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NURS 617 CLINICAL PRACTICUM LOG. COMPLETE SOLUTION
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NURS 617 CLINICAL PRACTICUM LOG. COMPLETE SOLUTION
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CLINICAL PRACTICUM LOGStudent: Email:
12 0
Met
Date Hours Minutes Met, Unmet,
In Progress
Objectives
3. At the conclusion of the practicum experience, the graduate student
will recognize how pathophysiological processes manifest into signs
and symptoms, and how those processes relate to clinical decisions
and diagnosis of illness and disease seen in the emergency
department clinical decision unit patients.
3.1. Discuss with preceptor current medical trends and
evidence-based practices related to the pathophysiological
changes seen in patients with cardiovascular disease admitted to
the emergency department clinical decision unit low-risk chest
pain observation unit.
Supportive
Narrative
May 5, practicum day five with my preceptor, I completed a fifth history and physical
with complete medication list including prescribed, over-the-counter, and supplements
on a patient in the clinical decision unit (CDU) and documented in Typhon.
Documentation was not completed by myself in the patient record, Sarah, my
preceptor, completed her physical exam and was present during the history and
documented in the medical record.
The patient chosen for my physical exam on practicum day five was a 76-year-old
female who came in to the emergency department (ED) from urgent care (UC). Prior
to her arrival to the CDU her plan of care was discussed with the ED resident. The
plan was to obtain three sets of troponin levels. If negative, the patient would have
an exercise stress test the following day. According to our patient handoff, the patient
had complaints of chest tightness which had been present all the night prior after
returning home from a multiple day bus tour. The patient stated she had pain most of
the night which eased enough she could sleep around 0300 the morning of May 5.
The patient was pain-free on exam after receiving 324mg aspirin prior to her arrival
in the clinical decision unit (CDU). Her HEAR score was 5. Her first EKG showed non-
specific T-wave abnormalities which were gone on the EKG obtained on her arrival to
the CDU. The technician who performed the EKG stated she had to replace the leads
as they were not correctly placed on the patient’s chest on her arrival to the CDU.
This might explain the absence of the previous abnormalities. However, there was a
noted slightly elongated QT segment which was absent from the first.
The patient’s exam was unremarkable except for fine crackles in bilateral lung bases
, heard on posterior auscultation only. Her cardiac rhythm was also concerning. The
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