You should respond to both discussions separately–with constructive literature material- extending, refuting/correcting, or adding additional nuance to thei

You should respond to both discussions separately–with constructive literature material- extending, refuting/correcting, or adding additional nuance to their posts. 

Minimum 150 words each reply with references under each reply. 

Incorporate a minimum of 2 current (published within the last five years) scholarly journal articles or primary legal sources (statutes, court opinions) within your work. Journal articles should be referenced according to the current APA style (the online library has an abbreviated version of the APA Manual).

discussion 1

Clinical Week 2 Reflection: Iron Deficiency Anemia Assessment 

As a nurse practitioner student in my second week of clinical rotation, I saw a diverse range of patients, each with particular and intricate medical requirements. A 52-year-old woman who had symptoms typical of iron deficiency anemia (IDA) was one patient case that caught our attention. This experience helped me improve my diagnostic reasoning and assessment abilities in addition to helping me comprehend the clinical approach to a common condition. 

In addition to frequent headaches, the patient reported persistent exhaustion, shortness of breath during mild exertion, and a noticeable craving for ice, or pagophagia, a common IDA symptom. Upon physical examination, I noticed mild tachycardia, brittle nails, and pallor in the nail beds and conjunctiva. Her medical history included a diet deficient in foods high in iron and heavy menstrual bleeding, both of which were consistent with potential causes of IDA. 

Her laboratory tests revealed low mean corpuscular volume (MCV), decreased serum ferritin, and low hemoglobin and hematocrit levels, all of which are indicative of microcytic anemia. This information led us to create a care plan that included dietary counseling to increase iron intake (lean red meat, leafy greens, fortified cereals), oral iron supplementation (ferrous sulfate 325 mg daily), and a referral to gynecology for additional menorrhagia evaluation. We also talked about potential gastrointestinal side effects and suggested taking iron supplements with vitamin C to improve absorption. 

Three differential diagnoses were considered: 

1. Iron Deficiency Anemia (IDA): The patient's symptoms, low ferritin, and microcytic hypochromic anemia in the lab led to the primary diagnosis of iron deficiency anemia (IDA) (Short & Domagalski, 2013). 
2. Anemia of Chronic Disease (ACD): Given her age and chronic fatigue, she was considered to have anemia of chronic disease (ACD); however, ferritin is normally normal or elevated in ACD, which was not the case in this instance. 
3. Thalassemia Trait: Given her low MCV, thalassemia trait was taken into consideration; however, this was less likely because she had no family history and a normal RBC count. 

Nutritional counseling on iron-rich foods and avoiding tea or calcium during meals, which can hinder iron absorption, were part of the patient's health promotion. Education regarding the significance of medication adherence and how to spot symptoms of worsening anemia was also stressed. 

Interpreting lab results in light of clinical symptoms was one of the difficulties I encountered this week. At first, I wasn't sure if a chronic inflammatory disease could be the cause of the anemia. I now have a better understanding of how ferritin and iron saturation levels can distinguish between different types of anemia after going over the entire panel and talking with my preceptor. Confidently explaining the condition to the patient and giving her the confidence to control it with food and medicine was a success. 

The event this week served as a reminder of how crucial it is to treat patients holistically. In addition to diagnosing, I discovered the importance of follow-up planning, patient education, and interdisciplinary teamwork, particularly for conditions like anemia that may require GI or gynecological evaluation. As my training continues, I'm learning how important it is for advanced practice nurses to be able to connect the dots in their patients' lives that affect their health in addition to identifying clinical patterns. 

The American Society of Hematology (2020) states that dietary changes, oral iron therapy, and determining and treating the underlying cause are the first-line treatments for IDA. I felt more confident in my practice and our clinical decisions were guided by the application of these guidelines. 

discussion 2

This week’s clinical experience was successful and did not have any challenges. I was able to establish positive and trusting relationships with the patients I encountered, making them feel heard and supported. Working as part of a team with doctors, nurses, and other healthcare professionals significantly improved my collaboration skills. One of the notable successes is that I was able to accurately document patient information, including outcomes, assessments, and interventions. I also cared for patients with different medical and surgical conditions, including those with chronic illnesses.

The Signs and Symptoms

This week, I encountered a 70-year-old white female with congestive heart failure. The nursing home resident has been complaining of a rapid heartbeat. She has been experiencing swelling of the feet and ankles during the past month and increasing SOB (shortness of breath) when lying down and with activity during the past six weeks. The patient feels tired most of the time, and she is very weak. 

Assessment

(ECG) was performed to check how slowly or fast the patient’s heart is beating. A chest X-ray provided detailed images of the chest, which were required to check the condition of the heart. Subjective information was obtained by asking the patient to discuss her medical history and symptoms, including how long they last and their frequency. A physical examination was conducted to check for signs of CHF and disorders that may have affected her heart. Blood tests were ordered to diagnose disorders that can lead to heart issues (King & Goldstein, 2022).  

Differential Diagnosis

Depending on the symptoms presented by the patient, the first differential diagnosis is chronic kidney disease. The disorder is characterized by swelling of ankles and feet, chest pain, high blood pressure, shortness of breath, and other symptoms (King & Goldstein, 2022). The second differential diagnosis is respiratory failure, which is a disorder that occurs when there is excess carbon dioxide or insufficient oxygen in the body. Heart failure and respiratory failure have several overlapping symptoms, which makes the latter a possible diagnosis. The third differential diagnosis is pericarditis. It causes symptoms that are similar to the ones presented by the patient, including swelling of feet and legs, heart palpitations, fatigue, and others (Chen & Aronowitz, 2022).

Plan of Care

Treatment of CHF usually includes medicines and lifestyle changes. The patient was prescribed lisinopril tablets 5 mg once per day. The dose may be adjusted as required, but should not exceed 40 mg daily. Lisinopril may have some side effects such as dizziness, reduced urine output, confusion, cloudy urine, blurred vision, and others (Chen & Aronowitz, 2022). As a result, the patient was advised to check with her provider immediately if she experiences any unwanted effects. 

Health Promotion Intervention

The patient was encouraged to make certain home and lifestyle remedies to improve her CHF symptoms. The provider advised her to avoid smoking because it can raise her blood pressure and damage her blood vessels (Sapna et al., 2023).  Smoking also increases the heartbeat and reduces blood oxygen levels. She should check her feet, legs, and ankles for swelling daily and call her provider if her swelling exacerbates. A patient with CHF also needs to limit salt and eat a healthy diet that includes whole grains, vegetables, and fruits (Sapna et al., 2023). 

Lessons from this Week’s Clinical Experience

From this week’s clinical experience, I gained valuable insights into the management of patients with CHF. I learned that CHF patients require a comprehensive treatment approach that includes close monitoring, lifestyle changes, and medication management to enhance the patients’ quality of life and outcomes.