Geriatric Clinical Experience for the Final Week as a Student Nurse Practitioner

Introduction

The final week of my clinical experience as a student nurse practitioner at a family health clinic focused on caring for older adult patients. This experience provided valuable insights into the challenges and successes of working with this population. Throughout the week, I encountered various signs and symptoms, conducted assessments, developed plans of care, and implemented health promotion interventions. This essay will discuss my experiences, including challenges, successes, assessment of a patient, possible differential diagnoses, health promotion interventions, and the lessons learned from this clinical experience.

Challenges and Successes

During my final week as a student nurse practitioner in the geriatric clinic, I faced several challenges. One significant challenge was managing multiple chronic conditions in older adult patients. Many older adults have complex medical histories, making it essential to prioritize and manage their conditions effectively. Additionally, addressing medication adherence and polypharmacy proved to be challenging due to the number of medications older adults often take.

Despite these challenges, I also experienced successes during this clinical experience. One notable success was building rapport with older adult patients. Through active listening and empathy, I was able to establish a therapeutic relationship built on trust and mutual respect. This allowed me to address their concerns and provide appropriate care.

Assessment of a Patient

During this clinical experience, I encountered a patient who presented with several signs and symptoms. The patient complained of fatigue, shortness of breath, and swelling in the lower extremities. Upon assessment, the patient had crackles in lung auscultation, elevated jugular venous pressure (JVP), and pitting edema in both lower extremities. Based on these findings, I developed the following assessment:

• Signs and Symptoms (S&S):
  • Fatigue
  • Shortness of breath
  • Swelling in lower extremities
  • Crackles in lung auscultation
  • Elevated jugular venous pressure (JVP)
  • Pitting edema in both lower extremities
• Plan of Care:
  • Order a complete blood count (CBC) and comprehensive metabolic panel (CMP) to assess for any underlying medical conditions.
  • Perform an electrocardiogram (ECG) to evaluate cardiac function.
  • Refer the patient for an echocardiogram to assess cardiac structure and function.
• Possible Differential Diagnoses:
  1. Congestive heart failure (CHF): The patient’s symptoms, such as fatigue, shortness of breath, and edema, along with physical exam findings of elevated JVP and crackles in lung auscultation, suggest the possibility of CHF.
  2. Chronic obstructive pulmonary disease (COPD): The presence of crackles in the lung auscultation may also indicate COPD as a possible differential diagnosis.
  3. Renal insufficiency: The swelling in the lower extremities and pitting edema could be suggestive of renal insufficiency.
• Rationales:
  • CHF: The patient’s symptoms and physical exam findings align with the typical presentation of CHF. Further diagnostic tests, such as an echocardiogram, can help confirm this diagnosis.
  • COPD: Crackles in lung auscultation are common in patients with COPD due to airway inflammation and mucus production. Additional assessment tools, such as pulmonary function tests, can aid in confirming this diagnosis.
  • Renal insufficiency: Swelling and pitting edema are often associated with renal dysfunction. Further evaluation, including renal function tests, can help determine if renal insufficiency is contributing to the patient’s symptoms.

Health Promotion Intervention

To promote the health of this patient, it is crucial to address the underlying causes contributing to their symptoms. One health promotion intervention for this patient could involve providing education on lifestyle modifications, including:

• Encouraging a heart-healthy diet low in sodium and high in fruits and vegetables to manage fluid retention and blood pressure.
• Promoting regular exercise, such as walking or low-impact activities, to improve cardiovascular function and reduce symptoms.
• Educating the patient on the importance of medication adherence and the proper use of prescribed medications.

These health promotion interventions can help manage the patient’s symptoms and improve their overall quality of life.

Lessons Learned as an Advanced Practice Nurse

This week’s clinical experience provided valuable lessons that will benefit me as an advanced practice nurse. One key lesson was the significance of comprehensive assessments in older adult patients. By conducting thorough assessments and considering the differential diagnoses, I can accurately diagnose and develop appropriate plans of care for my patients.

Additionally, I learned the importance of interdisciplinary collaboration in managing complex cases. Older adult patients often require input from various healthcare professionals, such as cardiologists, pulmonologists, and nephrologists, to provide comprehensive care. Collaborating with other healthcare team members ensures that patients receive holistic care tailored to their specific needs.

Supporting the Plan of Care with Research Guidelines

To support my plan of care, I consulted current peer-reviewed research guidelines. The American College of Cardiology Foundation (ACCF)/American Heart Association (AHA) guidelines recommend a thorough evaluation, including history, physical examination, and diagnostic tests, for patients presenting with symptoms suggestive of heart failure (HF) (Yancy et al., 2013). These guidelines emphasize the importance of assessing both clinical signs and symptoms, as well as utilizing diagnostic tests such as echocardiograms, to establish a precise diagnosis and develop an appropriate plan of care.

In conclusion, my final week as a student nurse practitioner in the geriatric clinic provided valuable experiences in caring for older adult patients. Despite facing challenges such as managing multiple chronic conditions and medication adherence, I also achieved successes in building rapport with patients. The assessment of a patient with signs and symptoms of fatigue, shortness of breath, and swelling led to the development of a comprehensive plan of care and the consideration of possible differential diagnoses. Implementing health promotion interventions and learning from this clinical experience will positively impact my future practice as an advanced practice nurse.

Reference: Yancy, C. W., Jessup, M., Bozkurt, B., Butler, J., Casey Jr, D. E., Colvin, M. M., … & Givertz, M. M. (2013). 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Journal of the American College of Cardiology, 62(16), e147-e239.