One of the tough things about being a new NP is worrying about my physical assessment skills. More precisely worrying that I'll miss something important. Part two of that worry is wondering whether I'll know how to manage a situation appropriately if I do
During the conference I went to in Boston, I went to a session on fine-tuning assessment skills where the instructor promised that if we followed her techniques we would
feel things (say, ovaries) more often, we'd be more precise in our descriptions of what we were feeling, and our patients would be happier with us too (no more mining for a cervix with the speculum).
Friday I had someone come in with right adnexal pain and some funny bleeding. So I collected myself and mentally went over some of the things the instructor wanted us to do, and I found a 4 cm (about) tender mass on/near(? not sure which) her right ovary. Now chances are this was just a cyst, but it kinda freaked me out anyway. I hopped out of the room, did a quick huddle with the other NP working with me, and we decided to send her to the ER. If it was a cyst, and it ruptured over the weekend, she could be in a lot more pain. At the ER they'd be able to do ultrasound and find out exactly what it was, and give her some serious pain meds. Pretty sure it wasn't an ectopic, because her PT was negative. The other NP was going to call her Saturday and see what happened -- I can't wait to find out.
The very next patient, while I was doing her history said that sometimes she had some dull abdominal pressure/pain. She said she'd had an ultrasound and they found some "spots" on her uterus "that could make it tip" and she was supposed to have another ultrasound but she hadn't done it yet. OK, so what could this be about? I started doing her bimanual exam and the lightbulb went on -- "did they say you had fibroids?" Why, yes! And I actually could
feel it... wow. Most of my patients are 16 - 25 year old young women, not too many of them have fibroids, so I hadn't actually felt any since I was in clinical back in 2003. I'm going to have to write a letter to the instructor of that session...
Yesterday, I drove all over creation again. I went to a citizens hearing for HR bill 676 -- John Conyers universal health care bill. Much more on this to come.