Wound Care Reflection

For clinical week 9, I was assigned to the UMC Wound Care Clinic to view a different field of nursing. As soon as I arrived at the clinic the nurse told me that I could bounce around from patient room to patient room to view as many wounds and burns as possible. The first patient room that I went into was a young Hispanic man who had an infection on his right lateral thigh area that spread from the popliteal area to the greater trochanter. When I asked the patient what had happened he told me he was injured at work and the injury got infected, which he never went to the doctor to have it evaluated. So, basically the infection was eating away at his skin and muscles. The patient has to come to the wound clinic every day to get dressing changes.

A meaningful event from my clinical experience was during week six when one of my colleague and I along with the RN performed a wound care procedure on one of my client who had pressure ulcers on her coccyx area and wound on the right foot. It was my first time doing wound care on a client who has severe wound type. Client is a 90 years old female who has been admitted to the unit for Osteomyelitis, it is an infection of the bone, caused by bacteria breaking into the body’s tissues and entering the bloodstream through an open wound (LeMone, p.1382). The client said a dog bit her foot at a park few years ago and that’s how she got the wound. Client has a wound care dressing order that needs to be changed daily with Betadine soaked gauze for all areas,

The following assignment will take the form of a case study. The subject is a 79-year-old sikh gentleman, who will be known as patient X. Patient X only speaks English as his second language. Patient X has developed a wound on his right hip after being admitted a few days previously, after suffering from a stroke. Patient X has a history of a mild stroke and has slow mobility and uses the aid of a frame to mobilise. Patient X is obese, a heavy smoker and now

Dale Gordon has been a patient in the ICU for 6 days after developing complications after open heart surgery. He is an 82-year-old African American who is disoriented to place and time. He lives with his daughter Claudia in her home. Claudia and her two brothers visit Mr. Gordon daily since he has been hospitalized. Mr. Gordon has not been eating well since the surgery and has lost 3 pounds. Mr. Gordon has type 2 diabetes and is on oral antihyperglycemic medication. Before he came to the hospital, Mr. Gordon was able to only ambulate for short distances. He has orders to get up in a chair twice a day. Joan, a student nurse, is caring for Mr. Gordon this morning. She has reviewed his medical record and is now ready to start caring for him.

I observed the documentation process from week -2 in my clinical setting and through reading the related documents I gained theoretical knowledge of documentation . I week -4 I did the the return demonstration of documentation with my instructor successfully and started the documentation process in clinical and developed my communication skill . I think my learning plan helped me to achieve this goal . When I started this semester I wanted to learn about the wound care . To achieve this goal I observed the techniques of wound care in week -10 demonstrated by my instructor and reviewed the related resources of wound care . In week -11 I was successful in return demonstration of wound care and evaluated by my instructor . The plan I made

During community placement, my mentor and I visited M (patient), a 75years old lady, who was presented with a Pressure Ulcer, on the heel of her right leg. On arrival, my mentor asked me to manage M’s wound. However, I have observed and participate in carrying out this skill (wound care) with my mentor on several occasions. I explained the procedure to M and gained her consent to carry out the procedure.

Under the scope of practice of an RN from the New York State Education Department, an RN can diagnose and treat human responses to actual or potential health problems. To be able to perform those tasks a care plan must be made for each client. An RN manages the health care services such as observing and assessing the health status of clients and implementing/assessing nursing care. This all falls under the initial assessment of a client, which is within the scope of an RN. An RN uses information gathered as part of client assessment, they then have the capacity to assign client care to other members of the nursing team, RNs and LPNs, and assign tasks to other care providers such as nurse’s assistant. Even though there are parts of the nursing process that may be delegated to qualified personnel, the initial assessment is the RNs responsibility. The initial assessment is the basis for safe and appropriate client care, which makes it so vital and why not just anyone can perform it. RNs hold the overall responsibility in the nursing

A unit that consists of 70 registered nurses (RNs) who care of (31) beds. Some of the nurses were met by the

Q by taking vitals right away and report immediately, since the night shift reported elevated blood pressure at the end of their shift. This would help in determining the next step in delegating and treating Ms. Q. If her blood pressure remained elevated, the RN would delegate the LPN/LVN to proceed with the next step. After getting vitals for Ms. Q., the RN would ask the UAP to assist with Mrs. A, because she is scheduled for a Doppler flow study this morning and can help by bringing the machine to the room and by assisting the patient with morning care and ambulation prior to the study being done. The RN could have delegated Ms. Q vitals to the nursing student as well, but since the vitals were extremely high, the RN chose to have an experienced UAP report the vitals within a specific time frame. The RN has delegated these tasks because they are within the UAP’s scope of practice. They are trained to perform certain duties and tasks such as documenting and reporting information, and assisting patients with their activities of daily living. If the RN were to delegate the administration of medication they could possibly give it to the wrong patient and cause adverse reaction. The fluidity of the communication between the UAP and the RN team leader greatly impacts identifying what is expected from the UAP to communicate to the RN. Siegel and Young (2010) explain that the UAP needs clear guidelines and procedures,

Suppose there is a patch call with a patient exhibiting chest pain and the ambulance is five minutes out. In this case, the room is equipped and prepared with all the essential needs for the chest pain patient upon their arrival in the ambulance. After the patient has arrived, the primary nurse on duty receives a report from the Emergency Medical Technician (EMT) that accompanied and provided initial care to the patient in the ambulance. At the same time, the secondary nurse and ERT become technical, or hands on. The patient is administered oxygen, cardiac monitors are placed, an EKG is administered, locks and labs are drawn, normal saline is administered, and a urinalysis is taken along with the patients’ blood glucose level. Each of these tasks is initiated prior to the Emergency Room Medical Doctor (MD) seeing the patient, or at the same time. Emergency

Delegation as defined by the State of Michigan Public Health Code as “…means an authorization granted by a licensee to a licensed or unlicensed individual to perform selected acts, tasks, or functions which fall within the scope of practice of the delegator and which are not within the scope of practice of the delegatee and which, in the absence of the authorization, would constitute illegal practice of a licensed profession” (RN Accountability For Delegation Decisions). What this states is that the RN has the legal right to delegate appropriate tasks to LPN/LVN and UAPs (unlicensed assistive personnel) or CENA’s. The importance of delegation of care is vital to the success of the patient’s outcome to leave the acute hospital setting. The RN must be agile in overseeing that the tasks assigned are done correctly and accurately due to the fact that they are ultimately responsible and accountable for that patient. In the acute hospital setting, the RN may delegate to the LPN/LVN

I can relate to one of the points in your discussion. I work in a small community hospital in the Wound Healing Clinic. We are an outpatient addition to the hospital. We have one nurse who has the primary responsibility of the acute admissions wound care. Last year we were bought by a large health systems. Recently, we were informed that we, the Wound Center, are held responsible if a patient has a hospital acquired pressure ulcer (HAPU). As part of this new directive we were also informed that prevalence rounds were to be done weekly. This is what you described your facility does once a month. These changes place responsibility for care which our staff does not even provide, moreover the changes were never discussed with our clinical coordinator.

I first want to thank you for the work you all do in keeping the units in the hospital staffed. I am hoping you can clarify and help me understand a situation that occurred Monday night with Raylene Colvin. Raylene, who is a CICU nurse and new off orientation this week was pulled to ED, and replaced in CICU with Christina Thomas, an ICU PRN nurse. When Raylene was a float, she was not ever orientated to ED and she states she had only functioned as a resource nurse twice while in the med/surg/tele float pool position. Raylene also states she took the role as resource on Monday night. Additionally, she was sent home in the middle of the night around 2 am, because ED no longer needed her while Christina worked in CICU. I am having a hard

10:24-10:50 AM SC completed monitoring phone call with Pa on 12/24/2015. SC spoke with Tina Carroll Pa’s dtr and CG/DOC. Tina reported that Pa is getting worse and she is just doing the best she can. No falls, ER visit, hospitalization or medications were reported since last contact. Tina reported that Pa is satisfied with services and her agency and aides. Tina is requesting weekend PAS support. SC informed the Tina that SC will assess Pa’s needs that home visit in January, 2016 Tina agrees. Tina confirmed that Pa is receiving services as indicated in the ISP in the following type, scope, amount, frequency and duration: Pa receives Agency Model PAS 4 hours 5 days a week 10am - 2pm via Independent Home Care. PAS provide assistance with bathing,

According to Bastable and Doody (2007) an objective is a specific, single one-dimensional behavior. Objectives are used to form a map to provide directions on how to achieve a particular goal. In this lesson the students will have two goals. The first is for the student nurses to be able to identify all the supplies necessary to change a sterile dressing and to be able to correctly assess when a dressing needs changed or reinforced. The lesson plan will contain the following objectives: