Brittany’s Blog

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Week 1 Philip, South Dakota

6/9/14– Traveled to Philip, SD from Rapid City. It was a nice and calm drive. Upon arriving in Philip, made my way to the cabin where Amanda had already settled in. We then traveled 3 miles to the Philip Clinic where we met our coordinator, Jennifer. She was lovely and showed us the clinic, hospital, nursing home, and town in about an hour. I was not use to that coming from Rapid City.  After lunch we attended a meeting with some of the staff at the nursing home. It was interesting to see some of the issues in their nursing home are the same in many nursing homes, under staff and safety.

6/10/14 – Started off the morning talking to a PA and his course of career. I was very interested to see how far PA’s have come in independence but also how much has changed with liability. Then as we were just wandering around, a radiology tech came and grabbed us and was great about teaching and showing us films that she has seen and different studies and how they can be different. I was so excited because I feel my education lacked in that area. I will learn so much from her and will spend a day with her next week also. After our Ice Cream social we signed on to VSee where we happen to miss the meeting. OOPS. We will see if we can reschedule or if we can just go with our community project. First night life out on the town we went to the nursing homes dance night. I was taught the Waltz and the two-step. Finished off our night at the softball game.

6/11/14 – Today started off a little nerve racking. Amanda and I were interviewed on Live Radio. It wasn’t as bad as I thought it would be but still a new experience. They were talking about this weekend (Philip Festival days). Amanda and I are getting pretty excited and bought tickets for Friday night’s entertainment. We spent many hours at the local pharmacy. It is in the process of changing owners and staying privately owned. I have not spent much time in a pharmacy but nice to see how things work together and given some advice on how to make scripts so the pharmacist can best be utilized.

6/12/14 – We started off our day at the hospital pharmacy. I cannot believe how some of these towns work all on paper with no computer system. The pharmacist recounted medications that were used in the hospital from the day’s prior. Amanda and I spent most of the day at the assisted living. The nurse and manager showed us around while the UAP and cook gave us the real experience of cleaning, cooking, and serving. We met many residents that were excited to show us some of their hobbies. And although I could not figure out the puzzle with one of the residents, I won a game of kings in the corner.

6/13/04 – Amanda and I are in lab today. The morning was slow allowing 2 individuals in the lab to discuss the machines and what labs they can run in house and what they send out to Rapid City. It is very interesting how much Philip has to offer its community. They informed us that they have an annual health fair and where they offer lipid panel, vitamin D levels, PSA, TSH, and BMP as a discounted rate. This is wonderful to be able to get your annual screening at a price that is affordable. Later in the afternoon we ran a CBC with an elevated WBC. This individual also had a Chest X ray that appeared normal, so we asked the physician what his plan of care was and he informed us he was still thinking bacterial infection and started on antibiotic. It was a very informative day as Amanda and I worked together with our knowledge to talk about medication and what microorganism they are used for.

Weekend 1 – This weekend was Philips festival days. We started off the weekend at the rodeo and street dance. One of the hospital employees sat with us and told us about scoring, bronco riding, and the participants who have been around and done well at current tournaments. Saturday we started off the day at the parade, went to the local dinner, and the demolition derby that afternoon. It was my first demolition derby and wow was I surprised how many people showed up and got involved. Sunday we are invited to ride horse and help move cattle. I loved it! I don’t have many opportunities to do this, so I was very grateful that someone from the community took us out. Lets just say by the end of this week, we already have had many different experiences and have met many community members.

Week 2
6/16/14 – Wow today was a busy day. Amanda and I ran around trying to keep up with Terry the PA in Philip. We saw everything from UTI, pneumonia, fracture radial and ulnar, DVT, and hematoma in the calf related to trauma and being on blood thinners. We also saw ER patients ranging from chest pain, which we ruled out MI and diagnosed with GI symptoms, pneumonia that has progressed despite prior antibiotic treatment, and an individual traveling though town that had an episode of vomiting blood. We had looked at many individuals’ labs, and x rays. We were able to see 1-2 cases of pneumonia per x ray and a fractured radial and ulnar with slight displacement. We were able to see compounding of medications done by the nurses, which Amanda was very interested in. Today had many challenges when I had to dictate 2 history and physicals on ER patients. I have done many histories in other rotations, but usually not the first day I follow a new provider. I was up for the challenge as I will be graduating in a few months and will need these skills as a practitioner. Today was long and after a 13 hour shift I am ready for bed!

Good night.

6/17/14 – Today was much more my speed. I was able to see many patients, 13 in fact, with the PA to follow after with evaluation. One of the patients had a rare cardiac dysrhythmia that was found just a few years ago after a syncope episode. He now has a pacemaker and defibrillator and is doing very well today. A patient came into the ER with abdominal cramping and history of kidney surgery. She happens to have a urinary tract infection. A 20-year-old male with shoulder pain after surgery on his labrum was evaluated using an X ray. They X ray showed a very rough glenoid fossa. After discussing with the Orthopedist, he informed the PA and myself that when repairing a ligament they can use anchors that go into the bone and cause a change on the X-ray. That was very interesting to see the change from an X-ray when you do not have hardware placed. We really got involved in the community and played 2 softball games. We at least won one :-)

6/18/14 – We started off our day trying to get out of bed. Amanda and I were so sore when we got up. When we finally figured out how to move to get out of bed, we went with the PA who discharged a patient from the hospital. We had admitted the patient with fatigue and he requested to go home after feeling more comfortable in 2 days. After our discharge we long arm casted a young 9 year old with a fractured radial and ulnar who had been splinted for 2 days. After we placed her cast on, she was very at ease but her mother was concerned about pain. The PA reassured the parent that kids do great and they will let you know when there is an issue. Our 6-year-old little girl came back in with diagnosed pneumonia. She still felt pretty tired and ill. We wanted to continue the current antibiotics because she has only been on them for 36 hours. Another interesting case included an elderly gentleman who came in with knee pain, his knee pain was osteoarthritis but he had a heart rate of 108. And EKG was done and shown to be in atrial fibrillation. What a great thing to show about being thorough.  Only 1 ER patient came in during our shift. She was an elderly lady with a temperature of 103 degree and very lethargic. A urinalysis was performed and seen to have a urinary tract infection.

6/19/14 – Amanda and I are following the local physician today. We had planned to be with the chiropractor but plans changed. I really enjoy having Amanda by my side. It’s been wonderful for my education of medications and also how small towns’ function as she is from Clark, SD. Our first patient came in with a rash. GOSH I HATE DERM!!! Rashes all look so similar and have just similar symptoms to determine what reaction they are having. Our patient has not had any new medications, no change in diet, or different detergent. The rash looked very similar to an allergic reaction. Her husband has been spraying his crops and she is unsure if that could be the culprit. We advised her to wash her cloths, take antihistamines, and keep a diary so we can determine the causative agent. We only had one ER patient all day. He has chronic constipation and was having abdominal pain. He was given magnesium citrate and sent home and given instructions if he did not have a bowel movement in 1 day to come back in for another ½ bottle. Our older gentleman who has a pacemaker placed for syncopal episodes with recent atrial fibrillation detected came in to figure out his plan of care. He will be taking a beta-blocker and started on anticoagulation for stroke prevention. Our last patient of the day has had fatigue, headaches, and cough symptoms off and on for the last few months. She was worried about West Nile, however, it is not the season for West Nile. We had to start a workup and found her to have h. pylori, which is a bacteria that can cause stomach ulcers. This may have been contributing to many of her symptoms. It was great to see that because my differential diagnosis where not pointing me down that path.

6/20-22/14 – Drove to Sioux falls for a cousins wedding. Wonderful outdoor wedding with great weather. I enjoyed myself with dancing and family.

Will be driving back to Rapid City with my family and heading to Philip again on Monday.

Week 3
6/23/14 – To the nursing home we go! Starting off our week at the nursing home meeting many residents. We helped the activity coordinator and also observed restorative care. You can really tell I am use to the hospital or clinic because they keep saying RT and all that pops into my head is respiratory therapy. After lunch we decided we would see a few patients in the clinic and when the nursing home staff was doing wound change that they could call in. We saw 2 wounds that have been caused by different things that have been open for 2-4 years and have dressing changes often. Very interesting to see how the wound developed and how much things have changed the course of the medical management. A great case we saw was a young teenager who had a wound on the first finger, it was known that the cows have an open wound on it’s utters. This was a viral reaction from a cows disorder. Our last patient of the day was back pain. The elderly women had been moving furniture and had pain that started that night. She was unable to move to let me palpate the area. After an x ray was performed, you could see an old L1 injury that she informed us she did last year after a fall on the ice. No acute injury was seen, directing us to a muscle injury. We also talked about doing a MRI in the future to keep evaluating her L1 injury.

6/24/14 – Today we had 4 pediatric patients. One with a chronic cough. He has had this cough for many months this year and had concerns with it last year. After a chest x ray and elevated white blood cell count we determined he has pneumonia and started him on antibiotics. Our second pediatric patient came in with abdominal pain. He was such a little cutie and really did not want to be at the clinic. After abdominal films and blood work to rule out bacteria issues or hepatitis A, a diagnosis of gastritis was made and we encouraged his mother to decrease sugary foods and carbohydrates to decrease gas production. This will help with his distension and gas pain. Our 3rd pediatric patient was an 11 year old who has a history of reactive airway disease and has been using a nebulizer to help with his congestion and cough that started one week prior. After doing a history and physical we decided to go up on his medications of Singular. This may help cut down the inflammation in the airway. Our final pediatric patient of the day was a young boy who has chronic ear issues. Head had placed tympanic tubes in his ear and they were still having troubles. The provider gave the option to see and ear, nose, and throat specialist to help determine if there is any further evaluation or treatment that may be more effective than his current antibiotics. Our day finished with a softball game. We were supposed to be play two games….. yep Amanda and I both had little injuries that made us sit the bench for the following game. I feel so old when I can’t run to first base and we are playing individuals that are 50 years old. Maybe someday I will get into better shape and be able to do that when I am 50.

6/25/14 – Amanda and I had a really hard time getting out of bed. With one upper quadriceps injury myself and one quadriceps injury with Amanda, we looked like gimps. When we finally iced our legs and took ibuprofen we were ready to start the day. We went to the clinic to see if anything exciting was going on before heading to the pharmacy for the morning. We had one patient in the ER with an ankle injury. After many x rays, a CT was preformed to determine the extent of the injury. The majority of the injury was soft tissue and the patient was given medications and sent home. We then headed to the pharmacy where we helped count mediations and get prescriptions ready for the patients. We were told that yesterday was a very busy day for them and they are happy to have help when they can get it. After we returned to the clinic in the afternoon, we followed radiology. However, they were slow, so Amanda and I started to work on our presentation and surveys for the program. It was nice to start getting on our homework as we are more than half way done with the RHEPS program.

6/26/14 – Today was spent in the clinic with Terry. It  was a great day for me to start taking responsibility of patients. I was able to make an assessment and plan of care for patients in the clinic. Our first patient was an elderly patient in the hospital, transferred from the nursing home. There is progressing in her lung disease and an increase in her cough. Her family is very involved in her care, which is wonderful to see. I was pretty excited when a patient came in with a shin laceration and was placed in the treatment room.  I was excited to put in sutures, however, the open wound did not need sutures but instead I placed steri-strips. We had two patients who came in for INR checks. This is to determine the medical management of Coumadin. Both patients had to increase their dose to maintain blood viscosity.  Our last patient of the day was an ankle trauma who has been working out in the farm and fell in a hole. She managed to continue doing her chores and work in on the tractor until the end of the day. After x rays, we diagnosed her with an ankle sprain. After her workup she went home with RICE therapy, rest, ice, compression, and elevation. Our day ended with a bike ride and several more bug bites.

6/27/14 – Another day in the clinic… I was happy to see that we only have a 6-7 in the morning and 3-4 in the afternoon. It is a great time to get ready for the weekend, as I will be taking call with Terry. I also found out we have a half-day of clinic on Saturday morning. I think its great that in such a small community they have a clinic open on Saturday. Today we had an adorable little boy. His parents stated that he was fussier then normal and has been pulling at his left ear. He also started to have a rash on his feet approximately 2 days ago. After fully examining the patient, I realized his ears looked well, but what appeared to be hand, foot and mouth. It is a viral rash that causes irritation to the posterior pharynx, which could be causing his fussiness. We have seen many individuals with allergies, today alone we had 3 patients who had been taking antihistamines over the counter and it was not giving enough relief. For 2 of the patients, we administered a steroid injection.  Our last 2 patients today were both pediatric patients. A teenager with diagnosed mononucleosis wanting to be released for contact sports. At this time, the diagnosis was made 1 week prior and he was not release. Terry recommended at least 4 weeks from diagnosis and 3 weeks of symptoms free period before non-contact sports could be initiated. After 1-2 weeks with no concern with non-contact, a contact sport could slowly be introduced. Our final patient was an 11-year-old female with ear pain after diagnosing with an external ear infection antibiotics were prescribed.

6/28/14 – Terry is on call, so we have a half-day in the clinic. Upon arriving at the clinic, we were discharging a patient who was originally from the nursing home who has lung cancer and had a rapid progression of cough. She was diagnosed with pneumonia and started on IV antibiotics. After 3 days she was progressing enough to go back to the nursing home. Terry wanted me to work on discharge orders, so I spent a little time doing the orders as I have not done that during my other rotations. After returning back to the clinic, I had 2 patients, one with a cough for 2-3 weeks and given an antibiotics. Another patient in with abdominal pain in the upper left quadrant, a CT was performed to rule out diverticulitis or gastric ulcer. The CT was negative and leaned more toward gastric reflux. After clinic was done, we were still on ER call. Only called in twice, one by a gentleman who had a syncopal episode while working hard at fighting a fire. Dehydration was diagnosed and he was given fluids. Another ER patient was a young man with pink eye. He had been traveling and his parents wanted it evaluated.

6/29/14 – On call. nice to have a relaxing day. Amanda played a little catch with her significant other and I did homework for school. I can’t complain because I graduate in a few months and need to get all my paperwork in.  In the afternoon the ER picked up. We saw 5 individuals in the ER. Two with fish hook injuries. Terry did the first fish hook removal, but I was able to do most of the second hook removal. I was pretty excited to call that my first procedure in Philip. Nice easy one to start with. We also had one syncopal episode and one confused patient. Both were elderly with multiple comorbidities.

Week 4
6/30/14 – Man did I pick the right career. Today we followed the dentist. We saw many different dental procedures from cavity removal and fillings placed to fitting partial dentures. We even had the opportunity to see a tooth extraction which neither Amanda or I were too much a fan of. It was great to see how busy and well up to date the dentist practice was, but not a career I will take into consideration for myself. I respect dentistry and think they do a wonderful job but I was happy to only spend a day in the office so I wasn’t too afraid for my next appointment. After spending many hours in the dentist office, we went back to the clinic and followed Dr. Holman. I was encouraged to see a patient I had seen the week before with abdominal pain and a cough. She came back in with more abdominal pain in the left upper quadrant that radiated to her back. After looking at her skin, it was apparent she had shingles. I was shocked as we had looked at her skin the week before when she was having symptoms and there was nothing. I know you can get the symptoms before the rash but it didn’t even cross my mind for a diagnosis at that time. I need to keep my mind open and look for all things that can explain symptoms. Our final patient was a young lady with migraines and chronic urinary tract infection.  Her urine did not look infected, yet she had lower back pain. She will need further evaluation to rule out more serious illnesses. What a day. Both Amanda and I are tired and ready for bed.

7/1/14 – Tuesday. O Tuesday. Amanda and I were ready to go but spent this morning talking about our last week plans. When we need to have our presentation done, what parts we need to go over, and drawing a conclusion to our surveys. This morning with Terry was interesting. Did a short arm cast on a patient we had done a long arm cast on for 2 weeks with a distal ulnar and radial fracture. We also had child with a wart we had done cryotherapy on a week or so prior. It had not changed and she wanted to know other alternatives. Her father chose to have the wart removed with a scalpel and then try cryotherapy again. During my education as a PA, we learned that this is more effective. It was interesting to me that our first cryotherapy was not effective at all. In the afternoon we had a patient of Dr. Holman who had a ganglion cyst we aspirated and placed steroids in. I was surprised at how thick the cyst fluid was. I have seen previous cyst aspirations but the fluid concentration has been different for all of the patients. Everyone is so individualized and it’s amazing to see that. Our final patient in the clinic was a very challenging case. A young man with a temp of 102 and body aches. His rapid strep was negative and WBC within normal range. His presentation seemed so bacterial but ended up being a viral infection. I can relate to the patient wanting to feel better, as he has a 102 temperature and is sleeping all the time during the summer months. What a bummer. But viral infections have to run their course.

And another 2 wins for the PHI softball team. Amanda and I got through both of the games however; we are still a little sore.

7/2/14 – What a gorgeous day. So hard to work on our presentation as we have our final day tomorrow and the weather is so great. We waited to the last minute to fix and combine our work. But it’s getting there. I am not ready to be done as I feel I am getting the hang of this small town living. My boyfriend came up for the morning and it was great. He toured Philip and we went to the local breakfast café. It was wonderful. I don’t know how we missed this café for the last 3 weeks. I will go back before I leave as I have one more week in Philip.

7/3/14 – The day arrives to give our presentation. Terry first wanted us to come in and see a few patients. Our first patient was a male in for a testosterone shot. He has been getting them for a few weeks now and just needs a brief visit to make sure everything is going well. Our next patient had knee pain after a diagnosed sprain medial cruciate ligament. She was having a flare from her osteoarthritis and was having increased discomfort. I was able to inject some steroid into the joint and help decrease pain. After we were finished we went down to the conference room to give our LOVELY presentation. We were met by many wonderful people and had great food; our presentation wasn’t too bad either. It was great to be done with the presentation but still want to spend more time learning about what the great town of Philip has to offer.