Christine Rombawa

NURS 360

Reflective Journal

Week 5

Did I identify any cultural factors related to client and family? (Describe

I feel that it is important to provide culturally sensitive quality care to patients and families

of the pediatric, adult, and elderly populations with acute and chronic medical conditions and

mental illness. My patient was a Filipino female that was originally from the Philippines. She was very

pleasant and grateful for everything that I did for her. After building a rapport with her she addressed me

as anako, which is a word of affection that means child.

Part of her cultural belief and practices have to do with temperature. She said that cold water is

not good for her stomach and body. She preferred hot water over cold water, so I was sure to offer her hot

water throughout the day instead of cold water to increase hydration. This is a common cultural belief and

preference among the Filipino population. She was also very polite, and not always truthful about her

pain and needs. She stated that a tolerable pain level for her is a 5. She also refused pain medication

majority of the time. I explained to her that it is okay to ask for pain medication if she is in pain, and it

isn’t an inconvenience, and reinforced that we are there to help her. She did not want to ask me to do

anything, and when I did she apologized and thanked me. English was not her primary language, so when

I spoke to her it was important to speak in simple terms and ask her specific questions to verify her

understanding instead of vaguely asking, “Do you understand?”

Family relationships have significant importance in the Filipino culture. She lives with her sister

and brother and helps take care of the children that are living in the household and she does most of the

cooking. She enjoys cooking for the family and it is a very important role for her.

Christine Rombawa

Student Name Christine Rombawa ________ Date: Week 5_________________

N360 Weekly Self Evaluation

1. Considering your patients current status, list potential complications and strategies for prevention and early recognition.

Possible complications: Bowel obstruction, atelectasis, pneumonia, DVT, PE, infection, dehiscence of surgical incision, constipation.

Prevention and early recognition: Focused abdominal assessment, monitoring for decreased or absent bowel sounds, distention, firmness, pain and tenderness. Check last BM, and presence of flatus. Encourage fluids, ambulation, and diet with fiber, along with administering stool softeners and laxatives PRN. Educate pt. on importance of IS and SCDs, along with symptoms to report. Verify their understanding by asking questions to determine if teaching was effective. Encourage ambulation, use of SCD, IS, cough and DB while splinting. Monitor respiratory status and assess for SOB, dyspnea, diminished and/or adventitious lung sounds, serial CXR. Administer analgesics, antibiotics and anticoagulants as ordered and prn. Assess pain level pre and post intervention. Aseptic technique, good handwashing. Monitor surgical incision for increased pain, signs and symptoms of infection, and approximation of wound edges. Monitor I&O and lab test results.

2. Am I getting more comfortable with the use of the nursing process to plan and evaluate nursing care? (Give examples of how it is better now or problems that still bother you).

I feel that I am getting more comfortable with using the nursing process to plan and evaluate nursing care. This week I had the same patients on both days, and as they progressed my plan for them changed. My plan for day one was different from day two because their condition improved and their protocol level increased. I still have so much to learn, yet I feel that I have been able to prioritize my patient care by using the nursing process and evaluating which patient I should assess first and what my plan is with the direction of my clinical instructor and primary nurse.

3. Were my nursing diagnosis and plan of care individualized for my patients? (Give examples of how you did this.) Do I have difficulty in this area? (Explain).

Yes, my nursing diagnosis and plan of care was individualized for my patients. I know that each patient is different because they may have other secondary conditions and risk factors, along with different social, cultural and mental needs. They also have different medications and knowledge about their treatments. It’s helpful to draw from your previous experiences to help give you some

Christine Rombawa

insight as to what else you could do for this patient, or what complications you should anticipate, monitor for, and prevent.

4. How are my assessment skills developing? Am I being as thorough as I need to be? What areas are still difficult for me and what am I doing to improve? (Be specific).

I feel that my assessment skills are developing appropriately. I feel that there is so much to learn and nursing is a career that requires a life time commitment of learning. To improve, I will gain more experience, listen to the directions and guidance from my clinical instructor and primary nurse, research things that I am not sure of, and do my best to provide compassionate quality safe care.

5. What new skills did I implement this week? How did I do? What could have helped me to improve? Did I ask for help when I needed it?

A new skill that I implemented this week was discontinuing a Foley catheter. It is a pretty simple skill, yet I was sure to seek clarification from my CI prior to completing the skill. I think I did well. Something that can help me improve is having more opportunities to insert Foley catheters or have the opportunity to do straight catheterizations.

6. How is my time management progressing? What areas of difficulty have I found and what can I do to improve? How do I monitor my time management while in the clinical area?

I think that my time management is progressing well as I become more familiar with the location of things and I plan and cluster care. Completing my documentation earlier has also helped. Administering medications and treatments on time is a way that I monitor my time management. It is also important have good team work and coordinate with my clinical instructor, primary nurse and nurse aid.

7. Was I involved in making referrals for my client in any way? How could the nursing role in this process have been strengthened?

Christine Rombawa

My patient could have benefited from a referral for a home care nurse aide to assist with ADLs, household chores, shopping, cooking, and transportation to doctor appointments. She refused at this time at stated that she would let her doctor know if she would need those services later.

8 .List the specific interventions, in order of priority, for two of your clients and explain how you determined which interventions took precedent.

Reason for admission, medical status and history, along with secondary diagnoses. Use of PCA. ABCs

Patient 1:

1. Abdominal assessment monitoring for decreased or absent bowel sounds, distention, pain and tenderness. Monitor surgical incision for increased pain, signs and symptoms of infection, and approximation of wound edges. Monitor VS, I&O and lab test results. Check last BM, and presence of flatus. Encourage fluids, ambulation, and diet with fiber, along with administering antibiotics, analgesics, stool softeners and laxatives PRN.

2. Assess the patient’s respiratory rate, rhythm, depth, effort, chest expansion, and use of accessory muscles. Monitor VS, LOC, cap refill, pulses. Auscultate the lungs for areas of diminished or absent breath sounds and the presence of adventitious sounds. Use pulse oximetry to monitor oxygenation. Monitor for asymmetrical chest expansion. Encourage deep breathing, coughing and use of SCD, and IS. Instruct patient in splinting with a pillow during coughing and movement. 3. Assess c/o pain, characteristics, precipitating factors. Administer pain medications prn, assess effectiveness of pain medication. Assess patient’s ability to accomplish activities of daily living. Administer analgesics prior to increased activity. Fall precautions.

Patient 2

1.Assess patient’s respiratory status (PCA morphine), LOC, VS, cap refill, peripheral pulses, sensation, temp of affected extremity, strength, ROM. Monitor for numbness, tingling, “pins and needles”, increased pain, cap refill <2 seconds, coldness, color, compartment syndrome.2. Assess c/o pain, characteristics, precipitating factors. Administer pain medications prn, assess effectiveness of pain medication. Assess patient’s ability to accomplish activities of daily living. Administer analgesics prior to increased activity. Fall precautions. Monitor surgical incision for increased pain, signs and symptoms of infection, and approximation of wound edges.3. Monitor UO, BS, I&Os, BM, n/v4. Use abductor wedge while in bed, educate patient on proper positioning, no bending from the waist, and no hip flexion greater than 90 degrees. Encourage ROM to unaffected extremity, increase in protocol level. Encourage use of IS, SCD, compression stockings, cough and DB.

Christine Rombawa