Clinical Reflection

Many authors including, Pawlas and Oliva (2008) and Bennis and Nanus (1985) discuss the importance for the supervisors to spend much of their time listening to the views of others incising their students and incorporating these ideas into their thinking as a powerful tool for personal development. Moreover, on the job training, mentorship or continual education, are not always easy to access for the educator, my first-hand experience has been that this has been a valuable learning tool which has made me explore how I do what I do when supporting students in their clinical education. Given that my role is a long-term relationship, and that adults learners develop incrementally over time, a supervisor can assist in that change by working with students to establish meaningful long-term goals, working patiently on the

Patient was encouraged to perform some activities of daily living such as feeding, grooming. She was encouraged to verbalize less fear of falling because anytime we want to reposition her, she will scream that she will fall. Patient was also anxious but we used distraction (TV) to reduce her anxiety. I wrote her favorite movie on the white board so that anybody can put it on for her.

Patients will report to physical therapists with a multitude of impairments throughout the progression of the disease. The most prominent impairments will present during cerebellar testing. Patients will show signs of dysmetria, dysphasia, dysdiadochokinesia, and ataxia primarily as a result of the atrophy and damage to the cerebellum. Instability and lack of postural control will be demonstrated during the Romberg's test. Additionally, cranial nerve testing will have positive results for many cranial nerve palsies such as CN III, V, VII, IX, and XII. Patients show weakness in their trunk and extremities during the manual muscle testing. Vestibular testing will result in abnormal VOR, saccades, smooth pursuits and nystagmus. As a result of these impairments, patients experience functional limitations. Primarily, these patients are considered to be “high fall risks,” which ultimately decreases their independence due to weakness, instability and decreased postural control. These patients will feel uncomfortable in many situations and be unable to function independently in the community. This creates an increased risk for further injury. Due to the dysmetria and weakness, patients will also experience difficulty with their daily living skills, such as maintaining proper hygiene; They will have trouble bathing themselves and brushing their teeth without assistive equipment. PT interventions can help minimize and control these limitations. The implementation of balance training and assistive devices will be imperative interventions for an individual to modify and adapt to their gait

Resident alert, oriented and able to and follow two step verbal instructions. resident co-operated well with the assessment. Reported ongoing right shoulder and bilateral knee pain. hypersensitivity on his bilateral toes. Resident maintained ROM in the bilateral UE and LE, which is within the functional limits. Strength maintained at 4+/5 in UE and LE muscle groups. A decline in his endurance and activity tolerance noted from the last assessment. Some tightness noted in the bilateral hamstrings and calf muscles. Resident has good sitting and fair standing balance. His Tinetti score declined from 20/28 to 16/28 since the last assessment, which indicates a high fall risk. Resident ambulates short distance(SOBE noted) with one assist using 4WW

There are mild limitations with her heel bilaterally (Yamamoto, 2007). She demonstrates spasticity in all lower extremities and her trunk (Yamamoto, 2007). Her movement reflects significant spasticity in her legs (Yamamoto, 2007). Although she can sit independently, she has difficulty sitting on the floor without her legs extended in front of her for support (Yamamoto, 2007). She requires assistance when moving in and out of sitting in a chair, undressing skills such as removing shoes and socks (Yamamoto, 2007). She can push up in prone to hands and is able to crawl for short distances (Yamamoto, 2007). She supports her weight in a supported standing position with knees in a small degree of flexion, hips adducted and feet plantar flexed and pronated (Yamamoto, 2007). She ambulates with a walker for short distances (Yamamoto, 2007). There is incoordination with her upper extremities caused by mild increased muscle tone (Yamamoto,

During the ICU rotation, there was an opportunity to interview an intubated patient, with whom I was assigned to for 2 consecutive clinical days. As per the patients and reports given by the nurse, the patient came to the emergency department complaining of right abdominal pain. Furthermore, the patient's lungs were unable to compensate making it difficult to breathe due to the patient being morbidly obese. In addition to this, the patient had a past medical history of Coronary Artery Disease, Diabetes Mellitus and Hypertension and a left atrium enlargement. Therefore, the patient was admitted intubated on 10/22/2017 and taken to the ICU, as a result of a perforated viscus ulcer.

This week during clinical I was placed with a very independent patient who currently was in good state of mind and relevant health. My patient this week suffered from numerous heart problems and was recently diagnosed with Multiple Sclerosis. Throughout the day while I was at clinical my patient had yet to receive the news from his health provider of their recent findings but he was so happy because he finally was going to be discharged and sent home from the hospital. From the interactions I had with him we developed a working relationship. He told me how his boss from work name was Celeste and that he met his wife at age 22 and has been with her since. He even called me his good luck charm at the end of the day and wished me luck with my

During my clinical rotation in the ER, I had a patient who came in complaining with shortness of breath and cough for the past few days. He had a history of CHF and COPD and was on 2L of oxygen at night. While I assessed him with the nurse by my side, I heard audible wheezes and crackles in his lung bases. He also had a persistent cough. I knew that he was having a COPD exacerbation and needed appropriate medications to ease his discomfort. I discussed my findings with the nurse and after examining the patient the nurse agreed with me. We relayed the information to the physician who concurred with us after examination and gave us orders to treat the patient’s COPD exacerbation.

Nursing report that pt fell over the weekend. Pt reported he was trying to take off his pants off while sitting on the edge of the bed. Pt lost his balance and slided off bed. Facilitation of Bobath techniques and movement to increase sensory input to (L) UE and awareness of hemiplegic (L) UE. Tone management, including positioning of (L) UE into multiple weight bearing planes and through being in quadruped position due to hypertonicity. Pt performed 1/4 active (L) scapular elevation.

Ischemic stroke is also known as a cerebrovascular accident (CVA), or “brain attack” is a sudden loss of function resulting from disruption of the blood supply to a part of the brain. Ischemic stroke is caused by an emboluslodged in the small vessels of the brain, causing the oxygen and glucose deprivation to the brain. For Mrs. William case, she is diagnosed with ischemic stroke that is affecting her left side hemisphere of the brain, which is causing her to experience right side symptoms (right-side paralysis, right field homonymous hemianopisa, and global aphasia) (Hinkle & Cheever, 2014). The nursing interventions that the patient is exhibiting the clinical manifestations are:

Joint Mobility- The client illness has affected her range of motion in her left upper extremity and both lower extremities. She has trouble reaching with the left arm.

Kolb (1984), describes learning as an activity as a relatively change in behavior due to experience whereby knowledge is gain through the conversion of experiences. Learning thorough reflection is an essential tool in practice based on personal professional learning setting where learning took place from the individual own professional experiences, (Bolton, 2010). Therefore this reflection essay aims to critically evaluate my clinical practice learning experiences and my current higher education learning process and how effectively lifelong learning was managed towards my own personal professional development. After completing my high school, I choose nursing as professions in my career pathway because I prefer to be involving myself in developing

S: Pt. reports no pain in the residual limb but still has difficulties getting in and out bed independently. Pt also complains of loss of balance when hopping from the kitchen to the bathroom c the RW. O; Pt. began the session c vital signs assessment: BP, HR, RR and SpO. Pt. performed Functional activities. Bed mobility: Supine to sit, sit to supine x5 Mod.I. Patient completed x3 standing pivot transfer Mod. I in order to improve getting in and out of bed without difficulties. Pt. also performed pre-gait activities: Sto S x15 c one arm support and prolonged standing c RW x5, 10 sec holding to improve balance. Pt. hoped about 16 feet c RW Mod.I. Pt. educated in HEP during TE training: Clamshells c GTB seated 3x10; Adduction ball squeezes

The patient 78-year-old female who is brought to the ED after dialysis treatment complaining of severe pain in her extremities. It is chronic pain, but it has worsened over the past 2 weeks in her arms, leg and back. She is known to have history of DVT, coronary artery disease, asthma,end-stage renal disease on dialysis,congestive heart failure, hypertension, had a past pulmonary emboli, COPD, non-insulin-dependent diabetes, arthritis, hypothyroidism had a right hip replacement and afistula in her left upper arm. The patient underwent a physical therapy eval in the ED, which reveals she needs moderate assistance to transfer to sit to stand, again moderate assist of two to transfer the goal is to develop independence of transfer. The gait

After a total of three clinical days so far, I have already encountered different situations and gained a great deal of experience. However, one particular event seems to stand out and this event happened on my third clinical day. In this episode, I was trying to get the patient up from bed to get her ready for breakfast but she refused to cooperate.