First Clinical Week Reflection

First Clinical Week Reflection

· Did you face any challenges, any success? If so, what were they?

· Challenges were getting used to clinical setting like assessing patients for the first time

· Describe the assessment of a patient, detailing the signs and symptoms (S&S), assessment, plan of care, and at least 3 possible differential diagnosis with rationales.

· Mention the health promotion intervention for this patient.

· What did you learn from this week’s clinical experience that can beneficial for you as an advanced practice nurse?

· This was the first week of clinicals so give examples of learning new techniques

· Support your plan of care with the current peer-reviewed research guideline.

First Clinical Week Reflection

Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources within the last 5 years. Your initial post is worth 8 points.

1. Did you face any challenges or successes this week?,

2. How did you assess your patient (S&S plan of care differential diagnoses)?,

3. What were at least 3 possible differential diagnoses with rationales?,

4. What health promotion intervention was provided?,

5. What did you learn this week that will benefit you as an advanced practice nurse?

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Comprehensive General Answer (≈500 words)

Clinical Experience and Challenges
This week marked the beginning of my clinical rotations, and it was both exciting and challenging. The primary challenge I faced was adapting to the clinical environment and building confidence in assessing patients for the first time. Performing head-to-toe assessments required balancing communication with patients, accurate documentation, and critical thinking. A key success was that, despite initial nervousness, I was able to complete assessments and begin to connect symptoms with possible underlying conditions. This allowed me to gain more confidence in my clinical reasoning skills.

Patient Assessment
One patient I encountered presented with shortness of breath, mild chest tightness, and fatigue. On examination, vital signs revealed a respiratory rate of 24 breaths/min, oxygen saturation at 91% on room air, blood pressure of 148/92 mmHg, and a heart rate of 102 bpm. Auscultation revealed diminished breath sounds with occasional wheezing in the lower lobes. The patient also had a history of hypertension and smoking.

Based on these findings, the initial plan of care included:

• Administering supplemental oxygen as needed to maintain SpO₂ above 94%.

• Encouraging the patient to use pursed-lip breathing techniques.

• Ordering a chest X-ray and spirometry to further evaluate lung function.

• Providing smoking cessation education as part of health promotion.

Differential Diagnoses with Rationales

1. Chronic Obstructive Pulmonary Disease (COPD) – The patient’s smoking history, wheezing, and dyspnea are consistent with COPD exacerbation. COPD often presents with airflow limitation, hyperinflation, and hypoxemia (GOLD, 2023).

2. Asthma Exacerbation – Although more common in younger individuals, adult-onset asthma can present with wheezing and dyspnea. However, the absence of a clear history of asthma makes this less likely.

3. Congestive Heart Failure (CHF) – The elevated blood pressure, fatigue, and dyspnea raise suspicion for heart failure, especially given the possibility of pulmonary congestion. An echocardiogram would help differentiate this.

Health Promotion Intervention
Health promotion focused on smoking cessation counseling, since continued smoking significantly worsens lung function and overall cardiovascular health. Additionally, I discussed the importance of regular physical activity tailored to tolerance and medication adherence. Providing resources such as smoking cessation programs and support groups was emphasized.

Learning as a Future Advanced Practice Nurse
This first clinical week taught me the importance of integrating patient history with physical exam findings to formulate differential diagnoses. I also learned new techniques for performing lung assessments, using clinical tools, and interpreting early diagnostic clues. These skills will benefit me as an advanced practice nurse by strengthening my ability to identify subtle changes in patient status and develop evidence-based care plans. More importantly, this experience reinforced the value of communication, patient education, and preventive care in long-term health outcomes.

 

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