NR 511 WEEK 8 REFLECTION WITH UPDATED & CORRECTED CITATION (NR511)

Exam (elaborations) NR 511 WEEK 8 REFLECTION WITH UPDATED & CORRECTED CITATION (NR511) DIFFERENTIAL DIAGNOSIS REFLECTION 2 Part 1 – Clinical Experience and Gap Review In this NR 511 clinical rotation I was in a primary care office where I saw a total of 129 patients and completed 130 hours. I saw a well-rounded adult-age population comprising of every age group from 18 to 85+ with most of them being in the age range 36 to 55. I saw two pediatric patients age 1-4, one patient age 5-11, and five patients age 12-17. This totaled 6.21% of my patients seen this session who were in the pediatric range; this is short of the required 15% for the family nurse practitioner program (FNP). As one of my weaknesses was confidence and ability to connect with pediatric patients I will bring my stethoscope to practice on my nieces and nephews. I will also ensure I have good clinical experiences with pediatrics in the future. Per the MyEvaluation reports, I saw four patients from the pacific islander population (3.10%) and thirty-two from the Hispanic population (24.81%) which is fairly representative of the Utah population. According to the US Census Bureau, in Salt Lake County Utah, the pacific islander population here is 1.7% and the Hispanic population is 18% (United States Census Bureau, 2017). Per the MyEvaluation logging tool, I also saw one African American patient (0.78%) and two Asian patients (1.55%) which is slightly lower than the population of these groups in Salt Lake County, Utah at 2% and 4.2% respectively (United States Census Bureau, 2017). However, I did label 4 patients, or 3.10%, of my patients seen as “other”. The following areas are considered Asian by the US Census Bureau: Far East, Southeast Asia, or the Indian subcontinent (United States Census Bureau, 2017). I should have labeled these “other” ethnicities as Asian because they were primarily middle eastern. If I had done this, I would have the appropriate percentage of Asians seen per the US Census Bureau of my area. Therefore, for this gap I will correctly label the ethnicity of my Asian patients for my future clinical sites. I did a lot of well woman exams, breast exams, and 10 pap smears. I also removed an intrauterine device (IUD). I did 18.6% of my hours in women’s health, so I exceeded the required 15%. I do know that I have an Internal Med rotation next where I may not see as many patients in women’s health so I am looking for a partial-rotation with an OB/GYN as a back-up. I also want to do an OB/GYN rotation since I am still weak at doing paps on obese elderly women. At first, every pap was difficult, but I quickly mastered the technique in young healthy women. The excess tissue from age-related sagging and the obesity made it harder to find the cervix and not pinch vaginal tissue with the speculum; therefore, I would like to work on that skill more. I was able to do a lot of adult acute and chronic care and the complexity was well balanced. I did many well-exams, sick-exams, hospital follow-ups, and exams of patients with many controlled and uncontrolled illnesses; I even sent several patients to the emergency room. I do not feel that any gaps are represented in this category, but I still have personal goal for improvement here. I noticed that I was better and more knowledgeable about the chronic illness and well physical exams. I was weakest, as is expected, in coming up with differentials for acute concerns. Despite improving in all these areas over my clinical experience, I plan over the twoweek spring break is to make one document with the common complaints and differentials I should consider for each. This will ensure even greater growth for me in the future. These three common complaints compromise the three weakness I plan to address as part of this reflection assignment: upper respiratory infections (URIs), abdominal complaints, knee pain etc… The primary gap in this clinical experience was clearly pediatric in nature. 15% of my hours in this session were not in pediatrics as required, only 6.21% were. Additionally, my next session is in internal medicine so I will likely not get the required pediatrics there. Therefore, I