The course in context has contributed significantly towards the achievement of the syllabus goals which are eleven in number. The first goal was that by the end of the course, the learner was to be in a position to demonstrate sound critical thinking and clinical decision making. Through the detailed guidance on how to take a good history from a patient, including the significant complaint and an expounding on them to identify the major systems involved, the art of critical thinking continues to develop. Critical thinking guides the course an individual's takes as he continues to gather information from the patient. With a good history, sound clinical decisions are an assurance.
Through the step by step techniques outlining the physical examination of the different body system and core functional assessments, it's now possible to develop a comprehensive patient's database which was a second goal of the course. A full patient's database must include complete functional assessment including an assessment of the functional health patterns, a complete health history, a comprehensive physical examination and appropriate diagnostic tests related to the presentation of the patient. A complete functional assessment of the patient helps to determine the nursing care plan of the patient whose main pillars include goal establishment, nursing interventions and their evaluation with rationales (Doenges, Moorhouse & Murr, 2014). Appropriate diagnostic testing ensures that the patient does not go through unnecessary and irrelevant diagnostic tests and also monitors that no one ignores the critical diagnostic tests. With proper diagnostic testing, it's easy to make appropriate diagnoses and also reduces the cost burden of many tests of which some are expensive.
Through the course, it is now possible to do a comprehensive risk assessment in patients, which is vital in directing one to the diagnosis and in determining the way of management for the patient. Various risk factors will expose patients to different conditions. In considering the cardiovascular system as an example, risk factors in patients that could easily contribute to cardiovascular diseases include smoking (Carter et al., 2015) and high cholesterol levels as risk factors for atherosclerosis and coronary artery disease and intravenous drug use as a risk factor for infective endocarditis mostly due to the bacteria Staphylococcus aureus. With an understanding of risk assessment in patients, better management is a guarantee. Risk factors for hepatocellular carcinoma will include a history of liver infections such as Hepatitis B and smoking history among many other factors.
Through the course, analyzing ramifications of common mental health illnesses on the patients, family, and community is now possible. The course contributed to this by allowing the acquisition of the necessary knowledge and skills in useful data collection from patients, communities and families and also on the ways to identify major mental illnesses by doing a comprehensive mental status exam that is of great aid if one is to understand the effects of mental illnesses on various individuals. A complete mental status exam involves an analysis of the patient's behavior, emotional status, speech, and cognitive functions. Suicide is a common effect in most mental patients as supported by a study done on the impact of physical illnesses and psychiatric disorders on suicide risks (Qin et al., 2014) and both significantly contributed to high suicide rates.
The course has greatly aided in understanding the principles behind various necessary laboratory tests and result interpretation. There is a proper understanding of the reasons behind the ordering of multiple tests. Laboratory tests include hematological, clinical chemistry tests, immunological and microbiological among many others. Major hematological tests include full blood count and coagulation tests like Prothrombin time and Activated partial prothrombin time. With a complete blood count, one can quickly rule out conditions such as infections, anemia and even hematological malignancies such including leukemia and lymphomas. Clinical chemistry tests include renal function tests and liver function tests among many others. In most facilities, renal and liver function tests continue to serve as routine laboratory tests in patients. Apart from ruling out organ abnormalities, the tests guide health practitioners in identifying the right medications for various patients. Understanding necessary laboratory tests and result interpretation is now possible through this course.
Through the course, it is now possible to correlate assessment findings and underlying pathology and physiological changes. Using the respiratory system as an example, an increased respiratory rate of more than twenty from a clinical assessment of a patient points to a pathology most likely in the lungs. Yellowing of the eyes indicates to a pathology mostly in the hepatobiliary system with an abnormality in the normal physiological processes involving bilirubin metabolism. A history of pain during urination point to a possible pathology in the lower urinary tract system (Bartges, 2018). Through this, the course has, therefore, worked to ensure a comprehensive understanding of the patient by learning how to correlate assessment findings with the underlying pathology and physiological processes.
It is now possible to establish a differential diagnosis based on data assessment. In an individual with hematemesis, possible causes of this are any pathologies in the upper gastrointestinal tract including bleeding esophageal varices, gastroesophageal reflux disease, peptic ulcers and gastritis among many other causative factors. Having a list of differential diagnosis allows clear thinking as to what is the possible cause of the patient's presentation rather than limiting oneself to a particular condition that could in the end not be the primary reason. With the right diagnosis, there is an assurance of effective patient management.
The course has allowed learning on developing effective and appropriate plan care for patients. The application of this possible through consideration of life circumstances, cultural, ethnic and developmental variations among different individuals. Though individuals may present with similar signs and symptoms, same management techniques are not a guarantee to all of them due to various life circumstances of each. It is therefore essential to take time to understand each person uniquely as they present without bias focusing on the history of others with almost similar conditions.
The course has also continued to set a foundation for satisfactorily complete advanced physical assessment majorly through the use of the specified text that is elaborative in its descriptions on various aspects (Bickley, 2013). Through the course, it is also now possible to work collaboratively with other health professionals because of the colleague relationship skills acquired including respect as key in cohesion.
Cardiovascular Assessment Learning From The Course
In doing a cardiovascular assessment, a focused cardiovascular history is crucial. Significant signs and symptoms that one should elicit from the patient during history taking include a history of dyspnea, orthopnea, palpitations, paroxysmal nocturnal dyspnea, easy fatigability, orthostatic hypotension, fainting and history of fevers. Ruling out a history of temperatures is critical in the identification of infective endocarditis. In asking the patients about it, it is necessary to use a simple language that is easily understood by the patient. Below is an illustration of the possible cardiovascular symptoms and how to ask the patients.
- History of dyspnea- "Do you have any difficulties breathing?".
- History of orthopnea- "Do you find it hard breathing when lying flat on the bed?"
- History of palpitations- "Are you aware of your own heart's beating?"
- History of paroxysmal nocturnal dyspnea- "Do you suddenly wake up at night feeling like you are out of air forcing you to run to the windows to open the curtains in an attempt to get air?
- History of easy fatigability- "Do you get tired easily when doing less than your normal daily activities?"
- History of orthostatic hypotension- "Do you feel dizzy when you suddenly stand from a sitting position?"
With a focused cardiovascular history, one is able to understand the pathology in the patient quickly. In history taking, identification of risk factors is also essential. Major risk factors for cardiovascular diseases include smoking history, diabetes, hypertension and a family history of sudden cardiac death. Upon completion of the cardiovascular history taking, a comprehensive physical assessment is significant. The physical evaluation involves the phases of inspection, palpation, and auscultation.
With observation, it is possible for one to rule out the possibility of a hyperactive precordium whose presence points to cardiac pathology. On palpation, one can rule out the presence of palpable thrills, abnormal and displaced apex beats and a left parasternal heave. Palpable thrills indicate a possible valvular pathology with apex displacement mostly in mitral regurgitation and a left parasternal heave indicates hypertrophy of the right ventricle. Palpation of body pulses is also part of the systemic examination. Finally, key in cardiovascular assessment in auscultation for normal heart sounds S1 and S2 and extra heart sounds indicating pathologies. Additional heart sounds are in the forms of murmurs, snaps, and clicks, S3, and S4 abnormal heart sound.
To sum it up, this course has been of great benefit in gaining the necessary health care knowledge and skills.
Bartges, J. (2018). Dysuria. Textbook of Small Animal Emergency Medicine, 72-75.
Bickley, L. S. (2013). Bate's guide to physical examination and history taking(11th). Philadelphia, PA: Wolters Kluwer/Lippincott Williams & Wilkins. ISBN: 978-1609137625
Carter, B. D., Abnet, C. C., Feskanich, D., Freedman, N. D., Hartge, P., Lewis, C. E., ... & Jacobs, E. J. (2015). Smoking and mortality-beyond established causes. New England journal of medicine, 372(7), 631-640.
Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2014). Nursing care plans: guidelines for individualizing client care across the life span. FA Davis.
Qin, P., Hawton, K., Mortensen, P. B., & Webb, R. (2014). Combined effects of physical illness and comorbid psychiatric disorder on risk of suicide in a national population study. The British Journal of Psychiatry, 204(6), 430-435.
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