Student: Greg Cook Student: Greg Cook Date of patient visit:
Date of patient visit: 3/11/2013/11/20111 Reason for
Reason for Patient Patient Visit: Visit: Annual phyAnnual physicalsical Identificati
Identification on and problem statement:and problem statement: Patient
Patient initials: initials: J. J. H.H. Age: 50
Age: 50 Sex: Male Sex: Male
Marital Status: Married Marital Status: Married Race: Caucasian
Race: Caucasian Occupation:
Occupation: Police Police dispatcherdispatcher
Source of Information: Patient; appears reliable Source of Information: Patient; appears reliable Problem
Problem Statement: Statement: “I’m here “I’m here for a for a physical. physical. It’s been It’s been about a about a yearyear since I’ve seen a
since I’ve seen a doctor. doctor. My wife and My wife and I are applying for fosteI are applying for foster parentr parent status and are required to have a physical”.
status and are required to have a physical”. Subjective Subjective HPI:
HPI: 50 y/o 50 y/o white male white male presents today presents today for annual physifor annual physical. cal. PatientPatient states requires
states requires physical for physical for foster parent foster parent status approval. status approval. PatientPatient states that he is usual state of
states that he is usual state of “good health”. Reports that he has“good health”. Reports that he has occasional “problems with hemorrhoids” (occasional notice of bright occasional “problems with hemorrhoids” (occasional notice of bright red streaks on stool and toilet paper after passage
red streaks on stool and toilet paper after passage of large hardof large hard stools).
stools). States that his hemorStates that his hemorrhoids are not currhoids are not currently causing him rently causing him anyany problems.
problems. He also rHe also reports occasional aeports occasional and self-limitind self-limiting episodes of ng episodes of diarrhea, which he attributes to s
diarrhea, which he attributes to stress (currently symptom free).tress (currently symptom free). Denies chest/abdominal
Denies chest/abdominal pain. pain. States usually States usually has one formhas one formed stool ined stool in morning.
morning. Denies change in boweDenies change in bowel frequency or l frequency or consistency (except consistency (except asas previously
previously noted). noted). Denies Denies nausea/emesis. nausea/emesis. Denies Denies dark dark tarry tarry stools.stools. Denies recent we
Denies recent weight gain/loss. ight gain/loss. Eats regular diet wEats regular diet with no recentith no recent changes.
changes. His only His only other complaintother complaints are for s are for seasonal itchy seasonal itchy eyes,eyes, sneezing, and runny nose
sneezing, and runny nose (currently symptom free).(currently symptom free). Pertinent Medical
Pertinent Medical Denies chronic medical conditions.Denies chronic medical conditions. Immunizations up to date
Immunizations up to date (last TD 200(last TD 2006). 6). States passed 5mm States passed 5mm kidneykidney stone 2007
stone 2007. . Right ankle frRight ankle fracture (non-displaced, acture (non-displaced, football) 199football) 1991.1. Preventive
Preventive screenings: colscreenings: colonoscopy (never). onoscopy (never). Patient does Patient does not wantnot want colonoscopy because
colonoscopy because he does not he does not like the, “like the, “idea of anestheidea of anesthesia”. sia”. LastLast eye exam 2010, last
eye exam 2010, last dental exam 2009.dental exam 2009. Current
Surgical History
Surgical History Vasectomy 2007.Vasectomy 2007. Family History
Family History Father died at 74 years of age from “prostate cancerFather died at 74 years of age from “prostate cancer that traveled to br
that traveled to brain”. ain”. Mother living (Mother living (85 years ol85 years old) has history of d) has history of “glaucoma and osteoart
“glaucoma and osteoarthritis”. hritis”. Has one sibliHas one sibling (brother, ng (brother, 57 years 57 years old)old) with history of “hypertension, otherwise in good
with history of “hypertension, otherwise in good health”.health”. Social History
Social History The patient r The patient reports his heeports his health to be alth to be “pretty good”. “pretty good”. HeHe never smoked and admits to drinking 1 six-pack of beer every month never smoked and admits to drinking 1 six-pack of beer every month or so.
or so. The patient The patient is marris married and ied and has no has no children. children. He iHe is physicalls physicallyy active outside of work (plays intramural baseball and takes care of his active outside of work (plays intramural baseball and takes care of his three hor
three horses), but ses), but does not does not participate participate in routin routine aerobiine aerobic exerc exercise. cise. HeHe consciously watches his caloric and fat intake, but is otherwise on a consciously watches his caloric and fat intake, but is otherwise on a regular di
regular diet. et. He iHe is sexually s sexually active active in a in a monogamous rmonogamous relationship. elationship. HeHe denies the use of r
denies the use of recreational drugs. ecreational drugs. His wife also woHis wife also works outside of therks outside of the home and they are
home and they are both self-supportive on their current combinedboth self-supportive on their current combined incomes.
incomes. He has no curreHe has no current concerns regardint concerns regarding his activities of dng his activities of dailyaily living.
living.
Review of Systems Review of Systems General
General Reports in Reports in usual state of usual state of “Good” health and “Good” health and weight. weight. DeniesDenies fever, chills, re
fever, chills, recent weight gain cent weight gain or loss, weakness, fatigue, pain. or loss, weakness, fatigue, pain. StatesStates that his last
that his last physical exam was in 2010.physical exam was in 2010. Skin
Skin Denies recent rashes or changes Denies recent rashes or changes in texture or moles.in texture or moles. HEENT
HEENT Denies headaches. Denies headaches. Denies probleDenies problems with vims with vision or hearision or hearing.ng. Wears reading glasses, l
Wears reading glasses, last eye exam ast eye exam 2010. 2010. Denies use of heariDenies use of hearingng aids.
aids. Denies Denies glaucoma glaucoma or or cataracts. cataracts. Denies Denies frequent frequent nasalnasal
congestion/stuffiness, but occasional seasonal teary eyes, runny nose congestion/stuffiness, but occasional seasonal teary eyes, runny nose and
and sneezing sneezing (currently (currently asymptomatic). asymptomatic). Denies Denies nosebleeds. nosebleeds. DeniesDenies permanent/remov
permanent/removable dental prostheable dental prosthetics. tics. Last dental Last dental exam 201exam 2010.0. Denies swollen glands/limps, neck stiffness.
Denies swollen glands/limps, neck stiffness. Thorax and Lungs
Thorax and Lungs Denies history of lung disease, allergies, orDenies history of lung disease, allergies, or asthms.
asthms. Denies episodeDenies episodes of unexs of unexplained shortneplained shortness of bress of breath.ath. Cardiovascular
Cardiovascular Denies “heart trouble”, high blood pressure,Denies “heart trouble”, high blood pressure,
rheumatic fever, heart murmurs, irregular beat, palpitations, or chest rheumatic fever, heart murmurs, irregular beat, palpitations, or chest pain/discomfort.
pain/discomfort. No prior No prior stress testress test or st or EKG.EKG. Peripheral Vascular
Peripheral Vascular Denies extremity edema, coldness, leg Denies extremity edema, coldness, leg cramps,cramps, skin ulcers.
skin ulcers. Abdomen
with nausea/vomiti
with nausea/vomiting, heartburn, or ng, heartburn, or food intolerances. food intolerances. Regular diet.Regular diet. No recent c
No recent change in weihange in weight. ght. Denies chronic Denies chronic diarrhea, but hdiarrhea, but has self-as self-limiting episodes of di
limiting episodes of diarrhea which he arrhea which he attributes to stress. attributes to stress. Also reportsAlso reports episodic problems with hemorrhoids with blood on toilet paper and
episodic problems with hemorrhoids with blood on toilet paper and streaking of passage of hard s
streaking of passage of hard stool. States currently has a couple smalltool. States currently has a couple small hemorrhoids wit
hemorrhoids with no bleeding. h no bleeding. Denies history Denies history of jaundice, gall of jaundice, gall bladder,bladder, or liver disease.
or liver disease. Genitourinary
Genitourinary Denies urinary frequency, hesitancy, incontinence, orDenies urinary frequency, hesitancy, incontinence, or burning with
burning with urination. urination. History History of passing of passing 5mm 5mm kidney stonkidney stone 20e 2007. 07. InIn a long-term monogamous relationship. Denies sexual issues.
a long-term monogamous relationship. Denies sexual issues. Metabolic/Hematologic
Metabolic/Hematologic Denies thyroid problems, heat/coldDenies thyroid problems, heat/cold intolerance, exc
intolerance, excessive hunger, essive hunger, thirst, or thirst, or history of dihistory of diabetes. abetes. DeniesDenies concerning bruising,
concerning bruising, ease of bleease of bleeding. eding. No history No history of bloodof blood transfusions.
transfusions. Psychiatric
Psychiatric Denies trouble concentrating, nervousness, anxiety, orDenies trouble concentrating, nervousness, anxiety, or panic attack.
panic attack. Denies difficDenies difficulty falling or ulty falling or staying asleep. staying asleep. OccasionalOccasional (once/week) getting out of bed earlier than waking time to urinate (once/week) getting out of bed earlier than waking time to urinate (associated with drinking fluids at night). Denies mood changes, (associated with drinking fluids at night). Denies mood changes,
hearing voices, frequent unhappiness, or desire to harm self or others. hearing voices, frequent unhappiness, or desire to harm self or others. Denies nightmares, m
Denies nightmares, memory loss, or eemory loss, or excessive life xcessive life stresses. stresses. No recentNo recent deaths in family or close friends.
deaths in family or close friends. Musculoskeletal
Musculoskeletal Right ankle fracture (football, non-displaced) 1991.Right ankle fracture (football, non-displaced) 1991. Occasional pain both knees, which he attributes to years of playing Occasional pain both knees, which he attributes to years of playing sports and not to a tr
sports and not to a traumatic event. aumatic event. Denies other ortDenies other orthopedic injury orhopedic injury or arthralgia.
arthralgia. Neurologic
Neurologic Denies history of stroke, seizures orDenies history of stroke, seizures or frequent/incapacitating
frequent/incapacitating headache. headache. Denies Denies tremors.tremors. Objective
Objective General Appearance
General Appearance 50 year-old male who is awake, alert, and50 year-old male who is awake, alert, and cooperative.
cooperative. Clothing iClothing is well s well kept and kept and appropriate appropriate for season. for season. He iHe iss oriented to person, place, and time and answers all questions
oriented to person, place, and time and answers all questions appropriately.
appropriately. Appears stated Appears stated age, appears to age, appears to be healthy, be healthy, and doesand does not appear to be in any acute
not appear to be in any acute distress.distress. Vitals
Vitals BP R
BP Right aright arm m sitting. sitting. 152/92152/92 HR 72
HR 72 RR 16 RR 16
Sa02 99% on room air Sa02 99% on room air
Tympanic temp 98.7 Tympanic temp 98.7
Head
Head Normocephalic, short Normocephalic, short cut hair clean cut hair clean with fine texturwith fine texture. e. Scalp withScalp with no lesions, tenderness.
no lesions, tenderness. TMJ full ROM wTMJ full ROM without clicks o pain ithout clicks o pain bilaterally.bilaterally. No frontal or
No frontal or maxillary sinus tenderness.maxillary sinus tenderness. Eyes
Eyes Symmetrical, Symmetrical, sclera sclera white, white, conjunctiva conjunctiva pink. pink. No drNo drainage. ainage. PERLAPERLA 3/2.
3/2. Fundoscopy (without Fundoscopy (without pharmacologic mypharmacologic mydriasis): red driasis): red reflexreflex present, no hemorrhages, lens opacities, disk
present, no hemorrhages, lens opacities, disk cupping, papillidema,cupping, papillidema, optic
optic vessels vessels appreciated appreciated 2:3 2:3 AV AV ratio. ratio. Visual Visual acuity acuity deferred.deferred. Ears
Ears External eExternal ear, no lesions, ar, no lesions, masses, drainage, masses, drainage, or tenderness. or tenderness. CN ICN I grossly intact.
grossly intact. Otoscopic exam: TMOtoscopic exam: TMs pearly grey s pearly grey with + cone of liwith + cone of light,ght, no bulging, no
no bulging, no erythema, landmarks appreciated bilaterally.erythema, landmarks appreciated bilaterally. Nose
Nose No nasal flariNo nasal flaring. Septum midlng. Septum midline, turbinates ine, turbinates pink and moist. pink and moist. NoNo lesions, polyps, or nasal
lesions, polyps, or nasal discharge bilaterally.discharge bilaterally. Throat and Mouth
Throat and Mouth Membranes Membranes pink/moist. pink/moist. Uvula is Uvula is midline, midline, tonsilstonsils at pillars, no redness or exudates.
at pillars, no redness or exudates. Neck
Neck Trachea mi Trachea midline. dline. Thyroid and Thyroid and lymph nolymph nodes not des not palpable.palpable. Breasts
Breasts Inspection: no gynecomastia, Inspection: no gynecomastia, nipples symmetrical, everted,nipples symmetrical, everted, no drainage.
no drainage. Palpation: BrePalpation: Breasts/axilla node asts/axilla node palpation deferrpalpation deferred.ed. Heart
Heart No JVD No JVD at 90 at 90 degrees. degrees. Carotids Carotids not assessed. not assessed. S1 best S1 best at apex.at apex. S2 best
S2 best at base. at base. No extrNo extra sounds.a sounds. Thorax and Back
Thorax and Back No abnormal No abnormal curvatures. curvatures. Symmetrical Symmetrical expansionexpansion with respiration
with respiration Lungs
Lungs Lung fields Lung fields not palpated/percussed. not palpated/percussed. Anterior and Anterior and Posterior lPosterior lungung fields clear to auscultation.
fields clear to auscultation. Abdomen
Abdomen Round and non-diRound and non-distended with stended with no scars, no scars, striae. striae. NoNo abdominal tenderness
abdominal tenderness to palpation. to palpation. Liver and Liver and spleen not palpablspleen not palpable.e. Normoactive tympanic bowel sounds x 4,
Normoactive tympanic bowel sounds x 4, no abdominal bruits.no abdominal bruits. Extremities
Extremities (Upper)
(Upper) Nails without cyanosis or Nails without cyanosis or clubbing. Muscles well developed.clubbing. Muscles well developed. Distal pulses
Distal pulses +2. +2. Capillary Capillary refill refill < 3 < 3 seconds. seconds. Full actiFull active ROve ROM.M. (Lower) Nails without cyanosis or clubbing.
(Lower) Nails without cyanosis or clubbing. Muscles well developed.Muscles well developed. Distal
growth +
growth + great toes great toes bilaterally. bilaterally. Negative HNegative Homan’s.oman’s. Skin
Skin Color consistent Color consistent with race. with race. Warm, dry, Warm, dry, intact with intact with good turgor.good turgor. No peripheral/ce
No peripheral/central cyanosis. ntral cyanosis. No obvious rashes. No obvious rashes. Multiple Multiple smallsmall (<0.5 cm) flat hyperpigmented (brown) lesions on a
(<0.5 cm) flat hyperpigmented (brown) lesions on abdomen, chest,bdomen, chest, back, upper extremities, and neck (several with irregular borders). back, upper extremities, and neck (several with irregular borders). Lymph Nodes
Lymph Nodes Not palpable in head or neck or axilla or groinNot palpable in head or neck or axilla or groin Neurologic:
Neurologic:
Mental status: Awake, al
Mental status: Awake, alert, oriented to ert, oriented to person, place, and timperson, place, and time. e. NoNo confusion, anxiety, or agitation noted.
confusion, anxiety, or agitation noted.
Cranial Nerves: II, III PERLA, + consensual movement, + Cranial Nerves: II, III PERLA, + consensual movement, + accommodation
accommodation
II, IV, and VI: EOM intact II, IV, and VI: EOM intact Remaining Cranial Ner
Remaining Cranial Nerves: CN I not assesves: CN I not assessed. sed. CN V and CN VII – XCN V and CN VII – XIIII grossly intact.
grossly intact. Motor System: Mu
Motor System: Muscle strength 5/scle strength 5/5 in all extr5 in all extremities bilateremities bilaterally. ally. GaitGait steady w/o ataxi
steady w/o ataxia. a. Finger-to-nose, RhoFinger-to-nose, Rhomberg, heel mberg, heel to shin andto shin and pronator drift all performed bilaterally without deficit.
pronator drift all performed bilaterally without deficit. Sensory: Sharp, dull, light
Sensory: Sharp, dull, light in all extremities tested without deficit.in all extremities tested without deficit. Reflexes: Triceps 2+ 2+. Biceps 2+ 2+,
Reflexes: Triceps 2+ 2+. Biceps 2+ 2+, Brachioradialis 2+ 2+, PatellarBrachioradialis 2+ 2+, Patellar 2+ 2+,
2+ 2+, Ankle 1+ Ankle 1+ 1+. 1+. Babinski not Babinski not assessed.assessed.
Genitals
Genitals Not examinedNot examined Rectal
Rectal Not examinedNot examined Labs:
Labs: TSH, T3, T4, BMP, CBC, HA1C, PSA (all wnl).TSH, T3, T4, BMP, CBC, HA1C, PSA (all wnl). Assessment
Assessment 1)
1) EssentEssential sial stage tage 1 hy1 hypertepertensionnsion 2)
2) MultiMultiple cople congeningenital/dtal/dysplaysplastic nestic nevivi 3)
3) HeHemomorrrrhoihoidsds 4)
4) SeasonSeasonal al allerallergic gic rhinrhinitisitis 5)
Plan Plan 1)
1) Three day BThree day BP check wP check with plan to ith plan to initiate ACEinitiate ACEI if remI if remains elevatedains elevated 2)
2) Dermatology rDermatology referral foeferral for evaluation r evaluation of multiple of multiple hyperpigmented hyperpigmented skinskin lesions
lesions 3)
3) DiscuDiscussed imporssed importance of colon cancetance of colon cancer screenr screening colonoing colonoscopy and GIscopy and GI referral for
referral for hemorrhoids, epihemorrhoids, episodic diarrhea. sodic diarrhea. Discussed use of Discussed use of procedural
procedural anesthesia anesthesia options. options. GI GI referral referral placed placed which which will will bebe good for six months if patient changes mind.
good for six months if patient changes mind. 4)
4) azelazelastome nasaastome nasal, 1-2 sprays/l, 1-2 sprays/nostrnostril bid prn during alleril bid prn during allergy season.gy season. 5)
NORTHERN ARIZONA UNIVERSITY NORTHERN ARIZONA UNIVERSITY
SCHOOL OF NURSING SCHOOL OF NURSING
FAMILY NURSE PRACTITIONER PROGRAM FAMILY NURSE PRACTITIONER PROGRAM
NUR 661, Spring 2011 NUR 661, Spring 2011
Self-Analysis Self-Analysis
A completed self-analysis will accompany each SOAP note that you turn in. The A completed self-analysis will accompany each SOAP note that you turn in. The self-analysis will address the patient contact that is the topic of the SOAP note self-analysis will address the patient contact that is the topic of the SOAP note and will address your analysis of how you are doing overall in the clinical
and will address your analysis of how you are doing overall in the clinical experience. Address the following areas:
experience. Address the following areas: 1. Clinical Decision Making
1. Clinical Decision Making : how well did you think you did in your clinical: how well did you think you did in your clinical decision making? What worked/what didn’t work?
decision making? What worked/what didn’t work? For the rest of the semester For the rest of the semester (SOAPs 5, 6 and 7), please address the following: a) what are
(SOAPs 5, 6 and 7), please address the following: a) what are 4 common4 common differential diagnoses
differential diagnoses that you considered on this patient? What subjectivethat you considered on this patient? What subjective and objective data helped you to rule-in or rule-out each of these
and objective data helped you to rule-in or rule-out each of these diagnoses; and b) what are
diagnoses; and b) what are 2 “zebra” differential diagnoses2 “zebra” differential diagnoses that youthat you
consider? What subjective and objective data helped you to in or consider? What subjective and objective data helped you to in or rule-out each of these?
out each of these?
Essential hypertension: Essential hypertension: Secondary hypertension Secondary hypertension Congenital/dysplastic nevi: Congenital/dysplastic nevi: Melanoma Melanoma Lentigo Lentigo Hemorrhoids: Hemorrhoids: Rectal polyps Rectal polyps Rectal fissures Rectal fissures Lower GI Bleed Lower GI Bleed
I ruled out secondary hypertension with this patient; there is no indication of I ruled out secondary hypertension with this patient; there is no indication of endocrine or renal dysfunction (clinical presentation, ROS, exam, labs).
endocrine or renal dysfunction (clinical presentation, ROS, exam, labs).
Secondary hypertension is normally caused by: coarctation of aorta (Zebras), Secondary hypertension is normally caused by: coarctation of aorta (Zebras), Cushing’s, diabetes, pheochromocytoma (another Zebra, but he has no
Cushing’s, diabetes, pheochromocytoma (another Zebra, but he has no
tachycardia, nervousness, palpitations, sweating or other sympathetic/adrenergic tachycardia, nervousness, palpitations, sweating or other sympathetic/adrenergic symptoms) , and drugs such as antidepressants, appetite suppressants,
symptoms) , and drugs such as antidepressants, appetite suppressants, glucocorticoids, and MAOIs.
glucocorticoids, and MAOIs. I do I do want to want to rule out rule out “white coat “white coat hypertension” so Ihypertension” so I will ask patient to check BP
will ask patient to check BP in out of clinic environments. in out of clinic environments. He is not He is not pregnant so Ipregnant so I can rule out pre-eclampsia.
can rule out pre-eclampsia. The main
The main concern with his concern with his skin lesions is skin lesions is the possibility of malignancy. the possibility of malignancy. HisHis lesions are concerning and should be evaluated and biopsied for a definitive lesions are concerning and should be evaluated and biopsied for a definitive diagnosis by a dermatologist.
The patient gave a good description of his hemorrhoids and does not have any The patient gave a good description of his hemorrhoids and does not have any other GI symptoms
other GI symptoms (lower GI bleed). (lower GI bleed). He does He does associate the bright blood associate the bright blood withwith passage of hard stool so
passage of hard stool so a rectal fissure could certainly be the a rectal fissure could certainly be the cause. cause. Either Either way, I really want this patient to see a GI specialist for additional work-up and way, I really want this patient to see a GI specialist for additional work-up and cancer screening colonoscopy.
cancer screening colonoscopy. 2. Use of PDA:
2. Use of PDA: how did you use PDA to enhance your clinical decision makinghow did you use PDA to enhance your clinical decision making and incorporate evidence-based, point-of-care information into the decision and incorporate evidence-based, point-of-care information into the decision making process?
making process?
I used the PDA to run through some of the differentials (primary hypertension vs I used the PDA to run through some of the differentials (primary hypertension vs secondary) and to
secondary) and to research some of research some of the Zebras (pheochromocytoma). the Zebras (pheochromocytoma). I also I also ranran through the U.S. Preventive Services Task Force’s application to nail down
through the U.S. Preventive Services Task Force’s application to nail down preventive screening interventions (for this patient, SDT screening but he is in a preventive screening interventions (for this patient, SDT screening but he is in a long-term monogamous relationship, ASA prevention, lipids, hypertension
long-term monogamous relationship, ASA prevention, lipids, hypertension screening).
screening).
3. Interaction, Communication and Collaboration with the Patient/Family 3. Interaction, Communication and Collaboration with the Patient/Family This patient was a good historian with an uncomplicated med/surgical history. This patient was a good historian with an uncomplicated med/surgical history. The physician and I both spent time with this patient reviewing the importance of The physician and I both spent time with this patient reviewing the importance of a cancer screening colonoscopy, but he refuses the procedure because he does a cancer screening colonoscopy, but he refuses the procedure because he does not “like the
not “like the idea of anesthesia”. idea of anesthesia”. We both We both spent additional time discussing thespent additional time discussing the anesthetics and sedative agents used for this procedure (very short acting, very anesthetics and sedative agents used for this procedure (very short acting, very few side effects, rapid clearing of effects, no
few side effects, rapid clearing of effects, no ET tube, etc). ET tube, etc). We did put We did put in ain a referral, which will be good for 6
referral, which will be good for 6 months if he changes months if he changes his mind. his mind. We also tied theWe also tied the fact that the GI consult is needed for eval of his diarrhea as well as his
fact that the GI consult is needed for eval of his diarrhea as well as his
hemorrhoids and that we would hold starting ASA therapy for his heart health hemorrhoids and that we would hold starting ASA therapy for his heart health until he kicks this can further down the road.
until he kicks this can further down the road.
4. Interaction, Communication and Collaboration with Your Preceptor (and 4. Interaction, Communication and Collaboration with Your Preceptor (and others pertinent to the process)
others pertinent to the process)
5. Additional Self-Reflections:
5. Additional Self-Reflections: What did you learn from this experience? WasWhat did you learn from this experience? Was the learning important for you? Why or why not? What did you learn/observe the learning important for you? Why or why not? What did you learn/observe about yourself this week? How did you advocate for yourself? What do you about yourself this week? How did you advocate for yourself? What do you believe about what you learned this week? How will you transfer the knowledge believe about what you learned this week? How will you transfer the knowledge and learning you gained to other situation?
and learning you gained to other situation? Also address, how well you were Also address, how well you were able to address psycho social, cultural, and/or family-related issues, any able to address psycho social, cultural, and/or family-related issues, any ethical/legal issues, etc. with the patient.
ethical/legal issues, etc. with the patient.
I need to discuss why my preceptor deferred doing a rectal exam (has I need to discuss why my preceptor deferred doing a rectal exam (has hemorrhoids), and prostate exam,
hemorrhoids), and prostate exam, or genital exam or genital exam for this 50 for this 50 year-old. year-old. MyMy
female preceptor is very thorough doing breast exams, genital exams (but again female preceptor is very thorough doing breast exams, genital exams (but again
no rectal exams) on her
no rectal exams) on her female patients. female patients. This may be This may be a cultural issue with mya cultural issue with my preceptor, but I wonder how she got through med school (it was a foreign school preceptor, but I wonder how she got through med school (it was a foreign school however…so there
however…so there may may be be something there). something there). I’d I’d appreciate pointers appreciate pointers on on this.this.
Please be specific and insightful. We are looking for depth and breadth of Please be specific and insightful. We are looking for depth and breadth of self-analysis and
analysis and self-reflectioself-reflection. n. Add Add additional pages additional pages as nas needed.eeded.
Reference: Reference: Gutierrez, K. (2008).
Gutierrez, K. (2008). Pharmacotherapeutics: clinical reasoning inPharmacotherapeutics: clinical reasoning in primary care
