Nursing Coursework

Practicum – Journal Entry 9
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Practicum – Journal Entry 9
During my practicum, I had a chance to assess and manage a patient with a gastrointestinal disorder. The patient was a three-year-old girl who came to the doctor’s office with her mother. The girl’s primary complaint was Chronic Diarrhea. According to the mother, the child was passing loose, watery stool at least four times a day, and this had lasted for two weeks. Moreover, the child had the following signs and symptoms of diarrhea: weight loss, chills, fever, nausea, cramping in the abdomen, mucus in the stool, incontinence, vomiting, bloating, and zero control of bowel movements. A further examination of the patient also revealed symptoms of dehydration, such as thirst, dry mouth, lack of energy, passing less volume of urine, sunken eyes, and decreased skin turgor (NIH, 2017). When I pinched and released the patient’s skin, it did not flatten back immediately, confirming a reduced skin turgor.
Thus, to diagnose the situation, it was imperative that I examine the patient’s medical history, conduct appropriate physical examination and laboratory tests. As such, I ordered a stool culture to determine the presence of foreign bacteria in the patient’s digestive tract that may have caused diarrhea (Sweetser, 2012). Blood tests followed to rule out the presence of non-gastrointestinal disorders. Imaging tests and food tests were also conducted to rule out structural aberrations and to identify food intolerance respectively (Lembo & Cremonini, 2017).

The physical examination centered primarily on fluid and hydration condition of the patient. Therefore, complete digital rectal and abdomen examination for sphincter competence were paramount.
My ‘aha’ moment was when I realized that all tests and examinations pointed toward one disease which caused the patient to diarrhea: celiac disease. The kid was suffering from gluten intolerance which caused her to have chronic diarrhea. The doctor recommended fluid resuscitation and antibiotics to replenish the patient’s lost body fluids and to manage the disease-causing bacteria respectively. Overall, this practicum enabled me to apply to what I learned in the classroom to a real-world situation, making it one of the greatest experiences in my academic life.

References
Sweetser, S. (2012). Evaluating the Patient with Diarrhea: A Case-Based Approach. Mayo Clinic Proceedings, 87(6), 596–602. http://doi.org/10.1016/j.mayocp.2012.02.015Lembo, A., & Cremonini, F. (2017, December 12). Approach to the patient with diarrhea. Retrieved July 31, 2018, from https://www.cancertherapyadvisor.com/gastroenterology-hepatology/approach-to-the-patient-with-diarrhea/article/596273/NIH. (2017, February 01). Symptoms & Causes of Chronic Diarrhea in Children. Retrieved July 31, 2018, from https://www.niddk.nih.gov/health-information/digestive-diseases/chronic-diarrhea-children/symptoms-causes