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Discussion replies should at least 175 words, formatted, and cited in current APA style with support from at least 1 academic sources. No AI please. Incorporate a minimum of 1 current (published within the five years) scholarly journal articles. Journal articles should be referenced according to the current APA style. I have attached the discussion below.
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Discussion Reply 1- Rosa
Brief Overview of Clinical Experience
This week’s clinical experience was a wonderful learning experience. Most patients served
were mainly from the Hispanic community. In my case, serving the Hispanic population was not
a challenge. Still, I can mention that another nurse from another University was doing clinical
practice hours, and it was a challenge for her because she only spoke English. Overcoming the
language barrier and cultural differences helps build trustworthy relationships and
communication between patients and healthcare providers. Nonetheless, the utilization of
bilingual medical staff and cultural competency training played an important role in helping to
achieve significant success in patient engagement and communications.
Assessment of a Hispanic Patient
A 45-year-old Hispanic male visited the clinic with a complaint of continuous cough
and a harder breathing problem, which persisted for longer than two weeks. Vital signs that were
altered were high temperature, respirations 23, and weight loss for no apparent reason. The
patient’s main complaint was a persistent cough, affecting his daily activities and sleep; the
patient reported it troubling him. After his assessment, he showed tachypnea and sometimes
engaged his accessory muscles during breathing. Breath sounds were diminished, and there were
fine crackles at the base of both lungs. The patient’s medical history was hypertension and
hypothyroidism, which were controlled by his current medications. He denied being a smoker
and/or taking a recent trip. The patient’s family history includes hypertension and diabetes,
diabetes, hypothyroidism, and Tuberculosis. The combination of the physical examination and
his clinical history ruled out an array of respiratory diseases (Influenza, COVID-negative),
leaving the doctor to differentiate between them based on specific tests that would aid in
establishing the cause.
Plan of Care
The patient’s treatment plan incorporates immediate treatment strategies to manage
the patient’s condition. The initial orders were a stat diagnostic chest X-ray, sputum analysis, and
leukocyte count to identify the cause of the symptoms. Before diagnosis, the clinician advised
the patient with symptomatic relief for the cough and fever through medication, increased fluid
intake, cough suppressant, expectorants, and humidified air to relieve irritated nares. The Doctor
(preceptor) suspected Pneumonia and prescribed doxycycline 100mg twice daily for seven days;
MD will await test results. A follow-up appointment in 2 weeks also was ordered. In the long
run, there should be a process of reviewing and managing the patient’s existing conditions, such
as diabetes and hypertension, which might deteriorate his respiratory health (Dunphy et al.,
2019). Education on lifestyle change and medication adherence will be emphasized to prevent
further health problems. Also, education on compliance with prescribed antibiotics and
encouraging patients to get influenza and pneumococcal vaccines are essential (Sattar et al.,
2023).
Differential Diagnoses
Considering the observed fever, cough, and crackles upon auscultation, pneumonia
becomes an obvious diagnosis. The manifestation of the fever, respiratory symptoms, and cough
are appropriate for that diagnosis (Udwadia, 2019). A second differential diagnosis could be
acute bronchitis due to the patient’s persistent cough, fever, and tachypnea symptoms. A third
differential diagnosis could be Tuberculosis due to the patient’s nonspecific weight loss and
family history of tuberculosis. The co-occurrence of persistent cough and fever and the
demographic consideration further aggravate this suspicion (Udwadia, 2019). These differential
diagnoses are based on the patient’s presenting signs and symptoms and clinical history. The
diagnostic methods, including imaging and laboratory investigations, are intended for differential
diagnosis among these diseases by revealing typical findings, e.g., infiltrates suggestive of
pneumonia or granulomas diagnostic of TB.
Health Promotion Intervention
Respiratory disease education for this patient should be a key component of a health
promotion intervention, focusing on regular check-ups and compliance with treatment regimens.
Following the patient’s description and state of health, a culturally sensitive diet and exercise
program is also necessary and essential in managing hypertension (Meharg et al., 2020). This
method addresses his health issues in their present state and promotes his long-term wellness.
Reflection and Learning
The fact that this week was my first clinical experience, I have learned that a holistic
and culturally sensitive approach for patients is imperative. Being with patients from a different
background increased my awareness of the importance of considering cultural and personal
factors in treatment plans. This exposure has deepened my comprehension of an evidence-based
approach, exemplifying how combining the latest research with clinical judgment effectively
improves outcomes. This knowledge will act as a basis for me throughout the development of my
advanced practice registered nurse skills so I can guide my future interactions and interventions
with patients.
References
Dunphy, M. L, Winland-Brown, E. J, Porter, O. B, & Thomas, J. D. (2019). Primary care: Art and
science of advanced practice (5th ed.). F.A. Davis Company.
Meharg, D. P., Gwynne, K., Gilroy, J., & Alison, J. A. (2020). Exercise-based interventions for
Indigenous adults with chronic lung disease in Australia, Canada, New Zealand, and USA: A
systematic review. Journal of Thoracic Disease, 12(12), 7442–
7453. https://doi.org/10.21037/jtd-20-1904Links to an external site.
Sattar SBA, Sharma S, Headley A. Bacterial Pneumonia (Nursing) [Updated 2023 Aug 14]. In:
StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from:
https://www.ncbi.nlm.nih.gov/books/NBK568697/
Links to an external site.
Udwadia, F. E. (2019). Principles of respiratory medicine (2nd ed.). McGraw-Hill Medical.
Discussion Reply 2- Roxana
Hello professor and class,
I started the week smoothly and did not experience any challenges or issues. One of the
patients that I saw in the clinic is a 22-year-old while male who presented with a runny
nose, itchy eyes, and sneezing. The patient reports that the symptoms began a few hours
ago after taking part in a work-related picnic that took place in a nearby park. Other
symptoms that the patient reported include watery and red eyes, throat irritation, a
productive cough, and fatigue. The patient indicated that he is allergic to pollen and
sneezes when exposed to pollen. I undertook an assessment of the patient’s head, eyes,
ears, nose, and throat. The examination I notes that the patients eyes were red and
watery. The patient was also coughing and produced a clear phlegm. I also noted postnasal drip. No fever was noted. Respiration was unlabored.
Based on the presenting symptoms and the results of the physical examination, the three
differential diagnoses include allergic rhinitis, upper respiratory infection, and acute
sinusitis. Allergic rhinitis was suspected because the symptoms that the patient reported
are consistent with allergic rhinitis. These include runny nose, watery and red eyes, throat
irritation, and a productive cough (Bousquet et al., 2020). In addition, the patient also
reported that he is allergic to pollen and the symptoms began after a picnic in the park
where the patient could have been exposed to pollen. Acute sinusitis is also a possible
diagnosis. This is an inflammation of the spaces inside the nose (Jaume et al., 2020). This
condition is associated with symptoms such as nasal congestion, cough, and fatigue that
the patient presents with. The absence of a bad breath or aching of the teeth can be used
in ruling out this condition. Viral upper respiratory infection is another possible condition
based on the symptoms that the patient presents with. It is associated with symptoms
such as runny nose, itchy eyes, sneezing, coughing, and throat irritation (Jaume et al.,
2020). The absence of a fever and body aches which is associated with the condition can
be used in ruling out upper respiratory infection. The most likely diagnosis based on the
assessment was allergic rhinitis. No other tests was required for the patient. Regarding
the plan of care, antihistamine nasal spray was prescribed. This can help in the
decongestion of the nose. The patient was educated to take plenty of fluids and plenty of
rest.
The health promotion initiative undertaken for the patient is education about allergies
and the need to avoid exposure to allergies as they can result in an onset of allergic
reactions. The patient’s exposure to pollen in the park may have triggered the symptoms
experienced. Stressing the need to determine how to best avoid exposure to allergens can
help in reducing the frequency of infection. This week’s clinical experience started on a
good note. I was able to undertake an examination of patients with the guide of my
preceptor. The cases I saw helped me to develop differential diagnoses for different body
systems. As the clinical experience progresses, I am hoping to get more challenging cases
that I can help me improve my diagnostic skills and abilities.
References
Bousquet, J., Anto, J. M., Bachert, C., Baiardini, I., Bosnic-Anticevich, S., Walter Canonica,
G., … & Toppila-Salmi, S. (2020). Allergic rhinitis. Nature Reviews Disease Primers, 6(1), 95.
Jaume, F., Valls-Mateus, M., & Mullol, J. (2020). Common cold and acute rhinosinusitis: upto-date management in 2020. Current Allergy and Asthma Reports, 20, 1-10.
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