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This week marked my very first week in clinicals for this program. I attended three days and while I was pretty nervous at the beginning, I tried to remain calm and open for different learning opportunities. I am currently doing my clinical rotation at a primary care clinic that sees a wide variety of patients. The clinic offers both primary and urgent care services, as well as women’s health services and pediatrics. One of my biggest challenge this week was trying to work through my nerves. There were many times where I felt overwhelmed or out of my comfort zone, which, in time, will help me in the long run.I know that being out of my comfort zone will allow me to learn and attribute what I experience at the clinicals to my own practice one day. Another challenge for me was to try to remind myself that I am not in a hospital setting, and that the primary care clinic is very different than what I am used to at work. I have never worked in a medical office before, and the thought process of triaging, assessing, and treating patients is very different than what I am used to in the hospital. I believe that with more time at the clinic, I will become more comfortable and used to the workflow at the clinic.
A 27 year old female patient came into the clinic this week with complaints of lower abdomen pain and burning with urination. She had stated the onset of her symptoms came the night before, approximately 15 hours prior. She noted that her urine appeared cloudy, but denied any discoloration of the urine or presence of flank pain. Additionally, the patient reported a history of a urinary tract infection approximately 6 months prior. A urine dipstick was performed and a urine culture was sent to the lab, and the patient was diagnosed with acute cystitis and started empirically on nitrofurantoin, as this has helped in the past. Education was provided to the patient on antibiotic therapy, hygiene practices, and safe sex practices. Differential diagnoses of acute cystitis include vaginitis, urethritis, and pelvic inflammatory disease (Hooten & Gupta, 2021). Nitrofurantoin, along with trimethoprim, co-trimoxazole, and Fosfomycin, are all first-line agents to treat uncomplicated urinary tract infections (Beahm et al., 2017).The choice of the antibiotic agent should be reevaluated once results return from the urine culture (Beahm et al., 2017).
This week, I really enjoyed observing my preceptor interact with the patients, and how I was able to contribute to their care. I hope that going forward, I become more confident in my role and decision-making skills. I know that I have a lot to learn from my preceptor and his colleagues, and I am excited to continue my experience at this clinic.Furthermore, my experience this week further showed me just how important everyone’s role is at the clinic, and how important efficiency is, especially when there are patients waiting a long time in the waiting room.
Beahm, N. P., Nicolle, L. E., Bursey, A., Smyth, D. J., & Tsuyuki, R. T. (2017). The assessment and management of urinary tract infections in adults: Guidelines for pharmacists. Canadian pharmacists journal : CPJ = Revue des pharmaciens du Canada : RPC, 150(5), 298–305. https://doi.org/10.1177/1715163517723036
Hooten, T., & Gupta, K. (2021). Acute simple cystitis in women. In J. A. Melin (Ed.), UpToDate. Retrieved May 19, 2021, from https://www.uptodate.com/contents/acute-simple-cys…