Clinical Rotation Case Study Discussion Peer review articles within 5 years of publication publication. Reference 1. First reply The family problem list, f

Clinical Rotation Case Study Discussion Peer review articles within 5 years of publication publication. Reference 1. First reply
The family problem list, founded by Dr. Lawrence Weed in the 1960’s, is basically a summary
of problems concluded by conducting a detailed assessment of an individual within his/her
family unit (DeNisco & Stewart, 2019). Problem lists are still used today by Nurse Practitioners
(NP’s) and doctors alike to focus on general information such as the chronic or acute disease
processes, ongoing or active problems that are currently being addressed with the patient, and a
summary of the most significant things about the patient (Denisco & Stewart, 2019). After
reading case study #3, I have worked to compile an individualized problem list for the patient in
question. It is as follows.
1) Acute Self-limiting Problems
Denisco & Stewart (2019) state that the patient does not seem to have a very good understanding
of her health status in general or of any health-related problems she has which could raise the
concern that the patient just does not have the developmental age or cognitive ability to
comprehend her health status. She may also not have the emotional capacity to even have any
interest in her health with all of the other challenges going on in her life. Due to this lack of
information, not much can be determined about any acute self-limiting problems. The only
reason that the patient is at the health center in this case study was to inquire about pain
medication without any specifications as to why.
2) Routine Health maintenance
The case study does not mention routine health maintenance, but rather mentions that Ms.
Jenkins consistently visits the health center with injury related issues (Denisco & Stewart,
2019). There are concerns for these frequent injury-related visits listed below. Preventative care
and routine health screenings are not mentioned at all in this case.
3) Allergies
As with her past medical history or current health status, there are no allergies listed in this
study.
4) Family Planning
It doesn’t seem that Ms. Jenkins is actively doing anything to prevent future pregnancy since she
has a recent history of a miscarriage.
5) Social
Ms. Jenkins reports that she is a single mother, with an incarcerated husband, and no family
support (Denisco & Stewart, 2019). She and her three young children live in an economically
disadvantaged housing project which may not have the amenities to promote optimal health
outcomes. DeNisco & Stewart (2019) express the importance of being aware of the effects that
poverty plays on poor health outcomes, especially with women and children living alone not
receiving any extra support.
I don’t think it would be unreasonable to question the possibility of a pain medication
dependency since Ms. Jenkins only seems to be focused on receiving pain medication during this
visit which can often be translated as narcotic seeking behavior to healthcare providers.
Ms. Jenkins may also possibly have anger management problems as evident by the recent head
injury that she claims was the outcome of a physical altercation with another woman. Then
again, one could also consider the possibility of substance abuse in relation to the frequent injury
related health care visits. With injury there is usually pain involved which would increase the
chances of receiving a prescription for pain medication. Then there is an entirely different
possibility to consider that involves the anxiety the patient is presenting with paired with the
multiple injury related visits to the health center. What if the patient is secretively a victim of
domestic violence and just isn’t being forthcoming about this major potential issue? It is also
important to acknowledge that this patient is currently being investigated by the Department for
Children and Family for the neglect of her children. All of these assumptions would require a
much more intense assessment of this patient.
6) Chronic Problems and other
Denisco & Stewart, 2019 explained that this “other” category is to collect information about
other issues namely, “…family problems (death of family member, mental health issues, school
truancy), financial problems (unemployment, entitlements such as food stamps), sexual
preferences, and so on” (p. 52). Ms. Jenkins was noted to be acting anxious and hopeless. This
could be related to the above-mentioned problems or to “other” problems still left to be
considered. If there is an underlying substance abuse problem or domestic violence within the
family, it would not be unreasonable to assume that these possibilities may be where the anxiety
and hopeless feelings originate from. This kind of idea would remain an assumption until
verified by a health care provider. Again, a much more detailed assessment would be required to
conclude any of these issues mentioned. If, however, the provider finds signs within the
assessment that could lead to a more concrete assumption or if the patient admits to suffering
from or even the infliction of domestic violence then the proper actions would need to be
initiated by the NP to advocate for the social justice, safety, and human rights of the patient and
her children (DeNisco & Stewart, 2019).
2. Reply
Holmes states “The problem oriented medical record (POMR) and the “problem list” date back to
the 1960s; they were developed by Dr. Lawrence Weed as a simple way to document and
manage important health problems facing a patient” (as cited in Stewart and DeNisco, 2019, p.
52).
Acute self-limiting problems for Ms. Jenkins would include miscarriage, fractured wrist, and
head injury. These are all acute injuries or illnesses that could inhibit her day to day life.
Recommended routine health maintenance for Ms. Jenkins according the U.S. National Library
of Medicine (n.d.), include blood pressure screening, cholesterol screening, up-to-date
immunizations, yearly exams with your PCP, breast self-exam or clinical breast exam, pelvic
exam and pap smear, and STI screening (U.S. National Library of Medicine, n.d.). I picked these
routine maintenance exams and tests due to Ms. Jenkins risk factors and age. No allergies are
listed for Ms. Jenkins. Family planning for Ms. Jenkins would include education on birth control
as well as use of contraceptives, especially since her mother passed away from HIV. I would also
assess for new fertility issues due to a recent miscarriage. Social issues include the incarceration
of her husband and whether or not she has a problem with pain pills since she is seeking them on
this visit. There are no chronic health problems but there are problems in the other category.
Things such as the death of her mother when she was a teenager, her non-existent relationship
with her father and the on-going investigation by the Department of Children and Families for
child neglect.
She has had quite a few injuries recently, I would want to ask if she’s being abused or feels
threatened at home. I would need to ask questions regarding whether she has ever been
diagnosed with allergies (drug, food or seasonal) or if she has any chronic illnesses not
documented. I would need to ask questions regarding her routine health maintenance so I can
determine what tests and exams still need to be performed. I would need to assess her knowledge
of risk for the spread of STIs. She’s sexually active as evident by her miscarriage so she’s at risk
for pregnancy as well as STIs. I would want to find out about her husband’s incarceration to
assess if there is any connection to her seeking pain pills. I’d like to find out when her mother
acquired HIV and if she’s ever been tested. I’d also like to find out more information into her ongoing investigation and whether or not she’s feeling depressed as a result. This is a very
complicated case with many variables in play.
180
Chapter 6 Clinical Education, Case Presentation, Consultation
O CASE STUDY
and evaluation from his first preceptor who was a physician very experienced in clinical
Joe is an NP student entering his second clinical rotation. He received positive feedback
education of NPs, PAs, and medical residents. For the current clinical experience he is ata
busy federally qualified health center with a large immigrant population that are mainly
course to help him communicate with these patients as well as for his future as an NP.
Spanish-speaking. Joe does not speak Spanish but has started taking a medical Spanish
It has been a very different experience thus far, although it has only been 2 full
clinical days. The preceptor is a fairly new NP who has only been practicing for 2 years.
Her schedule is always overloaded and there are multiple issues to address with the
complex patients on her panel. The first day Joe followed the preceptor and did not
see any patients on his own. The second day he was directed to see a patient but to
be done in 10 minutes so the preceptor could come in and go over the history and
physical herself before they made a plan of care. The patient was a 62-year-old male
with a history of diabetes, hypertension, and depression. He did not speak much English
and so Joe had to use the translation services phone line. Joe had barely gotten the
translator on the phone when the preceptor entered and was frustrated he had not
completed the history and physical so she took over and saw the patient with Joe
shadowing once again. The next patient he was sent to see was a 21-year-old female
who was at the clinic for a discussion about contraceptive options. Joe had not covered
this topic yet in didactic education so he had to go to his preceptor to inform her about
this problem. The preceptor was visibly frustrated and said they would have to talk later,
that this did not seem to be going well as a clinical experience for him and she was too
busy to have such an “inexperienced student”
Discussion Questions
1. How could this situation have been avoided?
2. Are there steps to prepare a preceptor for what to expect with different students
at different levels of experience?
3. Who should Joe reach out to?
4. Who should the preceptor reach out to? Can this clinical experience work for Joe?

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