Goals My goal was to utilize the nursing process.

I wanted everything Ive learned from school and from Katherine to all come together. Continuously assessing my patients, recognizing potential problems and needed cares related to their diagnosis, organize and prioritizing my time, critically thinking by looking at their history and labs/test results, passing info on to the next shift, etc. Its kind of a lot, but I didnt have just 2 short term goals Outcome I am actually SO happy about how I did. I picked three of my own patients to care for that night. I was totally engaged in report and asking questions that I felt were important, I actually said hi instead of just waving at the patients when we introduced ourselves I finally felt comfortable going in the patients rooms without feeling like an imposter or stupid nursing student and doing their assessments. I was able to recognize pretty fast the biggest problems or potential problems the patients had, what labs or orders I would need to monitor and check on, I was on top of my patients medications and assessments I just felt more confident. Its where I should have been a long time ago, but its a big deal for me. Prioritization I think the first priority I needed to address was SAFETY. One patient came in because he had been having serious balance issues and had been having falls. He was taken down for an MRI right when we came on shift and when he came back, he popped out of bed and started to walk to the bathroom, when his daughters tried to help them he was SUPER grumpy. Just really stubborn and in denial of his problem. He didnt push his call light to go to the bathroom during the night like he PROMISED to and he was FAST out of bed. So we always had somebody nearby and the second we heard the bed alarm we ran to his room stat. Another one of my patients who also had a history of recent falls had a little dementia and I was never really sure if she would call so she also had a bed alarm on. My next priority was doing CWA assessments on my last patient admitted for an upper GI bleed with a history of ETOH. Anyways, safety was the first thing on my mind. Things that went according to plan My plan to keep my patients safe went according to plan- nobody fell or had any injury. The cerebellar CVA did try to get up once or twice but I got there in time. My patient that came in with severe dehydration and a UTI responded well to her fluid bolus and then maintenance fluid that we hung- she had a good amount of urine output that was light yellow and clear. She received all her antibiotics. Learning that Took place during the shift I learned how to assess and score patients on CWA protocol. I learned that you need to look at the patients history as soon as possible- I assumed that the previous nurse told me everything I needed to know about the dehydration/UTI patient so when I went in to do her assessment I was really confused about her mental status The nurse had told me that she was alert and oriented, but talking to her she didnt really seem to know why exactly she was doing at the hospitalshe was there but not really, some short term memory and then not So I was worried about dehydration or sodium problems or something but then I actually got a chance to look at her history and it said she had a significant history of dementia. So that would have cleared things up. I also learned that strokes dont always cause weakness or paralysis, they can cause balance problems. The man who had a cerebellar CVA had strong bilateral grips and could push and pull against resistance, he didnt have any drooping of his arms when he lifted them up, and he could use both his hands normally. But when he stood up, he was so

unbalanced and fell toward his right side. It makes sense I guess because the stroke was in his cerebellum, but it was just something I hadnt seen before. Situation where nursing made a difference A couple interventions that I was able to see immediate results were: 1. My ETOH patient ran a pretty high fever in the middle of the night so I called the doctor (YES I CALLED THE DOCTOR ) and got an order for ibuprofen and made him an icepack to put on his head. I checked his temperature about 30 or 45 minutes after and his temperature went down. Another one was with my UTI/dehydration patient. She really couldnt remember what the buttons meant on her remote. No matter how many times I reminded her that the big red button was to call us for help, she never remembered. It worried me so I wrote a not on a little piece of paper that said Push big red button to call us for help!! in big letters so she could read it. Guess what?? She actually used her call light. hehe What I would do differently Something I would do differently is check my patients rooms and the med rooms toward the beginning to make sure all their meds they needed were there and available instead of waiting until it was time to give them their med to find out that something they needed wasnt there and then having to call the pharmacy and order it and then having to give it late. I already stated before that I would look at their histories right at the beginning. Challenges So the dementia dehydration patients husband I think also had a little dementia or confusion going on Im not really sure what was going on at home with them but Im thinking that part of the reason she was so dehydrated and possibly malnourished (she had ketones in her urine and no history of DM or anything like that) was because they were both confused and not eating? I dont really know. So, the challenge was that the med list that nurse before us collected couldnt be verified at any pharmacy. The husband said that they went to the Walmart pharmacy so they called them and they said that they have never filled for her before. We called other pharmacys and they hadnt filled for them either. So during the night, her blood pressure started getting really high. I mean 189/84 high, So we paged the hospitalist and told them what was happening and how we couldnt verify her med list so we asked if she would write a prescription for blood pressure. The doctor said she wasnt worried about it if she wasnt symptomatic, and to just wait til the morning to figure out her med list?? Im no doctor, but shouldnt we treat something BEFORE they are symptomatic? That bothered me. When I hung up and told Katherine she shook her head and then shrugged her shoulders. So that is my first experience with a doctor who did something that really made no sense to me. How could we just ignore a blood pressure of 189/84? Does this really happen all the time Deanne? Skills Assessments, medications, charting, assisted with a dressing change of a 400 pound lady with a labia abscess by assist I mean try and put clean and dry ABD pad and 4x4s while Katherine held up all her folds and apron. That was pretty difficult.