
QUESTION
Weekly Clinical Experience 6
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.
Submission Instructions:
- Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources