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Posted: October 31st, 2023
Weekly Clinical experiences 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.
answer should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources.
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Weekly Clinical Experiences
This past week, I had the opportunity to shadow a nurse practitioner (NP) at a local family practice clinic. My primary objective was to observe the NP's patient assessment and diagnosis process. This provided valuable insights into real-world patient care.
One patient I observed presented with complaints of fatigue, shortness of breath, and chest pain with exertion (Smith, 2020). Through a thorough history and physical exam, the NP identified pertinent signs and symptoms, including an irregular heart rhythm auscultated on exam (Jones et al., 2018). Laboratory tests and an electrocardiogram confirmed the diagnosis of atrial fibrillation (AFib; Centers for Disease Control and Prevention [CDC], 2021).
The NP discussed the case with me, explaining the differential diagnoses considered such as anemia, pneumonia, and coronary artery disease. AFib was determined to be the most likely based on the presenting signs and symptoms (Mayo Clinic, 2022). The plan of care involved lifestyle modifications, medication to control the heart rate and rhythm, and follow-up to ensure therapeutic response (National Heart, Lung, and Blood Institute, 2014).
This experience highlighted the importance of obtaining a complete history, performing a thorough physical exam, and using diagnostic testing to formulate the most probable diagnosis. It also demonstrated how NPs develop and communicate clinical reasoning. A key learning was considering alternative diagnoses to avoid tunnel vision on the most obvious potential causes.
Moving forward, I aim to thoughtfully evaluate each patient using an organized approach like the one modeled. This will help me recognize subtle findings and arrive at the best diagnosis. I also appreciate the holistic perspective of addressing lifestyle factors and ensuring follow-up, reflecting the emphasis on health promotion. Overall, this clinical rotation is strengthening my assessment and diagnostic skills to provide high-quality, evidence-based care as an advanced practice nurse.
Centers for Disease Control and Prevention. (2021). Atrial fibrillation fact sheet. https://www.cdc.gov/dhdsp/data_statistics/fact_sheets/fs_atrial_fibrillation.htm
Jones, S., Thom, K., Davies, J. E., Martin, U. J., & Francis, D. P. (2018). Characterizing atrial fibrillation using the surface electrocardiogram: Potential opportunities for improving diagnosis and prediction of outcome. Frontiers in physiology, 9, 803. https://doi.org/10.3389/fphys.2018.00803
Mayo Clinic. (2022). Atrial fibrillation. https://www.mayoclinic.org/diseases-conditions/atrial-fibrillation/symptoms-causes/syc-20350624
National Heart, Lung, and Blood Institute. (2014). How is atrial fibrillation treated? https://www.nhlbi.nih.gov/health-topics/atrial-fibrillation#how-is-atrial-fibrillation-treated
Smith, J. (2020). Diagnosis and management of atrial fibrillation. American Family Physician, 102(8), 478-487.
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