Field Patient Assignment Paperwork

1. WEEKLY REFLECTIONS 2
Observations:Ihave observedthatthe unithaveequipment’sthatwillhelpthe healthcare professionalsindoingtheirtaskparticularly inassessing
the patients. I am talking about the bladder scanner and Doppler ultrasound that are available in both side A and B. I have also observe that
differenttype of people are roamingaround inthe unit.There are the patients,theirfamilies,the physicians,Occupational therapist, care aides,
managers, students, and the nurses in the unit.
Reaction/Reflections:My firstreactionwas beenamaze.The word that comesto my mindto describe whatI am feelingis“WOW”. To have this
equipment’savailable foruse isa great helpfor the healthcare professionalsinprovidingcare.I feltthat the unitis busy,but you can sense the
feeling of calmness. Even though people are in hurry they still look organize, and for me that should be the case, because we don’t want our
patient to see that we are rattled because this will also affect them in some way.
Interpretation/Internal Analysis:The way I reactedis justnormal.I came from a thirdworldcountry andwe don’thave thisequipmentavailable
to be use.The bladderscannerissohelpful infindingoutthe amountof urine thatisinside the bladder,sothatappropriate measure willbe done
inorder to correct itif the bladderisfull of urine torelease the tensionoutof it.Meanwhile the Dopplerultrasoundis use tocheckonperipheral
pulsesespeciallywhenitishardto detectitusingpalpation.Thisistocheckif tissue perfusioninthe lowerextremityisstillworkingappropriately
to preventfurthercomplications.Itis alwaysa common scene ina hospital unitto be crowdedand staff are busy,but what is importantisthat I
can use every personality to my advantage to learn. Like the physician and interns that are roaming around, as a student I can go with them
especially if theyare goingtomy assignpatient.Justbeingthere andlistentotheirconversationwillalreadygive meafull picture andunderstand
whatis really goingonwithmy patient,andin the longrunthiswill give me the advantage toanticipatewhatwillmypatientneedsandhowIwill
going to take care of him.
Decisions/Determination: After reflecting and interpreting what I have seen so far in the unit, I realize that how lucky we are to have this
equipment’savailable inthe unit.Myjobisknowhowtouse thisequipment’sonhand.Ineedalsotoknowhowtointerpretthe resultandreport
the findingstothe primarynurse. Itismyresponsibilityto showsome initiative tolearntouse thisequipment’stomyadvantage.Regardingwhat
ishappeninginthe unit,Iwill make itasa considerationthatthere isalwaysalearningopportunity.Ijustneedtoinvolve myself andbe proactive
enough to do my job as a student. My number one job in this field experience is to observe the unit routine and practices, followed by doing
assessmentsandbasiccare to my assignedpatient. Itismy responsibilitytobe alwayspresence mentally,physically,andemotionallyeveryfield
day. It is my responsibility to make my patient above any priority. Overall, it is my responsibility to strive to be a good and effective student.

2. WEEKLY REFLECTIONS 3
Observations:I have observedthatthe nurse-patientratioonbothside of the unitisusually1:3 or 1:4. I have alsoobservedthatthere are rooms
that are occupied only by one patient and I am thinking they are those patients’ that are isolated because of their condition but other rooms
usuallyhave 3to4 patientssharingone room.Furthermore,Ihave observedthatnursesinthe unitare usingSBARincommunicatingwithdoctors,
as well as IDRAW when communicating with each other.
Reaction/Reflections:My immediate reactionisIfeltchallenge,butthinkingthroughitthe ratio isnot bad at all.Iam alsoamaze that theyhave
thisisolationroomsinsucha busyandcrowdedunit. Ifeel thatthisisa rightmove for the managementtosegregate theirpatientbasingontheir
presenting illnesses to prevent spread of infection. I felt happy that the nurses in the unit where able to show us how to communicate
professionally to doctors and within their selves.
Interpretation/Internal Analysis: My immediate reactionand my feelings is just normal. I feel challenge but to think of it the ratio betweenthe
nurse and the patient is not too bad. I know that in other units or other wards in other hospital that ratio is much more. Having to many assign
patientcause burnoutto the nurse and as a resultthe nurse can’t performto his/herfull capability. Forthe managementdoingthisstrategywill
surelybenefitthe nurse toperformeffectivelywithhis/herduty.Since the LPN scope of practice islimited,Inoticedthattheyare partnerwithan
RN, and most of the case theirassignpatientroomare just near to each otherso that the RN can helpthe LPN ina task that theycan’t perform.
Havingan isolationroomina busyand crowdedunitisjustexcellentforme.Youdon’twantto spreadinfection,andthe bestwaytopreventthis
is to have isolationroomsforpatientwhoare immunocompromisedandseverelyill.Usingthe effective communicationtechnique inabusyunit
prevent miscommunication which can be detrimental on the health of the affected patient. A good communication and collaboration between
the health care providers is the best way of promoting wellness and preventing complications.
Decisions/Determination: After reflecting and interpreting what I have seen so far in the unit, it makes me think that a good communication
between health care providers plays a key role in the faster healing of a patient. As a student what I have learned in the classroom, I need to
practice and use it in a real setting. I need to practice my communication skill by talking to the nurse and reporting my assessment findingson
time.If giventhe chance I needtobe proactive topractice thiscommunicationskills,sothatinthe longrun I will be confidentinusingit.Toplay
my part in infection control, I need to wear appropriate protective equipment if I will be assigned to an immunocompromised and severelyill
patient. Whateverthe ratiois,whenIgo to the fielditismyresponsibilitytobe alwayspresence mentally,physically,andemotionallyeveryfield
day. It is my responsibility to make my patient above any priority. Overall, it is my responsibility to strive to be a good and effective student.

3. ROOM# 1022 - bed1
Name:P.U.
Age:59 yearsold
Code:Full code
Allergies:Hydromorphone
V/S:BP: 149/66
Temp:36.7
Pulse:79
RR: 16
O2 Sat: 95 RA
Activity:Independentwithacaine
Diet:Diet+ NPOafter midnightJune 19
Foley/Output:Insitu;sufficientamount
Drains:None
IV:D5 ½ NS@125cc/hr; secondarybag
withPantolocinfusion
O2: None
LBM: None
Other:
Pain:Deniesanypain;refuse morphine
Respi:Noadventitioussoundheardin
lungauscultation
Cardio:presence of non-pittingedema
on bothfeetesp.onthe ankle,
posteriortibialispulsesheardwith
Dopplerultrasound
In/Output:Accuratelytobe monitored
Glucometer:every4hours
Gastro: BSx4 but weak/hypoactive
Diagnosis:Abdominal Pain
History:Rectal Cancer,DM2,
Anemia,Hypertension,
Appendectomy,Sciatica,Liver
Hemangioma,ProstaticAdenoma
Chief Complaint:Unwell since
yesterday,central abdominal pain.
Ostomyon April 2016 for Cancer.
RecentICU admissionpatientpale
and weak.
Date of Admission:
June 18, 2016
SurgeryDate:Not applicable;went
to nuclearmedicine forscanning
MEDICATIONS
1. Pantoloc
2. Piperacillin/Tazobactam
3. Pantoprazole
4. Morphine
5. InsulinRegular(slidingscale)
6. Ondansetron
7.Dimenhydrinate
Assessment Focus Assessment Findings
1. NeurologicAssessment
2. ChestAssessment
3. Vital Signs
4. Abdominal Assessment
5. GenitourinaryAssessment
6. Peripheral VascularAssessment
7. PainAssessment
8. Bloodsugar
9. Stoma Assessment
10. IV Assessment
11. SkinAssessment
Patientisawake,alertandcoherent.He iswell orientedx3.
He isbreathingwell withease inrespiration,noadventitious
soundhearduponlungauscultation.Vital signstaken:BP:
149/66; Pulse:79; RR: 16; Temp: 36.7; O2 Sat: 95 RA. Patient
has no medicationforincrease bloodpressure.Patienthasan
IVFof D5NS@125cc/hr. Has an active stoma.Peri-skinarea
aroundthe stomaisfree fromrashesand warm to touch.
Bowel soundheardduringauscultationx4butweak.Foley
cath in situwithsufficientoutputamount.Bothfeetwithsign
of non-pittingedema. Patientdeniesanypain.Bloodsugar
takenat 1600 witha resultof 6.8 mmol/L.

4. MIND MAP

5. Definition of Terminologies:
1. LiverHemangioma - A liverhemangiomaisatanglednetworkof bloodvesselsinoronthe surface of the liver. Thistumorisnoncancerousand
usuallydoesn’tcause symptoms.The tumorisusuallysmall,measuringlessthan4 centimetersindiameter.Insome cases,however,itcan grow
much larger. A larger tumor is more likely to cause symptoms, such as abdominal pain and nausea.
2. Prostatic Adenoma – also called benignhypertrophy of the prostate is a benign tumor on this gland, locatedunder the bladder of men. This
causesan increase inthe size of the prostate,whichcanleadto symptomssuchas difficultyurinating,afrequentneedtourinate,aweakstream,
or difficulty ejaculating. The causes are not well-known, but age visibly plays a role: in fact, it mainly occurs in men over the age of 50.
The adenoma is usually not removed unless the symptoms become too troublesome.
3. Sciatica – painaffectingthe back,hip,andouterside of the leg,causedbycompressionof aspinal nerve rootinthe lowerback,oftenowingto
degeneration of an intervertebral disk.
4. Rectal Cancer - has grown throughthe wall of the colon or rectum and is attachedto or has grown intoother nearbytissuesor organs.It has
spread to at least one nearby lymph node or into areas of fat near the lymph nodes.
My analysis for this patient: The patient is still in NPO statusbut from what I heard from his nephrologist whenhe visited him that he give the
clearance toallowthe patienttoeatanddrinkwater.Off courseconstantmonitoringshouldbe doneonhiswaterintake tomatchwithhisoutput.
According to the doctor that his kidney was affected causing the abdominal pain. They are still doing further assessment to figure out what
procedure need to be done to the patient. The patient just went down to nuclear medicine for scanning purposes and they are waiting for the
result.
Patientcurrentstatus: The patientcapillarybloodglucoseisstable.He hasanIV of D5½NS@125cc/hr. Pantoloc infusionisrunningasasecondary
bag. Foley catheter in situ and draining with sufficient amount.
Possible patient teaching:
1. Since the patient is independent and able to walk with the help of his stick, I will encourage him to ambulate each morning during his stay in
the unit. This will promote normal blood circulation and improve metabolism.
2. Since the patientknowalreadyhowtocleanhisstoma,what I can do isto educate himaboutthe signof infections,what tonote forandgoing
to report.
3. I will encourage the patient to adhere to all treatment provided.
4. I will encourage the patient to eat food low in fiber once NPO status is lifted and also to increase his fluid intake.

6. 24 Hour Patient Care Flowsheet
PAIN – Patient denies any pain. Pain scale is 0 out of 10. Refuse morphine.
NEUROLOGICAL – Patient is awake, conscious, alert, and coherent. Level of orientation is x3 with person, place,and time.No sign of confusion
and dizziness.
RESPIRATORY – Patientisbreathingwitheasewithanormal rise andfall of thechest,nouse of accessorymuscletobreath.Noadventitioussound
heard upon auscultation. Respiratory rate at 16 cpm.
CARDIOVASCULAR – Patientcolorisappropriate withethnicity,warmtotouch,capillaryrefill lessthan3 seconds,andpulsesare strongto touch
peripherally except for the posterior tibialis its weak because of the ankle edema on both feet, Doppler ultrasound was used. Patient BP is at
149/66 mmHg and PR at 79 bpm. Patient has no hypertensive medication.
GASTROINTESTINAL – Patient is in NPO status, and hypoactive abdomen.
GENITOURINARY – Patient has Foley catheter in situ with sufficient amount of drain.
INTEGUMENTARY (SKIN) – Patient skin has a good turgor. No sign of skin ulcers and rashes. Lower legs a little bit dry.
MUSCULOSKELETAL – Patient is independent with the help of his stick for balancing.
PSYCHOSOCIAL – Not applicable
SAFETY – Call bell within reach, side rails are up on both sides, patient safety and equipment check done.
DRESSING/ INCISIONS – Stoma dressing is intact, clean, and dry. Peri-skin area is free from rashes and warm to touch.
DARINAGE TUBES – Not applicable
OTHER
Accurate IN/OUT to be observed.
Glucometer test to be every 4 hours.