Journal #1

What goal did you meet this week that you and your preceptor discussed?
My goal this week was to continue to see patients by myself. At both of my clinical sites, I met
this goal. At Blount Memorial, I was able to see 1/2 of the patients that were on my preceptor's
schedule, which turned out to being about 6 patients each. With the patients that I seen, I
explored the chart, went to see the patient, and presented to my preceptor about the patient and
my plan for the day. I was also able to discharge patients by myself. At Halls Family Physicians,
I saw all patients by myself. In addition to seeing these patients by myself, I also reported back to
my preceptor of the patients HPI, ROS, PE, and Plan. For the majority of the patients, I did not
need to seek help.
What areas does your preceptor feel that you need to work on for next week?
We discussed looking at other providers, including physicians, schedule to allow me more
opportunity to manage chronic conditions, such as diabetes, thyroid, hypertension. I feel like I
am doing well with acute visits but would like more opportunity with chronic patients.
What did you do this week that made you feel you gained confidence in a particular area of
patient care?
This week I was able to do my first joint injection. I had a patient that came in complaining of
bilateral shoulder pain, near the shoulder blade. She requested bilateral shoulder blade injections.
I was intimidated as I hadn't had the opportunity to see or do this procedure. After speaking with
the physician, I realized that it wasn't anything difficult. I was able to do both of her shoulder
injections easily and with no complications which increased my confidence.
Reflect on a challenging clinical situation or a situation where you did not feel confident in
a particular area of patient care.
The most challenging patient that I had this week was a gentleman that came in with a "sore" on
the middle of his forehead. He states that the "sore" came up out of nowhere, denied injury, had
been there for a few days, and was worsening. He stated that the "sore" hurt and was spreading
from the middle of his forehead to the left scalp and left eye. He states that his vision appears
"fuzzy" but denied eye pain. He denied pruritis. He had not done anything OTC.
As soon as I seen the "sore", I was concerned that it was herpes zoster. I was also very concerned
that he had developed herpetic ophthalmicus, as his left eye was red, swollen, and drooping.
How did you handle the situation?
I told the patient what I thought that it was. I also explained that with the concern for Shingles
affecting his eye, that this becomes more complicated and more concerning. I explained that after
discussion with my preceptor, and as long as she agrees, I will probably have to refer him to a
specialist to be seen now.
After speaking with my preceptor, and having her look at the patient, she agreed that it looked
like herpetic ophthalmicus. We called a local ophthalmologist that my preceptor often refers
patients to, and they were able to work him in to be seen then. I expressed how important that it
was that he go be seen now, and that he could risk vision loss if he does not follow through with
ophthalmology. Prior to him leaving, I gave him 80mg of depo IM and sent in a dose pack of
prednisone for him to pick up and start the following day.
What have you done or will you do to make you feel more prepared for this same situation
in the future?
I felt confident in my assessment and diagnosis skills. The only question I had was "is this really
herpetic ophthalmicus?", and do I need to refer to an ophthalmologist or ED? I followed up with
my preceptor a few days later, and she confirmed that it was herpetic ophthalmicus and that he
was following very closely, every few days, with ophthalmology.
Reflect on some areas of learning while in the clinical area that will benefit you the most in
your own practice.
I felt like I was challenged with two of the patients that I saw this week, both the lady that
requested bilateral shoulder injections as well the patient that presented with herpetic
ophthalmicus. Both of these scenarios were something that I had not had the opportunity to see
in clinic. I feel like both of these new experiences will help me in my future as a practicing nurse
practitioner.
What course objective did you address this week?
The course objective that I addressed this week was "collaborate with other health professionals
and utilize community resources to facilitate management of care for individuals and families
across the life span experiencing selected multi-system complex or chronic health problems
commonly seen in primary care" (King University, 2020), with the patient that presented with
herpetic ophthalmicus. I knew that this patient required urgent care, and care that was out of my
scope of practice, so with the help of my preceptor, we called a local ophthalmologist, to help
facilitate management of care for my patient with herpetic ophthalmicus.
Describe how you integrated one of the SON’s Professional Pillars during your clinical
experience this week.
The SON Professional Pillar that I integrated during my clinical experiences this week was
commitment. King University (n. d.) describes commitment as "the dedication and service to
patients, the profession, collaboration, and continued learning while holding oneself to the
highest standards of performance and accountability". I was committed to ensuring that the
patient that presented with herpetic ophthalmicus was treated quickly to prevent from visual
compromise. I collaborated with my preceptor to validate my assessment as well as collaborated
with a local ophthalmologist to help facilitate management of care. I also followed up with this
patient with my preceptor and found out that my assessment was correct and that he was being
followed very closely by ophthalmology.
References
King University. (n. d.). School of nursing. Retrieved from https://www.king.edu/academics/sch
ools-and-institutes/school-of-nursing/
King University. (2020). Nurs 5024-Seminar & intensive practicum. Retrieved from https://king
.instructure.com/courses/5947/assignments/syllabus