Week 2 clinical

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 be beneficial for you as an advanced practice nurse?
• Support your plan of care with the current peer-reviewed research guideline.

I feel as if I am learning a lot during my clinical rotation. It can be difficult sometimes due to the language barrier, but I am picking up Spanish and can understand a lot of what is said. The patient that stands out this week was a 62-year-old female who was previously diagnosed with scleroderma. She came in today complaining of increased neck pain and increase finger joint pain.

Scleroderma is an autoimmune disease that affects connective tissue. The most prominent feature of scleroderma is the process of progressive fibrosis resulting from the excessive deposition of extracellular matrix components in different tissues and organs. Vascular damage, inflammation and the presence of specific autoantibodies are also characteristic of systemic scleroderma. This autoimmune and fibrotic disease affects the skin and internal organs, such as lungs, heart, kidneys, musculoskeletal system, and gastrointestinal tract. Skin sclerosis is the main symptom (Soboleski et al., 2019) .

Systemic sclerosis is classified into two subsets based on the extent of skin involvement – limited systemic sclerosis (lcSSc) and diffuse systemic sclerosis (dsSSc). Patients with fibrosis of the skin affecting the hands and feet are classified as having lcSSc, whereas those with fibrosis of the trunk and proximal parts of the limbs are classified as having dsSSc.. Upon history and physical, the patient’s chief complaint was neck pain and finger pain. When her fingers were inspected closer, I could tell that the dermal lines on her fingers were not as pronounced. The skin on the other areas of her body seemed supple with good elasticity. The patient stated that she battles constant dryness and flaky skin. I did not see evidence of that t=during this visit, however, the patient states that she uses creams and oils every day for her skin. Heart sound was regular, lung sounds clear and equal bilaterally. The rest of her examination was unremarkable.

There is no specific treatment protocol for scleroderma, sometimes it will resolve on its own. More than often it will need a dose of prednisone to help the patient get “over the hump” and recover faster form from the Coronavirus. It is important for a patient with scleroderma to be monitored recently and to tl

References

Sobolewski, P., Ma?li?ska, M., Wieczorek, M., ?agun, Z., Malewska, A., Roszkiewicz, M., Nitskovich, R., Szyma?ska, E., & Walecka, I. (2019). Systemic sclerosis – multidisciplinary disease: clinical features and treatment. Reumatologia, 57(4), 221–233. https://doi.org/10.5114/reum.2019.87619 (Links to an external site.)

Mayo Foundation for Medical Education and Research. (2019, May 18). Scleroderma. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/scleroderma/diagnosis-treatment/drc-20351957.