Purpose
The purpose of assignment is to reflect upon valuable clinical experiences and receive feedback from student colleagues
Due Date: This assignment initial post is due on Friday at 1159 p.m and peer responses are due day 7 by 1159 p.m. Eastern for those weeks with reflective discussion assignments.
Requirements
Select an experience you have had recently in your practicum. Describe the experience, your thoughts and feelings, your evaluation of the situation, your analysis of the experience, conclusions and learning from the experience, and your action plan resulting from the experience, using scholarly writing, APA 7th ed. For peer response replies, critique 2 of your classmates experiences and discuss. Provide rationale and respond to faculty.
Student Post to be critiqued
This week during clinical I had a 33-year-old male that signed into the emergency room for a sore throat x 3 days and stated he felt short of breath today. The patient had already been diagnosed with strep and started on Amoxicillin. The patient states he had only taken three doses of the antibiotic. Vitals signs presented with a temperature of 99.6, HR 127, BP 169/107, RR 18, and O2 96%. My initial thought was he has only taken three doses of Amoxicillin it hasn’t been long enough, but he also states he feels short of breath so could there be something else going on? I felt this specific patient encounter taught me as a provider you must keep in mind the obvious but also think outside the box that something more could be going on.
Upon examining the patient, he appeared very uncomfortable. Every time he swallowed, he moaned with discomfort. The patient states he gets strep a lot and was last treated here. The patient complained of pain in the temporomandibular joint but also states he has had his jaw broken and had reconstructive surgery. The patient states it seems every time he gets strep this happens. The patient also states he feels achy in all of his joints. The patient was very tender on palpation of submandibular lymph nodes and temporomandibular joint on both sides more severe on the left side. Using a tongue blade, I was able to examine the back of the throat. Erythema was noted with 3+ tonsils and yellow/brown exudate. Uvula was midline with mild swelling and normal palate. The bilateral auditory canal was clear, TM intact, and clear. The patient’s lungs were clear and equal bilaterally.
After seeing the patient, I meet with my preceptor to discuss my assessment findings. We looked back in the chart seeing the patient was last seen in March for the same thing and had a clear CT of soft tissue and neck. My preceptor then asked what I wanted to do. I talked through the scenario stating we know he has strep, but he is tachycardiac and very tender upon palpation more so to the left side. I feel we need to collect a CBC, CMP, and lactic. Give him a steroid for swelling and something to help soothe his throat. Originally, we ordered Chloraseptic spray, but it was unavailable due to the pharmacy no longer being in the building. We then decided to have the patient gargle 1ml of viscous lidocaine. The patient also received 125mg of Solu-Medrol IV push and 1g of Rocephin IV push. The patient’s WBC came back as 20 and lactic 0.7. My preceptor then asked me what I thought about a CT of soft tissue neck. I explained due to high WBC, the patient being very tender to palpation, difficulty opening his mouth, and complaint of feeling short of breath it would justify doing one.
My weakness with this patient encounter was I felt I was looking more at what symptoms the patient did not have of peritonsillar abscess and less at how the patient presented. Common clinical manifestations of peritonsillar abscess reveal trismus with difficulty opening the mouth, swallowing is painful and difficult, dysphagia which can cause drooling, muffled voice, tender cervical lymphadenitis, swelling and erythema noted to the anterior tonsillar pillar and soft palate overlying infected tonsils, with displaced inferiorly and medially with a contralateral deviation of the uvula (Gunjan Gupta & Rachel H. McDowell, 2019). Although this was a differential diagnosis, I had originally had it in mind. After my assessment finding the patient’s uvula was midline with a normal palate and stating his jaws always do this when he gets strep, I moved it down on my most likely diagnosis.
The patient’s CT showed a 5mm abscess on the left side. This patient was then transferred to another facility for ENT services for pharyngitis, tonsilitis, and peritonsillar abscess. The patient received 600mg Clindamycin IV piggyback. This patient encounter taught me to always go with my gut even if not all of the assessment findings are consistent with my diagnosis, and always consider the patient’s presentation. It was obvious based on how the patient presented that there was more than just strep going on with this patient.