Journal #1

1. What goal did you meet this week that you and your preceptor discussed? What

areas does your preceptor feel that you need to work on for next week?

This week my preceptor discussed with me that I needed to get all of the practice that I can with

doing full assessments on every patient. She suggested that I read in the Uphold and Graham

book each night about different disease processes to gain a better understanding of what types of

focused questions to ask with each specific type of patient. For example diagnosis of diabetes,

hypertension, and joint pain, which were some of the types of patients seen during todays

encounters.

2. What did you do this week that made you feel you gained confidence in a particular

area of patient care?

I saw and completed four head-to-toe physical exams and charted completed SOAP notes on

each of the patients in the electronic medical record (EMR).

3. Reflect on a challenging clinical situation or a situation where you did not feel

confident in a particular area of patient care. How did you handle the situation?

What have you done or will you do to make you feel more prepared for this same

situation in the future?

The first patient I encountered was being seen for a follow up visit for diabetes. Her last

hemoglobin A1c levels were 9.7 and she is currently taking metformin 1000mg BID and last visit

had glimepiride dosage adjusted from 2mg to 4mg daily. I asked about diet and changes in

recent diet, to find that she has been under stress lately and had been consuming salt and vinegar

potato chips each night. I consulted with my preceptor about current diabetes medication
regimen and asked what appropriate medication changes would be for this patient. I spoke with

the patient about the importance of diet in diabetes management and offered suggestions of only

consuming portion size as well as different types of snacks that would be healthier options for a

diagnosis of diabetes. My preceptor suggested that I visit the National Diabetes Institute and

American Association of Endocrinology internet sites and become familiar with clinical

algorithms in management of diabetes.

I have limited previous experience with the musculoskeletal system. One of the patients

presented with a chief complaint of lower back and right hip pain, which had been ongoing for

several months and worsening. I reflected back to my Advanced Physical Assessment course,

and gathered all of the information possible using COLD SPA acronym to remember what

needed to be addressed. I also consulted with my preceptor about possible methods of treatment

for this situation. I plan to read and learn about joint pain and how to treat and manage chronic

pain.

4. Reflect on some areas of learning while in the clinical area that will benefit you the

most in your own practice.

The clinical site that I am at this semester is a rural free clinic in Wise, Virginia. These

patients are very grateful for medical care, but many cannot afford treatment options. I am

learning about available resources that will benefit these patients. For example, this week I

learned about the drug app GoodRx, which provides information about the cost of many drugs

and gives local options of where the medication may be purchased the cheapest.

5. What course objective did you address this week?

I did not encounter any patients of the reproductive age this week, although I feel that I partially

covered a few of the objectives.

Objective number one: Apply knowledge and research findings from the pathophysiological,

pharmacological, behavioral, and nursing sciences to the management of primary care problems

(commonly experienced by patients in the childbearing years).

Objective number eight: Collaborate with other health professionals and/or utilize community

resources to facilitate management of care for individuals (experiencing reproductive and/or

sexual health issues in primary care settings).

6. Describe how you integrated one of the SONs Professional Pillars during your

clinical experience this week.

I can think of many of the professional pillars that would be relevant to my first clinical day. The

one that I find most fitting is accountability. I noticed that every treatment regimen that my

preceptor suggested, she would reference back to current guidelines of practice. Reflecting on

what I have learned during my course in this program, the current guidelines are developed from

evidence-based practice. I feel that making decisions based on guidelines is a way of showing

yourself accountable to your patients, yourself, as well as your profession.