BSMCON NUR 3111P 1

PMH: COPD, HTN, CAD, asthma

Coronary Artery Disease
Chronic Obstructive Pulmonary Disease

COPD causes air Narrowing of the coronary

arteries causes the heart Amlodipine (Norvasc):
trapping which increases
muscles to work harder to
the risk for infection of calcium-channel blocker
Arformoterol (Brovana): pump. Once they stop
the lungs since the air pumping effectively, this can that widens blood vessels
inhaled long-acting beta- cannot be exhaled fully cause fluid to back up into the and improves blood flow;
agonist bronchodilator; pulmonary arteries and 5mg tablet
15mcg nebulization. eventually into the lungs
C.K.
Works by widening the 82 y.o.
airways of the lungs Pneumonia

Levofloxacin Psychosocial/Spiritual
and discharge needs
(Levaquin):
antibiotic used to
Continue to
Pneumonia is an acute infection of treat bacterial
the lung parenchyma. Pneumonia maintain activities
Priority Nursing Diagnosis (3 parts) infections;
Ineffective airway clearance related to occurs when the various defense of daily living.
route:750mg in
pulmonary edema formation as evidenced by mechanisms in the body become
D5W
abnormal breath sounds. incompetent or overwhelmed by the Taking walks with
Measurable outcome w/ timeframe: infectious agents.
Patient will display patent airway with clear
spouse to maintain
breath sounds by end of shirt 4-6-16
Lewis, pg. 522-523 good airway and
breathing
Nursing interventions you used with rationales:
1) Auscultate lung sounds, noting areas of
decreased or absent airflow or adventitious
sounds.
2) Assits and monitor effects of nebulizer Recent laboratory/diagnostic tests results with
treatment significance (i.e. why are they high/low?)
3) Use pulse oximetry toAnticipated patient teaching required
monitor oxygen
saturation
1. Teach pt. the importance of taking every WBC was normal range
dose of prescribed antibiotic to prevent drug RBC was 3.76 which is low and could
Evaluation: resistance.
Patient outcome met. Patients lungs were
2. Instruct pt. toclear
drink plenty of fluids and indicate infection is in bone marrow
bilaterally and he was discharged home
avoid alcohol and smoking affecting RBC production
3. 3. Teach pt. to get adequate rest
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Physical Assessment
This section must be completed by the stated due date/time and given to your instructor.

Document the assessment you completed.

Assessment Findings
Safety Bed in low position; non-skid socks; call bell within reach

Skin/Wounds Skin is warm and dry. Non-tenting and appropriate for race;

Respiratory Lung sounds clear bilaterally upon auscultation; Respirations were unlabored; rate: 16; O2: 96% on 2L via
nasal cannula
Cardiovascular Heart rate: 67; However, patient was fluctuating between normal sinus rhythm and sinus tachycardia; on
telemetry; S1 and S2 heart sounds auscultated; No edema noted; capillary refill < 3 seconds; radial and
pedal pulse +2; no JVD noted
Gastrointestinal Last bowel movment 4-4-16; normoactive bowel sounds; abdomen soft and non-tender upon palpation

Genitourinary Continent; uses urinal and toilet; Urine is yellow, clear, with no odor; emptied 450ml of urine out of urinal

Neurological Patient is alert and oriented times 4 (to person, place, time, and situation); Patient has clear speech and is
cooperative
Musculoskeletal Patient has steady gait; can walk independently with no assistance. Cranial nerve III intact (patient can raise
eyelids and move eyes), cranial nerve VII intact (patient can smile, frown); cranial nerve XI intact (patient
can shrug shoulders and turn head from side to side
IV Lines Peripheral IV in right hand (20G) that is patent, clean, and intact; saline locked;
Drains/Equipment

List two goals for the next practicum experience:

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1. One goal for next practicum is to continue to work on my physical assessment, really focusing on hearing good lung sounds.
2. A second goal for practicum is to continue to have frequent interaction with my patients.

Guide for Reflection

Guide for Reflection Using Tanners (2006) Clinical Judgment Model
Refer to the Toolkit for the questions to guide your reflection

Highlight the program thread that is most applicable to this reflection:

Communication and collaboration
Caring and the Catholic Health Ministry
Servant Leadership and Global Health
Safe, Quality, Evidence-based practice
Professionalism and commitment to Lifelong Learning

Introduction
This week in practicum, one of my patients was admitted for a partial right nephrectomy. He was a very pleasant man, and after conversing with him throughout
practicum, I learned a few things about him that I thought were worth mentioning. One of the things I learned about him was that he was a very heavy alcoholic
drinker. After he told me this, I wanted to know more about why he drank so much and if there was anything going on in his life that led him to drink as much as
he did.

Background
At the time of the situation, it was about 9 or 10 in the morning. I had been introduced myself to the patient and we were on friendly terms. Working as a patient
care tech in the hospital and as a CNA in a nursing home, I have encountered various types of people like my patient. I also have family members that are pretty
heavy drinkers, so I understand how difficult it can be for people who do drink a lot of alcohol to stop or cut back. I made sure to keep that in mind while I was
talking with my patient. In a situation like this, as a nurse, it is important to remain as nonjudgmental as possible. It is not my duty to look down on my patient
because he drinks alcohol heavily, but to teach him the benefits of cutting back and ideas and suggestions on how to do that. As I mentioned earlier, I have a
member of my family who also has problems with alcohol abuse, so when I found out my patient had the same issue, I was at once extremely sympathetic. Ive
witnessed first hand the complications that can arouse from this particular problem and I wanted to help as best I could with my patient.

.
Noticing
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Initially, I noticed that the patient was very forthcoming about his issues. He didnt try to sugarcoat anything. He knew that he was drinking too much and he
explained to me that he was trying to cut back. The more time I spent with him, the more I learned about his past. He had been arrested and put in jail a few times
for fighting and other things, so that told me he definitely lived a different lifestyle.

Interpreting
Overall, I thought the situation was a good one because my patient and I seemed to be on good terms and he was very open about his issues. I also think he
was very appreciative to have someone to talk to about it. This particular exchange of communication between the patient and me was slightly different than
the one I had between my family members. In the case of my family member, they were more withdrawn and uncommunicative with me about their
problem. With my patient, there was much more back and forth between us, and that really helped because there was no guesswork on my part. The patient
was willing to be truthful. As I was doing my physical assessment of my patient, I wanted to see if I noticed any signs of alcohol withdrawal from him. I
made sure to pay close attention to neurological function and musculoskeletal system to see if there were any changes. I really did not see any signs of my
patient going through alcohol withdrawal, but I did learn that sometimes those affects dont show up until a couple of days later so he might have been going
through the start of some of it. I believe my patient was aware of his alcoholic problems, but I also feel as if he was probably not going to change his ways
anytime soon. He understood the complications but was willing to accept them.

Responding
My goal for the patient was to get him to try to make lifestyle changes and to cut back on his drinking. It was also important for his friends to understand this as
well and also be fully engaged in helping him cut back. In order to help him do that, I focused on teaching the patient on the detrimental effects of drinking
excessive alcohol. I explained some of the long-term effects it can have on the body as well. One thing I was worried about throughout the patient teaching was if
the patient was truly taking in what I was saying or if it was just going in one ear and out the other. Even though he verbally stated he understood, I wasnt so
sure he would take the necessary steps to stop.

Reflection-in-Action
The patient accepted what I told him with a good attitude. He understood what I was teaching him and promised he would take the steps to change his ways.

Reflection-on-Action and Clinical Learning

One way my nursing skills expanded was that I was able to work on the teaching aspect of nursing. This patients issues provided me an opportunity to get
more involved with the teaching part of nursing. Another way my nursing skills expanded was my communication improved. It was important for me in this
situation to not only talk with my patient but also to be a great listener. The third way my skills expanded was I worked on my physical assessment skills and
started connecting my finding with what the patient was diagnosed with. If I could do anything differently for next time, I would try to get the family
members and friends more involved with the patient teaching. I would also try to seek out some more resources for the patient to use when he was finally
BSMCON NUR 3111P 5

discharged from the hospital. As I just mentioned, I think it is important for the patient to know what other kinds of resources are available to him or her to
use when dealing with a similar situation. Sometimes issues like this take more help than family members, who can sometimes be more harmful than helpful.
I did not really experience any changes in my values or beliefs. However, I have empathy with similar patients now because you never know what could be
going on with a patient in his or her life that can have influence on their lives.

Physical Assessment
This section must be completed by the stated due date/time and given to your instructor.

Document the assessment you completed.

Assessment Findings
Safety Bed in low position; non-skid socks; call bell within reach, two person assist when ambulating; Patient
must be watched at all times when going to the bathroom; Patient also uses gait belt to help with
ambulation.
Skin/Wounds Skin is warm and dry. Non-tenting and appropriate for race;

Respiratory Left lung sounds clear, wheezing heard in right middle lobe. Patients respirations were 18, unlabored. O2
was 94% at room air
Cardiovascular Heart sounds S1 and S2 heard; no murmurs. Patients heart rate was 95, regular rhythm. Patients radial
pulse was +2 and pedal pulse was also +2; Capillary refill was <3 secs. No edema noted. No JVD noted
Gastrointestinal Last bowel movment 4-5-16; normoactive bowel sounds; abdomen soft and non-tender upon palpation;

Genitourinary Patient had foley catheter that was removed in the morning. Urine was yellow, clear, and no odor. Patient
voided the toilet later on in the afternoon. Urine was also yellow, clear, and without odor.
Neurological Patient is alert and oriented times 4 (to person, place, time, and situation); Patient has clear speech and is
cooperative
Musculoskeletal Patient is two person assist with the use of gait belt. Patient is stable on his feet. Patient tolerated walking to
bathroom well. Dorsal/plantar flexion on LLE 5/5, on RLE 3/5; LUE muscle strength: 5/5, RUE muscle
strength: 3/5; patient has muscle contraction in right arm (most likely due to stroke)
IV Lines Peripheral IV in left hand (20G) that is clean and intact; saline locked; Peripheral IV in right hand: patent,
BSMCON NUR 3111P 6

Drains/Equipment clean, and intact; JP drain in right lower side: drainage is brownish green, and about 50cc drained.

List two goals for the next practicum experience:

1. One goal for next practicum is to include more patient teaching if possible.
2. A second goal is to be more proficient with my medication pass.
BSMCON NUR 3111P 7