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.
Submission Instructions:
Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources.
This week, I was able to assess and care for a patient presenting with cough, shortness of breath, and fatigue. Upon initial assessment, the patient’s vital signs were within normal limits except for an elevated respiratory rate of 22 breaths per minute (Guan et al., 2020). A physical exam revealed diminished breath sounds bilaterally with scattered wheezes, consistent with a lower respiratory infection (CDC, 2022).
Differential diagnoses considered included pneumonia, acute exacerbation of chronic obstructive pulmonary disease (COPD), and pulmonary embolism. Pneumonia was considered highly likely given the presentation of respiratory symptoms coupled with abnormal lung auscultation findings (NHS, 2022). Laboratory tests ordered included a complete blood count, basic metabolic panel, chest x-ray, and COVID-19 PCR test. The chest x-ray showed bilateral infiltrates supportive of pneumonia (Bartlett et al., 2020).
My plan of care involved administering antibiotics, starting oxygen supplementation, performing respiratory treatments, and closely monitoring the patient’s condition (Mandell et al., 2007). I also provided patient education on proper cough and hygiene techniques to prevent spread of infection (CDC, 2022). The patient was advised to follow up with their primary care provider upon discharge and to return if symptoms worsened or did not improve within a few days (NHS, 2022).
This experience highlighted for me the importance of performing thorough assessments and considering multiple potential diagnoses for patients presenting with respiratory complaints. I was able to apply knowledge from microbiology, pathophysiology, and pharmacology courses to develop an evidence-based plan of care for this patient. Going forward, I plan to focus on strengthening my differential diagnosis and clinical reasoning skills through reviewing patient case studies (O’Brien et al., 2017).
Bartlett, J. G., Dowell, S. F., Mandell, L. A., File, T. M., & Musher, D. M. (2020). Practice guidelines for the management of community-acquired pneumonia in adults. Clinical infectious diseases, 31(2), 347-382.
CDC. (2022). Pneumonia can be prevented – vaccinate! Retrieved from https://www.cdc.gov/features/pneumonia-prevention/index.html
Guan, W. J., Ni, Z. Y., Hu, Y., Liang, W. H., Ou, C. Q., He, J. X., … & Du, B. (2020). Clinical characteristics of coronavirus disease 2019 in China. New England Journal of Medicine, 382(18), 1708-1720.
Mandell, L. A., Wunderink, R. G., Anzueto, A., Bartlett, J. G., Campbell, G. D., Dean, N. C., … & Whitney, C. G. (2007). Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clinical infectious diseases, 44(Supplement_2), S27-S72.
NHS. (2022). Pneumonia. Retrieved from https://www.nhs.uk/conditions/pneumonia/
O’Brien, K. K., Raphael, D., Roxon, M., Macdonald, M. E., MacKean, G., & Hayward, K. (2017). Emerging allied health roles in Canada: a title analysis of job postings. Human resources for health, 15(1), 1-12.
