Assignment: Practicum – Week 1, 2, & 4 Journal Entry and Journal Submission

Running head: PRACTICUM EXPERIENCE-JOURNAL ENTRIES

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PRACTICUM EXPERIENCE-JOURNAL ENTRIES

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Practicum Experience-Journal Entries-Weeks One, Two, and Four

Student

Advanced Practice Care of Adults

NURS 6531

Walden University

March 24, 20XX

Student Name:

Email

Preceptor’s Name: Preceptor’s Number:

Preceptor’s Email:

Journal Entry, Week 1-March 3, 20XX

The key to success as an aspiring advanced practice nurse (APN) is the ability to apply experience from the classroom and knowledge obtained from literature to practicum experience. Application of this concept will promote professional growth and will provide knowledge necessary for providing care to a multicultural patient population that is competent and effective. In order to care for patients with diverse cultural backgrounds, the APN may select a nursing theory to guide decisions and care provided in practice.

The purpose of this paper is to select a nursing theory to guide practice, compose a list of goals and objectives for practicum experience, and based on practicum requirements; generate a timeline of practicum activities.

Pender’s Model-Health Promotion

Using the Pender’s model, the APN will promote the health of the individual through improving degree of well-being. The Pender's model concentrates on experiences and characteristics based on the individual, perceptions and affect specific to behavior, and behavioral consequences. Each individual possess experiences and characteristics that influences following actions. Applying critical thinking when communicating, making decisions, and solving problems will allow the APN to apply skills when providing care. Using knowledge and skills to educate and motivate, the individual will display health-promoting behaviors that will lead to improved health, quality of life, and functional capacity (Petiprin, 2016).

The Pender’s model is instrumental with identifying and providing data to create interventions, identifying and eliminating risk factors for disease, and to practice and implement changes in health and health promotion techniques for patients (Heydari & Khorashadizadeh, 2014). The campaign to assist the patient to assume more responsibility and accountability for personal health depends on care provided by the APN and other healthcare professionals that is based on evidence-based practice (Alligood, 2018).

Goals and Objectives for Practicum Experience

Keeping the seven domains of practice in mind, I have composed the following goals and objectives, which will be used to guide practice throughout practicum experiences.

1. I will perform a complete head to toe exam on a patient during practicum while my preceptor observe and evaluate my performance and skills.

2. I will review the patient’s chief complaint and use critical thinking skills before assessing the patient to present a primary diagnosis with differential diagnoses and a treatment plan with guidance from my designated preceptor.

3. I will integrate the Pender’s health promotion model by educating the patient on ways to promote health and prevent the development or progression of disease.

4. By the end of my practicum rotation, I will perform a complete head-to-toe exam and interview with a patient without my preceptor and provide differential diagnoses and a treatment plan for the patient.

5. I will identify a patient with a common disorder such as hypertension, cardiovascular disease, and diabetes mellitus. Using critical thinking skills, I will utilize pertinent screening techniques and educate for this patient specific to the disorder.

6. Using research that is evidence-based, I will assist the preceptor in educating a patient to promote positive and healthier outcomes for the patient showing evidence through accurate documentation.

7. Using the Pender’s health promotion model, I will gain cultural competence, enhance communication skills, identify and utilize resources, and use skills obtained to communicate effectively with patients from diverse cultural environments.

Conclusion

As I progress through this journey to provide care for adult patients, the confidence, skills, experience and knowledge gained through my practicum experience and assignments throughout the course will allow me to provide quality care to patients in the clinical setting. Integrating the Pender’s health promotion theory into practice will allow me to provide care to individuals of multicultural backgrounds, identify individual behaviors, and provide education to promote healthier decisions in behaviors to improve health outcome of the patient. Through the practicum experience, I will gain the skills needed to enhance critical thinking and to appropriately diagnose and treat disorders presented by the patient.

Practicum Activity Timeline

Week 1:

• Discussion due by Wednesday, replies due by Saturday.

• Complete journal entry related to Theory for Practice.

• Clinical: Wednesday-2/28/18.

Week 2:

• Discussion due by Wednesday, replies due by Saturday.

• Quiz must be completed by day 7

• Complete journal entry related to pattern recognition in diagnosis.

• Clinical: Thursday-3/8/18.

Week 3:

• Assess a hypertensive patient for week 3 discussion board post. Make notation of the patient’s past medical history, social history, medication regimen, dietary and activity routines, family history, allergies, and any other pertinent factors. Provide suggestions to the patient for health promotion and strategies for managing hypertension.

• Complete first SOAP note.

• Discussion post due by Wednesday, replies due by Saturday.

• Preceptor on vacation March 12-16, no clinical time scheduled.

Week 4:

• Discussion 1 is due by Wednesday and Discussion 2 due by Thursday. Replies due by Saturday.

• Quiz due by day 7.

• Complete journal entry related to a cardiovascular disorder.

• Submit week 1, 2, and 4 journal entries and week 3 SOAP note.

• Clinical: Monday-3/19 and Wednesday-3/21.

Week 5:

• Discussion due by Wednesday, replies due by Saturday.

• Assignment 1: Pulmonary Function Testing (2-3 page paper). Due by day 7.

• Journal entry related to asthma. (Due in week 7)

• Clinical: Wednesday-3/28.

Week 6:

• Discussion due by Wednesday, replied due by Saturday.

• Quiz due by day 7.

• Journal entry related to abdominal pain. (Due week 7)

• Clinical: Monday-4/2 and Wednesday-4/4.

Week 7:

Discussion due by Wednesday, replied due by Saturday.

• Quiz due by day 7.

• SOAP note due by day 7.

• Week 5 and 6 journal entries due by day 7.

• Clinical: Wednesday-4/11 and Friday.-4/13.

Week 8:

• Discussion due by Wednesday, replies due by Saturday.

• Assignment 1: Chronic Kidney Disease (2-3 page paper) (due week 9).

• Journal entry related to a renal disorder. (Due week 10)

• Clinical: Monday-4/16 and Wednesday-4/18.

Week 9:

• Discussion due Wednesday, replies due by Saturday.

• Quiz due by day7.

• Assignment: Chronic Kidney Disease. Due by day 7.

• Journal entry related to musculoskeletal disorder. (Due week 10)

• Clinical: Monday-4/23, Wednesday-4/25, and Friday-4/27.

Week 10:

• Assignment: Patient Education on Stroke Prevention (Media presentation) due week 11.

• Discussion due by Thursday, replies due by Saturday.

• Submit SOAP note.

• Submit week 8 and 9 journal entries.

• Clinical: Monday-4/30 and Wednesday-5/2.

Week 11:

• Discussion due by Wednesday, replies due by Saturday.

• Assignment started in week 10 is due by day 7.

• Quiz due by day 7.

• Clinical: Wednesday-5/9 and Friday-5/11.

References

Alligood, M. R. (2018). Nursing theorists and their work (9th ed.). St. Louis, MO: Elsevier. Retrieved from https://books.google.com/books?hl=en&lr=&id=l7stDwAAQBAJ&oi=fnd&pg=PP1&dq=pender's health promotion model&ots=yVrGXYJMf9&sig=geSYFGZQuiKZa7Js1NrZvcj8CbE#v=onepage&q=pender's health promotion model&f=false.

Heydari, A. & Khorashadizadeh, F. (2014). Pender's health promotion model in medical research. JPMA. The Journal of the Pakistan Medical Association, 64(9), 1067-1074. Retrieved from http://jpma.org.pk/full_article_text.php?article_id=6937

Petiprin, A. (2016). Health promotion model. Retrieved from http://www.nursing-theory.org/theories-and-models/pender-health-promotion-model.php

Week Two Journal Entry-Pattern Recognition-March 10, 20XX

Completion of practicum this week has given me 16 clinical hours with Dr. So and So. I am now familiar with the clinical setting, clinical staff, and basic routine of patient flow. I have had the opportunity to see patients along with Dr. So and So with chief complaints including headaches, dizziness, high blood pressure, chronic back pain, elevated blood sugars, numbness and tingling in extremities, and more.

I have identified the established pattern of Dr. So and So where he first reviews the patient’s chief complaint. He then reviews the previous office note, the patient’s past medical history, current laboratory results compared to previous values, and the patient’s medication regimen assessing for changes in either of these factors. Once he has reviewed the data, he will establish a preliminary primary diagnosis and treatment options based on diagnosis.

Next, Dr. So and So enters the room and begin to converse with the patient asking about their family, hobbies and interests, and chief complaint. He further questions the patient on onset and duration of chief complaint, worsening or alleviating factors, and any associated factors related to the chief complaint. Once the patient has voiced all concerns, Dr. So and So performs a focused physical assessment based on the chief complaint. All physical examinations performed by Dr. So and So includes an assessment on the cardiovascular and pulmonary systems. The physical examination is an important aspect in the encounter between the patient and provider. Performing a physical exam allows the provider to collect vital information needed to accurately diagnose the patient, perform necessary testing, and prescribing accurate treatment (Mookherjee, Pheatt, Ranji, & Chou, 2013).

Pattern recognition is recognizing parallels between the presenting complaints and illnesses in memory from previous patients and/or literature. This recognition allows the provider to develop diagnoses early in the patient encounter. Pattern recognition leads to differential diagnoses and diagnostic assumptions followed by the provider collecting additional information that confirms or disprove the diagnostic assumption. Verifying this diagnostic hypothesis requires analytic reasoning to match the elements of the illness script with findings of the case at hand (Mamede & Schmidt, 2017).

An example of using pattern recognition of an illness is recognizing a patient’s complaint of facial pain, nasal congestion, runny nose, headache and/or sinus pressure and forming a diagnostic assumption of sinusitis. Another example is identifying signs and symptoms such as chest pain, pain in left arm, shortness of breath, or pain in the jaw and forming a diagnostic assumption of a myocardial infarction.

Conclusion

Pattern recognition is exhibited through identifying signs and symptoms that are common in certain illnesses. Using pattern recognition helps the provider to narrow down the diagnosis and prescribe necessary diagnostic testing which saves time and money for the patient. It also helps enhance critical thinking skills and decisions leading to proper diagnosis and treatment of disorders.

References

Mamede, S. & Schmidt, H. G. (2017). Reflection in medical diagnosis: A literature review. Health Professions Education, 3(1), 15-25. Retrieved from https://www.sciencedirect.com/science/article/pii/S2452301117300081

Mookherjee, S., Pheatt, L., Ranji, S. R., & Chou, C. L. (2013). Physical examination education in graduate medical education—A systematic review of the literature. Journal of General Internal Medicine, 28(8), 1090–1099. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3710393/

Week Four Journal Entry-Cardiovascular Disorder-March 24, 20XX

One patient in particular that presented in the office during my practicum experience was a 65-year-old-male with a history of mitral valve prolapse that led to mitral valve replacement surgery at age 58. Many individuals are affected by mitral valve prolapse and it is considered harmless unless regurgitation occurs and the patient becomes symptomatic (American Heart Association, 2018). Additional medical history on this patient included diabetes type 2 (diet controlled), hypertension, and osteoarthritis. The patient’s family history was positive for heart murmur with his father and hypertension with his mother. Social history was negative for alcohol, tobacco, or illicit drug use. The patient also stated that he exercised three to four times weekly and consumed a healthy diet.

This patient’s mitral valve was replaced with a mechanical valve and was prescribed aspirin 325mg daily and warfarin 5mg daily for to prevent platelet aggregation and clot formation on the mechanical valve. The patient was also taking metoprolol tartrate 25mg twice a day for blood pressure. In patients with mechanical valves, lifelong vitamin K antagonist such as warfarin is required. Direct oral anticoagulants such as dabigatran, rivaroxaban, apixaban, and edoxaban are contraindicated with mechanical valves (Gaasch & Konkle, 2017). The patient is now on routine monitoring for international normalized ratio (INR) levels. The patient’s INR was tested in office and his INR level was 2.5. The patient’s warfarin dosing was considered therapeutic and he was to follow-up in office in one month for another INR level check. Therapeutic range for INR levels with warfarin therapy is between two to three. The patient should be educated that foods rich in vitamin K, such as broccoli, cabbage, collards, and spinach may be consumed with moderation and consistency. In addition, strict adherence to warfarin therapy should be followed and no drastic changes in alcohol and food intake (Wigle, Bloomfield, Tubb, & Doherty, 2013).

References

American Heart Association (2018). Heart valve problems and causes. Retrieved from http://www.heart.org/HEARTORG/Conditions/More/HeartValveProblemsandDisease/Heart-Valve-Problems-and-Causes_UCM_450755_Article.jsp

Wigle, P., Bloomfield, H. E., Tubb, M., & Doherty, M. (2013). Updated guidelines on outpatient anticoagulation. American Family Physician, 87(8):556-566. Retrieved from https://www.aafp.org/afp/2013/0415/p556.html

Gaasch, W. H. & Konkle, B. A. (2017). Antithrombotic therapy for prosthetic heart valves: Indications. Retrieved from https://www.uptodate.com/contents/antithrombotic-therapy-for-prosthetic-heart-valves-indications