19. 25 February 2017 19
• My biggest concern about caring for J.K. was making sure I gave all of his medications on time.
He has been here for a while, and this was my first time taking care of him.
• I was nervous because his mother was usually in the room, and I was told she asked quite a few
questions.
• I did my usual assessment, and he seemed okay and wanted to stay in bed instead of going for a
walk.
• I did ask my preceptor to assess him because he has a little rash that was new today. Shortly
after she assessed him, he vomited 1time. I made sure that his IV was still running, and I let him
get some rest.
• His mother arrived and seemed really concerned that he was in bed and that he had a little rash
and had vomited once. She actually started to cry. I let her talk to him while I got another set of
vital signs. He didn’t have a fever, but his pulse was up a little and so were his respirations.
• I asked my preceptor if there was something else I should check. She called the doctor and got a
bunch of orders. I had to get help to coordinate all the consults and enter the lab orders. I didn’t
know how I was going to comfort the mother and get everything done.
• My preceptor said she thinks J.K. may have an infected catheter. I think they should have put in
an implanted port instead of this kind of tunneled catheter. I went to look for a policy or
protocol to tell me how to proceed with J.K.’s care.
SAME PATIENT- 2 NURSES.... Advanced Beginner
20. 25 February 2017 20
• J.K. was my youngest patient on Tuesday. I was a little surprised to hear his
diagnosis of NHL because the children are usually a little older when they get
that. I looked in the room as soon as I got out of report and noticed his mother
wasn’t here yet. I went right in and introduced myself and told him I would be
his nurse all day.
• I saw a baseball cap next to his bed, and I asked him what kinds of things he
likes to do in summer just to try to get to know him. He seemed pretty
comfortable with me, and I started my assessment.
• His pulse and respirations were higher than I would expect. Even though he was
afebrile, I was suspicious about his vital signs. He has a tunneled catheter for
chemotherapy and he is neutropenic, so you really can’t be too careful. It’s too
bad we need multiple ports for his chemo and blood draws, or he could have
had an implanted port.
• Knowing that he might not show the usual signs of infection and did have a little
rash starting, I was definitely thinking that he may have an infected catheter.
• I wanted to get him out of bed, but he said he was tired and didn’t want to get
up. He just didn’t seem right, so I asked the nurse who cared for him the last 3
days if he had been up and active. She said he had.
SAME PATIENT- 2 NURSES.... Expert
21. 25 February 2017 21
• J.K.’s mother came, and I met her at the door. I asked her if J.K. seemed to
be a little lethargic to her, and she agreed that he did. He vomited once
after she arrived, and she began to cry. I sat with her and answered her
questions about what I thought was happening.
• I excused myself and told her I’d be back in just a few minutes, but I needed
to call the doctor to get orders for labs and x-ray. I assured her she would
have an opportunity to discuss everything with the doctor and asked her if
she would like to accompany J.K. to any tests or diagnostics that may require
him to leave the floor. I could tell it was important to her to participate in
all of the decisions around J.K.’s care.
• I also took a quick look at J.K.’s admission assessment and found that his
mother was a single mom and had been going through some hard times. I
considered calling for a social worker and minister but wanted to wait and
talk to her a bit more before I did that.
SAME PATIENT- 2 NURSES.... Expert