Post Operation

Learning Report

1.The nurse monitors the patient closely for signs of shock, hemorrhage, inadequate oxygenation and hypothermia. The blood pressure, heart rate, oxygen saturation and breathing patterns will be closely monitored; it is the nurse's responsibility to carefully document each vital sign in the patient's record.
2. I learned how to access the patient when they come out of surgey. I also learned/ observed the order of the patient's assessment, so they can be released from the post-op area. 
3. The best thing that happened was that all the mornings surgeries  had finished so the floor was very busy. 
4. Nothing bad happened.
5. Week result: Was great. When I arrived on the floor I was introduced to a nurse and she told me to sit there while she assesses the patient and talk to the patient when she awakes. When the patient did she was very happy to see me and the nurses with bright smiling faces. It eventually led to us transporting the patient to the day-stay unit where I got to follow my mentor to tell the family about the surgery and how it went. Which was really cool cause I only get to see that done on the ER shows I watch on T.V. 

Learning Experience

1. The technology I observed was the charting and the examining of the patient. The nurse would ask the patient a question and the patient would respond and then the nurse would put in the chart. Then once she was done the nurse called the day-stay area to see if there was a room ready for that patient. 

2. For diagnostic procedures there was one patient who's oxygen level was at 92, but the nurse I was following she likes to have her patients a little bit higher than 92. So in result of that, she kept assessing the patient and kept him there a tad bit longer to see if his oxygen level increased. 

3. For therapeutic procedures each person when they have gotten out of surgery , and they start becoming talkative and alert they are giving the choice of a popsicle or ice chips. 

4. One patient had shoulder surgery so he was given a air pump for his sling to keep it elevated at a certain level and a certain degree. 

5. No medical terminology 

Journal 

    When I arrived on the floor there were rows of little stations that had monitors and nurses station to go. One patient was already out of surgery, and was talking to a nurse who was sitting next to her. At the nurses station they were reading the computers and calling doctors and the OR to see the status on patients. Everyone was really nice and open to talking to me. 

   The teaming skills were great. When the mass of morning surgeries came out it was like a team effort of helping get this patient here and this patient hooked-up and this patient off to day-stay and this nurse telling the family. It was really a family effort. Which I liked a lot. They were smiling and laughing and they were really talkative to me and really getting to know me and what I have learned being in this class. 

   I followed two nurses which was really cool I thought. I thought it was cool because each nurse is different and handles their patients differently. The first nurse I followed really talked a lot. Kinda about her life and such. I mean her and the patient were talking but the patient was really jut going "uh-huh and uh-huh". The second nurse I followed really talked to the patient but made conversation with the patient, and really got to know him. (well for the short amount time). There was a true difference. Both nurses were great don't get me wrong but the second one really took teh time to explain everything, showed me stuff on the monitor, and things like that. 

   I learned how on this unit when it gets busy you really have to help out. Also, you are only with this patient for a short amount of time but they are in your care so you have to make the best judgment call on their health. For example, with the nurse who wanted his oxygen level higher. It's how you practice and how you care for that patient. Each patient has a different history and a different procedure done, and each of those patients are different so you can't treat them the same. 

   I had a really good time on this unit. I learned a lot, and I got to be a bright smiling face when a patient woke up. I got to help out and I learned a lot about the patients and how to treat them differently. I would love to work on a unit like this. BUt, I think that short amount of time with that patient wouldn't be enough for me. I like to see the whole process through, and just passing the patient on to someone else just isn't my role. I had a great time. I hope I can go back. 

Med Surg floor 6

Learning Report

1. Med Surge nurses do a lot of jobs but the ones that my Mentor   

    did was administer medications, ease pain, encourage activity,            

    and prevent complications.

1. I learned how to manage all the different type of patients you could have at one time. My mentor had several patients at one time and at one point each of them needed her for something, so it was nice to see how to manage which order to go in because you want to be in so many places at once but you can’t. 
2. The best thing that happened was that I actually got to see several patients and it felt like a normal work day. My Mentor and I were making rounds to all her patients, and then she sat down to chart and some patients wanted ice so she let me get them ice. The whole time I was there all the health care workers were really welcoming. 
3. Nothing bad happened on the rotation.
4. There was no mistake.
5. Week: Good-It was really good. I got to see and learn a lot. My Mentor was great, and she really explained things after we saw each patient. Then like I said before I was able to get ice cubes and such for the patients. All the health care professionals were great and they even asked me questions of what I had seen or experienced which was nice.

Learning Experience

1. The technology I observed was charting of each patient. When they chart you can see any doctors orders, medications, what time those  medications were given, how much, the last time they showered, pain scale, ect. It is very time consuming, but needs to be done so that the doctor can look and see what is happening with their patient and make changes. 
2. For diagnostic procedures there was patient that we checked on that was getting his gallbladder removed. Reasons to have your gallbladder removed would be an infection, gallstones, or the gallbladder is not working normally.
3. For therapeutic procedures the same patient was having pain which is normal when dealing with the gallbladder, so the nurse gave him some pain medications but a very low dose since he was on the list for the surgery. Also, another patient was in his process of getting up and walking around so the therapist came up and worked with him, and actually got him sitting up in the chair talking with his family. 
4. The patient who saw the therapist had a Pacemaker. A Pacemaker is a small device that’s placed in the chest or abdomen to help control abnormal heart rhythms. This device uses low-energy electrical pulses to prompt the heart to beat at a normal rate. 
5. No medical terminology 

Journal

The environment when I got on the floor was very busy and you could tell that it was busy.  Several nurses were coming out of rooms, quickly charting and moving on, and there was one patient that was going  to a small surgery procedure. The personnel was great. They asked my questions about what I had seen and what I plan to do in my future. My mentor had the typical charting cart that you could roll around the floor, which is the same technology that was utilized. 

With the staff some were sitting at the nursing station charting, and some were treating and going in and out of patient’s rooms. The teaming skills were okay. All the nurses were kinda just trying to finishing the charting and trying to get doctors orders through, so there weren’t really teaming skills. The mentor that I followed really communicated with me really well. We would go into a patient’s room-treat the patient-then we would leave the room-then she would explain what she was putting into the charting and what she was going to ask the doctor for. 

I learned how busy it can be, and how to manage that at times. Cause at one point where all patient’s were needing us and so we kinda had to organize what was more important. There was no medical terminology used. 

The time I had on that floor was great. I didn’t really get to see a lot of interest things like people who had came, but I got to see a lot of patients. I got to see affect of the surgery and the post part of surgery which was cool. 

Day Surgery

Learning Report

1) Required to assess the patient and resources, plan for the scheduled surgery and postdischarge care, implement the plan, and evaluate the patient's and family's understanding of the information and their ability to provide for self-care at home in as little as 2 hours. 

2) I saw pictures of different endoscopies that have preformed at MMH. An Endocope is an instrument that can be introduced into the body to give a view of its internal parts.

3) The best thing that happened was that I got see different endoscopes that have been done, and I got to see the beginning of the admission process for surgery to take place.

4) The worst thing happened was that majority of the time I sat there. 

5) There was mistake.

6) This week: Bad- It was bad, because I literally had to ask the nurse if I could come in and observe. I sat there from the beinning to the last part of the experience. 

Experience Report

1) The technology I observed was the charting of different patients. Then on one of the walls there was a t.v. that had a list of all the surgerys witht he case number, OR in or out, and then post-op in or out. Also, the nurse admiting the patient. 

2) For diagnostic proedures, there were some OR nurses waiting to go into surgery, and they were reading up on their patient to see how much of each medication to give, if they signed the treatment form, they know the surgery and what. The anastegolist would read up to see how much to give, and then get the correct amount. 

3) For therapeutic produres, the nurse who I finally got to follow made sure that the patient knew exactly what the procedure was going to be, and then she also inserted an IV.

4) The patient had previous surgies. He had a broken his leg, which has a rod in which had happened several years ago.

5)  No abbreviations or medical terminology used.

Journal 

   When I arrived on the floor everything was very organized and clean. There were separate rooms that were small, and a hospital bed and a 1 chair for a family member to be there. There were proper medical things that were in there, like fluids and other things. The personnel ignored me, and it was like I wasn't even there. When I went to the nurses station and introduced myself, and everything. In response to me, I got, "here is a chair and a book." I thought was very rude. They continued their shifts, and it seemed like they didn't even know I was there.
   The staff was not straight up rude, but did ignored me. They went on their day, with charting and calling and scheduling opperations. Communication between the staff was very friendly, and you could tell that several of them are very good friends. The communication between staff and patient was warm and welcoming. The nurse that I watched was very welcoming. She didn't just go through all the steps, but also asked them personal questions and family questions. The diagnostic procedures were very simple. The operating nurses came and read their patients file and made sure everything was covered. Diagnostic prodcures, the nurse that I followed input an IV, so the patient could have fluids running through his body. 
   I learned the steps of how to admit a patient, and go through the pre-surgery questions and checking of everything. They really made the patient seem warm and welcomed. They asked some personal questions, plus asked if he knew what the surgery was, and was asked to expain it back to her, things like that. 
   The time I had was not that great, because of the personal. I didn't expect anything going on to the unit, but I was kinda disappointed by the way they treated me indirectly. I want to learn, and even if it's taking vital signs I want to learn. This someting I am passionate about and I want to know more. I don't think it's that hard to show me around and let me know things that happen on the floor, instead of me showing a book. 
   

X-Ray 101

Learning Report
1. involved with the assessment, planning, and care of patients who undergo diagnostic, interventional, and therapeutic procedures.
2. I learned the steps taken to do a contrast x-ray on a kidney. I also learned the proper steps taken to make sure that the organs can digest the contrast, also I observed now to measure the vorrect of contrast to give.
3. I had a contrast done on me two weeks ago on my kidney just like the patient it was cool to see the final pictures and x-rays of the patient. 
4. The worst thing that happened was that at the start the person I followed was not very receptive of me. As I started asking questions he saw that I really wanted to know and learn more, so his attitude changed. He became more receptive and really started showing my things.
5. I saw his attitude towards me, and so I looked at myself and changed how I appeared. I started listening more, asking questions, and really being more attentive.
6. This week was: fair. It was fair because nothing really exciting happened. Yes, it was cool to see what was done and to see actual results. But, I missed observing the treatment of patients. 

Experience Record
1. The technology I observed was the testing of a kidney through contrast.  In many cases, the use of a contrast dye is necessary to enhance these tests, but sometimes these dyes can either lead to kidney problems, or cause problems in patients with kidney disease. 
2. There weren't any diagnostic procedures.
3. There weren't any therapeutic procedures.
4. The patient I believed had a history of things on her kidney. She stated several times that she had this done before. She seemed very relaxed with every step they took. She knew every step that was taken, and knew what each step showed the doctors. 
5. There was no terminology.

Journal 
   When I got to the radiology department the nurses were all sitting at computers and examining x-rays. On several walls there were white boards that had a list of patients with names and what procedure they were going to have done. All supplies seemed very organized and well taken care of. When I saw the actual testing room, all proper PPE was arranged and was easly to get to. 
   The staff was looking at test results, and greeting patients that they were handling. The nurse I followed interacted with his patient with great communication and care. The whole staff was very relaxed and willingly to do anything. There was one point where they were looking at the schedule for the next several weeks, and one staff member couldn't work, so in result I saw how each staff member steped up and helped. They were all hard working members and were very open to discussion.
   I had to get a contrast done on my kindey. I never saw the reuslts, or even x-rays that showed the tumor that is on my kidney. The patient I saw did have the same thing. She also had been doing the same testing that I had to do. I was cool to see the actual results of someone's kidney testing. You could clearly see the tumor, and you could see the contrast go through and pop up on the testing. It was a great learning experience. 
   I had a fair time. Nothing really happened. I learned how x-rays work, and how the doctors use them to diagnosis a problem. I did learn a lot, but it was slow getting started. I really had to step up to the plate and take my own learning into my own hands, which I think was nice thing in the end. I have been lucky by having several great rotations and several great medical professionals to teach me. This rotation really made me take a step back and realize that I am not always going to have the AMAZING ROTATION. I did learn a lot don't get me wrong, but I can truly say that this is not the place for me. 

ICU

Learning Report 

1) When a patient has suffered a heart attack, stroke, shock, severe trauma, respiratory distress or other severe medical issue, it is vital that they receive immediate and intensive nursing care. Critical care nurses are adept at providing such care in settings where patients can be given complex assessments and treatment. 
2) I learned a lit of new things in the ICU. With the patient I saw I learned what monitors he was hooked up on, and what they were used for.
3) The whole time was great. I followed a nurse who really told me step by step what he was doing and why. Then towards the end he took a break, and I sat with Niomia. She explained some of the patients she has seen and helped.
4) The worst thing that happened was seeing a patient that came into the hospital for a simple sickness, and it turning into something that put him in the ICU.
6) This week was good more likely fantastic. At the beginning I was scared  and nervous, but once I got into the ICU mode I really enjoued. I think I found job when I got older, and that's being an ICU nurse. 

Experience Report

1) The technology I observed was all the monitors that the patient was hooked up on. With the monitors it told you his heart rate, BP, and respirations. He also was on a venalator. A venalator is a machine that supports breathing. Most patients in the ICU are on venalators, but what patient families need to understand is that it doesn't treat a disease or condition. It is keeping a patient alive. 
2) The nurse I was following his patient was having high blood pressure. The nurse looked at his scans and tests and he realized that his blood pressure was raising due to the fact that he ws trying to wing the patient of the venalator.
3) For therapeutic procedures the nurse tried weaning him off of the venalator. Since, every time the nurse tried to wing him off the venaltor his blood pressure rised, so he had to choose which medicine was better to use to treat it.  But, since the patient's BP continued to rise the nurse said he would have to stay on it. 
4) The patient I saw was a COPD patience. A COPD patient means chronic obstructive pulmonary disease. Since the patient was a heacy smoker, which is the cause of his COPD.

Journal 
   When I arrived on the unit it smelled very cleaned, and it looked very organized.  There were rooms that were rooms that in the shape of an "U". Some rooms had yellow shoe holders which held the necessary products for the isolation rooms. They put a patient in isolation if those patients are contagious and will spread germs. In the ICU those patients immune systems are low, so they are very septible to getting infections or sicknesses very easly. 
   I observed nurses taking vital signs and interactions between the nurses and the patient's families. I noticed that with handling with ICU patient's families that you have to be extra careful about what you are saying, how you are saying it, and the tone of what you are saying it in. There were many safety procedures going on, with all the isolation equipment out, and very precised sanatation. The treatment procedures I saw were the treating of the patient's blood pressure to go down. it was very important to lower it, because if it didn't lower then he would have to stay on the venalator for longer time. 
   I learned how to communicate between the the nurse and the patient's family. Also, how to handle solving just one problem but looking at other things to find out the best solution. I also learned that with ICU patient's their vitals are going to be taken often. When I was there observing the patient's vital signs were taken about 4 times. Medical Terminology that was used was that the patient was labeled a COPD. 
   The time I had their was a great time. I was very nervous on going, but I had a great nurse that I followed. When he went on break, I sat with another nurse and her and I had a great talk. She explained on her experinces in the hospital and patients she has treated. I could really see my self working in a field like this. I liked how you have 2 patients and that you really get to connect and treat them. Because when I get into the medical field, I want to focus on getting that patient to the best health that they can possilby have, and I don't think I could that has well when I am seeing 6 different other patients. The ICU could be my field of practice, and I am very excited to see where it takes me, and what next week has instore for me. 

G.C. for the Week

Rehab 

-This week we got a new assignment task for G.C. I will define some terms,causes of those conidtions, and treatments that patients can do. 

Nocturia 

Define: Nocturia is a condition in which you wake up during the night because you have to urinate. This condition becomes more common as people age and occurs in both men and women, sometimes for different reasons.

Causes: 

• High fluid intake 
• Untreated diabetes (Type 1 and Type 2) 

Treatment: 

• depends on the type and cause of nocturia. If sleep apnea is considered, you may be referred to a sleep specialist or pulmonologist. 
• Some include interventions like restrict fluids, afternoon naps, or wear compression socks. 
• Some medications include:
• Anticholinergic medications: reduce symptoms of overactive bladder
• Bumetanide: diuretics that assist in regulating urine production.

Cataracts

Define:  Is a clouding of the eye's natural lens, which lies behind the iris and the pupil

Causes: As we age, some of the protein may clump together and start to cloud a small area of the lens. Overtime, it may grow larger and cloud more of the lens, making it harder to see.

Treatment: 

• glsses
• strong biofocals
• magnification
• appropriate lighting or other visual aids 
• Surgery 

Dysphagia 

Define: Swallowing difficulties, and usually caused by nerve or muscle probles.

Causes:

• Aging
• lateral sclerosis
• GERD (gastroesophageal reflux disease)
• Myasthenia Gravis 
• Radiation

Treatment:

• Is mostly caused by a neurological  problem, providing  effective treatment is challenging

Glaucoma

Define: a condition that causes damage to your eye's optic nerve and gets worse over time. It's often associated with a buildup of pressure inside the eye. Tends to be inherited and may not show up until later in life.

Causes:

• Occurs when pressure in your eye increases
• Eye fluid isn't circulating normally in the front part of the eye 

Treatment:

• prescription eye drops
• laser surgery
• microsurgery

Incontinence

Define: loss of bladder control

Causes: 

• muscles are weak or too active

Treatment: 

• depends on the type of problem you have and what best fits your lifestyle
• exercises
• medicines
• special devices 

Floor 5 please

Learning Report

1. Med Surg nurses provide adult nursing care before and after medical procedures, and as pateient's conditions and case load will vary daily, med-surgical nurses must be confident in managing complex and differeing care. 
2. I obserced several things that were in the medical book, example how to make the patient's bed.  I also learned that floor 5 is never really calm. Usually they are packed with patient's and going every which way.
3. The best thing that happened was that since the floor wasn't very busy I got to visit with the nurses. It was cool to do that, because last week I was in ER and ER doctors/nurses are different from everyone else, in result of that, I got to see how much they really like their job. 
4. Nothing really bad happened. 
5. There wasn't a mistake. 
6. This week--fair: It was fair because since there wasn't many patients we really just talked. I would have liked to be shown around or something. I missed the actual patient treating of patients. I learned that even though this floor can be exciting it's not where I need to be. 

Experience Record

1. The technolohy I observed was the online charting at the nurses station. There is one big nurses station, and then there are severaly smaller nurses stations around the floor. There two nurses can sit and chart their rounds, and also some nurses will use the station outside their patient's rooms so they can be right there.
2. I did not see any Diagnostic Procedures.
3. I did not see any Therapeutic Procedures.
4. There weren't really any diseases/disorders, but the patient's that I did see had a stomach surgey, and the other looked like she had cancer.
5. I did not encounter any terminology/abbrevations.

Journal 
   When I walked on to the floor it smelled very clean, and very orderly. I saw several nurses making their rounds, charting, and talking to doctors.  There were two crash carts in the major nurses station, and several doctors doing paperwork. I also noticed that on each door their were signs that said if the patient was a falling risk or a health risk (and you need to put on PPE).
   When I reached the nurses station their were several nurses their answering phones and arranging rooms so they can discharge and accecpt patients in. All the nurses were very kind, and whent hey talked about things going on at the hospitaly they always paused and explained what they were talking about, so I could join. The nurse that I followed and I changed several beds, cleaned up a room, and she started to help a patient in the shower, right before I left. 
   I observed how to make a bed, which was kinda cool, because I read it in the medical booklet and then I got to see it be done. I also got see how the nurse needs to be the advocate for the patient. A doctor wanted to release a patient, but the patient had high blood pressure. The nurse was saying if that if a patient with that good of health, and then having a simple surgery, and in result having blood pressure...isn't good. I saw how to use the proper tone, and maybe some good words that I could say to the doctor if I am ever in that spot.
    What I learned was that this floor was not for me. Even though I did have a good time visiting with the nurses, that I want to be involved with the patients. I don't think I could handle having several patients; I think I am more like 2 patients. I want to help with patient's and really be able to help them get to where they need to be.