Nursing Exemplar

This week, I was given the opportunity to care for two female patients – 205(1) and (2). The first patient, 205-1, was admitted with respiratory distress and had a past medical history of hypertension, schizophrenia and bipolar disorder. She was initially put on 2 L/min of oxygen and placed on oxygen titration protocol with orders to maintain O2 saturations between 88-92%. The patient was oriented to person and place, but had difficulty with time. She was also obese (BMI 30) and deemed a moderate assist with ambulation. Her care plan included total assistance with ADLs, smoking cessation and oxygen protocols, limited salt intake (3mg), and chronic pain management. The second patient, 205-2, was admitted with a right pelvic fracture and had

3.1.- Hospital updates: Following the hospital case coordination session last week, Ashleigh stayed in the hospital overnight. Ashleigh provided care for her father until the next day. Ashleigh was disappointed that John did not collaborate as he refused to eat her meal, have a proper shower and called her idiot.

Writer called Constance to find out if she has heard from the Visiting Nurse Association (VNA). Constance said yes and that they scheduled to meet on the 9th of this month. Constance said she will be seeing her pain managing doctor on the 8th. Also Constance said Medicaid approved for her to use long term care. Care manager was glad to hear that. Constance promised to update care manager after the

Action: CSP and Clinician introduced new case coordinator to MHS. CSP, Clinician and MHS discussed missed medical appointments. MHS explained the Medicaid transportation services did not pick her and the youth up for the scheduled appointment. MHS stated she received the letter from the DSS worker for Juliet’s medical physicians. CSP explained MHS must get the MUSC summaries updated with the correct information. MHS cannot no longer receive verbal instructions. MHS, Clinician and MHS discussed Juliet’s WIC appointment and the use of power milk. MHS explained Juliet is making milestones and responses to the voices of family members.

This patient arrived on time for her scheduled appointment with this writer. This writer introduces herself as the patient assigned counselor, at which the patient was pleased to be assigned to a counselor. This writer discussed with the patient UDS and the patient's prescribed medication. According to the patient, she provided information of her current medical concerns such as the seven blockage with her heart, her chronic back pain- the patient reports that she needs to replace 2 or 3 discs, and her foot surgery. The surgery for the patient's heart and foot are pending at this time. The patient reports she is scheduled to conduct a sleep apena on 03/03/2016 and is aware that she must provide an update to Nursing at the clinic. The patient praised about having a excellent Cardiologist, who is currently monitoring her heart. the patient was emotional discussing the many loss of her family who suffers from congestive heart failure. The patient reports, " I believe there is a GOD and he is

Mr. Brann is a 42-year-old male here today for followup from his left cerebellar stroke and left vertebral artery dissection, status post hospitalization in May of 2015

----- Clinic presents a black male 68 years old. Currently experiencing dyspnea and lethargy. For the past week he has been having a increase of difficulty breathing. Complains of alternating periods of sweating and chills. Other symptoms he has been experiencing is a productive cough with expectoration of thick yellow sputum. Patient is a ex- smoker, he was a 40 pack year history, denies smoking, stopped over 10 years ago. Medical history includes chronic bronchitis, hypertension, MI five years ago, has had a angioplasty, and denies chest pain since having angioplasty. Current medication combined albuterol/ipratropium MDI, nebulized albuterol prn, captopril, and hydrochlorothiazide.

Hello, I am Angeline S. Bernard, licensed practical nurse, with Aetna’s utilization management department for long-term care. I am a 20 year veteran in the health care industry, primarily in the field of nursing, interested in pursuing a management role. With 15 years spent in the acute hospital environment, as a nurse, I have also practiced in other settings. School nursing, occupational nursing, quality management, and utilization management, are all additional areas of practice.

When I arrive to the Trauma ICU 4800 unit, all of the nurses were already being followed by other students. The nurse in charge had me follow several different nurses, so I was able to observed several different patient cases. The first patient had received a triple bypass open-heart surgery. The patient had received a creatinine blood test. The patient had a dialysis machine next to them, which was used to function as the kidneys since the patient’s kidneys were not functioning correctly. Also, the patient’s body temperature was lowered from having a taken cool liquids so the nurses were keeping him warm with a bair hugger, which was a machine that helped regulate the patient's’ body temperatures.

2. A new graduate nurse is working in the pediatric intensive care unit. She has been employed a total of 5 months, 3 of which were spent in orientation. Her patient, a child with a cardiac defect and pneumonia, has a very unstable condition and has needed an increasing amount

During the home health observation day, there were several opportunities to observe a variety of patients with varying levels of functioning ability, different illnesses, and different needs and levels of interaction with the nurse. The first patient seen was a seventy-three year old Caucasian female with an ulcer on her right heel. Several weeks prior, she had scratched her left leg and she also had several small wounds on her left leg. The orders were to clean and redress the ulcer. She has a history of end stage renal disease, pneumonia, weakness, diabetes, dialysis, and right hip fracture. Upon entering the home, the patient was found to be sitting in a wheel chair in the living room watching television with her husband close by her side. She greeted the nurse with a smile and began to update her on her current condition. Her heel was “hurting” and she rated her pain an 8 on a scale of 1 to 10. She also had some “swelling” that she could not “get to go away; because, she could not get up and walk. They need to fix my foot so that I can get up and get around.” She told the nurse that she had been to see the doctor “yesterday” and the doctor had given her a written order that she wanted her to see. The order was written for an evaluation for a soft pressure shoe fitting. The nurse read the order to

CHIEF COMPLAINT: This is a post op note from a procedure performed July 21, 2015 by David Lin, MD.

The aim of this study is to provide a detailed account of the nursing care for a patient who is experiencing a breakdown in health. One aspect of their care will be discussed in relation to the nursing process. The model used to provide an individualised programme of care will be discussed and critically analysed.

Tanner (2006), had introduce the term ‘thinking like a nurse’. When I read this article I was wondering what it means and takes to think like a nurse, I am a nurse by profession and yet I don’t even know what it means. In order to be a professional nurse, nurses are required to learn to think like a nurse. To my surprise, to be able think like a nurse, a nurse got to clearly defined and understands what is critical thinking and clinical reasoning. Both terms are powerful terms and these terms explain the mental processes nurses use to make certain that they are doing their most excellent thinking and decision making for their patient’s better outcomes.

Nursing has evolved throughout the years. However, the patient remains being the focal point of the nursing profession and also in the metaparadigm concepts of: nursing, health, person and environment. These four concepts enhance the holistic person-centered care of the patient with the overall goal “on the patient and the individual’s particular health care needs. The goal of patient-centered health care is to empower patients to become active participants in their care. This requires [nurses] and other health care providers to develop good communication skills and address patient needs effectively” (Reynolds, 2009, p. 1).