Evaluation Of A Nursing For An Increased Intracranial Pressure New Admission

Nearing the end of my shift in the Emergency Department, I was requested to accompany a patient while the nurse readied the discharge papers. Upon entering the bay, I met a very small and fragile patient who was anxious to go home. Conflicted between my primary duties and responsibilities to complete training for two inexperienced volunteers, I decided to put forth my interests in teaching by demonstrating compassionate care to my trainees. Although the patient repeatedly refused my assistance, I gave my best effort to calm her as I cloaked a warm blanket around her. As I listened to her confide in me of all of her hospital anxieties, I was shocked from the lack of quality care she had received which made her feel more sick after the first

During my clinical rotation during my last semester of nursing school, I was able to work one on one with a BSN degree nurse named Judy in the ICU. Judy had three years of experience in the ICU setting. She had been a medical surgical nurse prior to her ICU transfer. The ICU at this hospital consisted of two associate degree level nurses and two BSN level nurses on my shift. I rotated three days in this particular ICU. I worked with Judy all three days of my rotation. I was excited about being placed with her for she seemed knowledgeable and skilled. We were given a male post trauma patient to work with all three days. This patient was a 30 year old male admitted for trauma related injuries and was considered unstable and was to be monitored in ICU. This patient had been involved in a motor vehicle accident and

Meanwhile, elsewhere in Habersham County, Tom was feeling slightly nervous as he exited the staff lounge and entered the hustle and bustle of County Hospital’s ER to begin his first shift as an RN. The first few hours of his shift passed slowly as Tom mostly checked vital signs and listened to patients complain about various aches, pains, coughs, and sniffles. He realized that the attending physician, Dr. Greene, who was rather “old school” in general about how he interacted with nursing staff, wanted to start him out slowly. Tom knew, though, that the paramedics could bring in a trauma patient at any time.

Additionally, the care environment developed a hazard when the patient population increased both in number and acuity with the admission of the acute respiratory distress patient and increasing patient load in the lobby without note of available back up staff being called in. Examples of errors from the flow chart comparison might include failure to assess and monitor when Nurse J initiates blood pressure and SpO2 measurements, fails to initiate ECG with respiration monitoring, fails to administer supplemental O2, and leaves the room without apparently noting the baseline of the patient2. Furthermore, there appears to be an error in the lack of communication collaboration between the RN and LPN regarding Mr. B’s post procedure status and monitoring needs, and there is a failure to rescue when the LPN notes the low SpO2 value, fails to respond, and instead re-initiates another blood pressure reading without noting the results. As Mr. B’s condition deteriorates and a code is called, an ACLS error is observed in the timeline when the patient is noted first to have absent pulse and respirations and that a monitor is next applied and the patient and displays ventricular fibrillation. Chest compressions appear to not have been the first action in this scenario, nor is end tidal CO2 monitoring noted as initiated to monitor the quality of compressions. These are examples of hazards and errors in the care of Mr. B and in an actual RCA the level of detail would likely turn up

We arrived at Clearview at 2231 Hrs. and took the patient to room 14. I went back outside and began to put our unit back together when Supervisor Carlock approached me and in a very agitated voice said: “WHY DID YOU PULL OFF?” Surprised, I said “What are you talking about?” He said loudly, “I TOLD YOU TO STOP AND YOU DIDN’T!” I replied, “Jeff was telling me not to stop because we had a pulse back.” He said “I DON’T CARE WHAT JEFF SAID, I’M YOUR SUPERVISOR AND I TOLD YOU TO STOP!” I said “Dennis, I think you’re talking to the wrong person, you need to be talking to Jeff, I was doing what he told me to do.” He replied “WHO’S YOUR SUPERVISOR, WHO’S YOUR SUPERVISOR, I AM, NOT JEFF, YOU DO WHAT I SAY!” I said ”yes, you are the supervisor, but at that moment I was doing what the Paramedic in charge of patient care was telling me to do, and what I felt was best for the Pt., since we had a 41 Y/O patient who had a pulse.” He said “I DON’T CARE, YOU DO WHAT I SAY!

a. Ask the family to stay in the waiting room until the initial assessment is completed.

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

Throughout most of the shift, my nurse preceptor and I were in the patient’s room either evaluating her and the fetus, performing exams, taking vital signs, administering medications and fluids, charting, or reading the fetal monitoring strips. We also kept in regular contact with the physician to keep him up to date on the patient’s status and to receive new orders. We also spent a lot of time talking to the patient, her mother, and her boyfriend. They were concerned for the status of the mother and the baby. We explained to them that both the mother and the baby’s heart rate was high and their goal was to decrease them both. In addition, my nurse preceptor explained how we were administering Tylenol and amoxicillin to reduce the fever and

At some point during the night Jenn was transferred from the emergency department and admitted to Butterworth’s cardiac intensive care unit in the Fred & Lena Meijer Heart Center. My dad refused to leave my sister’s side, staying with her night and day throughout her hospital stay. He fought with the doctors and nurses when they tried to tell him to go home and get some rest, stating that he felt he needed to be there. Overnight guests were strictly forbidden in the ICU, so they wouldn’t allow him a bed or a reclining chair. My dad slept on the cold hard floor next to Jenn’s bed, waking up for every person that came in the room. Having a conversation with the doctors or nurses every hour checking for status updates reporting any changes in Jenn’s condition that he had

The simulation exercise presented a complex situation when Charge Nurse Janice didn’t have enough nurses in her unit and the VP of Support Services called and her about the scheduled meeting. At the start of the shift, she responded unprofessionally to the situation by giving directions to the staff while on a personal call and reacting negatively to any patient update provided by the staff. Janice also created a bad impression to Elise, the new nurse, when she asked about her assignment. Janice addressed the patients’ names with the procedures they had. Knowing that there was a situational problem, Janice should have communicated properly and emphasized to the staff about teamwork to facilitate the workflow in the unit. Elise is new and inexperienced, but Janice could have utilized her help with basic tasks as long as she had been directed and coached properly.

Most weekend nights in the Intensive Care Unit are busy, but this particular Sunday night in July was more intense than any other. Working as a weekend night ICU manager, I do not normally care for patients one on one. I make rounds with each nurse on their patient on a nightly basis and oversee everything that is happening. I am also in charge of the staffing for my shift and the upcoming shift. On this specific night, we had one ICU bed available, but no staff on call. Every patient in the unit was a high acuity, therefore; the nurses were very busy, with no time to spare. The Emergency Department called with an admit that would be a one nurse to one patient ratio. I knew that our facility highly disliked turning patients away to

4:30 AM. I jump into my car and drive to Vital EMS in Worcester for a fourteen-hour shift as an EMT. Upon entering the ambulance, my partner and I are quickly dispatched to the residence of a 50-year-old male for an unknown medical complaint. As we rush to the scene with lights and sirens, my partner and I know that we must remain calm and immediately begin to allocate tasks. Upon arrival, I rush out of the ambulance and seize the first in bag, an oxygen tank, and the defibrillator. We head into the residence and encounter the patient who complains of chest pain and presented with inadequate oxygen saturation. I immediately realize that

This morning I am working 7a.m.-7p.m., on a really active Orthopedic Medical/Surgical unit in the hospital. I am assigned 7 patients today. I am of speaking on the phone to a physician about his client who has a history of Myocardial Infarction, Hypertension, and Hypercholesterolemia. The client’s vital signs had become unstable and he coded 10 minutes ago. I concluded with the physician that I called the Rapid Response Team, and that they are currently responding to his client. The physician has indicated that he would be in as soon as he can. I hung the phone up, and heard a loud distinct thump sound. I truly believe most nurses who have unfortunately heard that thump sound, definitely knows that sound is from a patient who has fallen

During my clinical experience, I encountered an unforgettable situation which holds significance to me as a nursing student. My patient had an intracerebral hemorrhage, subarachnoid hemorrhage, as well as dementia. As a result of her conditions, she was a two- person assist. While researching my patient’s health conditions the night before clinical, I became concerned about how I was going to take care of my patient due to the anticipated immobility. When I first met my patient, I began to feel apprehensive because I realized that it was a patient who I had seen on the unit two weeks ago. This patient was groaning and crying at night, disturbing other patients who were trying to sleep. Due to her restlessness, the nurses moved the patient to the nursing station every night and then moved her back into her room in the morning. Looking at

My patient was a 29-year-old female who was 34 weeks pregnant and brought in by EMS for a drug overdose. She had been found down outside of an apartment building with various needles, legal and illegal drugs. There was not much report from the EMS, just that she had a high heart rate in the 110s and noncompliant with questioning. After hearing that I would be receiving this patient, I honestly was angry. Frist, because of that innocent baby that she was surly about to have. Second, was fear because I had no clue where to go with this situation. There was much discussion with the other staff as to the safety of this patient coming to the ED because of how far long she was. However, she was stable from the labor and delivery aspect and was bound to our unit.