Embolism Case Studies

Pulmonary embolism, what is it and how are the outcomes for this disease process and why is this disease so very important to treat as soon as possible? Well according to Medline Plus pulmonary embolism are essentially blot clots that get into the arteries of the lungs and cause a blockage which can lead to many serious problems if not treated correctly. The type of clot that is usually attributed to this disease is one that comes from deep vein thrombosis which often comes from one of the lower legs. Pulmonary Embolism: Medline Plus (2016, March 15). The lungs are a very important part of the body as important in the process cellular respiration, which with the lungs take the carbon dioxide

On this second clinical for med-surg, I felt a bit more comfortable being on the floor. Before starting this clinical I had set a goal for myself to perform well and complete my assessment as thorough as possible. For pre-assessment I was set on just choosing a patient and not being afraid on what kind of diagnosis they had or how many medications they were on. As I selected my patient, I noticed that he had many medications and had had an ST-elevation myocardial infarction. I didn’t want to scare myself off from selecting this patient and caring for him on clinical day.

There were even times when the nurse asked us some of the medications and what they do, which we gladly answered. The nurse was very open-minded, and contributed to the conversation really well, without overshadowing the pharmacists. After discussing, we briefly split the questions that we wanted to ask among the three of us. Up until this point, I believed that our team would do well since we prepared ourselves. However, to our surprise, we were not prepared when the patient continuously complained about feeling dizzy, and not being able to breathe. All three of us were not knowledgeable enough to help the patient with his symptoms that he kept complaining about. At first, we attempted to adjust the bed, however, that did not help and made it worse. Not knowing what to do, we tried to persuade the patient to try to focus on the questions that we were about to ask in order to help with his symptoms. When the patient complied, the nurse started asking very general questions about his health and lifestyle. It was a great start until the nurse started asking questions that we were going to ask the patient. In the end, she asked all the questions that we planned to

This week, I was given the opportunity to care for two female patients – 205(1) and (2). The first patient, 205-1, was admitted with respiratory distress and had a past medical history of hypertension, schizophrenia and bipolar disorder. She was initially put on 2 L/min of oxygen and placed on oxygen titration protocol with orders to maintain O2 saturations between 88-92%. The patient was oriented to person and place, but had difficulty with time. She was also obese (BMI 30) and deemed a moderate assist with ambulation. Her care plan included total assistance with ADLs, smoking cessation and oxygen protocols, limited salt intake (3mg), and chronic pain management. The second patient, 205-2, was admitted with a right pelvic fracture and had

Minutes have passed and to my surprise, after shocking the patient multiple times, we had return of spontaneous circulation. A sense of excitement, and relief, poured over me. From my past experiences, I assumed that there was a small probability that this man would live; however, that day I learned that every patient is different. As a Physician Assistant (PA) I want to consider the entire combination of factors that make each person unique, analyzing all aspects of their life – physically and emotionally. Ultimately, this experience motivated me to channel all of my energy towards pursuing a career as a PA.

My educational fear in the past was during my first week off ICU orientation, I was assigned an admission from the ER of a post cardiac arrest middle aged patient who was placed on a therapeutic hypothermia. I verbalized to the Charge Nurse of being hesitant to accept the admission since I’m fresh off orientation. She told me “this would be a good experience for you”. I want to keep good positive impression to my colleague being a new nurse of my new unit and took on the mission to accept the assignment. After receiving a report, the unconscious patient arrived on our unit on a ventilator with hypothermic jacket and with multiple drips. My heart started to pound and said to myself “what am I getting into, transferring here in ICU is a mistake, and I just want to cry”. While being shaky, I took good long deep breaths. After the patient was situated the on the bed, I carried on the task according to the doctors’ orders and the protocols. I stayed in communication with my charge nurse for assistance, questions and moral support. I succeeded the patient care uneventfully on a 12 gruesome hours by working and collaborating with the charge nurse, the senior RNs as a

On September 28, when we went to Tripler Army Medical Center, I was placed in the Cardiac Ward. At that time, I was able to learn so many diagnosis dealing with the patients. The nurse had briefly explained what was going on with each individual patient and the type of treatments they are doing to help. She had also neatly clarified each medication she was giving them and told me exactly what it was used for. I was able to get an experience of hands on by taking a patient’s temperature. I had shadowed as she did so many things to make the patient feel comfortable and did everything to the best of her ability to make them happy. She had taught me how to record every piece of information about the patients on the computer by showing me what

My Story: Today, was an awesome, extremely busy clinical day; I absolutely loved it. I saw five total patients. The first patient that I saw was with Laura, this patient was diagnosed yesterday, 2/7, with cirrhosis of the liver and HEP C. The patient’s chart says he has a history of anxiety, however, the patient stated that his anxiety started when he was told in the ER on 1/25 that he could have cirrhosis of the liver (more information in part D and E). This patient was very interesting, and I was amazing by how much he was going through; I felt bad for him. I did vital signs and my part D and E with this patient, and built a therapeutic relationship with this individual. I completed my part D and E on my first patient, due to not knowing if other patients were going to cancel because of the snow, as well as I didn’t know what patients I could see because the NP, Tanya wasn’t in the office in the morning. At the end of the visit, the patient asked me if I would be coming back again. This made me feel good, because I knew listening and being there as support for this patient helped him. The rest of the day I followed the

I felt nervous because the patient was complaining of having a difficult time breathing, so I was afraid that he would stop breathing while I was taking care of him

During my Med-Surg clinical, I was assigned to a patient who was a 94 year female that had several medical conditions. The situation that ensued was difficulty communicating with her, since she did not speak English. Not only did the patient not speak English, but was only alert to herself, as well as extremely confused. As a result, being able to provide effective and quality care became a challenge. The reason for her admission was hyperkalemia, UTI, congestive heart failure (CHF) and acute renal failure (ARF). Unfortunately, the patient had other comorbidities that affected her well being such as diabetes mellitus, hypertension, atrial fibrillation, BPPV, CAD, s/p stent, DVT, CKD, stage 4 sacral decubitus ulcer, cholecystectomy, hip fracture and LE fasciotomy DVT.

Pulmonary embolism (PE) accounts for up to 30,000 deaths each year. (Beckman, 2014). It has been estimated that nearly one-third of deaths stemming from pulmonary embolism occur within the first hour. (Muckart, 2010). It can prove to be extremely difficult to diagnose pulmonary embolism due to the wide range of symptoms and presentations, or lack there of. (Muckart, 2010; Tarbox & Swaroop, 2013). Some patients with acute pulmonary embolism, possibly as many as 50%, are completely asymptomatic. (Muckart, 2010). Although the clinical presentation can vary dramatically, some of the main symptoms include tachycardia, sub-sternal chest pain, dyspnea, hypoxemia, hypotension and even possibly shock. (Tarbox & Swaroop, 2013). There are several risk factors attributed to PE, including but not limited to, recent immobilization, previous myocardial infarction or cerebral vascular accident, prior surgery or recent trauma. (Tarbox & Swaroop, 2013). Initial symptoms primarily present with severe respiratory distress, but the main adverse effects of PE effect the cardiovascular system due to the fact that the embolus causes an occlusion in the pulmonary vasculature. (Muckart, 2010). The obstruction within the pulmonary artery vastly increases vascular resistance, which results in right ventricular failure; therefore the left ventricular preload is minimized and cardiac output collapses. (Muckart, 2010).

I stayed close to the patient during this whole period, but I was not paying enough attention to her low oxygen level. The patient was a healthcare aid and she kept telling me that, “It’s ok, I am always a shallow breather”. However, I should have my own judgement ability and provide more competent care with timely evaluation of the effectiveness of the interventions.

The purpose of this journal is to reflect on my experience and skills gained during my clinical placement at Ben Taub Hospital. On my first clinical day, I was excited and nervous at the same time. My first placement was in the PREOP/PACU area. I was assigned to help a patient who had been in the PACU area going on 2 days. Normally, once the patient comes from surgery they are only in the PACU area for a short period of time before they are discharged home or given a bed in another area of the hospital. This particular patient still had not received an assignment for a bed. The physicians would make their rounds to come check on him daily. The patient was a 28-year-old Hispanic male, non-English speaking, he had a hemicolectomy. He had a NG tube, urinary Foley catheter, and a wound vac. My preceptor had just clocked in and she needed to check on the patient’s vitals and notes from the previous nurse. Once she introduced me to the patient and explained while I was there, she then asked me to check his vitals. (Vital signs indicate the body’s ability to regulate body temperature, maintain blood flow, and oxygenate body tissues. Vital signs are important indicators of a client’s overall health status (Hogan, 2014). I froze for a quick second. I have practiced taking vitals numerous of times and I knew I could do it correctly. I started with the temperature first, when I was quickly corrected on a major mistake I had made by my preceptor. I HAD FORGOT TO WASH MY HANDS and PUT

The set up was similar to my clinical routine. On entering the room, my teammates and I greeted her and asked her how she was doing. She was alert and oriented. She sounded exhausted. She was having generalized pain. I asked her if she was feeling short of breath she said “no.” She was already on 3L of oxygen through nasal cannula with an oxygen saturation of 93%. Her skin was warm to touch and her pulse bounding. She had crackles throughout her lung field. During my clinicals, I learned to link my patient’s assessment findings to her labs and orders. I also practiced using the SBAR to contact the physician. I attended an interdisciplinary round at the oncology unit where the team was planning palliative care for a patient. I noticed that the team was more directed towards pain management and therapeutic interventions. The team also made sure to include the family and the patient in the care. During the simulation, we contacted the doctor for an order of morphine.

During my first semester student clinical rotation, I was introduced to patient, 76 year old AB who was being treated at an assisted living facility. She was a wonderful patient and someone I immediately connected with. AB had been medically diagnosed with COPD and displayed all the classic physical signs of the disease such as wheezing, deliberate breathing, severe shortness of breath and nutritional deficit. She was my first patient as a student nurse and the first person I was able to complete a health assessment and nursing care plan for. I recognized early on that AB was special and someone who would be a great person to communicate with. With the initial assessment she was a little scared, but