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Clinical Experience Week 2

This week I began my clinical hours at my clinical site. It was a very good experience and scary at the same time. I was nervous starting in a new role, all while still learning and being unsure of myself. I think overall the day went very well. I learned the charting system and got to complete the charting on the patients that I saw. I am very used to the charting system at my hospital and this was very different.

Today we saw a lot of follow up appointments of patients that came into the clinic. One patient was coming back to follow up about his lab work. He had a low sodium level during the last visit. The sodium is still slightly low for this follow up appointment. The patient is still complaining of fatigue, but otherwise states he is improving. The patient states he drinks “a lot of water”. The patient’s physical assessment was otherwise normal. Plan of care includes encouraging the patient to drink gatorade or other electrolyte replacing fluids and monitor free water intake. He was advised to follow up with his primary care provider, and also to consider a referral with a nephrologist if his sodium level does not improve. His diagnosis is hyponatremia possibly relater to over hydration.

It is important for the patient to keep all his follow-up appointments. The patient was also informed that his provider needs to watch his condition closely. The healthcare provider needs to work with the patient to also prevent hyponatremia from reoccurring. We also reminded the patient to take all medicines exactly as directed. Certain medications can lower blood sodium levels. If you have done something that makes you sweat a lot, drink fluids that contain salt and other electrolytes. Also he was educated on when to seek care from his healthcare provider. He was instructed to call right away for severe tiredness, fainting, dizziness, loss of appetite, nausea or vomiting, confusion, seizures, or issues with walking. You may have to cut back on the amount of liquids you drink if you have extra water in your body (University of Washington Medical Center, 2019).

Hyponatremia is a common electrolyte disorder defined as a serum sodium level of less than 135 mEq per L. Your body needs sodium for fluid balance, blood pressure control, as well as the nerves and muscles.Treatment is based on the cause and the seriousness of your hyponatremia (National Kidney Foundation, 2020).

I think some things that can be beneficial for me during my clinical experience that can help me learn as much as possible includes being proactive, seeking to understand everything, to be a part of the team, and have an open mind to all the new potential experiences. Proactivity is especially important in the clinical experience. If you aren’t involved and taking steps to actively learn, your clinical hours can quickly become more like job shadowing. Ask questions of your clinical preceptors, whenever possible. Work to improve listening skills and having an open mind. Teamwork is key in your nurse practitioner program.

References

National Kidney Foundation. (2020). Hyponatremia. National Kidney Foundation. https://www.kidney.org/atoz/content/hyponatremia.

University of Washington Medical Center. (2019). Hyponatremia. University of Washington Medical Center. https://healthonline.washington.edu/sites/default/files/record_pdfs/Hyponatremia.pdf.