Physical Examination And Management For Patients With Multiple Comorbidities And Medication Management

I after receiving report the Rn and I went to the morning huddle or team meeting. The morning huddle includes MD’s, social workers, case manager, charge nurse/ DON and chaplain. In this meeting the Rn gives report for all her patients to the interdisciplinary team, and they together identify patients who are making progress in managing their pain or tolerating their symptoms, and they have to be re-evaluated for the need of hospice care and patients who are actively dying or who need to have their meds change.

My clinical duties performed this shift involved practicing time management and reporting skills. That morning, I was responsible for getting a detailed hand off report of the three patients during our walking rounds. I then went on the computer charting system to acquaint myself with the three patients and get organized with my plan of care for the day. This also involved reviewing the laboratory results and active physician orders for all patients. For the active physician

Interacted with patients in a group setting to observe behaviors and took notes accurately in orders to communicate their status to the medical specialists so recommended treatments and adjustments can be implemented.

The rotations through the hospital entities and the integration into the daily activities of management will provide countless learning opportunities and exposure to various types of leadership and management skills and form a strong mentor relationship. It will provide an opportunity to gain a comprehensive, high-level view of the entire organization while simultaneously gaining in-depth understanding and experience in specific areas of most interest. Having the

As a result of my versatile work experience, as well as my community and organizational involvement, I have learned the importance of being a team player in order to perform effectively and efficiency. Having exposure to multiple clinical rotations in variable institutional settings has enhanced my time management skills, multi-tasking ability, and effective communication to both diverse patient populations and fellow practitioners. These qualities, along with my genuine enthusiasm and empathetic passion to help others, will allow me to become an integral component to your residency team.

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.

My perceptions have changed dramatically since the Clinical 1 rotation. I have noticed that the minute I walk into my patient’s room, I start to collect data. I notice if they are breathing normal, what their skin looks like, what their cognition level is, and what equipment they have in their room. I have started to connect the “puzzle pieces” of the patient’s health, rather than just feeling like I have a bunch of random information. My perception of people has continued to stay the same from Clinical 1. I continue to have an interest in learning about patients and believe that they also have something to teach us. I have learned so much from the patients and it is fun for me to get to know different

The second week of my preceptorship brought many new experiences for me, and I can honestly say that each day I spend with my preceptor is better than the last. This week I focused on time management of a full patient load with continued documentation practice as well as admission and discharge procedures. I’ve had brief experiences in my past rotations assisting with discharge teaching and admission assessments however I have never been able to fully take charge and complete the process from start to finish, so this was a great learning opportunity for me.

Outpatient would be a patient who is having a day procedure such as ovarian cyst

The nurse on fifth surgical west stayed very busy throughout the day. When she comes on shift her day consists of beside report. Where they are at the patient’s bedside giving report. It is to ensure everything that is said is accurate and nothing is left out. How she prioritizes her day depends on the patient’s needs. It is difficult to know what will happen that day because patient’s can be discharged and admitted. The nurse prioritizes her patients by looking at the reason they are being treated. If everyone is doing ok then she goes by what medications are due. This is to reduce the risk of late medications. She also is aware of the patient’s pain level. She mentioned if the patient is in pain or uncomfortable then

Provides follow-up with patient/family when patient transitions from one setting to another. Completes timely post-hospital follow-up: Medication reconciliation, PCP or specialist follow-up appointment, assess symptoms, teach warning signs, review discharge instructions, coordination of care, and problem solve barriers.

I did an observership in the Cardiology Department at Veterans Affairs North Texas Health Care System, Dallas, TX. My duties were rounding with the Cardiology Consult team seeing 6-10 patients a day along with seeing patients in the Cardiology clinics on alternating days. I assisted in history taking and involved in the discussion of management of patients.Also, I observed patients undergoing stress echo cardio cardiographic tests as well as coronary angiographies and angioplasties for underlying Coronary Artery Disease.

This Friday, September 29th, I had my second clinical observation experience in the Cardiac Cath Lab. I was there from 7:00 a.m. till noon, viewing the flow and duties of the nursing staff on the unit, learning about the procedures done on this specialized unit. Throughout most of the morning I followed Sara, an RN, who had been in the unit for eight years. It was an impressive experience that broadened my previously limited knowledge of the roles and experience of a Cath Lab nurse.

This Friday, September 15th, I had my clinical observation experience in the ED. I was there from 7:00 am till noon, viewing the flow and duties of the nursing staff on the unit, as well as practicing the skills I have thus learned in school. Throughout most of the morning, I followed Jessica, who had been a nurse in the ER for ten years. It was an insightful experience that broadened my previously limited knowledge of the roles and experience of an emergency nurse.

Independent, hardworking, eager to learn and a team player, inspire to explore the Internal Medicine field in a friendly and a supportive environment where Faculty, residents, and Staffs work as a team, while challenging myself and improving the quality of patient care through best practice as well as excellent patient education, thus contributing to strengthening your residency program.