3 journals are required during the clinical preceptorship rotation. Journals are due following a designated number of shifts to your clinical instructor as directed. The objectives of the journals are:
- To identify individual goals and objectives for the preceptorship rotation.
- To promote professional development and clinical judgment through reflection and analysis of clinical experiences.
- To enhance communication between faculty and students.
- To critically reflect on learning through analysis, reconsideration, and questioning.
Journal Directions: Please use APA 7th edition for formatting journals 2 and 3.
Journal #2 The following are the requirements for your journal.
- Attach completed relevant shift objective forms with a summary of how objectives were met or not met.
- This portion I will complete
2. General observation
Comment regarding the environment, patients, families, health team members, etc. that had an impact on you.
- The environment of the Medical-Surgical floor. Even though med-surg is a very busy floor is a clean floor, supply rooms are clean and organized with easy access to supplies. With a good atmosphere.
- Patient being kind and thankful for the service we as nurses provide to them.
- Family members being cooperative with the patients’ care. Went as far as buying bakes, and chocolates in a gesture of thanking the service we provided to their loved ones.
- Health team members The Medical-Surgical floor is one of the floors where nurses have a higher patient-to-nurse ratio (Five patients per nurse). One special characteristic that I notice on the Medical-Surgical floor is that most of the nurses work very closely as a team even though they have a lot of work they always manage to help each other. This will be definitely a floor I would like to work on. Some of the nurses have mentioned that soon I will be part of their team.
3. Clinical Growth
Personal feelings regarding your clinical experience and growth. Identify new perspectives/insights regarding your practice.
- More confidence, more love, and respect for the nursing profession. More respect for healthcare professionals. A deeper understanding of people in disadvantaged communities, etc.
4. Strengths and Weaknesses
Self-evaluation of areas of strength and needed areas of improvement including an action plan to improve.
- Strengths- companionate approach to my patient, respectful to family members, respectful to patients’ cultures, work ethic, cooperative with staff
- Weaknesses. Learn the appropriate way to communicate with doctors to provide the best care possible to my patients
5. Patient Summary
Include in this discussion:
-A daily PRIORITIZED problem list for EACH of the patients from shifts #2 and #3 assigned to your care (Include patient age, sex diagnoses
-Identify the PRIMARY problem and list a summary of the medical management (nursing, medical, and /or pharmacological) for this problem.
SM is a 68-year-old female that came to the hospital with altered mental status. Her sister complained that the patient has not slept in three days and has dementia. The patient has a history of schizophrenia. The patient was diagnosed with acute cystitis without hematuria and altered mental status. Primary Problem UTI. The main goal is the treatment of underlying infection, Pharmacological intervention to improve mental status.
-Depakote 500 mg daily oral
-Amlodipine tab. 5mg oral
-Ceftriaxone (Rocephin) 1g NS 50 mL IVPB
-Duloxetine cap. 30 mg daily oral
CJ is a 50-year-old patient that was admitted for abdominal and penile pain. He is four days post-op, he underwent cystoscopy and dilation of the urethra. He is still complaining of penile pain when wanted to urinate. The principal problem is peritonitis. The main goal is pain management and the continuation of current treatment.
-Ciprofloxacin 500 mg
-Heparin 5000 units every 12 hrs.
-Piperacillin (Zosyn) 2.25 g. 12.5 mL/hr. every 8 hrs.
-Sevelamer (Renvela) 2400 mg oral 3xdaily w/ meals
-Vancomycin 1g IV with PD dosing 5 treatment days (Monitor CBC with diff, CMP vanco throughs weekly).
MC is a 55-year-old female that presented to the hospital for interval laparoscopic appendectomy possible right hemicolectomy. The patient was four days post-op. The patient underwent surgery on 04/14/2022 with laparoscopic converted open appendectomy with lysis of adhesion. The patient had no Primary problem lysis of adhesions. She was monitored for return of bowel function, she was passing flatus and tolerating a regular diet. Vitals were within normal limits. The patient was discharged home with a muscle relaxant and stool softener. The patient was educated at the time of discharge.
-Ketorolac (Toradol) Injection 30 mg
-Atorvastatin (Lipitor) 5 mg daily
-Enoxaparin (Lovenox) 40 mg daily
-Famotidine (Pepcid) 20 mg daily
-Polthylene glycol (Powder) 17 g daily
IR is a 53-year-old female who is two days post op. she had a total abdominal hysterectomy, lysis of adhesions, and bilateral salpingectomy. The patient is recovering well. Pain is being controlled with Hydrocodone. She is tolerating a regular diet, urinating, ambulating without difficulty, and with minimal vaginal bleeding. The abdomen is soft not distended bowel sounds are present in all four quadrants. The Primari problem menometrorrhagia. The goal for the patient is pain management and plan discharge for tomorrow.
-Norco 1-2 tabs 5/325 mg every 4 hrs. PRN
-NS 100 mL/hr. continuous
-Gentamicin in NS 50mL IVPB Dose 80 mg 104mL/hr.
-Clindamycin in dextrose (Cleocin) IVPB 900 mg 100mL/hr.
MD is a 61-year-old male who came to the hospital for generalized weakness. He is 24 days post-op he had an EGD with a biopsy procedure. The patient has a history of CVA, stroke with right-sided weakness, acute kidney injury, reactive thrombocytosis, acute blood loss anemia, and melena. The primary problem for the patient is Acute lacunar stroke. The goal for the patient is to continue with current treatment and continue with physical therapy.
-Amlodipine (Norvasc) 10 mg Daily Oral
-Atorvastatin 20 mg daily oral
-Haloperidol (Haldol) 2mg tab 3x daily
-Hydralazine 25 mg 3x daily
-Hydroxyurea 500 mg daily
-Pantoprazole 40 mg 2x daily
-Vitamin C tab 500 mg 2x daily
-Ferrous sulfate tab 325 2x daily
ZI is an 84-year-old woman with a history of severe arthritis of the right hip she was brought into the hospital for scheduled total hip arthroplasty on 04/05/2022. On 04/07/2022 she went for a right revision of total hip arthroplasty. The primary problems for the patient are benign osteoarthritis, Status post low friction arthroplasty of the hip. The goal is pain management, maintaining blood pressure within normal limits, and placing the patient in a skilled nursing facility.
–Vitamin D-3 2000 units tab
-Enoxaparin (lovenox) 40 mg Inj. Daily
-Citalopram (Celaxa) 20 mg daily
-Famotidine (Pepcid) tab 20 mg. daily
-Amlodipine (Norvasc) tab. 5 mg. daily
-Vitamin B-12 tab. 100 mcg daily
-Metoprolol tab. 50 mg daily
-Acetaminophen (Tylenol) dose 1000 mg 3x daily oral PRN
-Cefazolin 1g in NS 50mL IVPB Dose 1g 100 mL/hr. IV every 8 hrs.
BC is a 78-year-old male with a malignant neoplasm of ascending colon. He came to the Emergency Room for blood in the stool. He is nine days post-op. He had a laparoscopic right hemicolectomy complicated with obstruction procedure on 04/04/2022. The principal problem for the patient is Malignant neoplasm of ascending colon. The patient is NPO and not receiving any medication. The goal is to maintain the patient’s NPO and keep the patient as comfortable as possible. He is scheduled for a small bowel obstruction surgery in the morning.
-Pantoprazole (Protonix) Inj. 40 mg
BJ is a 67-year-old male with a history of DM he was brought in by ambulance to the emergency room with bilateral foot swelling. On 02/25/2022 patient went debridement for the second toe and right hallux. After the treatment, a nice said that she will take the patient home with her, she said needed a few days to get a room ready for the patient. Later the nice said that she was not able to take care of the patient and she will not take the patient with her. The patient was placed in restraints bilaterally due to violent behavior. The patient is waiting for placement in SNF. Principal problem is diabetic foot infection. The goal for the patient is to complete curse of antibiotics, continue Eliquis (DVT Prophylaxis), podiatry and wound care, and zero restraint order.
–Eliquis tab 5 mg
-Chlorpromazine (Thorazine) 50 mg
-Collagenase (Santy) Ointment toe bilateral daily
-Insulin Lispro Dose 0-6 units subcutaneous
PM is a 66-year-old female with a past medical history of hypertension and diabetes mellitus type 2 who presented to the Emergency Department on 03/31/2022 with a complaint of coughing up blood since the day before. The patient had pneumonia four months ago and completed an ABX. The patient complains of a lingering cough since. Chest X-ray revealed cavitations in both upper lobes and lower lobes. Primary problem: Pneumonia of both upper lobes due to infectious organism. The goal for the patient is to continue with TB treatment without complications.
-Ethambutol Dose 1200mg tab daily oral
-Pyrazinamide tab. 1500 mg daily oral
-Potassium Chloride 60mEq daily oral
-Insulin lispro Dose 0–12-unit subcutaneous 4x daily before meals
RA is a 69-year-old female who presented to the hospital yesterday due to not having a place for hemodialysis. Hemodialysis was done today, and the patient was discharged home with her daughter. The principal problem for the patient is end-stage renal disease on hemodialysis. The goal for the patient was hemodialysis and DC
-Amlodipine (Norvasc) tab. 10 mg daily oral
-Heparin 5,000 Units subcutaneous every 12 hrs.
-Hydralazine dose 100 mg oral 3x daily
-Metoprolol tartrate (Lopressor) dose 50mg 2x daily
-Insulin lispro Dose 0-6 Units subcutaneous 4x daily before meals and night
7. Additional readings (2 research journals required)
In your written discussion of your patients, include a brief discussion or outline of additional readings you have completed each week to improve your understanding of your patient condition.
Journal # 3 Articulate your personal reflections on the concept of ministry to the sick as a Christian nurse
(1-2 pages – due by last week of preceptorship).
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