KalenThomas

October29,2014
NURS2701
PhyllisSwift
PreceptorshipJournal#3Med/Onc

Requirements PersonalExperience:
LongtermGoal: Performallpatientcaresonatleastonepatientthroughouttheentire
shift.Includingpatientteachinganddocumentation.
TwoShorttermGoals: SuccessfullyplaceaperipheralIV.
Correctlychartandswitchoutbagsofmaintenancefluid.ChartIs
andOscorrectlyaswell.
OutcomeforGoals:
Werethegoalsmet?
IwasabletosuccessfullycareforourpatientinW307
independently,butEricawaswithmemostofthetimethatIwas
caringforthepatient.Iwasabletodomostofthenecessaryskills
independently,butwhenIdidhavequestionsIdirectedthemtoErica
andshewasabletohelpmefindtheinformationthatIneeded
withoutjustgivingmeimmediateanswers.
IdidhavethechancetodaytoinsertaperipheralIV,butaftergetting
aflash,Iadvancedthecatheteranddidnotgetanymoreblood
return.SoEricaendedupplacinganotherIVaftermyfirstattempt.I
willcontinuetodevelopthisskill.
Ericafirstshowedmehowtoprogramthepumpandhowtochart
IsandOsforinfusionsandthenIwasabletodothemfortherest
oftheshiftasshesupervised.
Howwereprioritiesset?Ex.
Labs,Diagnosticexams,Pt
History
WehadonepatientwhowasusingaVapotheramon30litersof
oxygenat70%.Hewasourmostcriticalpatientandwewereableto
assesshimfirst.HewasadmittedforMetabolicacidosisposs
ETOHabuse.Hehaddevelopedliverfailure,andisonmany
medications.
Didthingsgoaccordingtoplan?
Exwastheshiftasuccess?
Theshiftdidgoverywell.Ifeltlikewewereabletoperformour
assessmentsearlyinthemorning,mostofourmedicationswere
administeredontimeandwewereabletoroundonallofour
patientsatleasteveryotherhour.Buttherewerequiteafewtimes
thatwehadplannedtogotoonepatientsroomandthenanother
patientwouldneedhelptogetuptotherestroom.Sowewouldhave
tomodifyourplansandassisttheotherpatientfirst.Thiscaused
severalveryminorsetbacks,butoveralleverythingwentverywell.
Discusslearningexperiences: Ilearnedtheflowofthechartsonthemedicaloncologyunit.My
preceptorisacentralstaffingnurse,butsheusedtoworkonthe
medicaloncologyunit.Shealsowentthroughseveralpatientcharts
withmeandshowedmewheretofindthedoctorsordersandwhere
toinitialduringshiftchange.Asdoctorscameinandwrotenew
orderssheshowedmethatthecorrectwaytonotitistowrite
NotedkThomasRNandthenthetimeanddate.
Describeasituationinwhicha
nursinginterventionmadea
Oneofourpatientshasbeeninthehospitalforalittleoveraweek
now,andhasbeenrefusingashowerforseveraldaysnow.WhenI
differenceinpatientoutcomes: firsttalkedtohimaboutgettingashowerhetoldmethathewastoo
tiredandthathewoulddoittomorrowifhewasfeelingbetter.Iknew
thatpartofthereasonhewasntfeelingwellwasbecausehewas
sosweatyanddirty,soIhelpedhimtounderstandthatifhegetsup
andshowersitwillhelphimtofeelbetter.Heagreedtodosoand
afterthathewasevenabletositupinthechairforseveralhours.
Whatwouldyouhavedone
differently?Why?
OnethingthatIwouldhavedonedifferentlyisthatIwouldhave
chartedmypatientassessmentrealtimeinthepatientsroom.My
preceptorisabout5monthspregnantandshehasahardtime
standingtheentireday,sowedoeachofourassessmentsand
thensitdowntochartthemoncetheyareallcomplete.Shehas
beenanursefor3yearsandhasaloteasiertimerememberingher
assessment,butIstrugglekeepingthemallstraightinmyhead.So
formynextclinicaldayIwillchartmyassessmentinthepatients
roomrightafterIamthrough.
Challengeswereidentified:
Possiblesolutions:
MymainchallengeforthedaywasplacingaperipheralIV.Iwasable
tofollowallofthestepscorrectly,andIgotaflash,butwhenI
advancedthecatheterIdidntgetanybloodreturn.SoIwillcontinue
toworkonthisnursingskillthroughoutmypreceptorshipandtryto
improvemyskillatplacinganIV.
ListofSkillsperformed: Patientassessment
Administermedications
Administerlovenoxinjection
Hangmaintenancefluidsasprescribedbythedoctor
PlaceanIV
Patientdischargeteaching
Administerinsulininjections