D3cLR

· You should respond to at least two of your peers by extending, refuting/correcting, or adding additional nuance to their posts. 

· All replies must be constructive and use literature where possible cited in current APA style with support from at least 1 academic source for each response.

RESPONSE 1

Clinicals

            During this week's clinical experience, I started at a new clinical site with a knowledgeable preceptor. However, I experienced some challenges because it was

a holiday weekend, and the office was closed on Monday. As a result, I had to find a way to make up my hours while managing my clinical hours and work

commitments. This situation was a bit challenging I was determined to overcome it and make the most of my time at the clinic. In addition, one of the patients I

evaluated was a new male patient that is a 65-year-old male. He came to the facility to seek aid with weight loss and obtain a new primary physician. The patient was

recommended to our clinic and was interested in the weight management program and primary care.  In assessing the patient, he was 5'6" tall and weighed 290 lbs,

and he has a hx of diabetes, hypertension, depression, high cholesterol, and anxiety. His Blood Pressure was slightly elevated.

            Moreover, further assessment revealed that the patient depicted signs and symptoms that were a bit concerning. The patient was overweight, evident from his

BMI, which I calculated from his weight and height measurements. In addition, the patient complained of a sore throat in the morning, which was attributed to his

snoring. Additionally, the patient mentioned he had poor eating habits and used a BiPAP machine occasionally, though he didn't like it. Furthermore, the patient

reported being retired and not exercising because of his knee issue,  he reports that his wife cooked for him.

            Based on the information I collected, I developed a care plan for the patient. In developing the care plan, my primary concentration was on the patient's

weight management because the patient desired to lose weight and address any underlying health conditions (Després et al.,2021). In addition, I address his poor

eating habits, motivate him to engage in regular physical activity despite knee issues, and referred him to Silver Sneakers to support him and his wife by encouraging

them to change their lifestyle. Regarding my differential diagnosis, I need to consider the patient to have congestive heart failure, depression, or hypothyroidism. I

considered depression as a possible differential diagnosis because of the patient's history of depression and anxiety, which could have contributed to his lack of

encouragement to engage in exercise and overeating. In addition, I considered heart failure as a differential diagnosis because the patient had a history of obesity,

hypertension, and possible sleep apnea associated with his snoring and morning sore throat. Further evaluation was done regarding medication compliance and Bipap

usage. Lastly, I considered hypothyroidism as one of the differential diagnoses because it is associated with fatigue, weight gain, and depression.

            Furthermore, in a health promotion intervention for a 65-year-old male patient, my concentration was educating him on behavior and lifestyle modification. I

offered the couple dietary advice stressing the significance of healthy food choices, portion control, and decreasing calorie intake. In addition, I also encouraged the

patient to engage in constant physical activity that can suit him, like engaging in low-impact exercises that are beneficial for his weight management and general

health. Furthermore, I addressed the patient's snoring and morning sore throat by educating him that he needs to use his Bipap every single night.

            Lastly, from this week's clinical experience, I learned the importance of an inclusive approach to weight management, especially for geriatric patients with

numerous comorbidities. In addition, the clinical experience reinforced the significance of addressing the social, psychological, and physical aspects of weight loss and

how it impacts lifestyle choices. I also gained a profound understanding of the challenges the patient's experience and the significance of offering them support,

resources, and education to facilitate behavior and lifestyle change and enhance long-term success (Leisegang et al.,2020). Supporting the plan of care, I used

evidence-based practices in weight management, such as the American College of Cardiology (ACC) and American Heart Association (AHA), which offer guidelines on

obesity management in adults and which stress the significance of lifestyle modification such as regular exercising and diet for achieving weight and enhancing

cardiovascular health.

RESPOSE 2

Weekly Clinical Experience 3

            This week, I had the opportunity to observe and interact with geriatric patients in an outpatient setting. I had a chance to assess and evaluate multiple geriatric patients, which helped me better understand conditions that often affect the elderly. During this clinical experience, I had the opportunity to observe the use of various medical assessments and nursing care practices while also engaging in conversations with the patients in their homes.

            During this week’s clinical experience, there were both challenges and successes. One of the challenges I faced was navigating the complex needs of each patient. I needed to think on the fly and adjust plans and assessments to address each patient’s current needs and conditions appropriately. Another challenge was managing the patient’s medication and activity schedule. Many patients were on complex medication regimens and had difficulty remembering the plan and taking the medicines properly (Scerri et al., 2023). In addition to managing the medications, getting the patients to be actively engaged in their activities was challenging, as many of them were tired or resistant to change. I worked with the patients to understand them more deeply while considering their preferences.

            I encountered a patient who was a 70-year-old female with mild dementia. During the assessment, she appeared confused and disorganized and quickly overwhelmed with tasks. Her skin was dry and pale, with some stains around her eyes. She was able to ambulate with a rolling walker, and her mental status was assessed to be mildly disorganized. Her vital signs were within normal ranges, with no other significant medical history. My care plan for this patient included monitoring for safety while maximizing her physical and cognitive ability levels by introducing simple physical activities and providing a stimulating physical environment. These activities included using her rolling walker while ambulating, engaging in a range of motion, and stretching exercises, and participating in strength training. The patient was introduced to cognitive stimulation activities such as Sudoku and word puzzles to assist with cognitive functioning. For leisure activities, the patient was encouraged to participate in activities such as colouring, painting, and listening to music (Huang et al., 2022). Additionally, the patient was always monitored for safety, and signs of discomfort or distress were reported to the physician. Finally, drug regimens were discussed with the patient and her family to ensure the medications were taken correctly.

            The three possible differential diagnoses that could have been determined from the assessment include Alzheimer’s disease, vascular cognitive impairment, and significant depression. Alzheimer’s disease is an age-related neurodegenerative disorder characterized by cognitive decline, physical immobility, and changes in behaviour. Vascular cognitive impairment is caused by decreased blood flow to the brain due to small or large vessel disease, resulting in impaired cognition and physical dexterity. Major depression could be a differential diagnosis due to the patient’s physical immobility and lack of interest in activities.

The health promotion intervention for this patient included encouraging her to participate in an exercise program that focused on ambulation, range of motion, and strength training to help improve strength, balance, coordination, and socialization. Additionally, the patient was provided with cognitive stimulation and leisure activities to help keep her engaged (Pournik et al., 2022). I also gave the patient information about their medications, potential side effects, and drug interactions. Lastly, I provided the patient with information about community resources and available preventive services.

            This week’s experience taught me about the complexities of caring for a geriatric patient. It’s essential to consider the individual patient’s needs and preferences to ensure an optimal level of care is provided. I also gained a deeper understanding of the different assessments used to evaluate geriatric patients and the various interventions that can be employed when caring for them.

Support for the plan of care can be found in the American College of Rheumatology practice guidelines for the prevention and management of falls in older adults. These guidelines recommend that physical activity and exercise be included in the care of geriatric patients to help maintain balance and reduce the risk of falls (Kodishala et al., 2022). Additionally, cognitive activities and leisure activities can be used to help maintain cognitive functioning and to promote a positive mood. Therefore, my care plan followed the established guidelines for geriatric care and provided the patient with appropriate interventions to help improve her overall health and well-being.