What did you learn from this week’s clinical experience that can beneficial for you as an advanced practice nurse?

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 possible differential diagnosis. 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.Sample 1:This week in pediatric clinic rotation I consider having been a successful one. My preceptor allowed me to take on many patients independently and she helped explain, teach me, and answering all of the questions that I had. I realized I was much more comfortable speaking with the parents, asking them about their children’s health history, answering their questions with my preceptor present, and especially much more comfortable assessing my infant and children. This week a patient that stood out to me was A.M, a 13-year-old girl that came into the clinic with her mother. She has a history of iron deficiency anemia and has come to the clinic in the past 5 months twice before with recurrent complaints of feeling tired and feeling her heart beating fast. This usually exacerbates when she is menstruating. Anemia may have multiple etiologies, but the most common cause among reproductive-age women is iron deficiency. Adolescent women with IDA may experience negative effects on cognitive function, audiovisual reaction time, and physical performance. Published risk factors for IDA, including race, poverty, education, low iron intake, heavy menses, parity, and a previous diagnosis of IDA, are based on all women of reproductive age, variably defined between 12 and 49 years (Sekhar, 2016). She is currently taking supplements of ferrous sulfate 325 mg once a day. Her mother also states she has been feeding her daughter foods that are high in iron including spinach and broccoli, but neither the supplements or the change in diet has helped. The patient states she gets tired just from walking from her room to the bathroom and this makes her very nervous and scared. She has had her blood drawn twice before in the pediatrician clinic. Her initial hemoglobin count 5 months ago was 10.4. Three months ago, her hemoglobin was 8.4. Today, she complains of the same feeling of tiredness and feeling her heart is skipping a beat.When assessing A.M., I immediately notice her skin throughout her body is pale. I assess the mucus membrane in the lower lash line, which were pale in color. I notice she has cracked and dry lips especially in the corners of the mouth. Her nail beds are brittle and spoon-shaped. There is no capillary refill of her nails of her hands or her feet. Due to the clinical presentation of the patient, my preceptor spoke very seriously to the patient and her mother that her condition has worsened and would want to take a sample of blood for a CBC to determine her current hemoglobin levels and to drive to the local children’s hospital emergency department for a more in-depth review of her current status as well as provide supportive care and education regarding the child’s specific condition. Her current hemoglobin in the clinic was 7.4. My preceptor states she has a recurrent diagnosis of Anemia. The patient’s mother was very worried and nervous when the laboratory results were given, but my preceptor assured her that at the hospital they would do further testing to rule out any occult bleeding. They will also rule out any other diseases, infections, inherited blood anemias, lack of other minerals and vitamins in the body, uterine fibroids, uterine cysts, leukemias, or other cancers. The mother asked what other tests would they do at the hospital that has not already been seen through the sample of blood taken today at the pediatrician’s office. My preceptor explained that at the hospital they may want to know specific information regarding her blood work. This includes a PT/PTT, a peripheral smear, reticulocyte count, and possible blood transfusion. The young girl may also be seen in the future by a hematologist who specializes in anemia and other blood disorders. Typically, when an adolescent with heavy menstrual bleeding is referred to a hematologist, it is because the referring provider suspects the possibility of an underlying bleeding disorder. The role of the hematologist is threefold in the evaluation of such patients: (1) perform a clinical and laboratory evaluation for an underlying bleeding disorder based on the degree of clinical suspicion, (2) identify and manage any concomitant iron deficiency, and (3) provide input to the referring provider regarding the management of heavy menstrual bleeding, particularly for patients with identified hemostatic defects (O’Brien, 2018).This week in pediatric clinical rotations has opened my eyes to the importance of a thorough medical history including past laboratory work as well as the importance of a careful and complete assessment of the patient. A comprehensive examination of the patient including both subjective and objective symptoms will help to gain a more accurate diagnosis, an overall positive health care outcome for the patient, as well as save time in the case of implementation of life-saving treatments.ReferencesO’Brien, S. H. (2018). Evaluation and management of heavy menstrual bleeding in adolescents: the role of the hematologist. Hematology 2014, the American Society of Hematology Education Program Book, 2018(1), 390-398.Sekhar, D. L., Murray-Kolb, L. E., Kunselman, A. R., Weisman, C. S., & Paul, I. M. (2016). Differences in risk factors for anemia between adolescent and adult women. Journal of Women’s Health, 25(5), 505-513.Sample 2:This week in clinical rotation becomes a challenge too, as we know, almost every American family have their kids and home these days of world pandemic. The preceptor is being very helpful and always guide me into this new part of advanced nursing, pediatric. The office continues working by a virtual method of telemedicine, always following HIPPA guidelines and regulations. I started to feel more comfortable with children’s care and their health needs; I think that the role of my preceptor is essential, and his support during all patients’ encounters makes me feel secure, helping me develop the necessary skills for my future as an advance provider. The case got my attention this week was a 7-year-old boy, A.P, whose father contacted the primary acre office due to lack of school interest. A.P’s father mentioned that when he started school, his son was always interested in getting ready and going to school to see his friends and teacher, but since the mandatory stay home law, he dedicates more time to play videogames, and stay awake late. A.P has changed his regular sleeping schedule, and in the morning, wake up late. Homeschooling is the new method of getting education due to the Pandemic, and getting A.P awake early to attend school becomes a challenge; he is refusing to enter the school web-side and do his homework, and started becoming anxious and wetting the bed. Guided by my preceptor, I started to collect essential data related to A.P medical history. His father states he is a healthy child, ahs his immunizations up to date, ahs no history of hospitalizations or surgeries. He only recalls common cold a couple of times that never require other treatment than symptomatic. He was always motivated by going to school and visit a closer family. But since the Pandemic played all day with several devices and refused to go the bed early, and sometimes wet the bed at night. After reviewing this patient negative medical history, also we asked the father about a family history of any mental and neurological illness; he denied so. After performing a guided physical assessment, we found a healthy child, good hygiene, and well-groomed, unremarkable system review, no presence of rash or any fever, appears to be motivated for school activities, but the state is not the same because he does not see his friends. In this case, the instructor explained A.P’s father and me that probably the lack of attention is second to home quarantine, influencing the child to feel anxious and decreasing his motivation for his age school activities. The most important part of this visit is education to the parent; instruct him is limited A.P gaming hours to establish a routine sleeping time, avoid drinking copious amounts of fluids before going to bed and encourage the child to sleep early and wake him up on time for online schooling. In this education, we emphasize in motivate the child in other home activities like painting, crafting, and playing together to increase his activity, create an in-home schedule including several chores and activities, including mealtimes. This home schedule will help the child and the family adapt to this quarantine and decreased the anxiety secondary to staying at home. Also, encourage the father to participate and help the child in school homework and activities and promote a healthy home routine, including play, meals, exercise, and sleeping time for better and healthy child development. As a professional helping parents in their child activities become a responsibility these days, because not only children are suffering lack of social relations, the entire family is now inside their homes adapting to this new world, including us healthcare providers and practice modalities.ReferencesCohen, D. (2020) How to Help Your Child Get Motivated in School. Child Mind Institute. [online] Child Mind Institute. Available at: https://childmind.org/article/how-to-help-your-child-get-motivated-in-school. [Accessed 21 May, 2020].Sample 3:This week’s clinical was very thoughtful as a lot of parents have been worried about the pandemic on their children. The patient I had this week was a 7-month-old male presented with his mother for a history of fever that started two days ago, the temperature was up to 1020 taken orally, and was initially responsive to acetaminophen. However, his mother mentions that the temperature returns four hours after the medication was taken. Yesterday the child has been tired, irritated, and breathing rapidly. The mother denies any abdominal retractions or nasal flaring, the mother also notes rhinorrhea and refusal breast and baby food. She also says the whole family has had a cold recently, but the patient has no associated cough, ear pulling, ear discharge, red eyes, or rash. He’s been healthy; immunizations are up to date, no surgeries or hospitalizations, and history of immunodeficiencies. Mother reports of being worried about the Covid-19 in children, which they described as Pediatric Multi-system inflammatory syndrome.Physical Exam Findings:General: Alert, non-toxic, fussy with parts of the exam, but consolable. Interactive with her mother, playing with a book her mother hands her.Vital signs: Temperature: 101.2 0 F orally/Heart rate: 110 beats/minute/Respiratory rate: 32 breaths/minutNasal exam: no nasal discharge or congestion./External ear canal normal,/Eyes: No erythema of the conjunctiva or eye discharge/ Cardiac: Regular rate and rhythm/Lungs: All lung fields are clear to auscultation Mildly tachypneic, but not distressed (no retractions or nasal flaring). Abdomen: Bowel sounds indicate normal intestinal activity. Skin: Warm. No rashes. Capillary refill < 2 seconds.Oropharynx: The pharynx reveals no erythema or exudate; moist mucus membranes without lesions; normal dentition.Initial Differential diagnosis consideration in a child with fever and congestion.Viral Upper Respiratory Infection: Based on finding and the presentation of the common cold is variable. Throat irritation, sneezing, nasal stuffiness, rhinorrhea, cough, fever, and irritability are common symptoms of a URI.Pneumonia: Viral pneumonia often presents with moderate fever, nonproductive cough, and gradual onset of upper respiratory tract symptoms. Lung exam findings may include wheeze and are often bilateral.Bacterial pneumonia: typically presents with the abrupt onset of high fever, cough, and ill appearance. Some children have chest pain. Bacterial pneumonia may be a secondary infection following recent URI. Lung exam findings may be focal or subtle. Important Physical exam findings for pneumonia are tachypnea, dyspnea, crackles, decreased breath sounds.Acute otitis Media: Typically develops 3-5 days after onset of upper respiratory symptoms. One of the more specific symptoms is otalgia (ear pain, tugging at ears). Other symptoms include fever, irritability, cough, anorexia, and, less commonly, vomiting and diarrhea. Otitis media is a common complication of URIs in this age group.Patient Management: Based on the child presentation and physical exam, we recommend:Fever Reduction: Fever is frequently accompanying a viral upper respiratory infection in children is not harmful and is usually faded in three to five days. The mother should be educated about how to manage fever if fever reduction is needed. She can continue to give acetaminophen (a teaspoon of 5mL).Comfort measures Nasal suction for infants. She can use nasal saline before suctioning to help loosen secretions. To relieve nasal congestion, suction gently with a blunt-tipped bulb syringe before feedings and sleep. Using a bulb syringe to aspirate nasal secretions may promote drainage and comfort. Proper cleaning and air-drying of bulb syringe reduce the opportunity for the growth of organisms inside the syringe (Emerson, 1951).Regarding her concern about the Pediatric multisystem inflammatory syndrome in children, which is a new health condition that is related to Covid-19. It appears similar to Kawazaki disease, and toxic shock syndrome. Based on CDC: those are the common signs and symptoms: The first symptoms are usually a skin rash and fever. Individuals with NOMID may also have chronic meningitis (inflammation of the membranes surrounding the brain), which may lead to headaches, seizures, and vomiting. Hearing loss, vision loss, and intellectual disability, may also occur (Hoffman, 2011).References:Emerson Jr EB. Nasal, nasopharyngeal and throat suction apparatus for the newborn and small infant. AMA Am J Dis Child 1951;82:169-70.Hoffman H. Neonatal-onset Multisystem Inflammatory Disease. National Organization for Rare Disorders (NORD). 2011; https://rarediseases.org/rare-diseases/neonatal-onset-multisystem-inflammatory-disease/ (Links to an external site.). Accessed 10/25/2016.