Clinical Experience as Nurse Practitioner Student in OBGYN (Essay Sample)
This week is my first week as a nurse practitioner student in OBGYN clinical. So I
have to talk about the experience and a patient
Describe your clinical experience for this week.
Did you face any challenges, any success? If so, what were they?
Describe the assessment of a patient, detailing the signs and symptoms (S&S),
assessment, plan of care, and possible differential diagnosis.
What did you learn from this week's clinical experience that can beneficial for
you as an advanced practice nurse?
Support your plan of care with the current peer-reviewed research guideline.
Pt is 28 year old who presented to the clinic for OB follow up. GA 33 weeks
Gravida 5 para 2. pt has had 2 c-section. No complain. Pt is for a C- section in
Weekly Clinical Experience
Weekly Clinical Experience
This week was my first experience in the OBGYN clinic as a nurse practitioner student. I got so discouraged and felt frustrated with myself and completely felt blank and out of my content. I met a 28-year-old patient whom I will refer to as Pt. Pt presented herself to the OBGYN clinic for follow up. Her gestational age was 33 weeks, gravida 5, para 0. Pt has previously had two s-section without any complains. Her first C-section was 8 years ago (at 20 years old) and the second one was 4 years ago (at 24 years old). She has been able to have check-ups regularly since her last C-section. According to her medical records, she is scheduled for a Cesarean section on 8/12/2020.
Pt looks tired with pale eyes. She is quite restless but is responsive. Pt climbs the examination bed with a lot of difficulties. Pt however struggles to lie on her back for examination of the abdomen, an indication of an underlying problem in her uterus. Her abdomen is round and too big. Besides, Pt has a pale scar in her lower abdomen.
First, the fundal height was measured. A biparietal diameter (BPD) was used to access the gestational age of Pt (Namburete et al., 2015). Her fetal BPD was 8.5cm which corresponds to 33 weeks. An ultrasound was also done to confirm her gestational age (Namburete et al., 2015), and the results showed her gestational age to be 33 weeks 3 days. The fundal height was compared with the dates of the patient to see whether they correspond (Chee, 2016). Additionally, the liquor volume was assessed by feeling the movement of the fetus during palpation (Chee, 2016). The fetal heart was also assessed by listening since Pt had reported that she had not felt any movements of the fetus since morning. The overall state of wellbeing of the fetus was assessed after abdominal palpation. The fetal examination showed that the fetus was still in a breech position. Additionally, Pt’s lower segment of the uterus was assessed through ultrasound. The ultrasound showed that the previous C-section scar was thin all through its length and the anterior part of the wall of the uterus was deficient. Pt was diagnosed with CSSD- Cesarean section scar dehiscence after ruling out wound hematoma. Wound hematoma is usually caused by bleeding that seeps out of a blood vessel into nearby tissue, as a result of an injury (Abdelazim et al., 2018). Pt said that she had not had any injury on her abdomen, since her last C-section. The possibility of wound hematoma was therefore ruled out after a close examination of the scar both externally and internally.
Plan of care
The life of the fetus and the mother was at risk as there was a need for urgent action. Pt was given magnesium sulfate and betamethasone for fetal protection and fetal lung respectively, in strict adherence to the protocol of the hospital (Abdelazim et al., 2018, and Cignini, et al., 2016). Pt was then taken for an emergency cesarean section, after neonatology consultation, cross-matching, preoperative investigation, and counseling (Cignini, et al., 2016). Pt was discharged after a successful postoperative recovery and a series of counseling.
This week's experience made me learn a l
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