Reflective Journal Assignment | Essay Help Services

Edit, paraphrase, rewrite, make flow from paragraph to paragraph.

Reflective Journal

One significant event that occurred during my clinical day, a 52-year-old female present for Type 2 diabetes mellitus follow-up and prescription refill of Janumet 10mg and Lantus insulin. Patient is receiving medication assistance through Health Link in which she gets her Janumet for free. The preceptor did not want to continue patient on Janumet because it causes impairment in renal function. Patient creatinine increased from 1.2 to 1.7 and GFR decreased from 65 to 59, since last visit 3 months ago. I went over abnormalities in lab work and effects of Janumet on renal function.  Patient became very upset and wanted to continue Janumet because she was getting it for free. She couldn’t afford to pay for her medication and didn’t want to change to something different. The preceptor and I looked online to see if we could we find a savings card for a different medication with the same effectiveness as Janumet. The preceptor decided to discontinue Janumet and place patient on Glipizide and Victoza. The preceptor gave patient a box of Victoza to last her until she follow-up next week. Instructed to check fingerstick blood sugar twice a day and to keep a log of her blood glucose readings.

The impact of this event increases my understanding of advanced practice nursing by emphasizing the importance of obtaining laboratory test as needed for management of conditions and diseases; checking lab results for abnormal findings; adjusting treatment plan based on those findings; and the importance of follow-up visits to see if they are responding to the treatment plan. All these processes with help me build upon my knowledge, training, and skills, as I transition into the role of an advanced practice nurse.

Some specific things I’m continuing to learn, is conducting a history and physical, how to perform a focused assessment, abnormalities to look for during a physical exam, taking history and assessment findings to develop a diagnosis and differential diagnosis, developing a plan of care that includes interventions, patient and family teaching with return verbalization or demonstration, and giving emphasis to the importance of follow-up care.

During my clinicals I observed a situation that made feel a certain way.  There was a patient that came to the clinic that wasn’t feeling well and needed his prescriptions refilled.  He wanted to be a walk-in.  The Licensed Practical Nurse (LPN) informed preceptor about patient, that he missed his last appointment in March and hasn’t been to the clinic in over 3 months. The preceptor told LPN to tell patient to schedule an appointment. The LPN didn’t triage the patient to find out his compliant, why he missed his last appointment or why he hasn’t been to the clinic. I feel the staff should have worked the patient into the schedule that day.  He could have been very sick, needed care, and was turned away.