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Challenges For Managing Type 1 Diabetes And Pregnancy Discussion

Challenges For Managing Type 1 Diabetes And Pregnancy Discussion

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Challenging Patient Encounter A: NEW OB with Uncontrolled Type 1 Diabetes

What was most challenging: It was challenging to manage a newly pregnant patient with previously unknown Type 1 Diabetes. It was complex to discover the condition through a urine test and subsequently deal with a miscarriage.

What did I learn: This experience brought to light the significance of thorough and early prenatal screening. It emphasized the importance of raising awareness of pre-existing conditions that may have an impact on the course of a pregnancy. On an emotional level, it underscored how important it is to offer kind assistance during trying times, like a miscarriage.

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Resources available: I utilized standard prenatal screening protocols and engaged with the obstetric team for guidance (Johnston et al., 2023)Challenges For Managing Type 1 Diabetes And Pregnancy Discussion.

Evidence-based practice: I followed guidelines used to manage diabetes in pregnancy. The guidelines focused on optimizing maternal and fetal well-being.

New skills and learning: Enhanced empathy care delivery during emotionally charged situations. I learned the intricacies of managing diabetes in pregnancy.

What would I do differently: Implement more comprehensive pre-conception screening to identify potential risk factors earlier. Strengthen emotional support resources for patients facing pregnancy complications.

Managing patient flow: I prioritized timely consultations, collaborated closely with the obstetric team to streamline care.

Challenging Patient Encounter B: 41-year-old with Uterine Fibroid and Abnormal Bleeding

What was most challenging: Navigating the diagnostic challenges posed by abnormal uterine bleeding in a patient with a history of regular periods, no contraceptive use, and a husband with a vasectomy. The discovery of a uterine fibroid added complexity.

What did I learn: This case emphasized the importance of considering atypical presentations of gynaecological issues. It highlighted the need for clear communication when conveying complex diagnoses and treatment options.

Resources available: I applied established protocols for investigating abnormal uterine bleeding, including transvaginal ultrasound (Heremans et al., 2022). I also collaborated with gynecologists for consultation on the management plan.

Evidence-based practice: I followed evidence-based guidelines for diagnosing and managing abnormal uterine bleeding, including the use of imaging to identify underlying causes.

New skills and learning: Developed better counselling skills for explaining complex medical conditions and treatment options. I Gained insights into managing gynaecological conditions that deviate from standard presentations.

What would I do differently: I would ensure clearer communication about potential causes of abnormal bleeding during initial consultations.

Managing patient flow: Focused on efficient scheduling of diagnostic tests and consultations to streamline the patient’s journey through the healthcare system.

Challenging Patient Encounter C: Fertility Issues and Uncooperative Spouse

What was most challenging: Addressing fertility issues in a patient where the husband refused to provide a sperm sample. Despite evidence of ovulation and fertility drug use, the inability to rule out male factor infertility created a delicate situation.

What did I learn: This case emphasized the importance of delicate communication and counselling in fertility-related issues. It underscored the need for involving both partners actively in the diagnostic process and fostering a supportive environment.

Resources available: I Utilized fertility specialists for guidance and engaged in open communication with the couple. Collaborated with reproductive endocrinologists to explore alternative diagnostic approaches.

Evidence-based practice: Followed evidence-based protocols for managing infertility by Penzias et al. (2020).  I focused on comprehensive diagnostic evaluations.

New skills and learning: Enhanced communication skills, particularly in navigating sensitive conversations. I gained insights into the psychological and emotional aspects of fertility challenges.

What would I do differently: Adopt a proactive approach in involving both partners early in the diagnostic process. Implement strategies to address potential reluctance in providing crucial diagnostic information.

Managing patient flow: Scheduled follow-up appointments and consultations strategically to accommodate the emotional aspects of fertility-related care. Collaborated with the fertility team for a coordinated approach to patient management. Challenges For Managing Type 1 Diabetes And Pregnancy Discussion

Communicating and Feedback

Improving Skills and Knowledge

I have a commitment to actively participate in ongoing learning and development to advance my expertise. It will be my primary goal to schedule frequent feedback meetings with my preceptor. This will promote candid discussion about individual cases. This strategy provides an ongoing feedback loop. This enables me to pinpoint my areas of improvement, learn about other strategies, and effectively hone my clinical skills.

Self-Assessment and Missing Components

I understand the value of self-evaluation in identifying any gaps or flaws in my current performance. It is essential to carefully examine communication techniques, decision-making procedures, and interactions with patients. Through actively requesting feedback from my peers and Preceptor, I am able to assess my strengths and areas that still need improvement. This proactive approach guarantees that my strengths and opportunities for development are well-rounded.

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Preceptor Feedback

I greatly appreciate my Preceptor’s constructive criticism as a means of fostering my professional development. Having open lines of communication about my areas of strength and weakness as well as targeted advice on honing my craft has been extremely helpful in my learning process. Creating a mutual feedback loop with my Preceptor lays the groundwork for ongoing improvement, which in turn ensures the best possible patient care and efficient teamwork within the healthcare system.

References

Johnston, M., Warton, C., Pertile, M. D., Taylor‐Sands, M., Delatycki, M. B., Hui, L., … & Mills, C. (2023). Ethical issues associated with prenatal screening using non‐invasive prenatal testing for sex chromosome aneuploidy. Prenatal Diagnosis43(2), 226-234. https://doi.org/10.1002/pd.6217

Heremans, R., Van Den Bosch, T., Valentin, L., Wynants, L., Pascual, M. A., Fruscio, R., … & IETA Consortium. (2022). Ultrasound features of endometrial pathology in women without abnormal uterine bleeding: results from the International Endometrial Tumor Analysis study (IETA3). Ultrasound in Obstetrics & Gynecology60(2), 243-255. https://doi.org/10.1002/uog.24910

Penzias, A., Bendikson, K., Falcone, T., Hansen, K., Hill, M., Jindal, S., … & Hurd, W. (2020). Evidence-based treatments for couples with unexplained infertility: a guideline. Fertility and sterility113(2), 305-322. https://doi.org/10.1016/j.fertnstert.2019.10.014

In your journal entry, answer the following questions: Challenges For Managing Type 1 Diabetes And Pregnancy Discussion

Learning from Experiences

  • Reflect on the 3 most challenging patient encounters and discuss what was most challenging for each.
  • What did you learn from this experience?
  • What resources did you have available?
  • What evidence-based practice did you use for this patient?
  • What new skills are you learning?
  • What would you do differently?
  • How are you managing patient flow and volume?

Communicating and Feedback

Respond to the following reflective questions:

  • How might I improve on my skills and knowledge, and how to communicate that back to my Preceptor?
  • How am I doing? What is missing?
  • What type of feedback am I receiving from my Preceptor?

PLEASE PAY CLOSE ATTENTION TO RUBRIC AS THIS IS WHAT SHE IS GOING OFF OF FOR GRADING.

SCHOLARLY RESOURCES X 3-5

APA FORMAT

 3 Most challenging patients

  1. NEW OB with uncontrolled Type 1 Diabetes of which was not known until Urine came back with large amounts of Glucose. Patient did end up miscarrying.
  2. 41-year-old with complaints of heavy bleeding, severe cramping and small clots from November 27 to December 17. Patient never has done this before. Periods have always been regular and last 3-5 days max without clots and cramping. Patient not on birth control. Pregnancy test negative. Husband had a vasectomy 3 years ago. Transvaginal ultrasound was performed, and Uterine fibroid was detected. Patient is scheduled for an ablation.
  3. Patient unable to conceive a child after fertility drugs and proof ovulation is occurring. Husband refuses to provide a sperm sample in order to rule out this being the issue instead of patient. Challenges For Managing Type 1 Diabetes And Pregnancy Discussion

Class Resources and Guidelines

  • Schuiling, K. D., & Likis, F. E. (2022). Gynecologic health care(4th ed.). Jones and Bartlett Learning.
    • Chapter 23, “Urinary Tract Infections” (pp. 469–478)
    • Chapter 23, “Menstrual-Cycle Pain and Premenstrual Syndrome” (pp. 495–510)
    • Chapter 26, “Normal and Abnormal Uterine Bleeding” (pp. 511–528)
  • Fowler, G. C. (2019). Pfenninger and Fowler’s Procedures for Primary Care(4th ed.). Elsevier.
    • Section 9, “Gynecology and Female Reproductive System”
      • Chapter 118, “Bartholin Cyst and Abscess: Word Catheter Insertion Marsupialization” (pp. 804–807)
      • Chapter 119, “Breast Biopsy” (pp. 808–813)
      • Chapter 120, “Pap Smear and Related Techniques for Cervical Cancer Screening” (pp. 814–824)
      • Chapter 121, “Human Papillomavirus DNA Typing” (pp. 825–828)
      • Chapter 122, “Wet Smear and Potassium Hydroxide Preparation” (pp. 829–832)
    • As you review the following resources, you may want to include a topic in the search area to gather detailed information (e.g., breast cancer screening guidelines; for the CDC – zika in pregnancy, etc.).
    • American College of Obstetricians and Gynecologists.Links to an external site.(n.d.). https://www.acog.org/
    • American Cancer Society.Links to an external site.(n.d.). https://www.cancer.org/
    • Centers for Disease Control and Prevention.Links to an external site.(n.d.). https://www.cdc.gov/
    • ANA Enterprise.Links to an external site.(n.d.). https://www.nursingworld.org/
    • American Association of Nurse Practitioners.Links to an external site.(2020). https://www.aanp.org/
    • HealthyPeople 2030Links to an external site.. (2020).Healthy People 2030 framework.Links to an external site.
      https://www.healthypeople.gov/2020/About-Healthy-People/Development-Healthy-People-2030/Framework
    • S. Preventive Services Task Force.Links to an external site.(n.d.-b). Search and filter all recommendation topics.Links to an external site. https://www.uspreventiveservicestaskforce.org/uspstf/topic_search_results?topic_status=P&searchterm= Challenges For Managing Type 1 Diabetes And Pregnancy Discussion

RUBRIC

This criterion is linked to a Learning OutcomeAssimilation and Synthesis: Content Reflection

30 to >29.0 pts

Excellent

Reflection demonstrates a high level of critical thinking in applying and integrating key course concepts and theories from readings, lectures, and/or discussions. Insightful and relevant connections are made through contextual explanations and examples.

29 to >19.0 pts

Good

Reflection demonstrates moderate level of critical thinking in applying and integrating key course concepts and theories from readings, lectures, and/or discussions. Connections are made through explanations and/or examples.

19 to >9.0 pts

Fair

Reflection demonstrates minimal critical thinking in applying and integrating key course concepts and theories from readings, lectures, and/or discussions. Minimal connections made through explanations and/or examples.

9 to >0 pts

Poor

Reflection lacks critical thinking. Superficial connections are made with key course concepts and resources, and/or assignments

30 pts

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This criterion is linked to a Learning OutcomeAssimilation and Synthesis: Personal Growth

30 to >29.0 pts

Excellent

Expresses solid evidence of reflection on own work. Demonstrates substantial personal growth and awareness of deeper meaning through inferences, well developed insights, and significant depth in awareness and challenges. Synthesizes current experience into future implications.

29 to >19.0 pts

Good

Expresses moderate evidence of reflection on own work. Demonstrates satisfactory personal growth and awareness through some inferences, insights, and challenges. There is mention of the future implications of student’s current experience.

19 to >9.0 pts

Fair

Expresses minimal evidence of reflection on own work. Demonstrates less than adequate personal growth and awareness through limited or simplistic inferences made, insights, and/or challenges that are not well developed. Minimal thought of future implications of student’s current experience.

9 to >0 pts

Poor

Expresses inadequate evidence of reflection on own work. Personal growth and awareness are not evident and/or demonstrate an impersonal experience. Lacks personal insights, challenges, inferences, and/or future implications are overlooked.

30 pts

This criterion is linked to a Learning OutcomeCommunication and Feedback

20 to >17.0 pts

Excellent

Clearly and completely reflects on communication skills and communication improvement and feedback implementation strategies with Preceptor.

17 to >15.0 pts

Good

Clearly reflects on communication skills and explains communication improvement and feedback implementation strategies with Preceptor.

15 to >13.0 pts

Fair

Relfection of communication skills is vague or strategies for communication improvement and feedback implementation are vague or incomplete.

13 to >0 pts

Poor

Relfection of communication skills is incomplete or missing, and/or strategies for communication improvement and feedback implementation are poorly developed or missing.

20 pts

This criterion is linked to a Learning OutcomeWritten Expression and Formatting

15 to >14.0 pts

Excellent

Well written and clearly organized using standard English, characterized by elements of a strong writing style and basically free from grammar, punctuation, usage, and spelling errors.

14 to >10.0 pts

Good

Above average writing style and logically organized using standard English with minor errors in grammar, punctuation, usage, and spelling.

10 to >5.0 pts

Fair

Average writing style that is sometimes unclear and/or with some errors in grammar, punctuation, usage, and spelling.

5 to >0 pts

Poor

Poor writing style lacking in standard English, clarity, language used, and/or frequent errors in grammar, punctuation, usage, and spelling. Needs work.

15 pts

This criterion is linked to a Learning OutcomeAPA

5 to >4.0 pts

Excellent

No APA errors

4 to >3.0 pts

Good

Contains 1–2 APA errors

3 to >1.0 pts

Fair

Contains 3–5 APA errors

1 to >0 pts

Poor

Contains >5 APA errors

5 pts

Total Points: 100

Challenges For Managing Type 1 Diabetes And Pregnancy Discussion

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