ANSWER
- Reflection on the Clinical Experience: Week Synopsis
The clinical experience this week included a wide variety of patient contacts, but one in particular stood out: a 56-year-old man who complained of chest pain and shortness of breath. In order to address patient-centered care issues and create a thorough assessment and management plan, I was able to use critical thinking and evidence-based methods in this situation.
Obstacles and Achievements
Challenges: Because of the patient’s low level of health literacy, getting an accurate history was the main obstacle. He had trouble comprehending medical jargon and providing a detailed explanation of his symptoms. Anxiety symptoms were also present, which made it more difficult to diagnose chest pain and distinguish between possible cardiac and non-cardiac causes.
Achievements: Building a trustworthy rapport with the patient by actively listening to them and demythologizing medical terms was a major accomplishment. His anxiousness was reduced by employing sympathetic communication strategies, which made it possible to comprehend his sensations more clearly. This enabled the patient to actively participate in the creation of his care plan and enhanced the quality of the assessment.
Signs and Symptoms (S&S) of Patient Assessment:
The patient complained of sporadic tightness in the chest that got worse with activity and got better with rest. He denied experiencing nausea, diaphoresis, or pain radiating, however he did describe experiencing minor dyspnea when exercising. He smoked for more than 20 years before quitting five years ago, and he had a history of hypertension. There was no discernible family history of cardiovascular illness.
Objective Results:
Vital Signs: SpO₂: 96%, RR: 20 breaths per minute, HR: 88 bpm, BP: 145/92 mmHg, and temperature: 98.4°F.
Physical examination: No peripheral edoema, no jugular vein distention, and normal cardiac and pulmonary auscultation.
Nonspecific T-wave abnormalities on the electrocardiogram (ECG) prompted additional testing.
Care Plan:
Diagnostics:
Troponin levels and a chest X-ray were ordered in order to rule out pulmonary disorders and myocardial infarction.
recommended for an echocardiography and stress test to assess heart function and detect ischemia.
Drugs:
prescribed sublingual nitroglycerin for discomfort in the chest as needed.
started taking 40 mg of atorvastatin every night to control cardiovascular risk.
Changes in Lifestyle:
given advice on quitting smoking, maintaining a heart-healthy diet, and engaging in regular, moderate exercise.
Follow-up:
A follow-up appointment has been set for one week from now to evaluate test findings and, if required, adjust treatment.
Differential Diagnosis:
The diagnosis of stable angina is most likely based on exertional chest tightness that is eased by rest and is consistent with coronary artery disease (CAD)-related myocardial ischemia.
Though less likely given the lack of common reflux symptoms like heartburn, gastroesophageal reflux disease (GERD) is nevertheless taken into consideration because of the overlap of symptoms.
Because there is no palpable soreness or aggravation, costochondritis is ruled out as a possible cause of chest discomfort.
Intervention for Health Promotion
Promoting health with an emphasis on lowering cardiovascular risk factors:
provided the patient with information about quitting smoking, with a focus on tools like nicotine replacement treatment and counselling.
discussed dietary adjustments, including as consuming more fruits, vegetables, and whole grains and lowering sodium and saturated fats.
promoted at least 150 minutes a week of moderate aerobic exercise, such as walking, as advised by the American Heart Association (AHA).
Important Things to Know as an Advanced Practice Nurse
The event this week made clear how crucial it is to combine evidence-based practices with patient-centered care. I discovered how important it is to modify communication tactics according to the patient’s comprehension level, as this is essential for encouraging treatment plan adherence. My understanding of cardiovascular disease management and the significance of early risk factor identification and intervention to avoid complications has also increased.
Evidence-Based Justification for the Care Plan
The management strategy is in line with the American College of Cardiology’s and the American Heart Association’s most recent guidelines, which suggest lifestyle changes and statin medicine as the main strategies for lowering cardiovascular risk (Arnett et al., 2019). Diagnostic procedures like stress testing are common for assessing suspected ischemic heart disease, and sublingual nitroglycerin is the first-line treatment for acute angina relief (Knuuti et al., 2020).
In conclusion
The importance of advanced practice nurses in identifying and treating complicated medical diseases like stable angina was reaffirmed by this clinical experience. I was able to provide complete care and enable the patient to actively participate in enhancing his health outcomes by fusing clinical expertise, patient education, and evidence-based recommendations.
Citations
& Ziaeian, B. (2019). Arnett, D. K., Blumenthal, R. S., Albert, M. A., Buroker, A. B., Goldberger, Z. D., Hahn, E. J.,…” Executive summary of the 2019 ACC/AHA guideline on the primary prevention of cardiovascular disease. American College of Cardiology Journal, 74(10), 1376–1414. 10.1016/j.jacc.2019.03.009 https://doi.org
Saraste, A., Capodanno, D., Barbato, E., Funck-Brentano, C., Knuuti, J., Wijns, W., & Bax, J. J. (2020). 2019 ESC guidelines for chronic coronary syndrome diagnosis and treatment. Journal of European Heart, 41(3), 407-477. 10.1093/eurheartj/ehz425 https://doi.org
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.
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. Your initial post is worth 8 points.