Nurs 5019 - Journal 5

NURS 5019- Journal #5
1. What goal did you meet this week that you and your preceptor discussed? What
areas does your preceptor feel that you need to work on for next week?
I have been attempting to identify abnormalities on x-rays of spine and extremities. I feel I am
making progress with this and learning more each day. I continue to challenge myself to come
up with as many differential diagnoses as possible with each new complaint, in order to expand
my thought process and assessment. I feel that my preceptor has challenged me each week with
goals that have not been easy to obtain, but have also taught me a lot. As this semester and
clinical rotation nears its end, I will continue to work on all of the goals we have set through this
semester in order to better myself in future practice.
2. What did you do this week that made you feel you gained confidence in a particular
area of patient care?
I was able to identify ascites in a patient. The patient complained of increasing shortness of
breath, tenderness of her abdomen worse on the left side, and increased bloating. During my
exam there were no audible bowel sounds, and positive fluid wave test in abdomen. I was
fortunate to be allowed to accompany the patient to the intensivist visit in urgent care (HMG has
an intensivist clinic in their urgent care setting. This clinic is run by hospitalists, and through
intervention in the clinic many patients keep from having to go to the emergency room for
treatment or undergo a hospital admission). The intensivist taught me how to ultrasound to
identify ascites in the abdominal cavity, as well as allow me to assist him in performing a
paracentesis on the patient.

The intensivist also, had an additional patient scheduled later that day needing a paracentesis, as
the patient is deciding on options with his future treatment regimen due to advancing liver
disease. (The gastroenterologist recommends treatment with a transjugular intrahepatic
portosystemic shunt, or TIPS, procedure in order to decrease his visits for routine paracentesis
for ascites). The intensivist doctor, as well as the patient allowed me permission to perform the
paracentesis with assistance of the physician.
I was worried that my assessment skills were lacking when I was unable to auscultate bowel
sounds on my patient. Through this experience, I feel that I gained confidence in trusting my
assessment skills to be able to identify abnormalities, as well as being able to see and perform a
procedure that I had never witnessed before that day.
3. Reflect on a situation where you did not feel confident in a particular area of
patient care. How did you handle the situation? What have you done or will you do
to make you feel more prepared for this same situation in the future?
I had a patient with a chief complaint of tonsillar abscess (self-diagnosed). He denies recent
fever, chills, drainage, cough, and stated that he noticed a pocket on his right tonsil few days
ago. He reported using organic apple cider vinegar and lemon water gargles regularly few
times per day for past week and feels this is getting some better. On exam the throat, nasal
passageways, and ears were clear, with no redness, or irritation noted, vital signs were within
normal limits. He did not want any prescription medications and did not warrant antibiotics at
this time. We reassured the patient and prescribed him miracle mouthwash as needed for
comfort, and the patient seemed accepting of this. I am seeing the desire for less prescription
medication and more natural alternative form of treatment more frequently in my current job, the
clinical setting, as well as at home with family members. I am often unsure of what to suggest to
these patients when desiring a more natural treatment. I hope to find a book, or continuing
education course offered that I could take, in order to learn of more holistic and natural
alternatives, in order to give the patient options for their care.
4. Reflect on some areas of learning while in clinical that will benefit you the most in
your own practice.
I feel that I have learned so much this semester that will benefit me in my future practice.
I have gained insight with patient complaints and learned not to have such a one track mind and
to think outside the box, keeping in mind all possible differential diagnoses and disease
processes that might cause a specific symptom or complaint.
I feel that I have advanced with my assessment skills through this clinical rotation. I have
learned how to properly perform many tests, especially orthopedic tests. I have reviewed
anatomy, expanded my medical vocabulary, and I feel that I am gaining better documentation
skills. I also feel that I have gained a better understanding of visit levels and ICD 10 codes.
I feel through learning how to identify abnormalities on x-rays will help me in my future
practice, especially in an office setting. I realize that most x-rays will not be read immediately in
an office setting, by a radiologist. Being able to identify major abnormalities, I will be able to
initiate a proper treatment regimen, and adjust the treatment plan as needed once the x-ray is
officially read. I realize this is a learning process, but feel this will help me gain confidence in
my treatment plan, as well as help me to gain trust from my patients.
I have had the opportunity to observe and perform many intra-articular injections and learned of
many different treatment options, some of which I did not realize were available for treatment,
for example a bone stimulator.

5. What was a challenging clinical situation and how did you handle it?
I feel it is challenging when faced with a complaint that has not been discussed thus far in the
classroom setting. There are many new diagnoses I learn in clinical each day, which we learn in
class a few weeks after the fact. Each day I attend clinical, I write down things not familiar with,
and research once I go home in the evening. I feel this has helped me to learn many disease
processes and treatment regimens, especially when studying for future weeks and body systems,
in the classroom setting. On the other hand, I find this a challenge in the clinical setting,
thankfully my preceptor this semester is very patient and an excellent teacher. I do realize,
however, education is a learning process, and you cannot know everything all at once.
6. What course objective did you address this week?
Objective 6: Teach individuals, families, and groups skills and behaviors to promote health,
prevent disease, and manage acute and chronic illnesses in adults and older adults.
I feel this objective has been met by teaching of patients and families with each encounter about
disease process, treatment regimen, as well as by teaching health promoting behaviors.

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NURS 5019- Journal #5

semester in order to better myself in future practice.

area of patient care?

treatment or undergo a hospital admission). The intensivist taught me how to ultrasound to

paracentesis on the patient.

disease. (The gastroenterologist recommends treatment with a transjugular intrahepatic

paracentesis with assistance of the physician.

procedure that I had never witnessed before that day.

alternatives, in order to give the patient options for their care.

your own practice.

processes that might cause a specific symptom or complaint.

my treatment plan, as well as help me to gain trust from my patients.

for example a bone stimulator.

6. What course objective did you address this week?

disease process, treatment regimen, as well as by teaching health promoting behaviors.

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