Describe your clinical experience for this week at a health clinic caring for geriatric patients as a student nurse practitioner student.
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.
Full Answer Section
One of the patients I saw this week was a 78-year-old woman named Mrs. Jones. Mrs. Jones had been experiencing shortness of breath, fatigue, and chest pain for the past few weeks. She had a history of heart disease, and her doctor was concerned that she might be having a heart attack.
I performed a thorough assessment of Mrs. Jones, including a physical exam, vital signs, and a review of her medical history. I also spoke with her about her symptoms and her overall health. Based on my assessment, I diagnosed Mrs. Jones with angina, a type of chest pain caused by reduced blood flow to the heart.
I developed a treatment plan for Mrs. Jones that included medication, lifestyle changes, and follow-up appointments with her doctor. I also made sure to educate her about her condition and how to manage it.
I faced a few challenges this week, but I also had some successes. One of the challenges I faced was dealing with the complex medical needs of geriatric patients. Many of the patients I saw had multiple chronic conditions, which made it difficult to develop treatment plans that would address all of their needs.
Another challenge I faced was communicating with patients who had difficulty hearing or understanding English. I had to be creative in my communication strategies, using gestures, pictures, and simple language to help patients understand their care.
Despite the challenges, I also had some successes this week. I was able to successfully diagnose and treat a number of patients, and I was able to build rapport with patients and their families. I also learned a lot about geriatric care, and I feel more confident in my ability to care for older adults.
Here is a more detailed description of the assessment of one of the patients I saw this week:
Patient: Mrs. Jones, 78-year-old woman
Chief Complaint: Shortness of breath, fatigue, and chest pain
History of Present Illness: Mrs. Jones has been experiencing shortness of breath, fatigue, and chest pain for the past few weeks. The shortness of breath is worse when she walks or climbs stairs. The chest pain is a dull ache that is located in the center of her chest. The pain is worse when she exerts herself.
Past Medical History: Mrs. Jones has a history of heart disease, hypertension, and diabetes. She has had a heart attack in the past.
Social History: Mrs. Jones is married and lives with her husband. She is retired and enjoys spending time with her grandchildren.
Physical Exam: Mrs. Jones is a well-developed, well-nourished woman. Her vital signs are within normal limits. Her lungs are clear to auscultation. Her heart has a regular rate and rhythm, and there is no murmur.
Assessment: Based on my assessment, I diagnosed Mrs. Jones with angina, a type of chest pain caused by reduced blood flow to the heart.
Plan of Care: I developed a treatment plan for Mrs. Jones that included medication, lifestyle changes, and follow-up appointments with her doctor. The medication I prescribed will help to improve blood flow to her heart. I also encouraged her to make lifestyle changes, such as quitting smoking and eating a healthy diet. I will follow up with her in a few weeks to see how she is doing.
Differential Diagnosis: The three most likely differential diagnoses for Mrs. Jones are:
- Angina
- Heart attack
- Pneumonia
I ruled out pneumonia because Mrs. Jones' lungs were clear to auscultation. I also ruled out a heart attack because Mrs. Jones did not have any other symptoms of a heart attack, such as nausea, vomiting, or dizziness.
The most likely diagnosis for Mrs. Jones is angina. Angina is a type of chest pain caused by reduced blood flow to the heart. It is often caused by coronary artery disease, which is a narrowing of the arteries that supply blood to the heart.
I am confident in my diagnosis of angina because it is the most likely explanation for Mrs. Jones' symptoms. I also have ruled out the other two possible differential diagnoses.
I am hopeful that Mrs. Jones will respond well to the treatment plan I have developed. I will follow up with her in a few weeks to see how she is doing.