Limitations and Challenges

APA format and 3 references within five years. Hospital setting Pulmonary unit please response to pos below
Main Question Post
This week was full of challenges and opened my eyes that I still have much information to learn. I am still struggling to analysis my patient and the information presented and develop a plan of action. Treatment for some aspects of care is easy, for example, the patient comes in with chest pain an EKG, serial troponins, and chest x-ray should be ordered to evaluate the cause of the chest pain and other tests depending on symptoms. This week I had a patient with metabolic acidosis and a high anion gap. The causes for a high anion gap are DKA, alcohol ketoacidosis, ingestion of toxins, Tylenol ingestion, aspirin, lactic acidosis, acute renal failure, and chronic renal failure (Epocrates Online, 2019). I knew DKA and lactic acidosis. I did not realize that other things could cause metabolic acidosis.
The patient was in acute renal failure and possible sepsis from pneumonia with an elevated lactic acid. I knew from experience that a patient in acute renal failure with elevated lactic acidosis and sepsis needs fluid to help treat these issues. People in sepsis are dehydrated from inflammation that causes vascular resistance, vascular dilation and leaking from the vessels (Semler & Rice, 2016). I also knew to order CBC, electrolytes, and CMP to check for WBC, BUN, Creatinine, potassium, and other electrolytes. From there I was unsure which antibiotics to order, and other tests that needed to be done.
My preceptor was very beneficial to help finish the rest of the plan. She helped explain what causes high anion gap, other tests to order by thinking through my assessment and other information gathered, and she also gave me references to use to guide antibiotic choices and other treatment options. When I went home that night, I went through the information and made note cards to reference for future use. In the upcoming clinical, I plan to use my preceptor, resources, and note cards to help figure out what the patient needs and how to think through the problem. By using the note cards for reference, it will help me to retain information and recall in the future. According to Zhan, Guo, Chen, and Yang (2018), repetition helps to remember information and retain it for a more extended period. The hippocampus is responsible for “encoding, consolidating, and retrieving” information that has been learned (Zhan, Guo, Chen, & Yang, 2018). Memorizing information will not help me to think critically, but it gives me a starting point.

Reference
Epocrates Online. (2019). Evaluation of metabolic acidosis. Retrieved from https://online.epocrates.com/diseases/460/Evaluation-of-metabolic-acidosis
Semler, M. W., & Rice, T. W. (2016). Sepsis Resuscitation: Fluid Choice and Dose. Clinics in chest medicine, 37(2), 241-50.
Zhan, L., Guo, D., Chen, G., & Yang, J. (2018). Effects of Repetition Learning on Associative Recognition Over Time: Role of the Hippocampus and Prefrontal Cortex. FRONTIERS IN HUMAN NEUROSCIENCE, 12. https://doi-org.ezp.waldenulibrary.org/10.3389/fnhum.2018.00277

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