LTC Evaluation Reflection: For my Long Term Care Rotation, I presented a 64 year old man who had presented to the ER after suffering neck pain while in dialysis. This patient had an extensive and significant past medical history, and for this reason I chose to present his case. Having had my LTC rotation in a hospital, few patients fit the criteria for a typical LTC patient. However, this particular patient was a gentleman who had a history of hypertension, hyperlipidemia, diabetes mellitus type 2, coronary artery disease, peripheral vascular disease, ex-smoker, and end stage renal disease on hemodialysis. While the patient was brought by EMS to the ER for his neck pain, he was found to be hyperkalemic and admitted for treatment. This patient’s presentation gave me valuable experience in treating electrolyte abnormalities and in treating patients with complicated presentations. This patient’s extensive history offered a look into how end stage renal disease patient treatment varies from other patients. Although the patient didn’t stay on the unit for very long, I was still able to follow his hospital course prior to him leaving against medical advice. Also, the patient had been admitted to Queens Hospital Center a week prior for a surgical amputation of three toes on his left foot. This was caused by osteomyelitis secondary to complications of his diabetes. It was very educational for me to follow a patient with such progressed disease. Also, during my physical exam of this patient, I was able to appreciate the thrill of his matured AV fistula as well as auscultation of the bruit in the AV fistula. Upon further examination, I appreciated a murmur in the right sternal border of this patient. After not hearing this murmur in the carotids, I spoke with a resident on my team and learned that dialysis patients often have a murmur that radiates from their matured AV fistula. This was a new experience for me that I think will be valuable in my career as a PA.
LTC Article Summary: This article describes various methods of improving infection outcomes in dialysis catheters. Tunneled central venous catheters are often used for hemodialysis administration in patients that are either having dialysis for a short time or are waiting for their AV fistulas to mature and be functional. However, as with any catheter entering the bloodstream, blood stream infections are a major risk. In this article, various types of catheter infection interventions were discussed and their efficacy discussed as well. These interventions included catheter exit site topical ointment application (usually a bacitracin or povidone iodine ointment, and only bacitracin was proven to have significant effect on mortality), antibiotic catheter locks, intranasal mupirocin, non-antibiotic catheter locks, and catheter hub devices. Overall, the CDC recommendations remain imperative in preventing tunnel catheter infections as these patients have a morbidity more than twice as high as patients with AV fistulas.
LTC Self Reflection: For my Long Term Care rotation, I had a rare opportunity afforded to me by the unprecedented COVID pandemic. I was able to go to Queens Hospital Center to their Internal Medicine department for my LTC rotation. Having thought I would be in a different setting for this rotation, such as in a nursing home setting, I was prepared to have a less engaging rotation. While that may sound as though a rotation in a nursing home is subpar, that is not at all what I’m getting at. I’m talking about the educational supplementation offered to me at QHC. I rotated with medical students during this rotation and so I was able to attend lectures and other seminars offered by the QHC internal medicine department. On top of that wealth of informative experience, the attending on my team gave small lectures every day on specific disease processes. I found this to be very beneficial for my PANCE studying. I consider myself to be lucky to have had this rotation in QHC’s internal medicine department because of this extra scholastic experience. Aside from the extra lectures, I also learned how QHC treats their COVID patients. Having been out of rotations during the height of the pandemic last March, I didn’t get to see treatment of COVID patients up close. While in my LTC rotation I was able to follow many COVID patients and studied their course of treatment carefully. I felt this was an imperative learning experience as I myself may end up on the frontlines as a new PA graduate in 2021.
This entry is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International license.
