Patient Observation

The patient is a 72-year-old female who arrived to the emergency department in cardiac arrest. Emergency medical services reports the patient was last seen eating breakfast at her nursing home and was found an hour later face down and unresponsive. After it was determined the patient was in asystole, an intravenous catheter was started and two rounds of Epinephrine was administered. Upon arrival to the emergency department the patient had pulseless electrical activity with sinus tachycardia on the monitor. Airway management was in process with a bag valve mask on 100% oxygen and chest compressions in progress. After intubation and stabilization the

This clinical rotation I was assigned to observe at the operating room, where they conduct various surgical procedures. The night prior to the clinical, I have to admit, was every bit unnerving. Especially, the fear of not knowing what to expect was daunting. There must have been a thousand scenario of what to expect or what might possibly go wrong playing through my head that night. However, after being introduced to the nurse I would be following, and meeting the surgeon and the rest of the team; my nerves settled down. The surgery scheduled was for a ventral hernia, which seemed routine, but complicated by a previous bowel realignment previously. The whole operation, from beginning to end, lasted a little over four hours. Although, the procedure lasted that long, it did not bother me even bit. In spite of standing for the whole duration of the observation, I never felt tired nor gotten bored. Notably, watching the surgical team working cohesively is like watching an artists who have

Vital observations were carried out efficiently, they were recorded every 15 minutes and a cardiac monitor was attached to continuously monitor for any deterioration. As a student nurse I assisted by recording vital observations using NEWS and assessing consciousness by using the Glasgow coma scale to ensure there were no signs of brain trauma (Le Roux, Levine and Kofke, 2013). In line with the NMC, my mentor supervised and countersigned my observations (NMC, 2011b). I promoted good patient safety as deterioration would be recognised early and appropriate care provided. Throughout the treatment process I witnessed and provided person centred care. Nursing and medical staff continuously checked patient comfort and obtained consent for treatment being provided.

Within this case study I am going to use two of the Chapelhow et al. (2005) enablers to discuss and reflect on the care of a patient I have been involved with on placement over a period of 5 weeks. ‘Enablers are the essential and underpinning skills that come together to provide expert professional practice’ (Chapelhow, C et al. 2005, p.2). These include; assessment, communication, documentation, risk, professional decision making and managing uncertainty. The enablers work together to provide a holistic approach to the care of patients in health care settings. I am going to focus on and discuss two of the enablers, linking them both together, which will be assessment and communication as I believe these two enablers can be related most to my patient.

The patient is a 12 year old female who presented to the ED with thoughts of self harm and cutting behaviors. The patient denies suicidal ideation, homicidal ideation, and symptoms of psychosis. The patient reports that she has been sad lately. Per- documentation the patient reports to peers at her school that she was trying to kill herself, which the school sent her to DayMark. Further, Daymak IVC the patient and requested further evaluation.

by Nurse J. After five minutes, the diazepam had no effect so Dr.T ordered two milligrams of hydromorphone IVP given at 4:15 in the afternoon. The patient received another two milligrams of hydromorphone IVP and five milligrams diazepam IVP at 4:20 p.m. because Dr.T was not satisfied with the patient’s level of sedation. When the patient appeared to be sedated at 4:25 in the afternoon, the reduction of his left hip took place. At 4:35 p.m., Mr. B’s BP is 110/62 and his oxygen saturation is 92%. The “conscious sedation” policy was not followed. He did not have supplemental oxygen and his ECG and RR were not monitored. Then, Mr.B’s oxygen saturation dropped to 85%. The LPN adjusted the alarm and repeated the BP reading. Nurse J and the LPN were very busy taking care of the other patients during this time. At 4:43 p.m., Mr. B was not breathing, had no pulse, BP is 58/30 and oxygen saturation is 79%. The stat code was called.

The patient did have black soot around his nose and mouth. Thats when first responders started manual ventilation's via BVM and 02 at 15 LPM. At this time Medic 1 assumed patient care. Medic 1 assigned first responders to obtaining vitals signs that are stated in the vital section of the report. It was at this time that Medic 1 applied a OPA after first measuring on what size to use. First responders also applied fast patches to the patients right upper chest and left midaxillary line At this time Medic 1 assigned first responders to start chest compressions a 15:2 ratio. Medic 1 at this time started a IO in the patients plateau region of the right leg. The Plateau region is inferior and lateral to the knee cap. At this time Normal Saline bolus was started with a 60 drop per ML set. Medic 1 found the patient to be in a sinus rhythm At this time miscommunication with Medic 1 and first responders happen with chest comparisons started. We then secured the patient on the cot via 4 straps and transported a code red patient to the nearest hospital. While enroute to hospital radio report was given with chief compliant and treatments listed in the appropriate category of the report. Vitals was continued to be taken every 5

In the previous assignment I mentioned that I had reached out to numerous healthcare professionals, but I was awaiting a response. In the meantime, I ended up shadowing my mother who is a registered nurse. After shadowing my mother, I discovered that I did not see myself as a visiting nurse. Luckily, I have another individual who is not only involved in the healthcare profession, but also extremely close to home. My neighbor, Janet, so happens to be a physical therapist and she happily allowed me to shadow her over this past month. Similar to my mother, Janet turned to working as a part-time physical therapist when she had children. She explained that most physical therapists work full-time, but the home health agency VNA Care employs numerous

B required as his health deteriorated. The LPN, however, made the error of not notifying the staff of Mr. B’s condition. She again, made the error of simply silencing the patient’s alarms and walking away. Furthermore, according to policy, Mr. B was to be provided supplemental oxygen and continuously monitored, including the use of ECG, throughout the recovery period, for which he did not have. These numerous hazards and errors eventually led to a code situation and ultimately the death of Mr. B. This death, as it turns out, was a result of a simple medication error for which the team must now implement a change to prevent similar errors from occurring again in the future.

Patient 1: The patient had a stroke and was unresponsive. I am on alert for a DVT due to the patient not being able to move or receive anticoagulants. Also, I was monitoring for signs of infection, respiratory changes, and the skin for pressure sores.

assess Mr. B’s respiratory states while Nurse J. and Dr. T finished the sedation and reduction

On Sunday January 10, 2016 at around 2316 hours, Security Officer Omar Alonso was contacted by E.D. Patient Registration employee, Ariel Ulanoff in regards of a male sitting at the left corner of the E.D. lobby who was making her feel unsafe because he was hitting himself in the head and face and also cursing. The Officer went to investigate and approached the male and asked if something was wrong and if he needed to get some medical attention. The male, whose name he later stated was Miguel Sanabria, said that he was just resting and that he did not need any help. The male appeared to be under the influence of some type of narcotic because he was sweating profusely and very fidgety but he was not aggressive or disrespectful towards staff or Security.

As some residents would be starting their four weeks Comer OR rotation for the first time at the beginning of the month, Please remind the new anesthesia Residents to return only narcotics to the after-hour box and to leave other medications in the anesthesia workroom or on their carts.

At my time in the facility, only good observations were made, all the teachers and assistant acted professionally and seemed to know what they were doing. There is not much to say in regards to how to improve, but maybe devoting more time to the infants individually could help to further the relationships with each infant. As far as the three R’s go, the one that was most observed, reciprocal care was dealt with respect followed by respectful care and ending with responsive care, however the responsive care provided was very good in terms of showing an example of the care. In my own practice I now know that I should tell infants what I am doing as I am doing it in hopes of experiencing responsive care, I should give them options to choose from

A twist on the "patient's perspective" approach is to describe a time when medicine failed to save or heal someone close to you. The purpose of this tactic would not of course be to rail against the medical profession, but rather to show how a disappointing loss inspired you to join the struggle against disease and sickness.