Ir Reflection

Type up notes on reflection after a lesson, (log these as daily entries like a paper journal/diary) in

The result of this was detrimental to the patient. Once the nurse from my unit went in to assess the patient she observed that the patient had a severely infiltrated IV, leaving her arm swollen beyond belief. Her vitals also revealed that she was hypotensive, febrile and in respiratory distress unstable and rapidly becoming septic. Thankfully interventions were taken just in time and the patient ended up being transferred to the ICU where she received the care needed to save her life. Just imagine what the outcome could have potentially been for this patient. Clearly this patient’s life was put at risk due to others carelessness and inability to follow rules and guidelines. Talk about conflict!

However, there are additional guidelines in terms of assessing the patient for prolonged catheter use. There should be frequent assessment and evaluation of the patient’s need for continued use. It is important to note that in addition to determining the patient’s need for catheterization, prior to insertion the nurse should also complete the following:

Only when it is absolutely necessary should a catheter be inserted into a patient. Every patient is assessed for the need for a Foley catheter. If the Foley is inserted, assessments are also then done daily to see if the need is still valid. If the reason is not justifiable the catheter must be removed from the patient (Joint Commission releases new NPSG for CAUTI, 2011). Nurses must follow guidelines while inserting indwelling catheters as well. Aseptic technique is critical to maintain during this process. The use of sterile equipment and a sterile procedure helps to reduce the risk of CAUTI. If in any way the catheter becomes contaminated during the process of insertion, the nurse should discard of the entire catheter and start with a new, sterile kit. Proper hand hygiene is very important before and after contact with indwelling catheters to decrease risk of infection. Maintenance of a close drainage is system is also important that way bacteria are not able to get in and cause infection (Revello & Gallo, 2013). Decreasing the number of times Foleys are inserted and how long they stay in for can help reduce the risk of CAUTI since the longer a Foley stays in, the higher the risk of infection becomes. Nurses must keep the catheter line patent, with no kinks to allow urine to flow freely through into the collection bag. When a urine sample must be obtained it must be done in a sterile

What should the nurse suspect when hourly assessment of urine output on a postcraniotomy patient exhibits a urine output from a catheter of 1,500 mL for 2 consecutive hours?

Until recently it was not uncommon for patients admitted to an acute care facility to have an indwelling catheter anchored for unnecessary reasons. Patients that came in thru the emergency department typically were sent to the units with unnecessary indwelling catheters in place and it was not unusual for a surgery patient to have an indwelling catheter anchored before or during a procedure. Once a patient was admitted and was transported to the units nursing would also anchor indwelling catheters for multiple unnecessary reasons. These Catheters could be

According to FindLaw (2008), Ellen H. Finnerty, a registered nurse is requesting the Board of Nursing in Texas to set aside the judgment where she was disciplined for gross negligence and incompetence. The board’s decision came after an incident where Finnerty chose not to comply with a physician’s order to intubate a patient before said patient was transferred to the ICU. In August 2002, Finnerty was working at Huntington Memorial Hospital as a charge nurse. A nurse (A. Magi) that was caring for patient(J.C.) begin to display symptoms of respiratory distress, such as rapid and labored respirations of 40 and an oxygen saturation of only 70%. With the assistance of a respiratory therapist, the patient was suctioned and Nurse Magi received orders from the primary care physician for 100% oxygen via a nonrebreather mask with the oxygen saturation to be maintained above 94%, several different blood test, for the administration of a diuretic. After the orders were performed and the patient was continually monitored, there were no changes to the respiratory rate. Another call was placed to the PCP, there was an order given for the patient to be transferred to the ICU and stat intubation. These orders were relayed to Finnerty, who then assessed the patient, but did not disclose her findings with the medical staff. Lab results indicated that insuffient blood oxygenation and acidosis. The

She immediately started to worry and stated “What excuse can I give you so you leave me alone?” I responded that we just needed to get ready for the day and we did not even need to call it therapy. Once she sat up she started hyperventilating. My supervisor was in the room at the time and said this was exactly what would happen the last time she stayed in the TCU. After 45 minutes, lots of encouragement, rest breaks and maximum assistance we finally got her dressed and situated in her recliner. While I was documenting the patient was talking to the nurse about how she did not want to have therapy anymore. The nurse responded to the patient and asked her why she was in the TCU if she did not want therapy. In the same week, this patient declined therapy all together and both physical therapy and occupational therapy had to discharge

The next step will focus on educating the unit’s staff. Employees that place an indwelling catheter will be required to go through a refresher course on proper insertion technique, indications for catheterization, and catheter care. Additionally, there will be a class on the new flow sheet created to track indwelling catheters (Andreessen et al., 2012). Posters with information pertaining to catheter care, CAUTI prevention, the new charting system, and alternative bladder management systems will be placed in highly visible areas such as break

The patient will require surgery to repair the hole in the intestines, and subsequently will have a drainage tube, NG tube, and feeding tube. All drains will need to monitored for placement/movement, and drainage. Input and output will be closely monitored and recorded. The patient will remain on NPO, or nothing by mouth, to rest the bowels along with frequent assessments to monitor for infection and bleeding. The nurse will need to monitor for bowel sounds, vital sign changes, temperature changes, pain, abdomen girth, and wound/incision inspections. The following labs will require monitoring: CBC, H&H, albumin, BUN & creatinine, glucose, and ABG’s and lactic acid if sepsis is suspected. Careful and frequent monitoring of labs will alert the nurse if the patient develops sepsis, or hypovolemia due to excessive bleeding (Belinhof, et al., 2012). In addition to vital signs and labs, the nurse will also include patient assessment into consideration before drawing conclusions by means of critical thinking. After the full assessment has been made, the nurse will report any findings to the health care provider that require further investigation or

The CNO then provided time for anyone who wished to bring new ideas for discussion. The CMO, named Dr. M. for anonymity, inquired about the risk of infection secondary to retrograde urinary flow during patient transportation. The research members offered to perform a literature review, and the CNO provided a completion deadline. Amy, used for anonymity, from the emergency department described her observations of first-year resident physicians inserting indwelling urinary catheters. She noted a lack of documented competency regarding residents inserting urinary catheters. Dr. M.’s body language appeared defensive with folded his arms, and he made a minimalizing remark about how physicians are not the cause for CAUTIs. Another nurse rebuked the comment, and Dr. M. agreed to add a competency assessment during the residents’ orientation. The CNO commended Amy for bringing her observations to the team’s attention. Before this meeting, patients were at risk of harm and infection as physicians were inserting catheters without proper documented competency. Now that Amy spoke up, the facility will ensure all who insert indwelling catheters will have proof of

This semester I learned a lot about writing in English 151. It has been a roller coaster ride with these essays for me this semester. I learned step by step how to write a good essay and how to have your readers be engaged in what you’re trying to tell them. Each essay I did has taught me something valuable I can take to the next level of English. I feel as if as the semester went by I did not take my writing that seriously and that reflected in my grades I received in each essay. It made me a better student and writer and it will reflect next semester. In this essay, I will reflect on what I learned throughout this semester that you should apply in your writing when you begin English 151.

site every couple of days lessens the associated risks of the catheter. One study, as reported by MEDSURG Nursing (2016), placed 755 patients into two groups. One group was the control which had the routine rotation every 72 hours. The other group was the experimental group that only had their I.V. changed when clinically indicated. Both groups had similar results. The control group has 60 per 1,000 device days, compared to the test groups 61 per 1,000 device days. This outcome shows that there is no statistic significance between either group (p. 45). The evidence stated by Worldviews on Evidence-Based Nursing also backs the results found by MEDSURG Nursing. Morrison and Holt (2015), researched studies and found that in a nonblind randomized control test, focused on phlebitis and infiltration rates, 33% participants in the control group and 38% in the test group had to have their catheter removed because of phlebitis and infiltration (p. 190). Both of these studies and many others all come to the same conclusion that changing the catheter does not greatly affect the outcome of I.V. associated risks. Not only is this practice unnecessary it also causes a rise in healthcare

The part of care that I found the hardest was patient teaching. Every time the patient looked down she would see the tubes. She asked what they were for and I explained that they were to help with feeding until her throat felt better and to collect her urine. This was difficult for her because she did not remember getting a surgery. She would look at the tubes for a while and then say she needed to pee. I would then explain to her that the bag was collecting her urine and she didn’t have to worry about going to the bathroom. The feeling she had was just the pressure from the catheter. The cycle of her asking what the tubes were and saying she needed to use the restroom went on for a while. I

During the home health observation day, there were several opportunities to observe a variety of patients with varying levels of functioning ability, different illnesses, and different needs and levels of interaction with the nurse. The first patient seen was a seventy-three year old Caucasian female with an ulcer on her right heel. Several weeks prior, she had scratched her left leg and she also had several small wounds on her left leg. The orders were to clean and redress the ulcer. She has a history of end stage renal disease, pneumonia, weakness, diabetes, dialysis, and right hip fracture. Upon entering the home, the patient was found to be sitting in a wheel chair in the living room watching television with her husband close by her side. She greeted the nurse with a smile and began to update her on her current condition. Her heel was “hurting” and she rated her pain an 8 on a scale of 1 to 10. She also had some “swelling” that she could not “get to go away; because, she could not get up and walk. They need to fix my foot so that I can get up and get around.” She told the nurse that she had been to see the doctor “yesterday” and the doctor had given her a written order that she wanted her to see. The order was written for an evaluation for a soft pressure shoe fitting. The nurse read the order to