Week 5 iHuman Assignment: Reflection Worksheet Paper

Week 5 iHuman Assignment: Reflection Worksheet Paper

Week 5 iHuman Assignment: Reflection Worksheet Paper

Address the following statements and questions. Write on this template and include the following components:

write 150-300 words in a Microsoft Word document

demonstrate clinical judgment appropriate to the virtual patient scenario

cite at least one relevant scholarly source as defined by program expectations

communicate with minimal errors in English grammar, spelling, syntax, and punctuation

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Some clinicians may find it difficult to explain the logic behind their clinical thinking. As you gain experience, your clinical reasoning will begin at the outset of the patient encounter, not at the end. Reflect on the clinical reasoning you used during this virtual patient encounter.

Describe the steps taken to identify and interpret the key findings in this case.

What are some “lessons learned” within the assessment that you can apply to your professional practice as a provider?

References APA <5years

Week 5 iHuman Assignment Reflection Worksheet Sample

Clinical Judgment

The patient presented with several symptoms, including fever, blood in stool, and elevated white blood cell count (WBC).these are the typical signs of infection. On performing a stool culture, the results confirmed the presence of Salmonella Enteritidis, aligning with the patient’s symptoms and justifying the use of Ciprofloxacin 500mg OD, an antibiotic effective against Salmonella infections. The elevated BUN of 26 from the Basic Metabolic Panel indicates a  potential kidney involvement, possibly due to dehydration secondary to infection. The elevated WBC count (13,500mm3), specifically with a notable percentage of band cells, indicated a strong inflammatory response and an ongoing infection (Paul & Walson, 2021).

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My clinical judgment also factored in the medication choices. I prescribed Ciprofloxacin based on the patient’s severe infection symptoms, positive stool culture, and bacterial susceptibility. The recommendation of acetaminophen for fever management aligns with best practices, and the inclusion of probiotics is useful in managing infectious and antibiotic-associated diarrhea (Kopacz & Phadtare, 2022). Antibiotic-associated diarrhea is a condition where diarrhea occurs as a side effect of taking antibiotics (Kopacz & Phadtare, 2022). This happens because antibiotics disrupt the balance of the natural gut microbiota, leading to an overgrowth of harmful bacteria such as Clostridium difficile (C. diff) or other pathogens, which can cause diarrhea.

Logic Behind Clinical Thinking

At the initial encounter, I engaged in a comprehensive review of the patient’s presenting symptoms, medical history, and initial diagnostic results. The presence of fever, blood in stool, elevated white blood cell count (WBC), and elevated band cells signaled an immune response (Eberhardt et al., 2022). Recognizing that severe infection symptoms were evident, I was prompted to consider a serious infectious cause as the primary differential diagnosis.

The diagnostic tests, particularly the Basic Metabolic Panel (BMP) and Complete Blood Count (CBC), offered vital insights. The elevated blood urea nitrogen (BUN) raised concerns about dehydration and systemic involvement of the infection (Sheley et al., 2023). The positive stool culture for Salmonella Enteritidis supported the hypothesis of an infection.

My clinical reasoning then led to the prescription of Ciprofloxacin, which was chosen based on the identified pathogen, salmonella Enteritidis bacteria, and the patient’s severe symptoms. The decision was bolstered by the patient’s need for immediate intervention due to the severity of the infection, marked by an elevated WBC count of 13,500mm3 and elevated Band cells of 10% (Sheley et al., 2023).

Describe The Steps Taken To Identify And Interpret The Key Findings In This Case

Step 1: Review of Presenting Symptoms

The initial assessment of the patient’s symptoms of fever indicated an immune response, which is often a sign of infection (Swearingen & Wright, 2019). Moreover, the observation of blood in the stool suggested a potential gastrointestinal inflammation or bleeding. These symptoms collectively signaled the possibility of a severe infection.

Step 2: Laboratory Data Analysis

On analyzing the laboratory results, two key findings stood out. The Basic Metabolic Panel (BMP) showed an elevated blood urea nitrogen (BUN) level of 26. This indicated potential kidney involvement, which could be due to dehydration associated with the infection or other systemic factors. The Complete Blood Count (CBC) showed an elevated white blood cell count (WBC) of 13,500 mm3, along with elevated band cells at 10%. This elevated WBC count and the presence of band cells indicated an active immune response, particularly to an infection.

Step 3: Microbiological Analysis

The negative result for Clostridium difficile (C.diff) ruled out one potential causative agent of gastrointestinal infection. However, the stool culture came back positive for Salmonella Enteritidis, which confirmed the presence of Salmonella bacteria in the gastrointestinal tract. This was a crucial key finding, narrowing down the source of infection.

Step 4: Microscopic Examination

The stool gram stain provided additional information by showing the presence of Gram-negative bacilli. This aligned with the characteristics of Salmonella bacteria, further corroborating the diagnosis.

Step 5: Immune Response Confirmation

The finding of fecal leukocytes greater than 10,000 WBC/mcL provided direct evidence of an inflammatory response within the gastrointestinal tract. This reinforced the suspicion of an active infection and an ongoing immune reaction.

Integration and Treatment Rationale

The integration of these key findings provided a comprehensive understanding of the patient’s condition. The elevated WBC count, band cells, and fecal leukocytes confirmed a robust immune response to a severe infection. The elevated BUN indicated potential kidney involvement, and the positive stool culture and Gram-negative bacilli confirmed the presence of Salmonella Enteritidis as the causative pathogen (Swearingen & Wright, 2019). Ciprofloxacin was prescribed due to the confirmation of Salmonella infection and the patient’s severe infection symptoms. Acetaminophen was recommended for fever management. Additionally, the use of probiotics aimed to support gut health and manage gastrointestinal symptoms.

Lessons Learnt

One of the critical lessons I learned from this assessment is the significance of differentiating between mild, moderate, and severe cases to tailor the treatment approach. The ability to integrate clinical data, interpret results, and prioritize interventions based on the patient’s condition is essential. Another lesson is the importance of patient education; I understood the need to educate the patient about hydration, rest, proper hygiene, and the rationale behind probiotic use (Swearingen & Wright, 2019). This experience has reinforced the importance of evidence-based practice and staying updated with guidelines. The clinical reasoning skills I have developed will guide me in making informed decisions, providing appropriate care, and improving patient outcomes in my professional practice as a healthcare provider.

References

Eberhardt, N., Bergero, G., Mazzocco Mariotta, Y. L., & Aoki, M. P. (2022). Purinergic modulation of the immune response to infections. Purinergic Signalling, 18(1), 93–113. https://doi.org/10.1007/s11302-021-09838-y

Hélias, M., Planchon, J., Bousquet, A., & Dubost, C. (2019). Salmonella entericaserovar enteritidis peritonitis with spontaneous intestinal perforation in an immunocompetent patient. BMJ Case Reports, 12(3), e228027. https://doi.org/10.1136/bcr-2018-228027

Kopacz, K., & Phadtare, S. (2022). Probiotics for the prevention of antibiotic-associated diarrhea. Healthcare (Basel, Switzerland), 10(8), 1450. https://doi.org/10.3390/healthcare10081450

Lacey, J., Corbett, J., Forni, L., Hooper, L., Hughes, F., Minto, G., Moss, C., Price, S., Whyte, G., Woodcock, T., Mythen, M., & Montgomery, H. (2019a). A multidisciplinary consensus on dehydration: definitions, diagnostic methods, and clinical implications. Annals of Medicine, 51(3–4), 232–251. https://doi.org/10.1080/07853890.2019.1628352

Lacey, J., Corbett, J., Forni, L., Hooper, L., Hughes, F., Minto, G., Moss, C., Price, S., Whyte, G., Woodcock, T., Mythen, M., & Montgomery, H. (2019b). A multidisciplinary consensus on dehydration: definitions, diagnostic methods and clinical implications. Annals of Medicine, 51(3–4), 232–251. https://doi.org/10.1080/07853890.2019.1628352

Paul, I. M., & Walson, P. D. (2021). Acetaminophen and ibuprofen in the treatment of pediatric fever: a narrative review. Current Medical Research and Opinion, 37(8), 1363–1375. https://doi.org/10.1080/03007995.2021.1928617

Sheley, W. C., Gray, M. J., Wilber, M. Q., Cray, C., Carter, E. D., & Miller, D. L. (2023). Electrolyte imbalances and dehydration play a key role in Batrachochytrium salamandrivorans chytridiomycosis. Frontiers in Veterinary Science, 9. https://doi.org/10.3389/fvets.2022.1055153

Swearingen, P. L., & Wright, J. (2019). All-in-One Nursing Care Planning Resource – E-book: Medical-surgical, pediatric, maternity, and psychiatric-mental health. Elsevier Health Sciences.