AMAIZING OFFER GET 25% OFF YOUR FIRST ORDER CODE FIRST25
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 possible differential diagnosis.
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.
PLEASE RESPOND TO THESE TWO STUDENTS DISCUSSION WITH 2 REFERENCES FOR EACH RESPONSE:
Submission Instructions: You should respond to at least two of your peers by extending, refuting/correcting, or adding additional nuance to their posts, all replies must be constructive and include at least two references, and formatted and cited in current APA style with support from at least 2 academic sources.
1) Emile, Jean – The clinical aspect of nursing is not new to me. However, going to my first day of clinical rotation was not without anxiety. I knew perfectly what to expect but the unfamiliar environment has made me somewhat perplex. When I started to see patients, my nervousness evaporated and my clinical thinking quickly surfaced.
I did not feel challenged; I knew my weaknesses and strength. However, I must assume that my challenges are yet to come. My preceptor has made easy for me to start by pre- establishing the rules and regulations of the office. She also has elaborated on how she conducts her rotations and made her expectations known. In term of success, I was able to come up with a few diagnoses along with my preceptors as we were seeing patients. by example, I could recall having detected a subtle intercostal retraction from one of the patients who has been previously diagnosed with bronchiolitis. The case has caught my attention because the parents were antivaccine. As a result, baby has not received any vaccine yet. It was a 2-month-old boy that was brought to the office 2 weeks earlier with a 2-day history of fever of 38.3 (100.9 F) and difficulty breathing, mild cough and occasional vomiting. His mother reported that he also had poor appetite and clear nasal discharge. He has no sibling, an unremarkable birth history and has no past medical history. During visit, the baby was seen active with no apparent sign of distress. His pulse was 140/min, respiratory 56 /min, and temperature 37.0(98.6F).
Physical examination showed a calm baby with supple neck, mild bilateral wheezing and subtle subcostal retractions, normal heart rate and Rhythm with no murmur, benign abdomen, no cyanosis and good perfusion in the extremities, and clear skin with no rashes. The patient was placed on beta2 agonist treatment q 4 hours, aerosol hypertonic saline and Pedialyte for rehydration. The parents were instructed to take the baby to the emergency room if cyanosis developed and respiratory distressed worsened. But as per the parents, baby was doing better and his appetite has improved considerably. As diagnostic differential I could think of asthma and bacterial pneumonia due to the associated bilateral expiratory wheezing, fever, and cough, respectively.
I have seen, observed, participated in the assessment of at least 8 patients for my first clinical day. It was very productive and I was able to acquire a great deal of medical knowledge. What I learned about this case was although the baby was in respiratory distress, hospitalization was not standard in mild cases of bronchiolitis and depends on the severity. If the patient is not hypoxemic and immunocompromised, the treatment is supportive and symptomatic in nature (Ricci, V. et al., 2015).
According to Burns, (2017) Bronchiolitis is a common lung infection in young children and infants. It causes inflammation and congestion in the small airways (bronchioles) of the lung. Bronchiolitis is almost always caused by a virus. Typically, the peak time for bronchiolitis is during the winter months. Bronchiolitis starts out with symptoms like those of a common cold but then progresses to coughing, wheezing and sometimes difficulty breathing. The course of the illness could have been prevented with the intramuscular administration of Palivizumab at 1 month of age during respiratory syncytial virus season. Palivizumab is a monoclonal antibody against RSV glycoprotein. It has been proven effective in the prevention against the RSV especially when contact precaution is implemented (Arcangelo, P. et al., 2016).
2) Cornet, Natasha – It was a very effective first clinical week and I have a wonderful preceptor who truly enjoys teaching. She is very thorough and a great health care provider. I am excited to see what this rotation has in store for me. G.P is a 15 year old girl accompanied by her mother presented with fever, cough, chills and fatigue. She has history of juvenile diabetes and family history of hypertension (HTN) and diabetes. Patient was suspected to have the flu. Patient assessment is a critical aspect of nursing practice essential for planning and providing patient and family-centered care. Influenza is a viral infection that attacks your respiratory system your nose, throat and lungs. At first, the flu may seem like a common cold with a runny nose, sneezing and sore throat. But colds usually develop slowly, whereas the flu tends to come on suddenly. Common signs and symptoms of the flu include: fever, aching muscles, chills and sweats, headache, dry, persistent cough, shortness of breath, tiredness and weakness, runny or stuffy nose, sore throat, eye pain, vomiting and diarrhea, but this is more common in children than adults. Emergency signs and symptoms in children can include: difficulty breathing, blue lips, chest pain, dehydration, severe muscle pain, seizures, worsening of existing medical conditions. The assessment has been perfectly executed, providing an on-site experience applicable in the future or advanced nursing practice. The assessment has prepared me for the future and complex tasks/setting through observations and interviews. Therefore, this week’s assessment provides me a concrete foundation to achieve successful and impactful outcomes.
This represents a clinical examination to establish the patient’s problem. The most common clinical assessments include diagnostic tests, comprehensive vs. problem-focused histories, differential diagnoses, and screening (Barkley, 2021). A flu swab was performed and patient was positive for influenza A. A prescription was given for tamiflu and was instructed to rest and drink plenty of fluids. How to Treat Flu Symptoms: in most cases, the best things to do when you have the flu are: rest at home, drink plenty of fluids, and avoid contact with other people. The Centers for Disease Control and Prevention (CDC) recommends annual flu vaccination for everyone age 6 months or older. The flu vaccine can reduce your risk of the flu and its severity and lower the risk of having serious illness from the flu and needing to stay in the hospital. Flu vaccination is especially important this season because the flu and coronavirus disease 2019 (COVID-19) cause similar symptoms. Flu vaccination could reduce symptoms that might be confused with those caused by COVID-19. Preventing the flu and reducing the severity of flu illness and hospitalizations could also lessen the number of people needing to stay in the hospital. Each year’s seasonal flu vaccine provides protection from the three or four influenza viruses that are expected to be the most common during that year’s flu season. The possible differential diagnosis for flu (influenza) includes: pneumonia, bronchitis, asthma flare-ups, ear infections, acute respiratory distress syndrome. Educating the vital and warning signs and establishing a clinical follow up are essential monitoring strategies. Evaluating out comes and assessing the needs aftercare is essential for preventing tertiary infection or a relapse (Barkley, 2021.
This week’s clinical experience provides me with a more substantial foundation to further expand my capacity for advanced nursing practice. Focusing on holistic and evidence based research care have significant experiences that I seek to utilize in my advanced practice career. Thus, I have learned caring entails incorporating the mind, body, and the spirit for a positive outcome. Therefore, examining a client from diverse approaches is critical for a collaborative care.