Weekly Clinical Reflection
Describe your clinical experience for this week.
- Did you face any challenges, any success? If so, what were they?
- Describe the assessment of a patient, detailing the signs and symptoms (S&S), assessment, plan of care, and at least 3 possible differential diagnosis with rationales.
- Mention the health promotion intervention for this patient.
- What did you learn from this week’s clinical experience that can beneficial for you as an advanced practice nurse?
- Support your plan of care with the current peer-reviewed research guideline.
Submission Instructions:
- Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources. Your initial post is worth 8 points.
Weekly Clinical Reflection
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Did you face any challenges or successes during clinical this week?,
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What were the signs and symptoms assessment and plan of care for your patient?,
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What are three possible differential diagnoses with rationales?,
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What health promotion intervention was used?,
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What did you learn that will benefit your advanced practice nursing role?
📝 Weekly Clinical Experience Reflection
This week’s clinical rotation offered an insightful experience that challenged my diagnostic and patient management skills while reinforcing the value of holistic care. One of the most notable encounters involved a 72-year-old male patient who presented with complaints of progressive fatigue, dyspnea on exertion, and occasional palpitations over the past three weeks. He denied chest pain, cough, fever, or lower extremity swelling. His past medical history included hypertension and osteoarthritis.
🌡️ Patient Assessment and Clinical Findings
Subjective (S):
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Chief Complaint: “I feel exhausted even when walking short distances.”
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Associated Symptoms: Dizziness, palpitations, mild headaches
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ROS: Denied syncope, fever, cough, GI bleeding, or recent weight loss
Objective (O):
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Vitals: BP 134/78 mmHg, HR 102 bpm (irregular), Temp 98.7°F, RR 18, O2 sat 96% RA
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General: Pale, slightly fatigued but alert
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Cardiac: Irregularly irregular rhythm, no murmurs
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Pulmonary: Clear to auscultation
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Abdomen: Soft, non-tender
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Skin: Mild pallor noted
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Labs: CBC revealed Hemoglobin 9.0 g/dL, MCV 78 fL, Ferritin 10 ng/mL, TSH within normal limits
Weekly Clinical Reflection
🩺 Assessment and Plan of Care
Assessment:
The patient was diagnosed with iron-deficiency anemia, likely secondary to chronic gastrointestinal blood loss.
Plan of Care:
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Initiate iron supplementation (Ferrous sulfate 325 mg PO BID with vitamin C)
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Order FOBT to assess for occult GI bleeding
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Schedule colonoscopy for further investigation
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Nutritional counseling for iron-rich diet
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Educate on medication adherence and follow-up importance
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Re-evaluate CBC in 4 weeks
🧠 Differential Diagnoses and Rationales
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Iron-Deficiency Anemia
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Most consistent with patient’s fatigue, low hemoglobin, microcytic anemia (low MCV), and low ferritin. Common in elderly due to chronic GI loss.
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Anemia of Chronic Disease
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Typically presents with normocytic or slightly microcytic anemia; less likely due to low ferritin, which is usually elevated in chronic disease.
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Atrial Fibrillation
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Suggested by irregular heart rate and palpitations; could contribute to symptoms but is more likely secondary or concurrent than primary diagnosis. Requires ECG confirmation and further cardiac evaluation.
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💡 Health Promotion Intervention
Health promotion included dietary education to encourage consumption of iron-rich foods (e.g., spinach, red meat, lentils) and avoidance of calcium-rich foods with iron supplements. The patient was also advised on hydration, medication compliance, and the importance of routine screenings for colorectal cancer, especially in the presence of unexplained anemia.
👩⚕️ Clinical Takeaways as an APRN
This week reinforced the importance of comprehensive assessment and the integration of subtle clinical signs to guide diagnostic reasoning. I learned to prioritize patient education and preventive screening, particularly in older adults at risk for hidden pathologies such as GI bleeding or malignancy. It also deepened my understanding of collaborative care—working with gastroenterologists, nutritionists, and pharmacists to support the patient’s full recovery.
