Introduction
Clinical experiences play a crucial role in shaping the development of advanced practice nurses. This discussion explores a recent clinical experience, focusing on patient assessment, plan of care, differential diagnoses, health promotion interventions, and the lessons learned from the week’s encounters.
Clinical Experience Overview
Throughout the week, I engaged in a clinical experience that provided opportunities to assess and care for a diverse range of patients. One of the notable cases involved a middle-aged patient presenting with recurrent abdominal pain and digestive discomfort.
Challenges and Successes
In this clinical experience, I encountered challenges related to deciphering the underlying cause of the patient’s symptoms. The success lay in effectively conducting a thorough assessment, collaborating with the healthcare team, and devising a comprehensive plan of care.
Patient Assessment
The patient reported experiencing episodic abdominal pain, bloating, and irregular bowel movements. Upon assessment, physical examination, and reviewing the patient’s medical history, several signs and symptoms (S&S) were identified: intermittent crampy abdominal pain, altered bowel patterns, distention, and increased flatulence.
Plan of Care
The plan of care incorporated both diagnostic and therapeutic measures. Given the presenting symptoms, a comprehensive approach was adopted. This included ordering laboratory tests (complete blood count, comprehensive metabolic panel, and inflammatory markers), abdominal imaging (ultrasound or CT scan), and potentially endoscopic evaluation.
Differential Diagnoses
Three possible differential diagnoses were considered: irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), and celiac disease. The rationale for each includes:
IBS: Matches the patient’s recurrent abdominal pain and altered bowel habits. The absence of specific biomarkers supports this diagnosis.
IBD: Inflammatory markers and imaging could identify inflammation of the gastrointestinal tract, correlating with the symptoms.
Celiac Disease: Digestive symptoms, especially bloating and abdominal pain, could indicate sensitivity to gluten.
Health Promotion Intervention:
As a health promotion intervention, dietary modifications were discussed with the patient. Emphasizing a balanced diet rich in fiber, low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs), and potentially avoiding gluten could alleviate symptoms and improve the patient’s quality of life.
Lessons Learned
This week’s clinical experience reinforced the significance of conducting comprehensive patient assessments, considering various differential diagnoses, and involving the interdisciplinary team. Moreover, I learned the importance of effective communication when discussing dietary modifications as a health promotion strategy.
Research Guideline Support
The plan of care aligns with current guidelines for managing gastrointestinal disorders. A study by Ford et al. (2018) highlighted the efficacy of the low FODMAP diet in alleviating IBS symptoms. Additionally, the American College of Gastroenterology’s guidelines emphasize the importance of considering IBD and celiac disease in patients with persistent abdominal symptoms (Rubin et al., 2019).
Conclusion
The clinical experience of assessing and caring for a patient with abdominal discomfort underscores the complexity of patient care. Effective assessment, differential diagnosis, interdisciplinary collaboration, and evidence-based interventions are pivotal in delivering patient-centered care that aligns with current research and guidelines.
References
Ford, A. C., Moayyedi, P., Lacy, B. E., Lembo, A. J., Saito, Y. A., Schiller, L. R., … & Quigley, E. M. (2018). American College of Gastroenterology Monograph on Management of Irritable Bowel Syndrome and Chronic Idiopathic Constipation. American Journal of Gastroenterology, 113(1), 1-18.
Rubin, D. T., Ananthakrishnan, A. N., Siegel, C. A., Sauer, B. G., & Long, M. D. (2019). ACG Clinical Guideline: Ulcerative Colitis in Adults. American Journal of Gastroenterology, 114(3), 384-413.
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