NURS 5019- Journal #5

1. What goal did you meet this week that you and your preceptor discussed? What

areas does your preceptor feel that you need to work on for next week?

I have been attempting to identify abnormalities on x-rays of spine and extremities. I feel I am

making progress with this and learning more each day. I continue to challenge myself to come

up with as many differential diagnoses as possible with each new complaint, in order to expand

my thought process and assessment. I feel that my preceptor has challenged me each week with

goals that have not been easy to obtain, but have also taught me a lot. As this semester and

clinical rotation nears its end, I will continue to work on all of the goals we have set through this

semester in order to better myself in future practice.

2. What did you do this week that made you feel you gained confidence in a particular

area of patient care?

I was able to identify ascites in a patient. The patient complained of increasing shortness of

breath, tenderness of her abdomen worse on the left side, and increased bloating. During my

exam there were no audible bowel sounds, and positive fluid wave test in abdomen. I was

fortunate to be allowed to accompany the patient to the intensivist visit in urgent care (HMG has

an intensivist clinic in their urgent care setting. This clinic is run by hospitalists, and through

intervention in the clinic many patients keep from having to go to the emergency room for

treatment or undergo a hospital admission). The intensivist taught me how to ultrasound to

identify ascites in the abdominal cavity, as well as allow me to assist him in performing a

paracentesis on the patient.

The intensivist also, had an additional patient scheduled later that day needing a paracentesis, as

the patient is deciding on options with his future treatment regimen due to advancing liver

disease. (The gastroenterologist recommends treatment with a transjugular intrahepatic

portosystemic shunt, or TIPS, procedure in order to decrease his visits for routine paracentesis

for ascites). The intensivist doctor, as well as the patient allowed me permission to perform the

paracentesis with assistance of the physician.

I was worried that my assessment skills were lacking when I was unable to auscultate bowel

sounds on my patient. Through this experience, I feel that I gained confidence in trusting my

assessment skills to be able to identify abnormalities, as well as being able to see and perform a

procedure that I had never witnessed before that day.

3. Reflect on a situation where you did not feel confident in a particular area of

patient care. How did you handle the situation? What have you done or will you do

to make you feel more prepared for this same situation in the future?

I had a patient with a chief complaint of tonsillar abscess (self-diagnosed). He denies recent

fever, chills, drainage, cough, and stated that he noticed a pocket on his right tonsil few days

ago. He reported using organic apple cider vinegar and lemon water gargles regularly few

times per day for past week and feels this is getting some better. On exam the throat, nasal

passageways, and ears were clear, with no redness, or irritation noted, vital signs were within

normal limits. He did not want any prescription medications and did not warrant antibiotics at

this time. We reassured the patient and prescribed him miracle mouthwash as needed for

comfort, and the patient seemed accepting of this. I am seeing the desire for less prescription

medication and more natural alternative form of treatment more frequently in my current job, the

clinical setting, as well as at home with family members. I am often unsure of what to suggest to
these patients when desiring a more natural treatment. I hope to find a book, or continuing

education course offered that I could take, in order to learn of more holistic and natural

alternatives, in order to give the patient options for their care.

4. Reflect on some areas of learning while in clinical that will benefit you the most in

your own practice.

I feel that I have learned so much this semester that will benefit me in my future practice.

I have gained insight with patient complaints and learned not to have such a one track mind and

to think outside the box, keeping in mind all possible differential diagnoses and disease

processes that might cause a specific symptom or complaint.

I feel that I have advanced with my assessment skills through this clinical rotation. I have

learned how to properly perform many tests, especially orthopedic tests. I have reviewed

anatomy, expanded my medical vocabulary, and I feel that I am gaining better documentation

skills. I also feel that I have gained a better understanding of visit levels and ICD 10 codes.

I feel through learning how to identify abnormalities on x-rays will help me in my future

practice, especially in an office setting. I realize that most x-rays will not be read immediately in

an office setting, by a radiologist. Being able to identify major abnormalities, I will be able to

initiate a proper treatment regimen, and adjust the treatment plan as needed once the x-ray is

officially read. I realize this is a learning process, but feel this will help me gain confidence in

my treatment plan, as well as help me to gain trust from my patients.

I have had the opportunity to observe and perform many intra-articular injections and learned of

many different treatment options, some of which I did not realize were available for treatment,

for example a bone stimulator.

 5. What was a challenging clinical situation and how did you handle it?

I feel it is challenging when faced with a complaint that has not been discussed thus far in the

classroom setting. There are many new diagnoses I learn in clinical each day, which we learn in

class a few weeks after the fact. Each day I attend clinical, I write down things not familiar with,

and research once I go home in the evening. I feel this has helped me to learn many disease

processes and treatment regimens, especially when studying for future weeks and body systems,

in the classroom setting. On the other hand, I find this a challenge in the clinical setting,

thankfully my preceptor this semester is very patient and an excellent teacher. I do realize,

however, education is a learning process, and you cannot know everything all at once.

6. What course objective did you address this week?

Objective 6: Teach individuals, families, and groups skills and behaviors to promote health,

prevent disease, and manage acute and chronic illnesses in adults and older adults.

I feel this objective has been met by teaching of patients and families with each encounter about

disease process, treatment regimen, as well as by teaching health promoting behaviors.