Reflective Journal Order 784261
Name
Institution
Reflective Journal Order 784261
Reflective Journal
One significant event occurred during my clinical day that entailed a 52-year-old female client. The patient was present for Type 2 diabetes mellitus follow-up and prescription refill of Janumet 10mg and Lantus insulin. She was receiving medication assistance through Health Link, where she gets her Janumet for free. The preceptor was reluctant to handle the 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 the last visit three months ago. I went over abnormalities in laboratory work alongside the effects of Janumet on renal function. The patient was dismayed and wanted to continue Janumet based on its free medication. She could not afford to pay for her medication, an aspect that challenged her quitting from the Janumet. The preceptor and I looked online to find a savings card for a different medication with the same effectiveness as Janumet. The preceptor decided to discontinue Janumet and place the patient on Glipizide and Victoza. The preceptor gave the patient a box of Victoza to last her until her follow-up next week. She was instructed to check fingerstick blood sugar twice a day while maintaining a log of her blood glucose readings.
The impact of this event offers a strong basis for my understanding of the evidence-based practice 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. Similarly, these procedures enhance the further buildup of my knowledge, training, and skills concerning my aspired advanced nursing roles.
I learned to conduct a history and physical exam, perform a focused assessment, abnormalities to look for during a physical exam, take history and assessment findings to develop a diagnosis and differential diagnosis, and develop a plan of care that includes interventions (Baid, 2006). Patient and family teaching with return verbalization or demonstration, and emphasizing the importance of follow-up care is amongst the areas I continued to learn from the processes I encountered while in the nursing practice.
During my clinical exposure, I observed a situation that made me feel a certain way. There was a patient that came to the clinic while unwell and required his prescriptions refilled. He wanted to be a walk-in. The Licensed Practical Nurse (LPN) informed the preceptor about the patient, pointing out that he missed his last appointment in March and has not been to the clinic in over three months. The preceptor told LPN to tell the patient to schedule an appointment. The LPN did not triage the patient to find out his compliant, why he missed his last appointment, or why he had not been to the clinic. I feel the staff should have included the patient to that day’s clients. Perhaps the patient could have been very sick and needed care. Similarly, I oppose the turning away of the patient because that could attract ethical considerations.
Reference
Baid, H. (2006). Differential diagnosis in advanced nursing practice. British Journal of Nursing, 15(18), 1007-1011.