I went to my primary care practicum site only once this week because I will be attending VCNP conference this week. Healthworks of Northern Virginia provides comprehensive care to the insured and uninsured patients. There is no requirement of residency and patient pay on sliding fee scale for services regardless of their legal status. This week there was 8 to 9 no shows. This is the maximum number of no shows that I have noticed in last two and half month. When my preceptor inquired about the situation with the manager, we found out that many patients are scared to come due to the fear of new immigration policy. Thus, I was only able to see 6 patients on Monday. I have completed 201 hours for my practicum III. I plan to finish all my practicum …show more content…
For the patient with medications follow up, the patient was 69-year-old female, her hypertension medication was lowered from 50 mg losartan to 25mg on her previous visit because she was having dizziness with 50mg of losartan. At this visit, she brought her BP machine from home to compare with our office BP machine. Also, I encouraged her to continue checking her BP at home regularly. In addition, her BP at home was less than 140/90. Patient was concerned that her BP was too high. I provided assurance and educated her that new guidelines say that BP less than 150/90 in adults 60 years and older requires no medical intervention. Also, her BMI was 19. I encouraged her to eat nutrient rich food that includes fresh fruits, vegetables and milk products. I educated about nutritional supplements such as boost or ensure and avoiding any diet restrictions. For the patient with Pap, she was having pelvic pain, along with regular pap test, I ordered BV, chlamydia and Gonorrhea, and UA. Also, the patient was complaining of peri menopausal symptoms, so I ordered FSH. I encouraged her on safe sex practices and self-breast exam. I ordered
The patient presented with common signs of compartmental syndrome. The interventions suggested to the staff at the hospital were not fully completed. The interventions given during the case presentation consisted of assessing the six Ps, swelling, and vital signs. I took the vital signs of the patient and the nurse recorded them in their system. The patient’s blood pressure was not within normal limits, so the blood pressure completed manually. The manual blood pressure was still elevated. An increase in blood pressure can indicate pain, swelling, and impaired blood flow to the extremities. When I was with the nurse, she sent the patient for an x-ray. Furthermore, the nurse should have then assessed what the patient has been doing and done education with the patient to elevate the leg above his heart. Many people do not know the scientific rationale and positioning of elevating the extremity above the heart. The nurse should have also assessed the patients expectation of pain relief, since his current medication (Ibuprofen) was not working to his expectations. This is when we left the floor; therefore, I was not able to discuss the patient care with the nurse. The nurse simply asked the patient about some of the six Ps of compartmental syndrome and did not complete the assess...
After review of the clinical information provided by North Central Bronx Hospital, the Medical Director has denied your admission to North Central Bronx Hospital. It was determined that the clinical information did not justify an inpatient stay. Acute inpatient hospitalization was not medically necessary. You are a 56 year old female with complaints of worsening pressure-like chest pain on the left sided that radiated to your left arm and neck. The symptoms began when you were at rest and woke you from your sleep. Based on the Interqual guideline (a decision based program to determine medical need) criteria to for acute coronary syndrome the clinical guidelines were not met because troponins were negative, there was no diagnostic testing such as a stress test, or documentation of ischemia in the clinical information that was submitted.
The receptionist was on the phone for quite a long time before she could reach out to Ms. Patient. In the end, the receptionist just took Ms. Patient’s insurance without any clarification and made her wait for a while. Additionally, she was unable to focus on Ms. Patient and got distracted when another patient asked for indications. The receptionist clearly indicated unprofessionalism when she was unable to provide adequate information for the patient when she was disoriented. Also, the receptionist did not have any manners when she failed to excuse herself when another patient wanted to speak with her. Ms. Patient stated that she felt extremely vulnerable and lost when no one was able to help her understand what was going on. Therefore, the healthcare team in this case was unsuccessful in providing a caring and helpful environment for the
The medical secretary, registered nurses, licensed practical nurses, and physicians communicated consistently and appropriately so that all staff could effectively complete the actions required of their respective roles. I noted the strong relationship between the nurses and the physicians. The nurses held a heavy influence on the physician’s decisions regarding a situation, because the nurses were the ones conveying pertinent information related to the patient’s status. Based on the information provided, the physician would make recommendations and provide guidance to the nurses. The physician’s directions were then carried out by the nurse, influencing the nurse’s plan of care for his/her
Patients who refused to visit the practice, patients who declined to admit that their high blood pressure was secondary to their refusal to take their losartan. Luckily, my provider had been seeing these people for many years, and knew the techniques that would yield in the greatest cooperation. As I watched and listened, I obtained a deep understanding of the value of a relationship between the patient and the provider. Where one might have struggled to gain patient compliance, my provider knew when to implement a stern tone, and when to dial it back and become more comforting.
I constantly reported to her concerning the condition of the patient in close time intervals across the day. On this day, a patient of mine had an IV site concern. The nurse assigned me to make some adjustme...
Without a doubt the lessons and exercises on time management were the most meaningful to me. They brought insight into why I seemed to be constantly working yet still never really got anything I wanted to accomplish throughout the day finished. I realized the majority of the activities I had been spending the most time on didn’t reflect my values of hard work and self discipline and long term academic goals to be successful in college. This motivated to completely change the way I managed my time by effectively striking a balance between my maintenance, committed, and free time.
Treatment for the client presenting to the APN diagnosed with hypertension, the first efforts should be focused on education. The patient should be informed of what current JNC 8 guidelines for the diagnosis of hypertension are. This will help the patient identify that he or she in fact has a problem and his blood pressure is abnormal. Further education should also include anticipated progression of the disease and complications from prolonged hypertension to help the patient understand the effects hypertension have on the body and risk of development of end-organ damage. Since hypertension is a silent disease, often void of symptoms, the patient must understand fully the implications of the disease and necessity to control the blood pressure.
The intention of this written essay is to demonstrate an understanding of my views on reflection and the issues surrounding reflective practice. It is based on nursing skills that I used during my practice placement, most importantly reflecting on the professional value of privacy and dignity.
When I was working as a bedside nurse in the Emergency Department, in one of my duties I was not satisfied with the treatment plan made by a resident doctor for XYZ patient. He entered intravenous KCL (potassium chloride) for the patient. The purpose of that medication and its dose for that patient was not clear to me. I assessed patient history and came to know that a middle aged patient came with the complaint of loose bowel movements, vomiting, and generalized weakness. His GCS (Glasgow comma scale) was 15/15, looked pale but was vitally stable. I exactly do not remember about his previous disease, social or family history but I do remember that he was there with his son. According to the care plan, I inserted intravenous cannula, took blood
This is my first practicum placement in the Lethbridge community and in a daycare centre. It has given me a different, but good experience from working in a Parent Pre-School Program (PPP). This placement is different from my last two placements, because it has allowed me to gain more experience with younger age group of children. The placement still gives the children the opportunity to learn through their play in play areas of language, art, water, sand, blocks, and kitchen (dramatic play). They also, have the ability to provide additional play areas, such as infant play, play dough, train set play, and outdoor/gym time to exercise their gross motor skills. The placement is a bit more structured by offering a time schedule of outdoor play,
Primary care physicians (PCPs) play a vital role in our healthcare system. Yet, recently, there has been a shortage in the supply of PCPs, and the supply is unable to serve the needs of the growing patient population, especially those living in rural areas or under government insurance programs such as Medicare and Medicaid. Due to the lack of PCP supply and the increasing number of patients, the delivery of care and quality of care have suffered as well. There is a limited interaction between a patient and physician, there is a delay of treatment, and there is a large amount of Medicaid patients who are unable to find PCPs that can accept them. Today, over sixty million Americans rely on Medicaid as their primary source of health care (Bachrach, 2010).
The term reflection means the examination of personal thoughts and actions. For nurses this means focusing on how they interact with their colleagues and with the environment to obtain a clearer picture of their own behaviour. This means it is a process in which a nurse can better understand themselves in order to be able to build on existing strengths and take appropriate future action (Somerville, 2004). Reflection is a way to bring your own intuition along with empirical knowledge together. Reflective practice in nursing is guided by models of reflection. Reflective practice model serves as a framework within which nursing or other management professions can work. Reflective practice model is also a structural framework or learning model that serves the purposes of a profession and is particularly applicable to health related professions. Reflective practice enables practitioners to learn to value themselves as significant people with values and feelings that are important factors in giving care. Whilst reflective practice allows the nurse to recognise the value of their experiences, they may also need support to work through a difficult situation. This is where reflection aids nurses in dealing with these challenging experiences (Johns, 1995). Reflection on experience offers nurses the opportunity to reflect on caring in practice in ways that its nature can be understood, where the skills necessary for effective caring can be developed and most significantly, where the values of caring for people can be highlighted, both to the individual nurse and the world in general (Johns 1996)
The physician inquires about how the patient is and begins the process of finding out what is wrong with the patient. The first thing that the doctor does is to put the patient at ease and to make them as comfortable as possible. The physician should begin the conversation with an open – ended question, such as, “How are you feeling”. The physician then encourages the patient to mention all of the ailments that they are experiencing. This is when the physician can learn the most about the patient’s personality and environmental influences. It is important for the doctor to be attentive and take good notes. The doctor explores in great detail the time of the ailments and the severity. The physician inquires about the patient’s past health and any family history that is of relevance. The physician then checks the accuracy of all the data and details collected to date and informs the patient of the next step in the process, the diagnosis. It is important that the patient does most of the talking throughout the interview, so that the doctor can elicit all...
Overall my experience of being in Lingleville ISD was a great experience that allowed me to learn a lot not only about the students in the classroom, but also helped me learn a lot about myself. Going in to this classroom I expected to only learn things about classroom management and maybe a few strategies. After spending a few days in this room I learned many other things. I did learn about classroom management but I also learned about content, strategies, organization, lesson planning, and inclusion adaptations. I learned that an inclusion special education student can really thrive being in a mainstream classroom, not only academically but also socially. It was a wonderful learning opportunity to get to be a part of that. My mentor teacher