Reflective Journal
As I have been progressing through the clinical experience the first few weeks I have focused on a learning the office routine/workflow and the electronic charting. I ahve been able to complete and record the history and physical exam. After this last week, my preceptor has said that I was ready to integrate this information into differentials with documentation in the record. We had been discussing the potential issue and concern, however I was shadowing him through the process. I reflect and think how the HPI is critical and the manner of the questions result from a solid foundation of system alterations and pathophysiology. I daily work of improving my abilities and will continue throughout the semester. I am excited …show more content…
H. has recently had several admissions over the last six months related to her atrial fibrillation (5). One admission was related to a gastrointestinal bleed from the Xaralto. She denies HTN, MI, cancer, or stroke.
Past Surgical History (PSH): 2016 Cardiac stress test/catheterization (Chest pain), 2016 cardioversion/TEE (AF) 2016 colonoscopy (GI bleed), 2016 permanent pacemaker/ablation (atrial fibrillation), 1975 Tubal ligation (method of contraception), 1970 Appendectomy (Appendicitis)
OB/GYN History: G. H. is postmenopausal (G2P2AB0), she is sexually active with the same partner for the last twenty years.
Personal/Social History: G.H. was a pack a day smoker for thirty years, She has not smoked for the last two years. She does not drink alcohol or use drugs. She does enjoy gardening and walking the rail trail. She has tried to eat more healthy this last year.
Immunizations: 2015 Tdp, 2016 Flu, 2016 pneumonia
Family History: Both her parents died of cardiac-related events (Dad (60 y/o), MI, Mother (70 y/o), MI. She could not remember the cause of her grandparent's death. Her son has HTN (30 y/o). Her other son is healthy w/o health issues. Her significant other is obese and does not see a physician for wellness …show more content…
The acute phase of care would be managed inpatient and would include intravenous anticoagulation and cardioversion. Then other pharmacotherapies may be used to attempt to keep the rhythm in sinus (Raizada et al., 2015). In research by Giner-Soriano et al. (2016), the "beta-blocker is the first-line therapy for chronic AF" (p. 873). Moreover, G. H. was being treated with a newer anticoagulant that did not require frequent lab work to assess coagulation studies. According to Opstelten, van den Donk, Kuijpers, and Burgers (2014), these medications can be used in "patients younger than eighty-years-old, few comorbid conditions, good renal function, and expected drug adherence" (p. 148). These medications all met the profile of the particular patient in the scenario. She was initially treated with a beta-blocker, and she met all of the listed inclusion criteria for a newer anticoagulant. The use of antiarrhythmic (Amiodarone) can be used when cardioversion is not successful (Raizada et al., 2015). The ablation is another option and has been successful in "60-70%" of patients (Raizada et al., 2015, p. 210). These were all of the interventions that were done for G.
As I have been progressing through the clinical experience the first few weeks I have focused on a learning the office routine/workflow and the electronic charting. I ahve been able to complete and record the history and physical exam. After this last week, my preceptor has said that I was ready to integrate this information into differentials with documentation in the record. We had been discussing the potential issue and concern, however I was shadowing him through the process. I reflect and think how the HPI is critical and the manner of the questions result from a solid foundation of system alterations and pathophysiology. I daily work of improving my abilities and will continue throughout the semester. I am excited …show more content…
H. has recently had several admissions over the last six months related to her atrial fibrillation (5). One admission was related to a gastrointestinal bleed from the Xaralto. She denies HTN, MI, cancer, or stroke.
Past Surgical History (PSH): 2016 Cardiac stress test/catheterization (Chest pain), 2016 cardioversion/TEE (AF) 2016 colonoscopy (GI bleed), 2016 permanent pacemaker/ablation (atrial fibrillation), 1975 Tubal ligation (method of contraception), 1970 Appendectomy (Appendicitis)
OB/GYN History: G. H. is postmenopausal (G2P2AB0), she is sexually active with the same partner for the last twenty years.
Personal/Social History: G.H. was a pack a day smoker for thirty years, She has not smoked for the last two years. She does not drink alcohol or use drugs. She does enjoy gardening and walking the rail trail. She has tried to eat more healthy this last year.
Immunizations: 2015 Tdp, 2016 Flu, 2016 pneumonia
Family History: Both her parents died of cardiac-related events (Dad (60 y/o), MI, Mother (70 y/o), MI. She could not remember the cause of her grandparent's death. Her son has HTN (30 y/o). Her other son is healthy w/o health issues. Her significant other is obese and does not see a physician for wellness …show more content…
The acute phase of care would be managed inpatient and would include intravenous anticoagulation and cardioversion. Then other pharmacotherapies may be used to attempt to keep the rhythm in sinus (Raizada et al., 2015). In research by Giner-Soriano et al. (2016), the "beta-blocker is the first-line therapy for chronic AF" (p. 873). Moreover, G. H. was being treated with a newer anticoagulant that did not require frequent lab work to assess coagulation studies. According to Opstelten, van den Donk, Kuijpers, and Burgers (2014), these medications can be used in "patients younger than eighty-years-old, few comorbid conditions, good renal function, and expected drug adherence" (p. 148). These medications all met the profile of the particular patient in the scenario. She was initially treated with a beta-blocker, and she met all of the listed inclusion criteria for a newer anticoagulant. The use of antiarrhythmic (Amiodarone) can be used when cardioversion is not successful (Raizada et al., 2015). The ablation is another option and has been successful in "60-70%" of patients (Raizada et al., 2015, p. 210). These were all of the interventions that were done for G.