Nursing Practicum Journal Entries (Adult Patients aged 18 years and older)
Week 5: Practicum Journal
For week five practicum experience I had an opportunity to attend to a lady patient aged 43 years old who suffered from coronary artery disease. She presented to the health care facility with pain over the chest that crossed to the arm and the jaw. She also complained of a feeling of burning sensation in the chest as well as increased shortness of breath, irregular heartbeat, dizziness, increased sweating, nausea, and fatigue.
Coronary artery disease is a condition that involves the narrowing of the arteries such that they can’t supply an adequate amount of oxygen-rich blood to the heart. The decreased blood flow may not cause the disease at first, but the building up of plaque in the coronary arteries increases the likelihood of the disease (Montalescot, Sechtem, et. al., 2013)
A close examination of the patient revealed that she used to smoke in her twenties, lives a sedentary lifestyle, and takes food with high cholesterol. The family history also revealed that a close relative developed the condition at an early, hence could be genetically motivated. I ordered for an electrocardiogram to reveal the evidence of the disease and create a management plan. The appropriate mode of treatment administered included lifestyle changes and use of medication. The lady ought to eat healthy foods, exercise regularly, and also take the cholesterol-modifying medications, and angiotensin- converting enzyme inhibitors and receptor blockers.
The practicum experience was essential in enhancing my clinical skills when dealing with the diseases that affect adults. I realized that many patients live with certain diseases without a clear understanding of how to handle them. As a nurse practitioner, I have a mandate of ensuring that such patients adopt a healthy lifestyle by having early screening and diagnosis. The practicum experience for the week helped to relate my classroom studies about cardiovascular diseases and a real life case in a practical session. By the end of the practicum experience, I expected to acquire more skills in patient handling and assessment.
Week 6: Practicum Journal
In week 6 of the practicum experience, I worked closely with a registered nurse practitioner to attend to a patient with diabetes. He was aged 48 years old and had lived with the condition for five years. According to his personal and medical history, it was evident that he did not receive the appropriate medical care to address the chronic disease. As such, he complained of negligence by the care providers who attended to him initially that made him change the facility.
At the time of visit to the health facility, he had elevated thirst and hunger, dry mouth, frequent passing of urine, elevated weight loss, and frequent headaches. A physical examination revealed the need to perform further tests like A1C test, fasting plasma glucose test, and oral glucose tolerance test for several instances to ascertain the health condition. It was necessary to make a treatment plan that fit the patient and easy to follow. It was also necessary for the patient to work closely with a nutritionist, eye doctor, and a diabetes specialist. The treatment plan involved taking measures to keep track of the blood sugar levels with medications, exercise, and diet.
The practicum experience enhanced my professional goals and self-assessment of the clinical skills. As earlier outlined, the goal of the nursing practicum experience was to have an exposure of real-life scenarios of patient handling, assessment, diagnosis, and treatment. It was important to have the experiences to enhance my nursing practice skills in dealing with multiple illnesses that affect adult patients. I acquired the skills of recording patient information as required and also use the personal history, physical examination, and other tests to make a diagnosis.
Week 7: Practicum Journal
In week 7 of my practicum experience, I handled a case of a patient who visited the health facility with complaints of adverse drug reactions. He was a male patient aged 33 years old and suffered from asthma. The earlier tests for the lung function involved Spirometry and peak flow measurements and taken after taking a bronchodilator. An imaging test of the chest-X ray and CT scan of the lungs and nose cavities helped to identify the cause of the breathing problems. He was diagnosed with severe persistent asthma.
The physician recommended the patient to take long term asthma control medications in the category of long acting beta antagonists. The prescribed drugs were salmeterol and are inhaled medications to open the airways. The drugs have a risk factor of increasing the risk of severe asthma attack. Thus, I consulted with other physicians who advised on the need to recommend inhaled corticosteroids which are anti-inflammatory drugs. The prescribed drug was fluticasone which has a low risk of side effects and safe for long-term use. A follow up was scheduled after two weeks.
The practicum experience was effective in enhancing my nursing skills in handling patient’s complaints. A nurse practitioner ought to have all round skills in addressing the patient needs. As identified in the experience, the patient complained of adverse drug effects which were prescribed by a different care provider. Thus, it was necessary to have a background check on the patient before making a different prescription. I acquired additional skills in handling patient information as well as assessing the different health problems. I found the practicum experience essential in enhancing my practical skills in communicating effectively with other care providers for the benefit of the patient.
From the practicum experiences, I acquired the relevant and applicable skills in dealing with patient data as well as decision making regarding diagnosis and treatment.
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O’Connell, J., Gardner, G., & Coyer, F. (2014) Beyond Competencies: Using a capability framework for developing practice standards for advanced practice nursing: Journal of Advanced Nursing, 70(12), 2728-2735
Thomas, A. C., Crabtree, M. K., Delaney, K. R., Dumas, M. A., Kleinpell, R., Logsdon, C.,…Nativio, D. G. (2012). Nurse practitioner core competencies
Montalescot, G., Sechtem, U., Achenbach, S., Andreotti, F., Arden, C., Budaj, A., … & Ferreira, J. R. (2013). 2013 ESC guidelines on the management of stable coronary artery disease: European heart journal, 34(38), 2949-3003.