San Bernardino Emergency Room Observation 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.

Pulling off the ramp, we turned onto Church Hill Road responding on a priority one for the cardiac arrest. I tried to review my field guide en-route to the call, but all I could see were flashing lights reflecting off the guide’s pages and crowds of cars moving over for our wailing sirens. Within three minutes we had arrived on-scene and it was clear that our patient was not in cardiac arrest; however, his 12-Lead EKG and oxygen saturation were marginally reassuring and pointed to an active heart attack. At this point in my EMS training I was a BLS provider, but had adequate knowledge to assist Kathy. Instinctively, I went right to work and loved every second of it. The concept of formulating a differential diagnosis in the field and testing that theory is one of the principle factors that kept drawing my back to EMS. In addition, I developed an unparalleled appetite for knowledge, stemming from my desire to get every differential diagnoses right. Coming to this realization early in my EMS career, we [healthcare providers] frequently forget that patients often lack the medical knowledge provided to us through years of training. Behind CT Scans and MRIs are patients with questions. Having the ability to provide compassion, sympathy and reassurance to a patient is a central part to their recovery and survival; therefore, we [healthcare providers] need to be able to care for our patients on a holistic level, focusing less on the disease and more on the

Minutes have passed and to my surprise, after shocking the patient multiple times, we had return of spontaneous circulation. A sense of excitement, and relief, poured over me. From my past experiences, I assumed that there was a small probability that this man would live; however, that day I learned that every patient is different. As a Physician Assistant (PA) I want to consider the entire combination of factors that make each person unique, analyzing all aspects of their life – physically and emotionally. Ultimately, this experience motivated me to channel all of my energy towards pursuing a career as a PA.

In September 2015, I had an opportunity to join the team of volunteers of the Inspira Medical Center in Woodbury. I joined the Emergency Department. My shifts were once a week for three to six hours. I had a chance to interact with patients, mostly to help ease their anxiety and fear. This experience was valuable because it allowed me not just to observe, but also to look at healthcare from the perspective of a patient. I realized that I did not have to be a licensed practitioner to understand patients’ concerns and fears. I also realized that any effort on my part to help ease such worries would go a long way towards helping the patient feel more secure in themselves and their

In this environment, I thrived. I adored the patients I encountered here and was fascinated by listening to the nurses speak. They spoke to each other fast, in their own obscure language. “Is patient x’s blood pressure

“Hey there” John looked over his shoulder at the smiling face of his new coworker. John greeted him as hallway smiled back not wanting to talk since he had woken up at 5:00am that morning. He quickly dashed over to his office and switched on his computer. He thought about the nine years of intensive study that he had to go through. The loud ringing of his pager interrupted his thoughts. He answered a few nurses difficult questions about what medicines to prescribe what to do with a few difficult patients. He placed his phone down a little nervous wondering if he had just killed someone by prescribing the wrong medicine. He grabbed his clipboard, jacket and stethoscope and went to go meet his first patient. “Mrs. Anderson, how are

I stepped behind the front desk of Spirit Medical Center’s emergency room to begin the night shift of April 23, 2002. Half of the rooms were already filled and my coworkers busied themselves moving throughout the sterile halls. If it weren’t for my pager calling me and two other nurses to take on a patient that would be arriving shortly in an ambulance, I would have been a part of the rush. Meanwhile, I observed the friends and families that occupied the uncomfortable wooden chairs in the waiting room. The majority of them wore a somber expression on their faces, but there were the few that had tears streaming down their cheeks uncontrollably as they took advantage of the conveniently located tissue boxes. My observations were soon distracted by the sound of approaching sirens.

This is my ninth clinical shift with my preceptor at Saunders Medical Center in Wahoo, NE, and it was on May 15, 2018 (Wednesday). Today I had the chance to work back in the OR. I had the choice to stay after my shift to place an IV in a treatment room patient, so I did as well. My duties were to place IV’s, gather report, preoperative care, a little bit of postoperative care, and helping clean up the OR after surgery. The patient census included: K. S. a 51-year-old female scheduled for a laparoscopic cholecystectomy with intraoperative cholangiogram; and T. M. a 30-year-old male scheduled for excision sebaceous cysts x2 scalp with full thickness skin graft from left neck donor site. Plus, one IV on a treatment patient, which I don’t have the information for this patient because I was only going in to place the IV. It was an eventful day and I learned how to work under pressure when things can turn for the worse in OR; it was a learning experience and I’m forever grateful! My shift started

The purpose of this journal is to reflect on my experience and skills gained during my clinical placement at Ben Taub Hospital. On my first clinical day, I was excited and nervous at the same time. My first placement was in the PREOP/PACU area. I was assigned to help a patient who had been in the PACU area going on 2 days. Normally, once the patient comes from surgery they are only in the PACU area for a short period of time before they are discharged home or given a bed in another area of the hospital. This particular patient still had not received an assignment for a bed. The physicians would make their rounds to come check on him daily. The patient was a 28-year-old Hispanic male, non-English speaking, he had a hemicolectomy. He had a NG tube, urinary Foley catheter, and a wound vac. My preceptor had just clocked in and she needed to check on the patient’s vitals and notes from the previous nurse. Once she introduced me to the patient and explained while I was there, she then asked me to check his vitals. (Vital signs indicate the body’s ability to regulate body temperature, maintain blood flow, and oxygenate body tissues. Vital signs are important indicators of a client’s overall health status (Hogan, 2014). I froze for a quick second. I have practiced taking vitals numerous of times and I knew I could do it correctly. I started with the temperature first, when I was quickly corrected on a major mistake I had made by my preceptor. I HAD FORGOT TO WASH MY HANDS and PUT

This was my last day in the hospital I dedicated to observe the skills and procedures performed in the emergency room after the doctor evaluates and places medical orders. I could evaluate the electronic medical orders, preparation of medicines, the use of pixie for dispensing the necessary drugs necessary for dispensing pixie and control them. I was in the guidance given by the nurse to the patient prior treatment, patient identification, how the EHR is used, also observe the canalization, blood test, the placement of cardiac monitor and oxygen mask. How patients are placed according to their condition whether in the general observation area, in cardiac, CPR or OB /

On a warm day in late spring, Dr. Doe stepped into his resident hospital ready to face the long hard day of administering anesthetics. His first patient, Mrs. Butterworth, is scheduled for surgery at 10:00 a.m. With the spare time, Dr. Doe decided to look over that days patient charts one more time to try to get to know his patients just a little better before administering potentially lethal drugs. Forming a connection with patients is risky business in this field, but is something that many anesthesiologists practice to make their duties more personal. Luckily for him, Mrs. Butterworth’s chart was exactly as he remembered- sixty-four years old, hypertension, nerve damage in her feet from Type II Diabetes.

My day was very quiet, but I got to see some very interesting things. We started out with four patients, but one was discharged around 9am. After lunch we received new admission. I have seen the process of discharging a patient, but I have not seen the process of a new admission. While caring for my patients I learned that liquid vancomycin can be given with diet drink. It has to be diet because if not given with a diet drink the patient can get bacteria. One of my patient’s had one part of her stress test completed early this morning. She then went to have an echocardiogram. I went in to see that procedure. Steve was very informational. He did a great job showing me each part of the heart, as well as her lungs. She had a really good heartbeat,

The emergency room is a difficult and trying place, as individuals can experience a plethora of emotions before, during, and after their treatment. This film illustrated several common themes within this setting, provided educational information about public health care, and demonstrated several skills I plan to use in practicum and post- graduation.

Over the past eight years I have gravitated towards the field of nurse anesthesia, patiently molding myself and my career into the requirements of its acceptance. I consider myself fortunate to have served in Guam’s only public Emergency Department and was happy to be able to give back to the island that raised me having started an exhilarating career as a graduate nurse in 2008. The constant exposure to trauma and critically ill patients along with the collaborative ability to control their pain, continued to fuel my interest in nurse anesthesia. Providing care to an underserved population in such a demanding setting, required nothing less of me than a solid knowledge base and sound technical skills. A base which I would continue to build

I had been called in to help with a trauma laparotomy of a patient who had been a victim of a major bomb blast in one of the busy areas of my hometown, Lahore, Pakistan. Hundreds of people had been injured rendering the city as well as the nearby hospitals in a state of complete chaos. “It is going to be a long night Asad!” muttered the surgeon as he effortlessly slipped his hands into the surgical gloves. “But I am sure, tonight will help you decide whether you belong to this side of the red line.” I eyed the redline that marked the sterile zone. Over the next seven hours my mind and body were stretched to the limits. Pain crept into every single muscle and my body hurt from contouring like a pretzel as I held the various retractors, latching onto every single movement in my visual field. I found myself captivated by the strokes of the scalpel, clicks of the forceps and precision with which the attending maneuvered inside the patient’s abdomen; a sea of red and yellow to me. It was right in those moments when all the shackles of doubt broke