Clinical experience

Sample Solution

Clinical Experience: A Week in Review

This week's clinical experience provided a valuable opportunity to apply theoretical knowledge to real-world patient care. I had the privilege of working with a diverse range of patients, from young children to elderly adults.

Patient Assessment

One particularly interesting case involved a 65-year-old male patient presenting with acute onset of chest pain, shortness of breath, and diaphoresis.

Signs and Symptoms:

• Substernal chest pain: A sharp, crushing pain radiating to the left arm and jaw.
• Shortness of breath: Difficulty breathing, especially with exertion.
• Diaphoresis: Excessive sweating.
• Nausea and vomiting: Associated with the chest pain.

Assessment:

• Vital Signs: Elevated blood pressure, tachycardia, tachypnea, and decreased oxygen saturation.
• Physical Examination: Cardiovascular exam revealed tachycardia, irregular heart rhythm, and diminished heart sounds. Lung auscultation revealed crackles in the bilateral lung bases.

Full Answer Section

Plan of Care:

1. Immediate Interventions:
   • Administer oxygen therapy to improve oxygenation.
   • Administer nitroglycerin sublingually to relieve chest pain.
   • Prepare for electrocardiogram (ECG) and cardiac biomarkers to assess for myocardial infarction.
2. Diagnostic Tests:
   • ECG: To identify arrhythmias or myocardial ischemia.
   • Cardiac biomarkers (troponin, CK-MB): To assess for myocardial injury.
   • Chest X-ray: To rule out pulmonary embolism or pneumonia.
3. Pharmacological Therapy:
   • Antiplatelet therapy (aspirin) to prevent platelet aggregation.
   • Anticoagulation therapy (heparin) to prevent thromboembolic events.
   • Beta-blockers to reduce myocardial oxygen demand.
   • Angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) to manage blood pressure.

Differential Diagnoses:

1. Acute Myocardial Infarction (AMI): The most likely diagnosis, given the patient's presentation of chest pain, diaphoresis, and ECG changes.
2. Unstable Angina: A less severe form of coronary artery disease, characterized by chest pain that occurs at rest or with minimal exertion.
3. Pulmonary Embolism: A blood clot that blocks blood flow to the lungs, causing shortness of breath and chest pain.

Health Promotion Intervention:

To prevent future cardiac events, the patient should be encouraged to:

• Quit smoking: Smoking is a major risk factor for cardiovascular disease.
• Adopt a healthy diet: A diet low in saturated fat and cholesterol can help reduce the risk of heart disease.
• Regular physical activity: Regular exercise can improve cardiovascular health.
• Manage stress: Stress reduction techniques, such as meditation and yoga, can help reduce the risk of heart disease.

Lessons Learned:

This clinical experience reinforced the importance of a thorough assessment and timely intervention in acute cardiac conditions. It also highlighted the need for a differential diagnosis to consider multiple possibilities. As an advanced practice nurse, I will continue to strive for excellence in patient care, staying updated on the latest evidence-based practices to provide optimal care.

References:

• American Heart Association. (2023). Heart Disease. https://www.heart.org/
• National Heart, Lung, and Blood Institute. (2023). What Is Heart Disease?
  https://www.nhlbi.nih.gov/science/heart-and-vascular-diseases