Weekly Clinical Experience 5

Discussion 1

Weekly Clinical Experience 5

This week's clinical experience was full of ups and downs. I encountered some new conditions for the elderly, and I had to consult my preceptor to guide me on how I could manage the conditions. The patients that we handle came from different cultures, and some of them could not speak the same language as I did. We had to involve other healthcare practitioners who understand their language to get a comprehensive history from them.

The Signs and Symptoms

This week, I encountered an 86-year-old woman, currently residing in a nursing home. She presents with dull, aching pain in her right hip that started 4 days ago after a fall in her room. She reports that she slipped on a rug and landed awkwardly on her hip. The patient reports having lower back pain, shortness of breath, and changes in her natural posture. The pain in her right hip is present most of the time, with varying intensity. Prolonged standing, walking, or lifting of objects seems to worsen the pain. The patient reports that lying down and taking over-the-counter pain relievers relieves her to some extent. According to the patient, the pain is not radiating elsewhere and is rated as 6/10 on the pain scale.

Assessment

A physical exam was conducted to look for signs of fragility fractures, posture changes, and height loss (Porter & Varacallo, 2023). A thorough neurological exam was done to rule out any spinal cord or nerve issues that could cause osteoporosis. The patient’s height was measured at different visits to assess for height loss. Other important aspects examined include the patient’s muscle strength, gait, and balance, as these can indicate fall risk. Two tests were ordered: a bone density test to measure the strength of her bones and a CT scan to diagnose bone and muscle conditions like bone fractures (Adejuyigbe et al., 2023).

Differential Diagnosis

The differential diagnoses include osteomalacia, Paget’s disease, and hyperparathyroidism (Porter & Varacallo, 2023). Osteomalacia refers to a disorder that causes an individual’s bones to weaken and soften. It is characterized by bone pain and muscle weakness. Paget’s disease refers to a condition, which alters the normal recycling process of bone tissue, causing bones to become weak, enlarged, and prone to fractures. Hyperparathyroidism occurs when the parathyroid hormone is unable to regulate phosphorus and calcium levels in the bones and blood (Porter & Varacallo, 2023). The disorder can lead to problems such as muscle weakness and bone pain. The three conditions discussed above are possible differential diagnoses because they affect the bones, leading to an increased risk of falling.

Plan of Care

The primary diagnosis is osteoporosis. The condition can be treated using medications called bisphosphonates, such as Ibandronate, Alendronate, and Risedronate (Aibar-Almazán et al., 2022). The patient was prescribed 70 mg taken once per week to treat her condition. She was advised to take the medications at least thirty minutes before the first drink or food of the day. Patient education about the side effects of bisphosphonates, such as abdominal pain and nausea, was provided (Porter & Varacallo, 2023). 

 

Health Promotion Intervention

The patient was educated about home and lifestyle remedies that can strengthen her bones and prevent falls. She was advised to avoid smoking because it can increase the chance of bone fractures and the rate of bone loss. Limiting alcohol can also reduce her risk of falling. Exercising regularly is essential to strengthen her bones (Aibar-Almazán et al., 2022). Caregivers were advised to check her house for slippery surfaces, electrical cords, and area rugs that might cause her to fall. They also need to ensure the patient wears low-heeled shoes and all rooms are brightly lit.

Lessons

This week's experience was beneficial. I was able to learn about the management regimen of osteoporosis. I will apply the idea in my future practice to manage similar conditions. I also improved my patient assessment skills and developed an education plan for patients, which is an important nurse role.

Discussion 2

Week 5 Clinical Reflection: Treating a 34-year-old woman with a urinary tract infection (UTI) 

During my adult care clinical rotation this week, I saw a number of patients with typical primary care issues, but one instance in particular caught my attention: treating a 34-year-old woman who had a urinary tract infection (UTI). My abilities in clinical reasoning, diagnostic interpretation, and patient education were all enhanced by this experience. I had a successful week that included both setbacks and minor successes, particularly in terms of boosting my self-assurance in treating acute infectious diseases. 

The patient had typical lower urinary tract infection symptoms, such as mild hematuria, increased frequency of urination, suprapubic discomfort, and dysuria. In order to rule out pyelonephritis, she denied having a fever, chills, flank pain, or nausea. Other than mild suprapubic tenderness, the physical examination revealed nothing unusual. A urinalysis of a clean-catch urine sample revealed moderate bacteriuria, leukocyte esterase, and nitrites. An uncomplicated lower UTI was diagnosed based on the clinical presentation and results. 

According to the Infectious Diseases Society of America (IDSA) guidelines for uncomplicated UTIs, the treatment plan called for starting empiric antibiotic therapy with nitrofurantoin 100 mg twice daily for five days (Gupta et al., 2011). The patient was also instructed to drink more water, take phenazopyridine if necessary to relieve symptoms, and go back for treatment if symptoms worsened or lasted longer than 48 hours. One week after treatment, a follow-up urinalysis was planned. 

Differential diagnoses considered included (1) vaginitis, due to overlapping symptoms like dysuria and discomfort; however, the absence of vaginal discharge or irritation and a normal pelvic exam ruled this out (Bickley, 2020). (2) Interstitial cystitis was another possibility, especially in patients with chronic urinary symptoms, but her symptoms were acute in onset. (3) Urethritis, often seen in sexually active women, was also considered, but the lack of urethral discharge or history of recent new sexual partners made this less likely. 

The goal of this patient's health promotion was to avoid getting UTIs again. She received education on the importance of urinating before and after sexual activity, avoiding harsh soaps, wiping from front to back, and not delaying urination. She was also taught how to spot early signs of a recurrence and get help quickly. As preventative measures, lifestyle changes were discussed and educational materials were given out. 

The importance of a comprehensive history and urinalysis in the diagnosis of UTIs was highlighted by this experience. Additionally, I discovered the importance of patient education for prevention and treatment adherence. I now see how crucial it is to adhere to evidence-based recommendations while adjusting care to meet the needs of each patient as an advanced practice nurse. My capacity to integrate clinical data and provide comprehensive, patient-centered care was strengthened by handling this case.