Nursing Practicum Journal Entries

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Week 8: Pediatric patient with hematologic disorder

The practicum experience regards a reflection on a patient who presented with the hematologic disorder during my practicum experience. The essay provides a description of the experience in assessing and managing the patient and his family. Also included are the details of the reaction in identifying the patient’s disorder.

A young boy aged six years was presented to the hospital by his mother with signs and symptoms predictive of iron-deficiency. The boy had fatigue, pale skin, irritable, with shortness of breath and palpitations. There were no physically identifiable signs and symptoms of the disease condition, but the boy appeared to be affected by the disorder.

Blood disorders impact some parts of the blood that prevent it from performing its functions. Most of the disorders are inherited, but may also be caused by other diseases, drug side effects and lack of particular nutrients in the diet. Hematologic disorders include the problems with the red blood cells, white blood cells, platelets, blood vessels, bone marrow, lymph nodes, spleen, and the proteins involved in bleeding and clotting (Burns, Dunn, Brady, Starr & Blosser, 2013).

From the case presented, it was necessary to assess the patient to ascertain of the hematologic disorder. Most children with mild anemia show no signs and symptoms, but some present with the symptoms exhibited by the patient.

I inquired about the condition of the boy and the likelihood of another member of the family having been diagnosed with anemia which was confirmed. The mother was not willing to share all the information about the family medical history. I ordered for laboratory tests in the diagnosis of anemia that includes the measurement of ferritin that shows iron stores, and transferring that indicates the body’s ability to transport iron for use in the red blood cells production. The measurement of hemoglobin does not detect the many cases of early iron deficiency because the red blood cells do not reflect the iron content until after 120 days (Burns, Dunn, Brady, Starr & Blosser, 2013). The tests confirmed the likelihood of anemia hence necessary to plan for the management of the disease.

Both the mother and her son could not believe the results of a positive anemic condition. However, I explained to them that the disease is treatable through several methods. I also advised the mother and the patient how to check the stool color and report it if it appears bloody. I had to recommend a treatment plan with the goal of increasing the amount of oxygen carried by the blood through raising the hemoglobin level. I recommended a dietary change and use of supplements. The common vitamin supplements taken include Vitamin B12 and folic acid (Moerschel & Janus, 2010). It was necessary to have a follow-up visit to assess the progress.

The experience was an exposure to a real world clinical setting of handling patients diverse needs. As learned in the classroom studies, many patients are unwilling to share their personal and family history. Also, they do not readily accept the outcomes of some tests. The practicum experience helped in acquiring the appropriate skills for diagnosis and handling of the uncooperative patients. The real world clinical setting has challenges that require the practitioner to address them appropriately to enhance the patient outcomes. The experience was helpful in putting to reality the many theoretical concepts covered in the classroom studies thereby enhancing my clinical skills.

Week 9: Journal Entry for a patient presented with gastrointestinal disorders

The journal entry entails a reflection of a patient who presented with the gastrointestinal disorder during my practicum experience at a local health care facility. The discussion has the details of my experience in assessing and managing the patient and his family. Also discussed is a reflection of the connection of the classroom studies to the real-world clinical settings.

Acute gastroenteritis remains to be a major cause of pediatric morbidity and mortality around the world. It accounts for more than 1.34 million deaths every year for children aged five years and below. The disease severity depends on the level of fluid loss, and an accurate assessment of the dehydration status remains an important step in preventing mortality.

Clinical Presentation

A six-month-old bottle fed baby was brought to my general practice room with 12 hours of history of diarrhea. She had green watery stools without blood and vomiting. Her mother seemed worried because the baby is irritable with fever averaging 38°C. Her brother in nursery school had just recovered from “gastro” problems that worried the mother. The baby is usually active and weighs 5.5 kg. Her skin is sunken and has a decreased skin turgor upon examination. She also passed urine during the examination, and a close overview of the health record revealed a loss of 0.5 kg over two weeks. My diagnosis of the condition was gastroenteritis and hence referred the child for a pediatric unit for enhanced care.

The diagnosis of the disease was confirmed by the use of a commercial enzyme-linked immunosorbent assay and was assessed to have moderate dehydration (Parashar, Nelson & Kang, 2013). The cause of the infection was confirmed to be rotavirus infection. The recent weight loss, reduced skin turgor, raised serum urea, and metabolic acidosis revealed the extent of dehydration. The details about the baby’s condition did not auger well with the mother who wondered how her both children were diagnosed with similar infections within short intervals. It was important to manage the condition in advance before it erupted to a bigger margin.

The management of the condition to the child was challenging because of dealing with a young baby. The management of the disease aims at preventing and treating dehydration, maintaining nutrition, and minimizing harm (Centers for Disease Control and Prevention, 2013). She was reluctant to drink, hence found appropriate to give an oral rehydration solution by nasogastric tube. The mode of treatment helped to rehydrate the baby for over six hours in the treatment room. She had to be observed overnight to ensure that she drunk enough amount and also passed urine. It was necessary to inform the lady about the mode of infection of the disease as a person to person and spread or ingestion of contaminated food and drink.

The experience connected my classroom studies well to the real-world clinical setting by enhancing my nursing skills. It was necessary to have the practicum experience due to the expertise acquired in handling pediatric disease conditions in real life. The theoretical concepts covered in the classroom were easier to relate with due to the practical sessions I had in the practicum experience. Of significance was the incorporation of evidence-based research information to the practicum experience that enhanced my skills of assessment, diagnosis, and management of health disorders.

 

References

Burns, C. E., Dunn, A. M., Brady, M. A., Starr, N. B., & Blosser, C. G. (2013). Pediatric             primary care (5th ed.). Philadelphia, PA: Elsevier; Chapter 26, “Hematologic Disorders”        (pp. 557–584)

Centers for Disease Control and Prevention. (2013). Managing acute gastroenteritis among           children: Oral rehydration, maintenance, and nutritional therapy. Morbidity and    Mortality Weekly Report, 52(RR-16), 1–20. Retrieved from            http://www.cdc.gov/mmwr/PDF/RR/RR5216.pdf

Moerschel S.K & Janus J.(2010) Evaluation of Anemia in Children: American Family Physician   Journal; 81(12):1462-1471.

Parashar, U.D., Nelson, E.A., Kang, G. (2013) Diagnosis, management, and prevention of            rotavirus gastroenteritis in children in  BMJ 347:f7204. doi: 10.1136/bmj.f7204.

BMJ Publishing Group. Reprinted by permission of BMJ Publishing Group via the Copyright Clearance Center



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