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Exert from NU 607 CPT: Critical ThinkingDemonstrate diagnostic reasoning and critical thinking in the development of a treatment planDiagnostic reasoning and critical thinking is something that I work very hard at in the clinical setting. As I advance in my practicum experience, I feel critical thinking and diagnostic reasoning is one of my biggest challenges. Critical thinking and diagnostics reasoning is the ability to use all resources available to create the plan of care for the patient.Example 1. 55 year old patient presented to the clinic with blood pressure of 160/98. Upon reviewing the patient’s chart, I identified that the patient has had an elevated blood pressure at the past 3 visits. Patient currently taking HCTZ 25 mg for his blood pressure. Upon review of the patient medication, I felt that adding Lisinipril 10 mg was going to be the best medication for his blood pressure. I was able to use my diagnostic reasoning skill to create my decision.Example 2. I saw an 85 year old woman with chronic anxiety and abdominal pain for the past year. She started having the anxiety and abdominal pain after her husband died a year ago. Patient had hx of CAD and takes Aspirin 325 mg daily. She refused to take Coumadin daily, and she had an adverse reaction to Plavix, so therefore ASA was the medication of choice. Over the past 2 months she has had a buzzing noise in both ears. I was able to use my critical thinking skills to diagnose her with tinnitus, and therefore brought back up the idea of Coumadin. Patient was to return in two weeks after a short vacation she was going on, and will use that time to consider if Coumadin is an option for her. Meanwhile, she continued the ASA because the tinnitus was not debilitating. Critical thinking skills are a skill that with continue to improve with time. I also feel that the more things I see in the clinic, the better my critical thinking will improve.There are infinite resources for this competency. Most of the resources that are useful will involve the identification of symptoms, and the ability to correlate those symptoms to my differential diagnoses. Grade 34/4/13Ex. 3- I have continued to expand on my critical thinking skills and diagnostic reasoning skills. I cared for 78 year old female that presented to the clinic with chest pressure that started the night before. She had shortness of breath, intermittent diaphoresis, and pains that radiated into her left jaw. When patient presented to the clinic, she didn’t have the diaphoresis, but all other symptoms were present. I diagnosed her with ACS, started and IV, did an EKG, administered oxygen, and gave her Nitroglycerin. I then called the ambulance and had her transferred to Stormont Vail where she received a heart catheterization. I feel that I used diagnostic skills and critical thinking skills by doing all those procedures and transferring her to the hospital. Grade 45/1/13Developing diagnostic reason and critical thinking skills is something that work very hard at to master on a daily basis in the clinic setting. I feel that this clinical experience has given me the opportunity to expand my critical thinking skills, and has really presented some difficult cases to work through. Ex. 4- 50’s year old woman without insurance presented to the clinic for her yearly blood work. She does not have much money, so we decided that a CBC, TSH, Comprehensive Met. Panel and Lipid Profile would be the best tests for her and give her the most amount data for the money. On review of her labs we found that her platelets were very low at 39. This was an alarming finding, especially because said she had no complaints. Upon further review I found that the patient had been thrombocytopenic for nearly ten years, but never this low. I immediately began researching what would cause the severe thrombocytopenia. I immediately thought alcoholism, vitamin deficiency, leukemia, or some sort of hepatic impairment. Once the metabolic panel came back normal, I was able to rule out the liver disease. This patient had some various bruising, and stated that she had been increasingly weak. My other thought was that the platelets were clumping, and we were getting inaccurate information. This case was very interesting so I had the opportunity to bring Dr. Colbern into the case. He too thought the test was inaccurate, although felt that if it were positive, we had some further research to do. Therefore I educated the patient about the importance of monitoring her bruising and weaken, along when why she needed to have a repeat test done at the lab in Holton. Grade 4 ................
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