My final week as a student nurse practitioner at a family health clinic was a whirlwind of activity. I had the opportunity to care for a variety of older adult patients, and I learned a great deal about the challenges and rewards of working with this population.
One of the challenges I faced was assessing patients who were reluctant to talk about their health concerns. Many older adults have a lifetime of experiences that have shaped their views on healthcare, and they may be hesitant to share their personal information with a new provider. I found that it was important to take the time to build rapport with these patients and to listen to their concerns without judgment.
One of the successes I had was developing a plan of care for a patient with chronic obstructive pulmonary disease (COPD). The patient was struggling to manage her symptoms, and she was at risk for hospitalization. I worked with the patient to develop a plan that included medication management, lifestyle changes, and education about COPD. The patient was able to improve her symptoms and avoid hospitalization.
Here is an example of an assessment I performed on an older adult patient:
Patient: Mrs. Smith, a 78-year-old woman
Chief Complaint: Shortness of breath
History of Present Illness: Mrs. Smith reports that she has been experiencing shortness of breath for the past few months. The shortness of breath is worse when she walks up stairs or does other activities. She also reports that she has been coughing up a lot of mucus.
Past Medical History:
- Hypertension
- Diabetes mellitus
- COPD
Social History:
- Lives alone
- No smoking history
- Drinks alcohol socially
Physical Examination:
- Vital signs: BP 140/90, HR 100, RR 22, SpO2 92% on room air
- General: Well-appearing, older adult female
- HEENT: Pupils equal, round, and reactive to light; Sclerae anicteric
- Neck: Supple, no JVD
- Lungs: Decreased breath sounds bilaterally, expiratory wheezes
- Heart: Regular rate and rhythm, no murmurs, rubs, or gallops
- Abdomen: Soft, non-tender, non-distended
- Extremities: No edema
Differential Diagnosis:
- COPD exacerbation
- Heart failure
- Pneumonia
- Anemia
Plan of Care:
- Oxygen therapy
- Albuterol inhaler
- Chest physiotherapy
- Antibiotics
- Follow-up in 1 week
Health Promotion Intervention:
- Smoking cessation counseling
- Influenza and pneumonia vaccination
- Weight loss counseling
I learned a great deal from my final week of clinical experience. I learned how to assess and manage the health of older adult patients, and I learned how to develop a plan of care that meets the individual needs of each patient. I also learned how to build rapport with patients and to communicate effectively with them.
I am confident that the skills and knowledge I gained during my clinical experience will be beneficial to me as an advanced practice nurse. I am excited to start my career and to make a difference in the lives of older adults.
