The Client That I Had

This week, I was given the opportunity to care for two female patients – 205(1) and (2). The first patient, 205-1, was admitted with respiratory distress and had a past medical history of hypertension, schizophrenia and bipolar disorder. She was initially put on 2 L/min of oxygen and placed on oxygen titration protocol with orders to maintain O2 saturations between 88-92%. The patient was oriented to person and place, but had difficulty with time. She was also obese (BMI 30) and deemed a moderate assist with ambulation. Her care plan included total assistance with ADLs, smoking cessation and oxygen protocols, limited salt intake (3mg), and chronic pain management. The second patient, 205-2, was admitted with a right pelvic fracture and had

This was my first shift back from having a few days off and I returned to work on a night shift. Patient A was admitted to the hospice that day. She was admitted for general deterioration and she had tried to maintain her independence up until breaking point. It was handed over she has aphasia.

A (assessment): Ms. O’Reilly’s vital signs are temperature of 37.5 C, pulse of 112, blood pressure of 102/52, and respirations of 24. Her respirations are still deep but have a regular rhythm. She has a CBS of 8.1 and regular insulin running as per orders. The lab work shows uncompensated metabolic acidosis with no hypoxia. Ms. O’Reilly’s neurological status has improved with a GSC of 13. Her dehydration is being treated with NS containing 40mEQ KCL/L running at 200ml/hr and potassium levels maintained at 4.

Patient G.M. is a four-year-old female from a middle class family living in San Diego. She originally presented with her mother and father to her general practitioner with lethargy and several vomiting episodes in the past few days. Her father stated concern after realizing her frequent urination in the past week. Her vital signs upon initial assessment were HR 140 RR 22 Temperature 102.7 degrees Fahrenheit, BP 70/62, O2 saturation 97%, 32 pounds, and 40 inches tall. Her General practitioner was concerned about type I diabetes and performed a blood sugar check. Upon assessment the monitor read HI, indicating that the level was above 500 and too high for the monitor to read. The doctor informed them she needed immediate treated in the closest pediatric ER due to the potential for diabetic ketoacidosis.

When I arrive to the facility this morning I was informed that one of the patients had passed away during the night, which was quite sad. Today I was in the acute ward all day and was able to watch the RN perform an ECG on a man that was bought in via ambulance who was complaining of chest pain. I watched as she placed the ECG leads on different positions of the chest. The RN showed me what a normal heart rate should look like. I also went around the ward taking OBS and notice that one of the patient's O2 levels were very low at 73%, the RN then gave the patient some ventolin through a mask to increase oxygen levels and they rose to 95%. The RN also showed me the medication charts and how they are to be read. I went around with her watching

On august 13, 2016 I was assigned to follow one of the ICU Nurse. It was a very calm day. She had two patient one was more critical than the other. Both patients were on the ventilator because they had to be intubated the night before. The lady is obese and had gastric bypass surgery two years ago and suffering from severe sleep apnea, but the patient is non-compliance to the CPAP treatment. That was her second time being intubated. She was admitted for seizure monitoring because she was constantly having seizures the day before while she was at home. Due to the fact that she did not want to wear her CPAP machine while in the hospital, after pain medication was administered she was found unresponsive, that was the reason for her intubation the night before. Patient was on intermittent suctioning, she has sinus tachycardia . I had the opportunity to observe some of her daily care. The patient was on fentanyl but when the Dr. try to wean her out of the ventilator she stop breathing, therefore, the DR. discontinue the fentanyl temporarily in other to retest her later.

During this day, I was assigned to care to one of our sick residents and based on my assessment, her condition shows no sign of improvement from her chest infection so I checked her vital signs specifically her respirations. After assessing her, we rang in the GP to inform him about the condition of his patient and asked him to schedule a visit. Also, in the afternoon, we had a new admission from Eversley. Firstly, we greeted the patient, introduced ourselves and oriented the resident to the unit. Secondly, the nurse from Eversley informed us about the relevant information about the patient’s

I am a second year nursing student in my third week of the practicum placement on a surgical ward with my co-student and the morning shift registered nurses. We had just finished analysing the patients handover report (Levett-Jones & Bourgeois, 2015) and I had been assigned to work with the registered nurse. I was looking after Mrs. Brown (pseudonym) is 82 years old New Zealander was admitted to surgical ward on the 08/06/16 for multiple SCC removals from L) hand and L) foot with skin grafts.

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

1) . As I look back, I could have spent more time with my nurse. Overall, today was a low-keyed day. I did a lot of vital signs, cleaning up the patient, and repositioning the patient. I did not get the chance to practice or observe any new nursing skills.

I was working night shift in a level 3 Neonatal Intensive Care Unit facility and my 10 days orientation was over. It was my first day working without my preceptor. Since I was a new staff, the charge nurse allocated two stable babies for me. One was Baby Zahra, a 33 weeks preemie, on room air, with nasogastric tube, with peripheral intravenous line to keep the vein open and feeding with expressed breast milk every 3 hours. I started my shift with a bit of nervousness knowing that I am on my own and wondering if I can remember everything that my preceptor had taught me during our orientation. I started my assessment and observed Baby Zahra to be pale, her skin was slightly mottled. I checked her vital signs. The cardiac monitor showed that she

My mentor also informed me that due to having dementia Mrs. Lewis did not understand why she had a tube into her stomach and that she had tried to remove it herself in the past which had caused some trauma to the abdomen (this resulted in the patient being very anxious whenever her PEG tube was touched, as she anticipated pain) and that sometimes the patient did not want her PEG tube touched and could be combative occasionally, using her left arm to hit out at staff. At this point I felt as though administering medication to Mrs. Lewis was beyond my capabilities as a student because of the mental health issues the patient had, I had no experience or knowledge at this point in my training in working with

Like a perfect automaton, the nurse proceeds to measure vital signs and note her findings with as little human interaction with you as is possible. After the nurse has completed her tasks, you must wait until the doctor pops his head in, nurse's records in hand. The doctor then proceeds to ask you some variation of the stock doctor question: "What seems to be the problem today?"

During my first semester student clinical rotation, I was introduced to patient, 76 year old AB who was being treated at an assisted living facility. She was a wonderful patient and someone I immediately connected with. AB had been medically diagnosed with COPD and displayed all the classic physical signs of the disease such as wheezing, deliberate breathing, severe shortness of breath and nutritional deficit. She was my first patient as a student nurse and the first person I was able to complete a health assessment and nursing care plan for. I recognized early on that AB was special and someone who would be a great person to communicate with. With the initial assessment she was a little scared, but

Patient also, has history of hypertension, GERD, morbid obesity, anemia, and depression. She reported that the past few months, she has been feeling very weak and overall generalized deconditioning. Her ability to care for herself including her activities of daily living (ADLs), and her basic physical needs (like bathing, grooming, ambulation, meal preparation, transportation, errands, and housekeeping), had decreased, and cannot consistently carry them out.