Please respond to discussion below using current APA edition and 2 scholarly ref

Please respond to discussion below using current APA edition and 2 scholarly ref

Please respond to discussion below using current APA edition and 2 scholarly references. Must be 150 words.
Success and Challenges of Week 6 Clinical Experience
I was faced with the challenge of seeing patients who did not want to be seen by a student nurse practitioner. Furthermore, some of them did
not refuse to be seen by me outright, they just displayed a difficult attitude and made assessing and talking with them more difficult. Another
challenge I faced was with choosing which medication to prescribe. For example, I know the patient needs to be started on a blood pressure
medication, but I find it difficult to determine which one, at what dose, and how many times a day.
Patient Assessment, Plan, Differential Diagnoses, and Health Promotion Interventions
A sixty-four-year-old woman presented to the office complaining of intermittent palpitations over the past week. The associated symptom
was shortness of breath and she denied aggravating and alleviating factors. The patient denies any symptoms of infection. The patient denied
smoking, alcohol use, and illegal drug use as well. She had a past medical history of hypertension and hyperlipidemia. Her physical assessment was
negative for an irregular heartbeat or murmur, edema was absent, and her lung sounds were clear bilaterally. Her vital signs were within normal
limits. An electrocardiogram (EKG) was performed in the office which showed normal sinus rhythm. Upon digging a little deeper, my preceptor and
I discovered that the patient had recently gone through some life-changing events, including a death in the family. The patient was crying and
appeared anxious. Once she calmed down, a GAD-7 was given to the patient to complete; she scored a ten indicating moderate anxiety. Differential
diagnoses included anxiety, cardiac arrhythmias, and pulmonary embolism (PE) (Goyal et al., 2023). We prescribed 5 mg of escitalopram (Lexapro)
daily for anxiety. The patient was instructed to return in six weeks for a follow-up as it can take up to six weeks to feel the full effects of the
medication (Landy et al., 2023). At that time, her response to the medication can be evaluated and the dosage can be adjusted accordingly. She was
also referred to a psychologist to provide talk therapy and behavioral intervention for her anxiety, as well as a cardiologist for a further workup to
rule out a cardiac cause for her symptoms. Health interventions include managing anxiety by reducing stress through meditation, yoga, deep
breathing, and relaxation techniques. In addition, the patient should be counseled to avoid stimulants like caffeine, energy drinks, nicotine, and even
some cold medicines (Heart Palpitations – Diagnosis & Treatment – Mayo Clinic, 2022).
What I Learned This Week in Clinical that Can Be Beneficial in My Future Practice
An 81-year-old Black female was referred to ophthalmology for blurred vision. The report from the consulting physician stated he suspected
sarcoidosis based on his findings. The patient had no pulmonary or cardiac symptoms, but because of the ophthalmologist’s report was sent for CT
imaging to further evaluate for the disease. Multisystemic sarcoidosis primarily affects the lungs and thoracic lymph nodes. Chest discomfort,
dyspnea, and cough are common symptoms in patients. Nonspecific rhinitis, recurrent sinusitis, and destructive lesions of the nasal septum and
turbinates are the results of upper respiratory tract involvement. Papules, nodules, plaques, ulcers, and erythema nodosum are cutaneous symptoms.
Arrhythmias and heart blockages emerge as a result of cardiac involvement. About 5 to 10% of sarcoidosis patients develop neurosarcoidosis, which
primarily affects the basal leptomeninges and cranial nerves. Granulomatous inflammation of the eye and its adnexal tissues is a characteristic
feature of ocular involvement in sarcoidosis. In thirty to forty percent of patients, ocular involvement is the first presenting characteristic. Uveitis,
which is present in thirty to seventy percent of cases, and conjunctival nodules, which are present in 40% of cases, are the most prevalent ocular
characteristics. Because of variations in case definition, the disease’s asymptomatic nature, insufficient population screening, and ascertainment bias,
the prevalence of sarcoidosis varies from region to region. According to reports, Black Americans have an age-adjusted incidence that is three times
greater than White Americans. The typical age at which sarcoidosis manifests itself is twenty to fifty years old. In addition, there is a higher
likelihood that uveitis, asthenia, and skin lesions are linked to late-onset sarcoidosis i.e. diagnosed at sixty-five years of age or older (Simakurthy &
Tripathy, 2023).

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