How I Made a Difference

                                     How I made a Difference

            Over the course of the semester, I was very fortunate enough to be able to experience a clinical rotation in person as well as online. There were many times that I felt that the little help I was able to offer the nurses and patients at my clinical sight made a difference in their day or even their stay. However, one moment that really stood out to me was when I walked into the room of a patient that was very disoriented to where she was. \As soon as she saw me walk in, her face lit up and was shocked because she thought it was her son whom she hasn’t seen in a few days because of her hospitalization walked through the door. I started doing vital signs on her and she just couldn’t stop talking to me about how much she missed him and how she wanted to see him. Luckily the floor was particularly slow that day, so I was able to stay and talk to her for a little bit before having to move on to the next room. As I was wrapping up with this client and getting ready to leave, she grabbed me by the hand and gave me a huge thank you and told me how nice it was to see a somewhat familiar face when she woke up even though it wasn’t who she thought it was.

            This interaction really stuck with me after all of these weeks because I never really thought that something so simple as just talking with someone about a person they miss with a complete stranger could have such an impact on a person. When I left clinical that day, I knew that I made a difference for the client. I may not have helped her recover from the procedure that she was receiving but I know that I helped make her time at the hospital a little more bearable.

Medication Reconciliation

 

 

Client Name BG                                                          Date of Review 11/3/2020

Allergies: none

Storage of Medication (How and where does client store medication?): places them in a weekly pill holder to be able to make sure he has taken his pills

Keeps medications in original container?      Yes or No.  If no, please explain: no, places in a daily pill holder with other medications. Keeps the next weeks meds in the original container

Access issues (in obtaining meds, trouble opening, reading labels, comprehension, functional issues – i.e. arthritis, hearing deficit, glasses)? May forget if he has taken his medications if weekly holder isn’t made up.

How many providers does this client use? Client has one provider

Drug (generic)

Trade Name

Dose

Where client obtains meds from?

Frequency

Intended Use

Patient Use (if different)

Demonstrates Understanding

Yes or No

Amlodipine

Norvasc

5 mg

Hannaford’s

QD, in the morning

Hypertension

“Blood Pressure med”

Yes

Diazepam

Diazepam

5 mg

Hannaford’s

PRN (typically 2x a week)

Anxiety

“high anxiety episodes”

Yes

Ondansetron

Zofran

8 mg

CVS

PRN (1x a week)

Nausea and vomiting

Nausea

Yes

Bisacodyl

Bisacodyl

10 mg

Hannaford’s

PRN (3x a month)

Constipation

Constipation

Yes

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

One of the safety concerns that this client has with his medication Diazepam is that it makes him extremely nauseous. This medication is known to cause the client to have severe nausea and vomiting (Kluwers 2020). Whenever they would take the drug it ended up in the client violently throwing up. This would then often make the client stop taking the medication which would then result in their “high anxiety episodes” to come back. As a result of this nausea the provider put him on the medication ondansetron (Zofran). This drug allows for the relief of his nausea and vomiting (Kluwers 2020). The safety concerns associated with the drug Diazepam are not only the sever nausea and vomiting that they are experiencing but also the possibility that the client will stop taking his medication allowing for the anxiety episodes to return once again.

While the benefits of taking Zofran allow for the ability to take their Diazepam (and some of the other drugs), it still poses a safety concern for the client. Zofran causes this client to become constipated (Kluwers 2020). A safety concern with the constipation is dehydration. Constipation is often caused by a lack of fluids and this client has stated that he often doesn’t drink enough water throughout his day. A second safety concern related to the Zofran is the arrythmias (Kluwers 2020) that the client has experienced. These arrythmias do not happen very frequently but they have happened enough to be alert for the potential of them happening.

Regarding the medication amlodipine (Norvasc) there are a few safety concerns regarding this drug for this client. When the client first started taking the drug, they reported fits of dyspnea, which is one of the adverse effects of the drug (Kluwers 2020). This is a safety concern because they are typically unpredictable and happen for long periods of time. Another safety consideration for this drug would any hypotension that could arise from the drug. Despite being a client with hypertension it is important for knowing that hypotension can still happen (Kluwers 2020).

With taking the bisacodyl which is a laxative, the client is at risk for the further dehydration and electrolyte imbalance (Kluwers 2020). The client is already at an elevated risk for being dehydrated with not drinking enough water throughout the day and taking a laxative on top of that could result in even more fluid loss. The laxative causes increased peristalsis and diarrhea which causes the client to lose the fluid that they are getting (Kluwers 2020). Along with losing fluids the client is also at risk for electrolyte imbalance. If peristalsis is increased the nutrients consumed go through the intestine at an accelerated rate causing not as much absorption.   

            For this client I would begin to develop a teaching plan knowing that they are somewhat health literate and are fairly capable and eager to learn. With knowing that the client is somewhat literate to some healthcare language so I would talk to them in a way that they would understand by using words like the common name of drugs but mix in some basic healthcare terms that they are aware of. This would allow for the client to feel that they are not being talked down to but included in the conversation, which is a way that this client has expressed is a better way to learn new information.

As for what I would teach this client in regard to Diazepam I would definitely make sure to educate the client on the importance of taking the medication in adjunct to the Zofran. Even though taking the Diazepam made the client nauseous without it the anxiety attacks come back. If this client continues to have these anxiety attacks new problems could arise. Anxiety plays a role in potentially developing heart problems, already having hypertension the client doesn’t need to increase his risk. A second education point I would make for this client would to be to make sure that they are avoiding consuming alcohol while on this medication. With Diazepam being a depressant of the CNS (the point), alcohol would only further depress the CNS which could lead to worsening adverse effects on the client. Of which could include respiratory depression and bradycardia.

Some educational considerations for the medication Zofran would be in the relation to the possible constipation and occasional arrythmias. A point that I would emphasis the importance of teaching would be for the constipation would be to stay hydrated. With this client already stating that they do not typically drink enough water in a day this puts them at a slightly higher chance of developing constipation. Educating the client on the importance of hydration will help to prevent constipation. For the arrythmias I would educate the client on the importance of going to their provider to get regular EKGs done. While the arrythmias that this client had experienced were not very frequent, regular screening for them can help to monitor that everything with the heart is staying normal. With other drugs possibly causing arrythmias as well it also puts a stress on the importance of checking telemetry.

When it comes to teaching this client about the Norvasc I world emphasize the importance of being able to know how to read a blood pressure cuff and how to use one. With already suffering from hypertension this should be a skill that this client should know how to do. Since Norvasc is helping to lower the clients blood pressure it is essential to be able to check if the blood pressure dropped too low. Since this is a skill that can be done at home, I would suggest to this client to possibly getting an electronic blood pressure cuff so they wouldn’t have to learn how to do the blood pressure manually. A second education point would be what to do if the client began to feel like he was having a fit of dyspnea. I would teach them proper breathing techniques that promote productive breathing.

Like along with Zofran, an educational focus on the medication bisacodyl, the potential for dehydration is still high. The education for this drug however needs to focus on replacing fluids that have been lost and not the ones that are lacking. With the medication moving things along the GI tract the water and nutrients are not absorbed as much as they typically would be if the medication wasn’t taken. A good way to make sure the client is getting enough fluids would be to educate him on other ways to get the fluids needed not just from drinking water. Other sources may include foods like spinach and cucumbers (Harrison, 2018). This way the client is having a variety of fluids.

 

                                                            References

Harrison, M. (2018). 10 water-rich foods that will help you stay hydrated. Retrieved November 05, 2020, from https://www.bupa.co.uk/newsroom/ourviews/ten-water-rich-foods-hydration

Kluwers, W. (2020). Lippincott Advisor. Retrieved November 05, 2020, from https://advisor-edu.lww.com/lna/document.do?bid=6

Kluwers, W. (2020). VitalSource Bookshelf Online. Retrieved November 05, 2020, from https://coursepoint.vitalsource.com/

Medication Reconciliation Reflection

There were a few safety concerns regarding the medications that this client was on. Among those safety concerns were dehydration and electrolyte imbalances, constipation, dyspnea, and severe nausea. These safety concerns came from the adverse reactions of one of the medications that this client is taking. This client was aware of the medications that he was on. This is important because this client was experiencing adverse effects from one medication, so their prescriber prescribed a new medication to help combat the adverse effects. This client was fairly well literate medically, so they were able to understand what each medication was for and what it was doing in their body. Each of the medications did a different job and reason for being prescribed to this client making the drugs not have any overlap on what they did for the client and in the client’s body.

Art in Nursing

 

As I look into this beautiful sunset I can only help but see how similar the art of a sunset is so closely related to the art in nursing. Much like a picture of a sunset has so many different layers that make it beautiful there are many different types of nursing that make it such a work of art. Being a nurse can mean so many different things with the types of nursing they can do. For example a nurse can be a nurse on the ICU, maternity floor, or the cardiac floor, which all require a different set of skills. This diversity that a nurse can have is what really makes it a work of art. Many of us have already been given the opportunity to begin to experience this in our clinical. One of the other ways the sunset depicts the art in nursing is that it is always changing. A sunset is always changing each day, just like a nurses day on the floor.  No two days will ever be exactly the same so they need to be prepared for anything, which isn’t a an easy task. The ability for a nurse to be able to handle this is an art on its own. 

For me the real beauty of art in nursing comes from the fact that it is so diverse and unpredictable. I find the most enjoyment in art when I’m surprised and always see something new, hence seeing the art in nursing in a sunset. Both nursing and sunsets are able to keep me on my toes and always be ready for the next day, because I never know what I’m going to get. 

ATI Module 2 Response

The second ATI module taught me how seriously we as a nurses need to take professionalism and to strive for excellence. With that being said we will be able to address any issues that may affect the work environment and the patient’s environment. This will help me as a student nurse because learning it now can allow for me to begin to practice these skills. Especially when I am in clinical, I can listen to what the modules and then go and actually apply it in person

ATI Module reflection 1

After completing the first ATI module it provided a lot of helpful tips. There were many test taking strategies that I have not been given in the past. I found them especially helpful for when the time comes and I need to take the NCLEX. Some of the most helpful tips given were the simplest ones. Things such as figuring out the best route to the building of the test so you don’t get lost. Things like that are not in the back of your mind on the day of a test that important. Getting this advice now is only beneficial in the long run.

Response to Theresa Brown’s Critical Care

Critical Care by Theresa Brown tells the story of a once English Professor at Tufts University who went on to become an oncology nurse at a hospital. She goes into great depth about what her first year working as a nurse was like for her after making such a big career change. She quickly learned what it meant to truly take care of patients from the time they arrive to the time they leave.

Of the several occurrences of death that Theresa Brown experienced, the one that stood out to me the most was her first experience. I thought that she was able to handle the situation she was in very well and very professionally. The death itself didn’t seem like it was a very easy death to witness or be a part of (well no death is easy to be a part of). While she had developed somewhat of a connection between the patient, Mary, and her family, she was still able to tend to her other patients and the responsibilities she had for them. When it comes to patient deaths, I don’t imagine it will ever get easier for a nurse as time goes on but unfortunately it is part of the job. Sometimes there is only so much a person can do to try and save a person’s life. I think that it is important to keep that in mind as a nurse but also it is important to not ignore any feelings that you as the nurse may feel after the death of a patient. I definitely think that the connection that is made between nurse and patient is very strong, so it is difficult for the nurse when a patient is lost.

One of the things that I felt Theresa could’ve been more critical of herself on was in chapter nine, when she was dealing with Irene’s situation. The surgeon invited her into the meeting with Irene’s family but since she had other patients to deal with decided that she couldn’t attend it, even though she thought of Irene as her number one priority. She also missed the meeting about what her family decided they were going to do with Irene in her deteriorating condition. While she did say she was wrong in that instance I feel that she should’ve acknowledged that she should have been at all these meetings with the doctors and the family. If I was in Theresa’s position, I would’ve tried to find a nurse that she could have delegated some of her other tasks to before just slipping out and missing the meeting. If she really felt that Irene was the patient that was her number one priority, then I think she could’ve tried a little harder to be in attendance of these meetings.

            A section of the book that was meaningful to me was the part about her patients back splitting open. This part really stuck out to me because it just shows how unpredictable being a nurse truly can be. When she was assisting with a pretty standard move of a patient from the bed to a chair and had her patient’s fully healed skin just split open, Theresa was able to keep calm and do her job as a nurse. I found this part of the book to be so meaningful because she was able to show and maintain composure and act accordingly as the nurse despite not having as much experience as the other nurse that she was working alongside with. I know that this is not an easy thing to do in such a shocking and unexpected situation. It is a strong quality that shows she is a strong nurse and it is one that I hope to have if an unexpected situation like this arises.

            When Theresa Brown relates a career in nursing the poem by Frank Bidart, I thought it was a very interesting take on one’s career choice. I do however think that this poem can relate to other careers beyond nursing. On certain days people are going to love their career and think that it is the best thing in the world and unfortunately other days they are going to think the very opposite. Nursing is not an easy profession and it is definitely not for everyone. With that being said, a person really has to love their work. There are many reasons that a person can love the work they do as a nurse, for me I love the idea of being able to actively help people in ways that others may not be able to. Knowing that I can help make a difference in a person’s life is enough reason for me to love a career in nursing. On the other hand, there can be some things that would make a person hate having a career in nursing. Having a difficult patient or a difficult family of a patient could really wear a person down and make them not like their career. I think as long as there is more love for a person’s career in nursing than hate then there’s nothing wrong with having a love hate relationship with nursing. I really enjoyed this insight into Theresa Brown’s first year as a nurse and I think it is really helpful for a new nurse to read.

           

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