This week, I had an interesting clinical experience with an 86-year-old patient who was admitted to the hospital
Weekly Clinical Experience 6
This week, I had an interesting clinical experience with an 86-year-old patient who was admitted to the hospital with complaints of shortness of breath and chest pain. One of the challenges was managing the patient’s chronic medical conditions, such as hypertension and diabetes, while treating the acute pneumonia. This required careful consideration of medication interactions and potential side effects. Another challenge was addressing the patient’s concerns and fears about their illness and hospitalization, as this can significantly impact their overall recovery. However, a success during this clinical experience was the timely and accurate diagnosis of pneumonia, which allowed for prompt initiation of appropriate treatment, ultimately leading to the patient’s successful recovery. Additionally, implementing a health promotion intervention during the patient’s hospitalization provided an opportunity to address the patient’s overall health and well-being, which can lead to improved outcomes and reduced readmissions.
The patient had a history of hypertension, hyperlipidemia, and type 2 diabetes. The assessment of the patient revealed that the patient was in distress, with labored breathing and chest pain. The patient’s vital signs were within normal limits except for a slightly elevated blood pressure of 145/80 mmHg. The patient also had a low-grade fever of 99.8°F. A physical examination revealed wheezing in the lungs, decreased breath sounds, and a gallop rhythm in the heart.
Based on the patient’s signs and symptoms, the differential diagnosis included acute exacerbation of chronic obstructive pulmonary disease (COPD), pneumonia, and congestive heart failure (CHF). The plan of care included ordering a chest X-ray, arterial blood gas analysis, and laboratory studies to assess the patient’s cardiac and pulmonary functions. Additionally, a 12-lead electrocardiogram was ordered to assess for any signs of cardiac ischemia (Dzikowicz, 2020).
The laboratory studies showed an elevated white blood cell count, which indicated the presence of infection, and the chest X-ray showed infiltrates in the lungs, which suggested pneumonia. Based on these findings, the patient was diagnosed with pneumonia, and the plan of care included starting the patient on antibiotics, supplemental oxygen therapy, and nebulizer treatments.
In addition to treating the patient’s current illness, a health promotion intervention was also implemented. The patient was educated about the importance of regular exercise, maintaining a healthy diet, and getting vaccinated against pneumococcal and influenza viruses. The patient was also advised to quit smoking and limit alcohol intake, which can exacerbate chronic conditions such as hypertension and diabetes (Mohammadnezhadostad etal., 2023). As an advanced practice nurse, this clinical experience taught me the importance of accurate and timely assessment in identifying a patient’s underlying condition. It also highlighted the significance of interdisciplinary collaboration in providing the best care possible for the patient.
Current guidelines recommend the use of clinical decision rules, such as the Pneumonia Severity Index (PSI) or the CURB-65 score, to help guide treatment decisions in patients with community-acquired pneumonia. These tools can help assess the severity of illness and risk of mortality, and aid in determining the need for hospitalization or intensive care. Additionally, evidence-based guidelines recommend the use of appropriate antibiotics based on the specific microorganism responsible for the infection (Alejandro et al., 2022), as well as non-pharmacologic interventions such as smoking cessation and vaccination to prevent future exacerbations.
In conclusion, this week’s clinical experience with an 86-year-old patient provided an opportunity for me to apply my knowledge and skills in assessing and managing a patient with acute respiratory distress. The patient’s condition was successfully treated, and a health promotion intervention was implemented to prevent future exacerbations. This experience reinforced the importance of ongoing education and collaboration with other healthcare professionals to provide the best care possible for our patients.
References
Alejandro, A. L., Leo, W. W. C., & Bruce, M. (2022). Opportunities to Improve Awareness of Antimicrobial Resistance Through Social Marketing: A Systematic Review of Interventions Targeting Parents and Children. Health Communication, 1-17.
Dzikowicz, D. J. (2020). Low voltage on the 12-lead ECG: A warning sign. The Nurse Practitioner, 45(9), 33-40.
Mohammadnezhadostad, F., Shojaei, D., & Ghazipoor, H. (2023). Investigation Of Nursing And Medical Services In Patients With Diabetes, Abdominal Pain And High Blood Pressure. Journal of Pharmaceutical Negative Results, 14(2).
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Clinical Experience Six
This week was a great success as I was able to help a patient discover complementary and alternative medicine strategies to aid in managing their chronic pain. Tailoring care to meet each patient’s individualized needs is imperative and will enhance compliance and overall satisfaction. It was a rewarding week with little challenges faced.
Patient Assessment
A 66-year-old male presents complaining of difficulty with urination, suprapubic pain, dribbling, and difficulty making It to the bathroom onset one week ago. He reports frequency and urgency and rates his pain a 3/10. He states his symptoms are persistent and denies any exacerbating or relieving factors. He denies current treatment, hematuria, dysuria, fever, chills, or other symptoms. Physical examination reveals: no abdominal distention or tenderness. Prostate exam: prostate feels enlarged and is tender to palpation. A urinalysis was completed and revealed: leukocytes: 500 WBCs/uL; Nitrates: negative; Protein: 10 mg/dL; Blood: 50 RBC/uL.
The differential diagnosis for this patient includes prostatitis, urinary tract infection, and prostate cancer. Prostatitis is inflammation of the prostate gland. Bacterial infections can cause this; however, not all cases. The signs and symptoms of prostatitis can vary depending on the type of disorder. They can include dysuria, difficulty urinating (e.g., dribbling), frequency, urgency, hematuria, groin or abdominal pain, fever, painful ejaculation, and others (Almugbel et al., 2018). Prostatitis has similar symptoms to a urinary tract infection and includes urgency, pain with urination, and frequency. Prostate cancer is one of the most common cancers among men. Detected early and confined to the prostate gland has the best prognosis. Prostate cancer may have no signs or symptoms in its early stage, but as it advances can cause symptoms such as difficulty urinating, blood in the urine, decreased force in the urine stream, bone pain, weight loss, erectile dysfunction, and others (Sekhoacha et al., 2022).
A prostate-specific antigen (PSA) test was ordered. Due to possible prostatitis, the patient was instructed to take Ciprofloxacin 500 milligram tablets. He was instructed to take one tablet orally every 12 hours for 14 days. Additionally, he was instructed to start Flomax 0.4 milligram tablets. Take one tablet orally once a day. The patient denied any concern for sexually transmitted infection. Instructed was given to drink plenty of fluids and avoid activities that place pressure on the prostates (e.g., bicycling) and limit caffeine, alcohol, and spicy food consumption (Almugbel et al., 2018).
Health Promotion
Proper weight management and regular daily exercise are ways to promote prostate health. Several studies show that moderate to vigorous exercise reduces the risk of urinary symptoms and benign prostate hyperplasia and helps with prostatitis (Galvão & Chambers, 2021).
Clinical Experience
This week’s clinical experience emphasized the importance of patient engagement. Patient engagement in care is a priority and vital to quality and safe care. According to Clavel et al. (2021), engaging patients helps to shape their care and treatment in ways that fit their individualized preferences and needs, resulting in improved health outcomes. Various approaches to care are utilized in clinical practice to foster patient engagement integration into their care, including the patient-centered care model, shared decision-making, and the partnership in care method (Clavel et al., 2021). All these approaches are part of a continuum of engagement and reflect the patient’s vital role in their care.
References
Almugbel, S., Alanezi, F., Alhoshan, F., Alkhalifa, R. O., Alkhzaim, A. H., & Almohideb, M. (2018). Classification and treatment of prostatitis: A review of literature. International Journal of Community Medicine and Public Health, 5(11), 494. https://doi.org/10.18203/2394-6040.ijcmph20184247
Clavel, N., Paquette, J., Dumez, V., Del Grande, C., Ghadiri, D. P., Pomey, M., & Normandin, L. (2021). Patient engagement in care: A scoping review of recently validated tools assessing patients’ and healthcare professionals’ preferences and experience. Health Expectations, 24(6), 1924–1935. https://doi.org/10.1111/hex.13344
Galvão, D. A., & Chambers, S. K. (2021). Exercise medicine in men with prostate cancer: Breaking barriers to increase participation. Prostate Cancer and Prostatic Diseases, 24(4), 942–943. https://doi.org/10.1038/s41391-021-00406-4
Sekhoacha, M., Riet, K., Motloung, P. A., Gumenku, L., Adegoke, A., & Mashele, S. S. (2022). Prostate cancer review: Genetics, diagnosis, treatment options, and alternative approaches. Molecules, 27(17), 5730. https://doi.org/10.3390/molecules27175730
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