Name: Tee Eng Chun

ID: BP080726024
Week: 7
Appendix A: Daily Reflective Diary
Date/Rotation: 1 Feb 2012 (day 3)/Care of elderly
Today’s activities.
 Continued to clerk a case in ward D3 involved a 76 years old patient (ABH), with hypertension, congestive heart failure,
atrial fibrillation and dignosed with AEBA secondary to community acquired pneumonia. ABH was administered to the
hospital due to shortness of breath and fever
 Continued to clerk the second case involved a 70 years old female patient (SS), with diabetes mellitus, hypertension,
epilepsy and currently diagnosed with phenytoin toxicity.
 Discussion with our preceptor on the first case
A significant experience/observation today.
 Observation on the management of atrial fibrillation for patient with high INR, PT and APTT
 Observation on the management of congestive cardiac failure (CCF)
Learning from this experience/observation.

1. Management of atrial fibrillation with high INR, PT and APTT

 According to patient’s laboratory results (INR:3.3), dose reduction of warfarin should be done and suggest to withhold
ticlopidine as it might increase the effect of warfarin if patient’s INR, PT and APTT do not reduce to normal range

Additional learning needs from this experience/observation and my plan to achieve the learning.

1. Management of CCF
 According to CPG, ACEI can be prescribed to reduce future cardiac event. Loop diuretics such as frusemide can be
added for treatment of congestive heart failure to prevent or alleviate the symptoms of fluid retention. if still no clinical
improvement, add spirinolactone. Beta-blocker will be added if there is clinical improvement, whereas the combination
of digoxin and ARB will be added if there is no clinical improvement

References include LEXICOMP and ministry of health clinical practice guideline

Summary of what I have learnt.
  Management of atrial fibrillation
 Management of CCF
Meaningful interactions with health care team (preceptors, doctors, nurses, other health care students and peers).
 The doctors and nurses are helpful in clarifying our queries in the ward

Feelings and thoughts about today’s learning experience.

 I have learnt a lot of extra knowledge from our preceptor today and experienced the meaningful interactions with health care
team.

Signature of the hospital preceptor:_____________