My assignment on special populations: chest, cough, and abdominal pain offered important clinical lessons. Though most aspects of the assessment went has planned, there are areas that did not go well and will need to be changed in my next assessment. One aspect of the interview that went well is how I conducted the clinical interviews. I conducted face-to-face interviews of the patients to be able to collect data about their present conditions, attitudes, and medical histories. Clinical interviews may be unstructured or structured. Unstructured interviews use open-ended questions, but structured interviews semi-structured questions that guide the interview schedule, but clinicians can focus on certain issue that catches their attention ( Pomeroy, 2014) . Some aspects of the assessment that did not go well include the choice of questions during Danny’s and Mr. Foster’s assessments. In the case of Danny, I used a structured interview that involved the use a pre-set list of questions. The use of pre-set questions may restrict the patient’s response. In Mr. Foster’s case, the interview schedule was short and it failed to uncover changes in the patient’s physical condition. In the future, I will use open-ended questions because they allow the patients to tailor their responses according to their circumstance ( Stuart, 2013) . Additionally, I will ask questions pertaining to any observed changes to a patient’s physical condition.
The findings that I uncovered during the assessment include the patients’ medical history, and their present physical and psychosocial conditions. In Danny’s case, I was able to uncover that the current prescribed medication was not effective, while reddening of the tympanic membrane and enlargement of the lymph nodes may indicate a Strep Throat (Raj & Birring, 2007). Regarding Mr. Foster, I uncovered that his vital signs including heart rate, blood pressure, and cholesterol levels were significantly higher than normal. Additionally, I noted that he was taking Metoprolol and Atorvastatin. I also uncovered unusual findings on the heart rate and rhythm, and the absence of a pulse. Regarding Mrs. Park, I uncovered the presence of a mass and distension of the bowel. I was also able to obtain information about her medical history.
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The questions that yielded the most information were open-ended questions. These questions do not restrict the patient’s response and the clinician can probe issues of interest further (Bickley, 2013). Open-ended questions also helps in uncovering the patient’s attitude, feelings, and personality.
The diagnostic tests that I would order based on my findings include allergy tests for Danny to preclude allergic cause and liver function tests to preclude asthma. A step culture test will be necessary to preclude streptococcal infection. For Mr. Foster, the tests that I will order include a chest X-ray, and a lab workup, echocardiogram, exercise stress tests, and a carotid evaluation. For Ms. Park, the test will include a CBS, an electrolyte profile, and a CT scan.
Based on the findings of the clinical assessments, I am presently considering various differential diagnoses. For Danny, the likely diagnoses are a Strep Throat, Upper Respiratory Infection, rhinitis, and allergies. For Mr. Foster, the differential diagnoses may include congestive heart failure, coronary artery disease with angina, carotid disease, pericarditis, aortic aneurysm, and GERD (Bickley, 2013). Finally, differential diagnose for Ms. Park include diverticulitis, bowel obstruction, constipation, and dehydration.
The patient teaching I was able to complete in Danny’s case included guidelines on how to maintain hygiene, the importance of water intake, and sufficient bed rest. Additional patient teaching in this case included seeking care if symptoms worsen, getting an annual flu shot, and consulting an allergist to preclude asthma and allergic reactions. In Mr. Foster’s case, the education I was able to complete include that importance of physical exercise, healthy diets, and how to conduct physical examinations. Additional education that was needed in this case included regular clinical visits and when to seek emergent care. For Ms. Park, I covered the importance of balanced diets, sufficient hydration, intake of fruits and vegetables, and when to seek emergent care. In Danny’s case, no medications are necessary at this point, but for Mr. Foster I would prescribe diuretics, an ACE inhibitor, and PRN nitroglycerin. The only medication I would prescribe for Ms. Park is an over-the-counter laxative. I believe that my clinical assessment showed sound critical thinking and clinical decision making because I considered the patients’ histories, collected data, and conducted clinical tests to inform diagnoses. Thus, my clinical assessment followed evidence-based practice.
References
Bickley, L. S. (2013). Bate’s guide to physical examination and history taking (11th). Philadelphia, PA: Wolters Kluwer/Lippincott Williams & Wilkins.
Pomeroy, E. C. (2014). Clinical assessment workbook - balancing strengths and differential diagnosis . Cengage Learning.
Raj, A., and Birring, S.S. (2007). Clinical assessment of chronic cough severity. Pulm Pharmacol Ther; 20 (4):334-7.
Stuart, C. C. (2013). Mentoring, learning and assessment in clinical practice: A guide for nurses, midwives and other health professionals . Edinburg: Churchill Livingstone.
