Discussion Problem 1:
Clinical Experience:
My communication abilities with my supervisor and patients have considerably improved over the week, as seen by my increased confidence in resolving concerns and listening to patients. Given that I am growing more confident and capable of communicating professionally, I believe this represents substantial progress in my career development journey to date. Effective communication helps nurse practitioners form therapeutic relationships and bond with patients, which improves patient outcomes. It also affects patients' satisfaction and health, quality of medical care, and benefits both providers and patients (Sharkiya, 2023).
The Signs and Symptoms:
This week, I saw a 75-year-old female nursing home resident who appears at the office reporting 4 days of increased urinary frequency, painful urination, confusion, and pelvic pain. She reports increased pressure in her pelvis, but denies blood in her urine. Her caregiver reports that her urine is cloudy and has a strong, foul odor. The patient also feels extremely tired. However, she denies fever, vomiting, chills, or nausea.
Assessment:
A pelvic exam was conducted to look for signs of infection. The patient's medical history was reviewed, and she was asked several questions regarding her symptoms. Several tests were ordered to assist in confirming her diagnosis. A urinalysis was done to check for signs of a urinary tract infection utilizing variables like white blood cells, leukocyte esterase, and nitrites. This was followed by a urine culture to determine the cause of the patient's symptoms (Mancuso et al., 2023). The patient's internal organs were viewed using an ultrasound.
Differential Diagnosis:
The first differential diagnosis is pelvic inflammatory disease because it causes symptoms such as pelvic pain and painful urination, which are similar to those experienced by the patient. The second differential diagnosis is a pyelonephritis (kidney infection) that occurs when bacteria move into the kidneys from other parts of the body, like the bladder (Al Lawati et al., 2024). A kidney infection is characterized by cloudy urine that smells bad, urinating often, belly pain when urinating and other symptoms. The third differential diagnosis is sexually transmitted infections like chlamydia and gonorrhea. These diseases can cause cloudy urine and other symptoms like pelvic pain and burning when you urinate (Bono et al., 2023).
Plan of Care:
Urinary tract infections can be treated using antibiotics such as Nitrofurantoin, Doxycycline, Amoxicillin, and sulfamethoxazole/trimethoprim. The patient was prescribed Nitrofurantoin 50 mg tablets, taken orally four times a day. Nitrofurantoin may cause side effects such as trouble breathing, headaches, feeling sick, and others. The patient should check with her provider immediately if she experiences any of these symptoms. She should continue taking her antibiotics for a week or more even if her symptoms clear up within a few days (Bono et al., 2023).
Health Promotion Intervention:
The patient was educated about home and lifestyle remedies that can help ease discomfort until her condition is cured. For instance, adequate water intake can help flush out bacteria and dilute her urine (Bono et al., 2023). She was advised to avoid drinks like alcohol and coffee because they can irritate her bladder. A warm heating pad may be applied to her belly to ease bladder discomfort and pressure. She must avoid wiping from back to front after visiting the bathroom because it causes bacteria to move from her rectum into her vagina and urethra (Bono et al., 2023). The patient also needs to pee often to lower her risk of becoming infected.
Lessons:
From this week's clinical experience, I learned how to diagnose and treat UTIs. Clear communication and coordination among healthcare providers are essential to provide comprehensive and consistent care for patients with UTIs. I also learned about the importance of providing culturally competent and person-centered care. When individuals feel understood and respected, they are more likely to actively participate in their care. Need Assignment Help?
Discussion Problem 2:
The clinical experience this week provided me with the freedom to apply theoretical knowledge and practice managing adult patients with common gynecologic complaints. The case is about a 34-year-old female who presented with vulvovaginal candidiasis, which presents a chance to see the process of assessment of a patient, determine the differential diagnosis, health promotion, and evidence-based care. This experience has renewed my ability to provide holistic and patient-centred care as an advanced practice nurse.
Challenges and Successes:
The issue of making the patient feel free to discuss intimate conditions, such as discharge and itching, was one of the primary duties I had to address. The development of trust and professional communication was a vital aspect to have an accurate history. One positive outcome of the consultation was the patient's desire to participate in health-promoting activities and agree to be monitored to prevent repeat instances.
Patient Assessment and Findings:
In the assessment, the patient reported to have a history of thick, white, and curd-like vaginal discharge with pruritus of the vulva and mild dysuria over three days. She denied post-coital odour, fever, or fresh sexual contacts. On physical examination, she had erythema in the vulva and vaginal walls which had adherent plaques of white color which could not be rinsed easily. It had a pH of 4.0 as befitting a fungal etiology. The presence of pseudohyphae and budding yeast was confirmed using a wet mount preparation, allowing for a diagnosis of vulvovaginal candidiasis to be made.
Differential Diagnoses with Rationales:
1. Bacterial Vaginosis (BV) (ICD 10 N76.0): BV causes thin, greyish discharge with a fishy odour and a high vaginal pH level above 4.5, often accompanied by discharge. A lack of these results reduced the possibility of BV (Gürünlü, 2022).
2. Trichomoniasis (ICD 10 A59): With its characteristic frothy yellow-green discharge, erythematous vagina, and elevated pH, trichomoniasis was eliminated due to microscopy negativity and the absence of relevant symptoms (Gürünlü, 2022).
3. Contact Dermatitis (ICD 10 L25.9):Vulvar irritation and itching can occur in conjunction with this disorder when individuals are exposed to allergens or irritating agents. Nonetheless, this diagnosis was not confirmed by the presence of discharge and microscopy findings (CDC, 2021).
Plan of Care:
The prescription was a single course of 150 mg oral fluconazole, which is in line with the CDC's recommendations for uncomplicated candidiasis (CDC, 2021). To prevent the recurrence of the disease, the patient was advised to wear loose-fitting clothing, use unscented hygiene products, and maintain excellent perineal hygiene. She was instructed to call back after a week, in case the symptoms did not improve or worsen.
Health Promotion intervention:
One of the most important health promotion interventions was education concerning modifiable risk factors that lead to yeast infections. The patient was advised to avoid taking unnecessary antibiotics, limit her intake of simple carbohydrates, and wear breathable cotton underwear. According to Gürünlü (2022), such education was designed to help the patient assume the role of the preventer and be able to detect early warning symptoms of recurrence.
Learning Reflection and Application to Advanced Practice:
This experience underscored the need to utilise clinical acumen in conjunction with laboratory results to make a proper diagnosis. I have learned that it is essential to create a nonjudgmental and open space when addressing deep healthcare issues, as this helps increase patient compliance and response. The improvement of the specified skills will be an essential aspect of practising as an advanced practice nurse and providing evidence-based, empathetic care to patients in primary and gynecologic care settings.
As Hellier and Wrynn (2023) indicate, I found that fluconazole is also a first-line agent in uncomplicated vulvovaginal candidiasis, with excellent efficacy and few side effects in immunocompetent individuals. I also observed that the incidence of recurrence is substantially reduced when patients are educated regarding the behavioural aspects of the condition; thus, there is a need to provide more education that involves customised counselling.
Conclusion:
The clinical encounter this week provided me with additional knowledge of how vulvovaginal candidiasis can be assessed and managed. Combining both the holistic treatment of pharmacologic care and preventive education proved beneficial. This exposure strengthened my competence and determination to provide advanced, evidence-based patient care to adult patients in primary care settings.