This section of the website will be formed from the diary I keep for my own portfolio and learning needs as I develop as a Trainee Advanced Clinical Practitioner. I will add all the resources I come across to help me in my learning and hopefully you can benefit too.
Worked with senior advanced clinical practitioner.
Really enjoyable day. Was asked to take histories from and assess to patients who presented to the Department.
First patient was a gentleman who presented with epigastric pain which he had initially described as chest pain. He had had a history of heart attacks in the past and one of the things which came out of the history taking session was that he had increased his dosage of aspirin to 150 mg per day without advice from his doctor.
The learning point from this encounter was to ensure that I am clear on the timelines of the presenting complaint. It became clear that the epigastric pain had started after he had increased his dosage of aspirin. We did take an ECG which proved unremarkable and the rest of the examination pointed towards this merely being a gastritis and there was no indication for any further treatment other than advice
The next patient was a lady who presented with chest and shoulder pain. The main learning point from this particular encounter from me was that I was probably far too focused on the cardiac aspect of her symptoms. From the history taking I was not particularly concerned that this was a cardiac problem, however I probably failed to explore the possible musculoskeletal issue that she may have had.
The advanced clinical practitioner who then went on to examine her focused more on the musculoskeletal and as a consequence we initially believed that this to be the cause of her pain. An ECG was done which was not concerning and we also did a chest x-ray. The heart shape on the chest x-ray was potentially globular and consequently we referred her to the medical team for further review.
“Globular heart” means a spherical cardiac silhouette, usually greatly enlarged and lacking the detailed outline of the right and left atria and apex. Characteristic of pericardial effusion and cardiomyopathy.
Pericardial effusion (“fluid around the heart”) is an abnormal accumulation of fluid in the pericardial cavity.
Cardiomyopathy is a weakening of the heart muscle or a change in heart muscle structure. It is often associated with inadequate heart pumping or other heart function problems.”