Internship at children national centerye

Internship at National Children Center 10/5/13 Internship at National Children Center Cooper Jovan is 17 years old boy diagnosed with HBSC. HBSC is characterized by chronic pain, asthma and OSA. Sickle cell disease is a disease acquired through genetic inheritance in families of African America, Arabian, Greek, Italian, Sardinian, Maltese, Turkish, and Indian ancestry. Patients who inherit the sickle cell gene from one parent (heterozygous Hbs/HbA) do not show symptoms and are termed sickle cell carriers. Patients who inherit the sickle cell gene form both parents (homozygous) are subject to severe sickle cell crises (Osborn, 2010, pg 2030). Both homozygous and heterozygous patients can pass their genes onto their children. Sickle cell carriers typically undergo some type of genetic counseling prior to childbearing (Armandola, 2002).
Past medical history of Jovan
Hg SC multiple admitted to the hospital, salmonella sepsis and L humerusosteomyelitis, priapism x1 is pain that can last hour to some days (Kahan et. al. 2009)., post tonsillectomy and adenoidectomy, use BiPap at night and chronic lungs disease related to sickle cell anemia.
Laboratory
Auto Abs retic count 19. 6, Hemoglobin 12. 1, automated Rectic 3. 67 High, immature retic fraction 7. 7% Low WBC count 8. 99 K/mcL Low, Hemoglobin 12. 1 gm/dL, Hematocrit 32. 6.
Assessment
After observing the patient, he showed symptoms of priapism, chronic pain and heavyfluid consumption; both on the IV and through normal drinking. He also had heavy urine output. I also focused on how the pain was managed along with the treatment procedure. With further information obtained from the patient’s chart and past medical history in it, I learnt what type of Sickle Cell he has and the medication that he’s on. The key information on patient reports included his diagnosis, the order of medication and the frequency of how the medication was administered. It also indicated any allergies that the patient may have. This information can be obtained electronically on the Kardex that the hospital uses.
My preceptor pointed out the importance of safe dosage of medication per the patient. This is known as medication calculation and it is very important to all patients but it is more critical for children and elderly patients. He also pointed out the importances of knowing when to use SBAR. This is because it increases patient safety by avoiding communication breakdowns between caregiver and the patient (Joint commission resources, 2007)
What I have learnt in the school enabled me to make proper assessment of my patient. I learnt the importance of communication, understanding the prescribed medication and how to administer medication by using the‘ 6 rights Rule’ in administering the medicine. The 6 rights rules means, right patient, right route, right medication, right dose, right time and right documentation (Daniels, 2004). Every document is different as there are different ways of documenting information on daily purposes.
Diagnosis
The hospital uses electronic documentation on the Kardex. In addition, the ordered care plan is also on the Electro-Kardex. This method of documentation is easy to read and follow hence increasing the convenience of attending to patients (Daniels, 2004). I spoke with my preceptor if I could add or modify the type of medicines to administer. The care planning that I had earlier learnt at school helped me in the organization of patient data. It also provided me with the correct mode of treatment to the patients at the hospital.
Planning
In the planning process, I planned out my day in advance. However, sometimes the day was too unpredictable to follow the plan to the detail. I ensured that I arrived early and took time to put my things away, relax and get some coffee. I then prioritized my day and did first things first. I made a list of what was to be done and focused on the most important activities while crossing them off my list as I did them. I did not let small interruptions interfere with my work. My plan, however, would change sometimes as the day goes by due to unexpected changes in patient condition. I also learnt the importance of delegation and I delegated out some tasks.
Implementation
Execution of the plan was quite smooth. It was made easier by certain institutional resources that facilitated the plan’s accomplishment. The major contribution to the success of my plan was the documentation process with the assistance of the Kardex software. This helped in saving time and ensuring everything was recorded properly. The availability of nurse clipboards and notebooks made it convenient for me to follow my routine. The hospital had vast resources on their computer system for educational purposes. Data collected aimed at helping students, interns and nurses on reading more about patients’ disease and how to administer medication. The percentage of work that I delegated was less than what I undertook myself. I pay more attention on patient’s medication to ensure that he did not miss on his dosage. I administered pain relieving medicines such as hydromorphone after every three hours routinely, PRN, oxycodone 15 mg tab daily, tramadol 75 mg tab after every six hours, ketorolac 30 mg IV and after every six hours. Since he is asthmatic, the patient is put on Bipapsmachine to enable him sleep and avoid any respiratory difficulties.
Evaluation
The patient progressed well and he responded to treatment positively. I also did well in providing the patient with quality healthcare and ensuring that his needs were met at all times in order to facilitate faster and efficient recovery. I documented my evaluation electronically using the Electro-Kardex. I also made a report of the patient’s progress to my preceptor two times to ensure that we gave the report to the nurse who was about to report to duty. I learned how to communicate therapeutics with patient and family. New admission data base and education was given to the patient and his family. In this regard, I used critical thinking skills by incorporating the use of evidence based practice to plan care and provide quality safe care to family and patient. I demonstrated safety in protecting patient. On a self-evaluation, I can say, I am much better than when I started the internship program.
References
Kahan, S., Miller, R. G., & Smith, E. G. (2009). In a page. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.
Daniels, R. (2004). Nursing fundamentals: Caring & clinical decision making. Australia: Delmar Learning.
Joint Commission Resources, Inc. (2007). Improving hand-off communication. Oakbrook Terrace, Ill: Joint Commission Resources.
Osborn , K. (2010). Medical-surgical nursing. (p. 2030). Upper saddle river, NJ 07454: Pearson education. Retrieved from http://::: wwww. pearsonhighered. com