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Katia Gedeon
Clinical Experience
This week I got an opportunity to serve in the outpatient unit where I acquired a lot of experience. The experience did not come without challenges and one challenge that stood out was communication. I handled different kinds of patients coming various backgrounds and cultures. They have different believes concerning healthcare and that means I had to communicate to every patient uniquely. There are situations where I had to involve family members or even trusted religious members of the patient to ensure I achieved the desired goals and this proved to be a challenge at the beginning. However, I eventually learned the tactics from other experienced staff numbers and I got better towards the end.
One interesting case I came across was a 48 years old Hispanic female who came to the clinic while complaining of abdominal pain. The patient weighed 68kg with a height of 165cm and her BMI was 24.98. I began by welcoming the patient, introduced myself, and explained to her that I would be asking her certain questions that she might feel uncomfortable with, however, the questions would help me understand her condition better and lead me to the correct treatment. I also reassured the patient that everything discussed would remain confidential.
I then began by asking her why she came to the clinic in which she said she was experiencing abdominal pain which began two weeks back. She also said that the burning pain is always on and off but experiences it at least once a day. Furthermore, the patient said that the pain has been getting worse such that on a scale of zero to ten with zero being no pain, she would rate her pain at seven. However, she said that the pain would at times go to zero which means she would not experience the pain. When I asked the patient to point to the exact place she experiences the pain, she pointer at the epigastric and said that the pain does no go to any other place. Some of the alleviating factors according to the patient were food, milk, and antacids while the exacerbating factors included hunger and heavy meals and she would occasionally experience nausea and even vomit.
I also asked her about her social life whereby she said she has four children that she delivered through C-section but denied taking alcohol, any illicit drug, or smocking. She also said she is only sexually active with her husband and does not have allergies to any medication. I then conducted a physical examination where I found out that the patient was not in acute distress. There was no tenderness and she had clear bilateral breath sounds when I examined her chest. The physical examination of her abdomen showed that it was non-distended and soft. However, there was a C-section scar.
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Differential Diagnoses
There were two main differential diagnoses in this situation namely:
Biliary Colic (ICD-10 Code K180.51): The pain in such a condition is worsened by fatty, heavy foods and could be witnessed by epigastric tenderness as was in this case (Fell & Brooks, 2019). Furthermore, the condition is associated with vomiting and nausea and mostly occurs in females aged forty years and above.
Peptic Ulcers Disease (ICD-10 Code K27.6): One of the signs of this condition is a burning epigastric pain that goes on and off, lasting for about two to three hours after taking a meal (Kuna et al., 2019). This was the chief complaint of the patient. Furthermore, this pain is also exacerbated by fatty foods and hunger and can be relieved by taking antacids.
Care Plan
I discussed with the patient the short-term and long-term nutritional goals and asked her about her preferences concerning drinks and food. I then created a daily fluid and food chat as well as weight chat that would help in calculating the caloric intake (Baiu & Hawn, 2018). Finally, I referred the patient to a dietitian.
One vital lesson I learned during this period is time management. I realized that the clinical, especially the outpatient unit was experiencing many patients and therefore, speed was essential. I needed to plan and manage my time properly to ensure that the patients do not wait too long while at the same time I should give every patient enough attention.
References
Baiu, I., & Hawn, M. T. (2018). Gallstones and biliary colic. Jama, 320(15), 1612-1612. https://jamanetwork.com/journals/jama/article-abstract/2707462 (Links to an external site.)
Fell, G. L., & Brooks, D. (2019). Gallstone and biliary disease. In Gastrointestinal and Liver Disorders in Women’s Health (pp. 331-345). Springer, Cham. https://link.springer.com/chapter/10.1007/978-3-030-25626-5_22 (Links to an external site.)
Kuna, L., Jakab, J., Smolic, R., Raguz-Lucic, N., Vcev, A., & Smolic, M. (2019). Peptic ulcer disease: a brief review of conventional therapy and herbal treatment options. Journal of clinical medicine, 8(2), 179. https://www.mdpi.com/2077-0383/8/2/179
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