Practicum Journal Entries

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The practicum journal entry regards a patient who presented with a dermatologic disorder during my practicum experience in my local health care setting. The description given has an assessment and management of the patient and his/her family as well as the reaction in identifying the dermatologic disorder. Also provided is a reflection of how the experience connects to the classroom studies in real-world clinical settings. The discussion has a basis on a case study of a patient with pediatric candidiasis.

Case Study

Mr. and Mrs. Rhodes visited the health care facility with their child aged five years and complained of skin infections that occur mostly in the skin folds, genitals, cuticles, and the oral mucosa. The symptoms started with the onset of the hot weather and the child used to wear restrictive clothing as well as having infrequent undergarment changes. The parents complained that the child had well-demarcated patches of different sizes and shape that manifested as painful red periungual swelling. The physical symptoms promoted the parents to seek a clinical advice after using skin ointments with no positive results.

It was necessary to assess the patient for a likely diagnosis following the observed symptoms. From the family history, there was no trace of the symptoms or a patient diagnosed with a related condition. I found it appropriate to examine the skin folds, genitals, cuticles, and the oral mucosa for related symptoms. The most affected parts were around the corners of the mouth and some parts of the genitals. A close examination of the Pediatrics’ condition revealed that the painful red periungual swellings were persistent, hence required appropriate measures to deal with them. I used the clinical appearance and potassium hydroxide wet mount of the skin scrapings for diagnosis.

The diagnosis of the disease was a surprise to the parents and also the child since they thought that it was a normal infection of the skin. Candidiasis is a skin infection with Candida sp, and the infections can occur anywhere. The symptoms vary, but the invasive candidiasis is common among the people with suppressed immunity and can be life threatening (Burns, Dunn, Brady, Starr & Blosser, 2013). The parents were inquisitive of the etiology and how to prevent future infections to the disorder after the diagnosis. I recommended a management plan that involved the use of topical and oral antifungal. I also advised the parents to frequently used powdered formulations like miconazole for two weeks. It was necessary for the parents to adhere to the management plan for a positive prognosis. A follow-up plan was scheduled and a hospital visit after two weeks for an assessment.

I realized that many patients, as well as their close caretakers, do not readily accept the clinical findings due to their perceptions and ignorance to some disease aspects. It was similar to the parents who were amazed by the realization that their child had candidiasis despite none of the family members having it previously.

The experience provided a practical case of a real-world clinical issue in a physical hospital facility that helps in enhancing my clinical skills. The experience helped in acquiring the skills of examining, diagnosing, management, and follow-up with a patient to help in disease management. The basics acquired in my classroom studies about effective communication skills with the patient, proper patient handling, and the need to inform the patient and the family members of the clinical procedures and expectations were actualized in the practicum experience. I found the practicum experience essential in enhancing the skills of relating with pediatric patients and their caregivers.

Week 6: Practicum Journal Entry

The practicum journal entry entails a description of a case of a patient who presented to the health facility with an ear disorder during my practicum experience. The entry also has the details of the experience with the patient and his/her family during the assessment and management of the disorder. Also documented are the details of the reaction in identifying the patient’s disorder and the relationship of the experience with the classroom studies to the real-world clinical settings.

Case Study

Miss. Whites was at work and received a call from the house manager that her five-month-old son was not feeling well. He was fussy in the morning hours and took a nap shortly afterward refusing to drink anything and developed a fever. Miss. Whites rushed and presented to the health facility where I practiced with the child.

Upon a close examination of the child’s ears, I informed the lady that her child had a middle ear infection. I inquired whether the child had been coughing a lot and if he recently had a runny nose. I also requested to know whether the child was properly breastfed and whether she was exposed to smoke. The response revealed that the child was bottle fed, did not have a runny nose, and no one smoked in her home.

The details about the diagnosis of the condition, otitis media, were not welcome by the mother of the child. She wondered how her child could have a middle ear infection despite following all the care guidelines given in postnatal counseling. She demanded a proper examination but informed her that the diagnosis was accurate, and the symptoms were associated with the disorder. The symptoms of otitis media in children include a severe earache, fever, and nausea, vomiting, and rupturing of the tympanic membrane and eardrum which is not very common (Burns, Dunn, Brady, Starr & Blosser, 2013). The appropriate prescription to the child was antibiotics and instructed the mother to give the child a non-prescription children’s pain medication. I scheduled an appointment within two weeks from then.

According to the American Academy of Pediatrics, middle ear infection (otitis media), is a common bacterial origin infection that enters the middle ear via the surface of the auditory tube mucous membranes (American Academy of Pediatrics, 2014). The inflammation of the tissues in the middle ear results in the infection. The tube is swollen, and pus accumulates in the tympanic cavity of the middle ear. As a practitioner nurse, it is important to have the basics of diagnosis and management of the acute otitis media for pediatrics. The classroom studies were effective in providing background information about the disorder which was useful in the practicum experience. I connected the classroom studies with the case presented in a real-world clinical setting and handled as required. A positive prognosis would be a blueprint for the success of the care and management plan offered to the patient. In essence, a practicum experience is more effective in enhancing the nursing practitioner skills than the theoretical sessions in the classroom which lack a practical experience and with a real case-related patient. It is needful to work in collaboration with other care providers as well the close-related caregivers to the patient for a positive outcome. I realized that nursing care requires a clear understanding of how to deal with a particular nursing problem to guarantee an appropriate diagnosis and management plan.

 Week 7: Practicum Journal Entry

The practicum journal entry for week 7 regards a patient who presented with the cardiovascular disorder during my experience at the health facility. The description has the details of the experience in assessing and managing the patient and his or her family as well as the details of the reaction after diagnosis of the disorder. Also included is the description of how the experience connects with the classroom studies to the real world clinical settings.

Case Study

Mr. and Mrs. Trump visited the emergency room with their six-week-old female to seek medical intervention.  They had the main complaints of lethargy, poor feeding, and respiratory distress. She had a healthy stay until two weeks before the presentation when she developed a febrile illness with a cough, rhinorrhea, and emesis. She later developed progressive respiratory distress, and the parents reported that she developed a lot of sweat on her forehead during feeding. Also observed was increased retractions and tachypnea.

A close examination and review of the patient history as narrated by the parents reviewed that their child was a product of a full term and normal pregnancy. Her delivery was non-complicated except for the meconium stained fluid. However, her pediatric follow-up was poor. From the physical examination and other tests like chest x-ray and electrocardiogram, there was a likelihood of a cardiovascular disorder. The diagnosis of the disease was via the chest x-ray which is more useful in the initial assessment of the patient with suspected heart failure. The child was diagnosed with congestive heart failure following an examination of all the signs and symptoms presented and also the tests.

The revealed information about the diagnosis was amazing to the parents since they never imagined that their young daughter would be diagnosed with a cardiovascular disorder at the tender age. It was challenging to handle the information despite the assurance that an early diagnosis was essential for an appropriate management plan. The child was admitted and loaded with digoxin as well as diuretics. The symptom improved but had a poor weight gain and continues to have the symptoms of heart failure in the medical management. It was necessary to refer her for a surgical correction of the ventricular septal defect at six months.

Congestive heart failure is the inability of the myocardium to meet the metabolic needs of the body. The cause can be an overwork of the myocardium, alterations in the myocardial performance, and metabolic derangements (Burns, Dunn, Brady, Starr & Blosser, 2013). The information acquired from the classroom studies about cardiovascular disorders was essential in handling the patient with close collaboration with other care providers. I had a practical experience and acquired clinical skills of handling cardiovascular disorder cases involving pediatrics. I acquired enhanced skills in patient assessment, examination, diagnosis, and decision making about the management plans. It is important for every nurse practitioner to have a practicum experience in a real-world clinical setting to learn more about patient handling and dissemination of information to the family and close relatives. It is a challenge to deal with family members who are uncooperative in the instances that require their participation in decision making. The need to have a rich theoretical background about the common health conditions cannot be underestimated by professionals in the health care field. The practicum experience and the classroom studies have a relationship in several aspects and thus important to collaborate them in clinical practice.

The three practicum experiences were effective in enhancing the practical skills expected for a practitioner nurse in their day-to-day activities.

References

American Academy of Pediatrics. (2014). Clinical practice guideline: Diagnosis and          management of acute otitis media. Pediatrics, 113(5), 1451–1465.

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 36, “Dermatologic Disorders” (pp.          877–927)

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 29, “Ear Disorders” (pp. 652–668)

American Academy of Pediatrics. (2014). Clinical practice guideline: Diagnosis and          management of acute otitis media. Pediatrics, 113(5), 1451–1465.

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 30, “Cardiovascular Disorders” (pp.       669–707)



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