Clinical Journal 2012
Paula Ridl
Lakeview College of Nursing
Foundations of Nursing Practice
N210
Hediye Scheeler
January 11, 2012

Clinical Journal 8
This week we didn’t have a clinical.  We worked together in lab today to learn the process of the foley catheter.  It went pretty smooth, and I feel confident in doing this procedure.  We each walked through insertion with female parts and male parts.  We worked in groups of three and helped each other with clues when the person got stuck.  Not much to talk about in the journal this week.  Keeping it all sterile is kind of tricky but once you do it a few times it’s easier. 
Clinical Journal 7
This week I was sent to wound care to assist Mary Holley the wound care nurse.  First she let me look at pictures of different kinds of wounds that she has seen come through her department.  She shared with me some of the stories that went along with the pictures.  I looked at pictures while she prepared for her three patients for the morning.  When the patients arrived I assisted her with whatever she asked of me.  We had two patients from the nursing home, and one patient from a home setting.  I took a picture of a diabetic ulcer on the patient’s left foot.  The patient had already had her left leg amputated above the knee.  I also watched the doctor debride an ulcer on the big toe.  Another patient had eczema on both the palms of his hands.  He also had a patch on his back and his left leg.  The doctor had prescribed him a lotion with steroids to be applied twice a day, but the personnel at the nursing home seemed to only get it applied in the morning.  Mary thought that the doctor was going to have to give the patient an injection into the palms of his hands, (Did she say what kind of injection and for what?) but when we looked at his hands they had improved greatly.  I also got to help transfer this patient from his wheelchair to the bed that he was examined in.  The third patient had a skin graft that was done last week.  I watched Mary change the dressing and put an Uno boot on the patient. How long did she say the Uno boot would stay on until the next change?  We cleaned up the exam rooms, and then we hit the hospital floors to perform any dressing changes that the nurses had not had time to do yet.  Out first stop was to a quadriplegic who had a very large stage 4 pressure ulcer in the sacral area.  I got to probe the wound with a sterile cotton swab, and I observed while Mary cleaned and packed the wound.  I got to help her bandage that area to make it somewhat water proof, since it was so close to the patient’s anal area.  I also got to talk a little to this patient, and she told me how her daughters help to take care of her.  This was due to the fact that when Mary opened the sterile gauze it fell out on the bed sheets, so she had to go back to pixus and get another package.  Then we went down to floor number three, and I got to change a hip replacement surgical bandage with instruction from Mary.  Then she also let me document it in the computer.  All and all it was a great day in clinical, and I learned a lot about proper procedures.  I also learned a lot about the different kinds of bandages, pads, preps, and gauze used in the hospital.  During the interaction with each patient, Mary explained why they did what they did to that patient.  It was a great experience. I am glad it was a good experience for you.
Clinical Journal 6
This week I had a very interesting patient.  She had lots of disease processes along with numerous surgeries.  I was impressed with her attitude, and I loved her sense of humor.  She was a delight to take care of on Tuesday.  I assisted her with a bed bath where I inspected and palpated her skin.  I listened to her heart sounds and lung sounds too.  I helped her to sit in a chair, and I changed her bedding.  I spent a lot of time just talking to her, and she shared many of her medical experiences with me. I didn’t get to observe or help with my client’s dressing change or med pass, because the nurse did these while I was inserting a catheter.  However, I did get to do her Accucheck before lunch.
I also got to insert a catheter into a male client.  It was a little beyond my knowledge, but with help from my clinical instructor it was pretty successful.  I say pretty successful, because I knocked the urine specimen cup over after I emptied the catheter bag.  Oops!   
Clinical Journal 5
Well this week I had a nurse and a patient who didn’t want me around, but that is okay.  My clinical experience was especially rewarding for this week, because I got to help numerous patients, a nurse, a CNA, and my clinical buddies.  Hopefully, next my patient will let me practice on them.  
I helped Michael administer oral care and transfer his patient from bed to chair.  I helped the nurse and CNA move a patient, clean him up, and I watched the nurse put a new dressing on his drain.  I also used a wet washcloth to moisten his lips as they seemed incredibly dry.  I then proceeded to the next room with the CNA where I helped give a bed bath, regowned, and made the bed with the patient in it.  
I learned how family members seem to get under the skin of a seasoned nurse.  I know I don’t want to be that nurse.  I guess I looked at it different than the nurse.  If my dad was in the hospital I would be there with him too.  I would want things done correctly and my father to be treated with dignity and respect no matter how many times they had to clean him up.  I made a connection with the daughter, but never mentioned what had happened in the room.  I’m pretty sure by what the daughter said to me that I made a difference in their hospital experience even if it was just a short time.  
Clinical Journal 4
This week we had our first clinical experience.  I practiced taking vitals except blood pressure on my patient because of her small arm size.  I did, however, practice blood pressure on my mom.  I also gave my patient a bed bath, inspected her skin during this bath, had numerous conversations with her about her family and her living situation, and watched the nurse administer go through her medication with her.  I also helped Kristine move her patient up in bed.  
I learned where all the supplies and equipment are kept on 4 west.  I went through the patient’s chart in their book and saw where different things about the patient were kept in that book.  I listened to report at the change of shift from the previous nurse to the nurse that I worked with.  I also learned how to use the Accucheck machine on our unit.  
I reported to my instructor and then the nurse an abnormal lab report when I received the printed copy from the lab.  The nurse had already seen the report in the computer and made note of this value for the doctor.  However, when she was checking the medication she forgot about the abnormal value and gave the patient a potassium supplement.  At this point I had not received the printout of the lab.  I brought it to the nurse’s attention when I did see the lab, and she assured me that she would let the doctor know what had happened if she saw her again that day.  I’m not sure if an event report was filled out.  I brought it up in lecture, and Hediye told me to include it in my journal to you.  
Clinical Journal 3
This is our third week, and we had our first Foundations test.  I felt like I knew the information, but I guess I will wait and see.  Most of the new students were very nervous to take this first test.  I remember that feeling well myself.  I had many questions on how I studied for one of these tests.  I told them to know the terms, answer the practice NCLEX questions, pay attention to the boxes in the chapters, and take as many PrepU questions as they can.  
I was a little concerned about Kelsie yesterday.  She didn’t seem like her usual bubbly upbeat self.  I am going to keep an eye on her the rest of the week to see if she bounces back.  I hope that she isn’t struggling with classes, but I could understand if she were.  
I heard from my mentor this week.  I look forward to meeting her in the near future.  I think that it is great that Lakeview has the mentor program.  It is nice to hear from someone who has made it through to their last semester.  I think it gives all the new students hope in a very heavy work load semester.  
I am a little nervous about the medication checkout in a couple of weeks.  I have passed Denno’s medication calculation test twice already, but I think I will revisit it just for practice.  I wanted to be a nurse to help people, and I sure don’t want to harm anyone by a med error.  This is probably my biggest fear.
Clinical Journal 2
This is our second week back to school.  The new students are still trying to get their bearings.  Today after Foundations lab I stayed and helped a fellow classmate with blood pressure.  He was pretty freaked out over having to test out on taking temperature, pulse, respirations, and blood pressure by next Tuesday.  So I figured I’d give him the opportunity of extra practice on me.  I also listened to his concerns and tried to reassure him.  I encouraged him to practice on his wife, friends, and anyone else he could get his hands on.  
On my home front, my daughter’s very first dog died on this last Monday, which just happened to be my birthday.  The dog was only seventeen and a half years old.  We’ve had her since my daughter was three.  It was pretty hard on her, but we talked a lot about it on Monday.  She was crying, because she missed her.  So I asked her if she would wish her back like she was before she died, and I think that made a big difference in how she looks at the situation now.
I am looking forward to computer training at Provena USMC tomorrow.  I have never viewed a computerized medical record.  I am excited about being able to read what is written in the notes about the patient, because last semester it was hard to decipher the hand writing in the charts.  
Clinical Journal 1
My first week back to school has been good.  I have not experienced any anxiety thus far.  I feel for all the new students, as I remember very well what it feels like the first two weeks.  Some of them look like a deer in the headlights, not knowing what to expect or make out of this whole experience yet.  
I am looking forward to this semester, because when I complete it I will have finished my first semester of classes that I started out in last January.  It was pretty disappointing to me to not be able to finish last semester, but it is not in my nature to give up.  It is also not in my nature to dwell in the past.
I am looking forward to my clinical site at Provena USMC, and the computer medical records.  Last semester I was at Colonial Manor and the medical records were all hand written.  I think the information will be easier to find and much easier to read on the computer.  
I hope that this great weather holds out and that we don’t have any snow days this semester.  Last year we missed a whole week because of snow.  I don’t mind snow, but I sure like it better when the sun shines as it has so far this year.  
I look forward to the Foundations class and working with all of the lab helpers and clinical supervisors. I’m sure they all will be as great as last year’s helpers and supervisors.  I hope to learn an incredible amount this semester to build a great foundation upon which to build my nursing career.