Kimberly Blatnica Preceptor Site: Surgery Center at Regency Park Clinical Reflection 4 17 October 2012 Today’s clinical experience allowed for new education and skill practice. I was able to precept in post-op, which was a great change. Being in pre-op, we are responsible for receiving clients from the OR. We then monitor them, reeducate, prepare for and perform discharge, and cleaning the area that was used by disinfecting, tossing and replacing linens, and moving the bed to an empty room in pre-op. We receive report from the circulating nurse and the nurse anesthetist when they first bring the patient to recovery.
Together we hook the patient up to the monitors and record the first set of vitals together. These include: blood pressure, heart rate, respirations, temperature, pulse ox, pain (if patient is conscious), and an ECG reading if they were general. When I first arrived to clinical today- I was told we were going to be busy. I was also able to work with clients’ receiving urology and ENT procedures, not just cataracts. Urology was new for me but I was excited to be doing something different. Learning needs identified for this experience were only regarding urology patients.
They differ due to the use of general anesthesia, the need to void before discharge, education of post-op care, and pain medication administration. Learning needs I identified from this experience includes education about the different urology procedures and education, how to effectively care for a general anesthesia patient during recovery, and complications. I met my needs by asking many questions during clinical and the use of our textbook. One of my client’s primary concerns occurred after he received a cystoscopy with the insertion of an indwelling urethral stent.
This patient was a 52 year old male, with mild hypertension. No other health concerns were noted in his chart. He originally scheduled the procedure in order to remove a very large stone. However after waking up and speaking with the surgeon, he was told he had been too inflamed for the procedure. The surgeon asked him to schedule a second attempt for the removal for next week, in hopes the stent would decrease the swelling. This client also did not know how to care for the stent. The stent will make a patient feel the constant urge to void. This sensation is often relieved by pain medication.
It is very uncomfortable and can easily be dislodged while passing stool, wiping, cleaning the area, and getting dressed. This specidic stent is attached to a string that hangs outside the patient’s body. The stent can lead to infection if the area is not kept clean. These were important concepts to discuss with the client. Main points I helped to educate were: take pain medication every 6 hours to eliminate the likelihood of increased pain, drink plenty of fluid to help flush the renal system, no bathes, signs of infection, situations when to calling the doctor is a must, and how to care for the stent.
I also helped administer 2 rounds of Fentanyl and two Percocet to help relieve his discomfort and urge to void. He was then able to void which resulted in blood tinged urine. We assured the patient this was normal for the first void following surgery. He was in a lot of pain during this process. It was more comfortable for him to stand, but during his stay he spent most of his time sitting. He also had a forty-five minute drive home, which is why we decided to administer two Percocet, instead of one. One course objective I met today was: demonstrate effective communication skills.
This was completed during every education session I had with my patients and their family member/friend prior to discharge. Regardless of the procedure, every person is provided with post-op care instructions. A second course objective I met was: collaborate with patients, families, health care team members, and others in the provision of care. I worked side by side with great nurses all day. We worked as a team with interventions, time management, discussions about the patient’s needs and concerns, reports, and preparations. We also worked close with those working in the OR.
Also, while educating patients, sometimes there is a need to collaborate alternatives. This is important to maintain outstanding health care. Report on one patient at least 3 times throughout the semester| The 52 year old male described previously received surgery today in hopes of removing a painful stone. He was experiencing abdominal pain and has had a history of past stones requiring surgery. Diagnostic studies for this patient included a previous x-ray and today’s cystoscopy. The indications for surgical stone removal include: stones too large for spontaneous assage, stones associated with infection or impaired renal function, stones which cause persistent pain, nausea, or ileus, a patient’s inability to be treated with medication, or a patient with only one kidney (Lewis, 1137). Those associated in this case were size, risk for infection, renal function, and pain. An aspect that differed from a typical care was the inability for stone removal and severe inflammation (Lewis, 1137-8). The passageway was so swollen; the surgeon could not even get near the stone’s location.
Furthermore, usually patients will know why they have the reoccurrence of stones, while this patient did not. They hope after removing the stone, they will be able to prevent further episodes by testing the actual stone’s composition. Another patient I cared for today was a 17 month old male. His diagnosis was unspecified chronic nonsupportive otitis media. He received a typanostomy. Many symptoms and complications of otitis media in our text are congruent with this patient’s history- even though this patient is not an adult.
The patient has a history of purulent exudates, bilateral hearing loss, and inflammation of the middle ear (Lewis, 426). Differentiating from our text, the child was often times seen pulling on his ears as a result of pain; while our text states it’s more likely to be painless (Lewis, 426). Complications of this disorder results in chronic inflammation which was most likely the cause of his pain. Typanoplasty, ear irrigations, antibiotics, analgesic, and surgery are all recommendations for those with Otitis media (Lewis, 426). These interventions were in the patient’s file.
Today, he had the tubes removed from both ears and left with a prescription for Tylenol and antibiotics. This procedure was recommended if medication was not successful (Lewis, 426). | Report on at least ONCE throughout the semester | Today during the recovery of the 52 year old male mentioned above, we noticed he did not have his two prescriptions written. It was important we found the surgeon before he left (this happened to be his last case). The patient was missing his prescription for his antibiotic and pain medication. Both important for his recovery and duration between surgeries.
My preceptor paged for the surgeon, and he happened to return before she returned to the patients area. I was feeding the patient ice cubes when he asked me what the call was for. I was able to show the surgeon his orders and blank scripts. He filled them out and I began to explain the use of and directions for both medications. I was able to communicate with the surgeon both effectively and professionally. Furthermore, it helped the surgeon was very nice- to staff and patients. I did not think or feel much about the interaction ahead of time. It happened so fast, but once it was over I was proud of myself.
I feel even as a student nurse, you still have to be prepared for anything. If I could, I would change the fact the prescriptions were written out ahead of time. At the surgery center we have receptionists that organize our charts. These staff members keep the jobs of nurses and doctors organized and effective. A couple weeks ago, I was going through a chart and noticed a patient’s medication reconsolidation form was missing. By speaking to the receptionists, they were able to obtain another copy. This form is very important when discussing medication regimens with patients in post-op.
It is important for new medications to be explained and checked for incompatibilities with other medications the patient is prescribed. I felt speaking to the receptionists was not much of a challenge; however, without their help we could have had a more serious complication. I do not feel receptionists get enough credit in the medical setting. They may not be running around all day; however, without them at the surgery center (which does not have EMRs) they play a role in patient safety and allow everyone else to perform their duties. |