Practicum Experience- Journal Entry

Practicum Experience- Journal Entry

Practicum experience provides an avenue for the relation of the classroom teachings and the clinical experience. This allows for the knowledge acquired to be applied in real life situation rather than the theoretical aspects that are taught in classes. During the practicum, I encountered Mr. P was seeking emergency care services within the facility. By handling his condition, the application and use of the knowledge acquired were put to task in an assessment of the condition. This journal entry dwells on the provision of personal, medical and medication history of the patient as well as an illustration of the management of arrhythmias.

Description of the patient

Mr. P is a 53-year-old male Black American who came to the facility accompanied by his brothers having been experiencing palpitations and dizziness for the last three days. The patient also reported difficulty in engaging in personal daily activities from the time the symptoms started presenting. The patient was diagnosed to have hypertension three years ago and has been on medication and follow-up care since the time of diagnosis. Three months ago, he was admitted having had a heart attack but was discharged home after improving. He was well until three days ago when the above symptoms commence manifesting. The situation has been worsening, and this prompted the medical attention in the facility.

Diagnosis with a rational and explanation

The diagnosis of arrhythmias entails a range of examination that includes physical assessment, review of the presenting symptoms as well as the medical history. In this case, Mr. P’s case can be related to the progression of hypertension that he developed three years ago. Various tests are conducted in the process of coming up with a diagnosis. An electrocardiogram can be done to assess the electrical activity of the heart. It indicates inappropriate generation and passage of electrical impulses in the instance of arrhythmias (Faber et al., 2015). Event monitors are also crucial for the diagnosis. With this method, the patient has the portable ECG device in place and records the electrical activity of the heart during periods where he experiences the symptoms. Through echocardiogram, the heart size, motion, and structure can be assessed via a transducer placed on the chest thus giving critical information for the diagnosis.

Other avenues for the determination of the arrhythmias can also include the stress test. In this method, the patient is subject to some stress such as exercising on a stationary bicycle with the heart activity being monitored (Afonso et al., 2017). This method of diagnosis uses the assumption that the arrhythmias are usually triggered or worsened by exercise.

Assessment and management of Arrhythmias

In assessing for the arrhythmias, the focus of the healthcare provider is on various indicators. These indicators that ought to be looked out for encompasses nausea, vomiting, palpitations, cold and clammy skin, syncope, restlessness, difficulty in breathing, pallor, decreased oxygen saturation, either hypertension or hypotension, increased or decreased heart rate (Spezzacatene et al., 2017). Other signs and symptoms to check out for include palpitations, diaphoresis, fatigue, weakness, tingling sensations in the extremities, reduced level of consciousness, irregular rhythm and rate of the heart, confusion and increased anxiety. The arrhythmias can also elicit pain in the chest, back, shoulder, arms, jaws, and neck.

Most of the arrhythmias are regarded to be harmless and are usually left untreated. Clinically significant arrhythmias, however, require intervention to prevent their occurrence as well as managing them or treatment of the condition leading to the arrhythmia. The management of the arrhythmias is usually directed towards prevention of formation of blood clots, reducing the heart rate to normal ranges, restoring the normal rate and rhythm, treating the causative condition as well as reducing the risk factors for heart conditions (Lip et al., 2017). The prevention of the arrhythmias can take the form of keeping off the triggers such as stressful work or engaging in conflicts, adopting a healthy lifestyle by exercising sufficiently to strengthen the heart muscles as well as adhering to the set treatment of for the underlying conditions.

Drug therapy is also essential for the management of arrhythmias. The therapy may entail calcium channel blockers that work to interrupt the movement of calcium to the heart as well as the blood vessel tissues. In so doing, they prevent elicitation of abnormal rhythms which may occur out of abnormal excitation at the nodes. Examples of calcium channel blockers include amlodipine, diltiazem, felodipine, nicardipine, and verapamil.

Beta-blockers can also be used to decrease the heart rate as well as the total cardiac output. It, therefore, lowers the blood pressure by reducing the impact of adrenaline. In the control of arrhythmias, they act on the cardiac centers to avert the occurrences of the abnormal excitations that lead to abnormal heart impulses (Katritsis et al., 2017). Examples of beta blockers are sotalol, atenolol, metoprolol, and propranolol. The management of arrhythmias also focuses on prevention of development of clots thus anticoagulants can also be used. They prevent the formation of new clots without dissolving the existing clots. This is key in the management of atrial fibrillation. The anticoagulants include aspirin and warfarin. Other anti-arrhythmic medications include amiodarone, procainamide, and flecainide.

In the case of Mr. P, the management of the cardiovascular condition revolves around the determination of the trigger based on the fact that he is a known case of atrial fibrillation and has been on management. The patient has been on nifedipine 50mg, and Lasix 20mg and the occurrence of the arrhythmias gives a hind on the need for evaluation of management and setting of a long-term plan for the condition.


The encounter with Mr. P provided a better engagement that made it possible for the relation of the classroom experience and the real occurrences of condition and patients.  This provided a better experience concerning confidence and management of cardiovascular conditions. This created for preparation for the management of a similar condition in future.




Afonso, V. X., Shi, J., Kim, S. J., Deno, D. C., & Morgan, D. J. (2017). U.S. Patent No.

            9,675,266. Washington, DC: U.S. Patent and Trademark Office.

Cabrera-Sole, R., Lucas, C. T., Urrera, L. R., Ruiz, S. G., & Saldaña, M. A. (2017). Abstract

P474: Comparison of the Effect of Different Calcium Channel Antagonists on Arterial

Stiffness and Central Pressures in Moderate Hypertensive Patients Receiving Enalapril as

First Line Treatment.

Faber, T., Rybak, K., Rieger, G., Mangoni, L., The, SHK, Tjeerdsma, G., … & De Weerd, G.

(2015, August). Diagnosis of arrhythmias in patients with unexplained palpitations using

long term continuous monitoring. In EUROPEAN HEART JOURNAL (Vol. 36, pp. 217-



Katritsis, D. G., Boriani, G., Cosio, F. G., Hindricks, G., Jais, P., Josephson, M. E., … & Lane, D.

  1. (2017). European heart rhythm association (EHRA) consensus document on the

management of supraventricular arrhythmias, endorsed by Heart Rhythm Society (HRS),

Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de

Estimulación Cardiaca y Electrofisiologia (SOLAECE). EP Europace19(3), 465-511.

Khan, A. R., Khan, S., Sheikh, M. A., Khuder, S., Grubb, B., & Moukarbel, G. V. (2014).

Catheter ablation and anti-arrhythmic drug therapy as first or second line therapy in the

management of atrial fibrillation: A systematic review and meta-analysis. Circulation:

            Arrhythmia and Electrophysiology, CIRCEP-114.

Lip, G. Y., Coca, A., Kahan, T., Boriani, G., Manolis, A. S., Olsen, M. H., … & de Oliveira

Figueiredo, M. J. (2017). Hypertension and cardiac arrhythmias: a consensus document

from the European Heart Rhythm Association (ehra) and Esc Council on Hypertension,

endorsed by the Heart Rhythm Society (hrs), Asia-pacific Heart Rhythm Society (aphrs)

and Sociedad Latinoamericana de Estimulación Cardíaca y Electrofisiología (soleace). Ep

            Europace19(6), 891-911.

Spezzacatene, A., Sinagra, G., Merlo, M., Barbati, G., Graw, S. L., Brun, F., … & Saffitz, J. E.

(2015). Arrhythmogenic Phenotype in Dilated Cardiomyopathy: Natural History and

Predictors of Life‐Threatening Arrhythmias. Journal of the American Heart

            Association4(10), e002149.

(Visited 5 times, 1 visits today)