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St Thomas University Week 1 Advance FNP Adults Clinical Discussion

  • You should respond to your peers by extending, refuting/correcting, or adding additional nuance to their posts.
  • All replies must be constructive and use literature where possible.

Katia Gedeon

Clinical Experience

I had the opportunity of working in the adults’ outpatient section this week, and I gathered several experiences. However, the unique challenge I experienced was time management. I realized that things were moving so fast in the outpatient, and the flow of patients was always high. Therefore, I had to adjust my speed when handling patients at every stage so that we would be able to attend to many patients without keeping them wait for so long.

One case that I experienced was when a 43-year-old white male came to the clinic complaining of severe pain in his right ear. He stated that he started feeling the pain about three days back, and the pain does not seem to go away. On further assessment, the patient said that he had a cold in the past week and started experiencing pain after the cold. The patient was not using any hearing aids, and that was the first time he was experiencing such complications. Furthermore, the patient said that he had not taken any medication to relieve the pain. I examined the hearing ability of the patient and discovered that he had a problem with hearing in his right ear. Additionally, some fluids were coming out of his right ear, and he felt like the ear is itching.

There were two primary differential diagnoses applicable in this condition which includes:

  • Otitis Media with Effusion: The fundamental characteristic here is fluid availability within the middle ear (Kennedy & Singh, 2017). The situation does not always indicate severe illness and mainly occurs in children after contracting a cold or other infection. The patient in this situation had a cold a week before this infection, and that alone could be a strong indication that the infection could be Otitis Media with effusion.
  • Chronic Otitis Media: This was the second possibility and is always diagnosed in a situation where subacute membrane perforation occurs within some chronic ear infection. It also comes with drainage (Danishyar & Ashurst, 2017).

The patient was referred to go the emergency room for eventuation maybe for myringotomy, a surgical procedure involving inserting specific tubes through the tympanic membrane to equalize pressure inside the ear (Kennedy & Singh, 2017). Besides, the patient was put on some antibiotics that would reduce the pain just within a day. However, I advised the patient that he must comply with the entire prescription even after the pain had faded off. I also instructed him to take soft foods and liquids since chewing or any other movement of the Eustachian tube could aggravate the pain further. Finally, I instructed the patient to either use an ice pack application or a warm heating pad. The heating pad needed to be turned on low and then be covered with a towel for safety purposes.

One important thing I learned from this week’s clinical experience is the importance of communication and diversity. I realized that patients from different backgrounds come to the clinic, and language sometimes becomes a barrier. For instance, a patient could not speak or understand English perfectly, which means that communication would be a challenge. There was a need for a translator, and as a nurse practitioner, I had to be very keen on non-verbal communication such as facial expressions and such things.

References

Danishyar, A., & Ashurst, J. V. (2017). Acute otitis media. https://europepmc.org/article/NBK/nbk470332

Kennedy, K. L., & Singh, A. K. (2017). Middle ear cholesteatoma. https://europepmc.org/article/nbk/nbk448108

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