Clinical Experience in Primary Care

Introduction

This week’s clinical experience in the primary care setting as an APRN student provided valuable insights into patient assessment, challenges, successes, and the importance of evidence-based practice. This reflection outlines a patient assessment, highlights key signs and symptoms (S&S), presents a plan of care, and discusses three possible differential diagnoses with rationales, emphasizing the significance of health promotion interventions.

Clinical Experience and Challenges

During this week’s clinical rotation, I encountered a diverse range of patients, each presenting unique healthcare needs and challenges. One notable challenge was balancing time constraints while ensuring comprehensive patient assessments. However, this challenge was met with success through efficient time management and prioritization.

Patient Assessment

One patient assessment that stood out involved a 45-year-old female presenting with chest pain, shortness of breath, and fatigue. Her medical history included smoking and a family history of cardiovascular disease. These S&S raised concerns about potential cardiac issues.

Plan of Care

1. Immediate Actions:
   • Administer oxygen to relieve shortness of breath.
   • Conduct an electrocardiogram (ECG) to assess cardiac rhythm.
   • Perform a focused physical examination to evaluate heart sounds and lung fields.
   • Start an intravenous line for potential medications.
2. Differential Diagnoses with Rationales: a. Acute Coronary Syndrome (ACS):
   • Given the patient’s chest pain and risk factors, ACS is a primary concern (American College of Cardiology, 2018). b. Pulmonary Embolism (PE):
   • Shortness of breath and chest pain could also be indicative of a PE, especially considering the patient’s smoking history (Konstantinides et al., 2019). c. Anxiety:
   • Psychological factors, such as anxiety, might contribute to chest pain, but it should be a diagnosis of exclusion.

Health Promotion Intervention: Incorporating health promotion into the care plan is essential for this patient. Smoking cessation counseling should be provided to address the patient’s smoking history. Additionally, education on lifestyle modifications, including diet and exercise, should be discussed to reduce cardiovascular risk.

Learning and Evidence-Based Practice: This clinical experience reinforced the importance of evidence-based practice (EBP) in nursing. Utilizing current peer-reviewed research guidelines helped guide decision-making, ensuring the best possible patient outcomes. Furthermore, it highlighted the significance of patient education in promoting health and preventing disease.

References

1. American College of Cardiology. (2018). 2018 AHA/ACC guideline for the management of patients with non–ST-elevation acute coronary syndromes. Journal of the American College of Cardiology, 72(18), e139-e228.
2. Konstantinides, S. V., Meyer, G., Becattini, C., Bueno, H., Geersing, G. J., Harjola, V. P., … & ESC Scientific Document Group. (2019). ESC guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS). European Heart Journal, 41(4), 543-603.

FAQs

1. What were the key challenges faced during your recent clinical experience in the primary care setting as an APRN student?
2. Can you provide an example of a patient assessment from your clinical rotation, detailing signs and symptoms, assessment, and the plan of care?
3. How did you address the time constraints while ensuring comprehensive patient assessments during your clinical experience?
4. What differential diagnoses did you consider for the patient presenting with chest pain, shortness of breath, and fatigue, and what were the rationales behind them?
5. How do evidence-based practice and patient education contribute to improved patient outcomes, as highlighted in your clinical experience reflection?