Recounters Medical Center Journal Report

For my seventh clinical shift at the Loma Linda Veterans Affairs Medical Center, my assigned preceptor Filipina Gumangan assigned me three patients on the 4NW unit. The unit where I precept is an intensive care step down unit. Filipina’s objective for giving me three patients this shift was to give me an opportunity to continue exercising my time management skills and to practice my reporting and charting skills, and wound care. This shift I was responsible for many clinical duties corresponding to the care of these patients. My patients this shift were Mr. B, a 72 year-old Vietnam War veteran newly diagnosed with colon cancer, Mr. S, a 65 year-old Vietnam War veteran in the hospital for complicated urinary tract infection, Mr. R, a 90 year-old Korean and Vietnam War veteran. Caring for these patients taught me more about the humanbecoming perspective of nursing and showed me about multidisciplinary coordination with peers, colleagues, and more.

I was really proud of myself yesterday. I finally got the chance to get practice using IV pumps. I have been wanting to get practice with them for a long time, but never had the opportunity to. I was definitely nervous about it because I’ve never used the IV pumps, and I had no idea of what to expect. I think I did well with them pumps, and I think I didn’t show my nervousness. This week I do believe I made some improvements in areas where I needed to improve in. This week when my patient received a new medication, I was on top of getting the medication administered. The last time I was in Newberry I did not make my patients new order a priority like I should have. I am learning how to receive information from my nurse and determine its prority.

* Personnel Issues: One of the key barriers to effective interaction for the pre-op nurses is that they are not getting any information from the registrar or the surgeon related to the patients unique circumstances. There is not a communication process in place for the pre-op nurse to actively communicate with the surgeon or his office regarding a patient’s care during their day of surgery. An additional factor in this situation was the pre-op nurse documented the mother’s contact information in her notepad, but not on the

On my second day of clinical experience this week I focused a lot on time management and documentation for a full patient load, and also on the admission and discharge process. After taking report on all three of our patients, I began my initial morning assessments. It was clear that our 8-year-old post-operative appendectomy was ready to be discharged. My priorities were assessing her incision sites and ensuring the presence of bowel sounds, as well as making sure she did not have a fever and was tolerating a general diet. After completing my assessment and documenting in the computer, we

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I was looking forward to this clinical as I was getting used to the environment. I worked with two patients. One of my patient was a 70-year-old male who came in with vomiting and diarrhea. They wanted to put him on C diff precaution, but they isolated him, as they are still growing stool cultures. What I have learned during this clinical was to check the last vital signs and accucheck first thing in the morning. This would help me prioritize my task for the patient. I went into the patient’s room and I did an assessment him. I had a positive interaction with the patient. He says he was improving ever since his admission. The nurse came in and stated that the doctors switched his diet to clear liquid. Therefore, I gave him jello and apple juice from the fridge. He had a bowel movement later, which was diarrhea. Then, I was concerned about his fluid and electrolytes. Therefore, I let the nurse know that he had a bowel movement that was watery. He also had lactate ringers IV attached to him. Therefore, when he was trying to go to the bathroom, I had to make sure he does not trip because of it. The doctor came later to check on the patient, and told him that he will soon be discharged. Nevertheless, they are still growing stool cultures because it takes a few days for it to

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The assigned nurse explained to the patient about pain management/ pain scale after surgery and how he will be waking up in the Intensive Care Unit where he was going to have chest tubes to remove the extra fluid from the chest cavity; he confirmed understanding and was ready to move on with the procedure.

Communication within the surgical team was extremely efficient. Everyone was very informative with one another, which helped the procedures move smoothly and effectively. All surgical procedures began with verification of the patient, surgical procedure, and surgical site. Although, in the article, “Why a RN in the OR?” explained that every member of the surgical team performed the verification individually, in this case, the circulating nurse simply read aloud the patient’s information along with stating the surgical procedure and site. Moreover, throughout a majority of the procedure, most of the communication consisted of the surgeon and the surgical technicians. The surgeon was mainly the individual to give commands and was very explicit in explaining what he was doing and what he was about to do in order for the surgical technicians to be prepared to hand him what he needed. Furthermore, as in the article described, the circulating nurse monitored aseptic practices and informed the surgical technicians to place objects that were no longer sterile in a specific bin. There was also a Certified Registered Nurse Anesthetist (CRNA), that monitored the patients’ vitals throughout the entire procedure and periodically gave the rest of the surgical team updates regarding the patient’s condition. Specifically, during an inguinal hernia repair, the patient began to cough during the procedure; however, the CRNA wasn’t able to witness it since he was behind

As I continue to read on about the surgery, I learned that there was “no anesthesia, no endotracheal airway, no surgical light (patient sitting upright and surgeon crouching to look up at the palate, his light source a window at his back), no aseptic technique, no suction, no epinephrine, no Dingman, no IVs,” and it was easily detailed enough that I could feel and see how Dr. Roux and Stephenson was

At first, the surgery seemed to be successful. But several hours later, the patient’s condition began to deteriorate, and it continued to worsen over the next few days.

I did not come in early to watch the set up of the unit for this appointment because I arrived an hour early in my last observation, and I feel pretty comfortable setting up and wiping down the unit. The student reviewed everything in the patient’s chart even though this was her fourth appointment with him. The treatment area, the maxillary left quadrant, needed local anesthetic before progressing forward with the procedure. She got a short needle ready for an injection to check off on an actual

I thought that today would be slow and boring because both doctor’s were out of the office. Turns out that I was wrong! There were only three people in the office today and that was me, one nurse, and the receptionist. One patient in particular absolutely could not go another day with a stent in her due to the severe pain that she was experiencing. Therefore; the nurse had to communicate back and forth with the doctor over the phone for him to give the order to pull the stent out. Although she was given the go ahead to remove the stent, she could not go out of her scope of practice in order to do the procedure. If there is a string that is visible, which in this case it was, a nurse can pull the stent out. I assisted with the procedure, held

Maintaining the sterile field requires constant vigilance from everyone on the surgical team — the circulator, the scrub person, the surgeon, the assistants, the anesthesiologist — everybody that is involved in that patient’s care needs to maintain constant vigilance and they need to function as a team in order to maintain it. Anybody who knows that a break in technique occurred should be able and feel perfectly free to point it out so that correction can be made immediately.

On June 21, 2017, I experienced a once in a lifetime event at Doctors Hospital by observing a thyroid lobectomy. I meet the surgical nurse Jennifer, who then took me to the girls’ locker room to change into new scrubs. Everyone who enters the operating room is required to wear new scrubs that the hospital provides to prevent the spread of bacteria. At this point, I started to get butterflies; I noticed my pulse started to rise and my breathing accelerated as I stepped into the area considered the “clean zone”. The “clean zone” is beyond a red line where everything has to be sterile, including wearing a mask, hair net, and booties. Walking down the hall toward the operating room, the nurse Jennifer explained to me the guidelines for entering. The scrub station is located outside of the operating room for everyone who enters. The most significant guideline she stressed was to not touch anything blue. The surgeons and the scrub nurse were dressed in blue alongside which stood a table and a tray containing a blue drape that held the surgical instruments. As we step into the operating room, I realize how meaningful it is to meet the crew, learn their method of working together, and to observe the patient’s recovery and progress.