Clinical Experience
During this week’s clinical rotation, I had the opportunity to care for a middle-aged female patient with complaints of shortness of breath, fatigue, and generalized weakness. The patient presented with a medical history of hypertension and obesity. As an advanced practice nurse, my primary goal was to assess the patient thoroughly, establish a differential diagnosis, and develop an effective plan of care.
Assessment of the Patient
Signs and Symptoms (S&S):
Shortness of breath on exertion (dyspnea)
Fatigue
Generalized weakness
Assessment:
Vital signs: The patient’s blood pressure was elevated at 150/90 mmHg, heart rate was 90 beats per minute, respiratory rate was 20 breaths per minute, and oxygen saturation was 93% on room air.
Respiratory examination: Auscultation revealed bilateral crackles and diminished breath sounds at the bases of the lungs.
Cardiac examination: A regular rate and rhythm with no murmurs or gallops were noted.
Laboratory results: Complete blood count (CBC) showed mild leukocytosis, and a chest X-ray indicated bilateral pulmonary infiltrates.
Plan of Care:
Based on the assessment findings, I developed a preliminary plan of care that included the following steps:
Administer supplemental oxygen to maintain oxygen saturation above 94%.
Initiate intravenous (IV) access for hydration and medication administration.
Perform an electrocardiogram (ECG) to assess cardiac function.
Obtain a detailed medical history to identify any recent infections or exposures.
Order blood and sputum cultures to rule out infectious etiologies.
Start broad-spectrum antibiotics to cover potential community-acquired pneumonia.
Differential Diagnoses
Community-Acquired Pneumonia (CAP): The patient’s symptoms, physical examination findings, and chest X-ray results are suggestive of CAP. As an advanced practice nurse, it is crucial to initiate appropriate antibiotic therapy promptly to improve patient outcomes (Jain et al., 2019).
Congestive Heart Failure (CHF): Given the patient’s history of hypertension and presenting symptoms of dyspnea, fatigue, and crackles on lung examination, CHF should be considered. Echocardiography may be necessary to assess cardiac function (Ponikowski et al., 2016).
Chronic Obstructive Pulmonary Disease (COPD) Exacerbation: The patient’s history of smoking and the presence of chronic dyspnea and diminished breath sounds may indicate a COPD exacerbation. Corticosteroids and bronchodilators can be effective in managing exacerbations (Vogelmeier et al., 2017).
Health Promotion Intervention
Incorporating health promotion is essential in the management of this patient. As an advanced practice nurse, I would focus on educating the patient about lifestyle modifications to improve her overall health. Emphasizing the importance of regular exercise, smoking cessation, and adherence to a heart-healthy diet can help manage hypertension and reduce the risk of future exacerbations (Jaarsma et al., 2016).
Learnings from Clinical Experience
From this week’s clinical experience, I have realized the significance of a comprehensive patient assessment in formulating accurate differential diagnoses and individualizing the plan of care. Moreover, early intervention is critical in managing acute conditions like community-acquired pneumonia. As an advanced practice nurse, staying updated with evidence-based guidelines and research is essential to providing the best care possible to patients (Metersky et al., 2019).
References
Jaarsma, T., Hill, L., Bayes-Genis, A., La Rocca, H. P. B., Castiello, T., Čelutkienė, J., … & Lainscak, M. (2016). Self-care of heart failure patients: practical management recommendations from the Heart Failure Association of the European Society of Cardiology. European Journal of Heart Failure, 18(10), 1150-1164.
Jain, S., Self, W. H., Wunderink, R. G., Fakhran, S., Balk, R., Bramley, A. M., … & Williams, D. J. (2019). Community-acquired pneumonia requiring hospitalization among U.S. adults. New England Journal of Medicine, 380(18), 1702-1712.
Metersky, M. L., Frei, C. R., Mortensen, E. M., & Restrepo, M. I. (2019). Predictors of Pseudomonas and methicillin-resistant Staphylococcus aureus in hospitalized patients with healthcare-associated pneumonia. European Respiratory Journal, 53(3), 1802108.
Ponikowski, P., Voors, A. A., Anker, S. D., Bueno, H., Cleland, J. G., Coats, A. J., … & Lancellotti, P. (2016). 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. European Journal of Heart Failure, 18(8), 891-975.
Vogelmeier, C. F., Criner, G. J., Martinez, F. J., Anzueto, A., Barnes, P. J., Bourbeau, J., … & Wedzicha, J. A. (2017). Global strategy for the diagnosis, management, and prevention of chronic obstructive lung disease 2017 report: GOLD executive summary. American Journal of Respiratory and Critical Care Medicine, 195(5), 557-582.
