Essay On Clinical Rotation

Why was skin-grafting necessary in this patient? (why not just let the skin heal on its own)

The patient’s vital signs have stabilized, with HR in the 70s, BP is in the 120s/60s, regular RR and 37.6o Celsius temperature. Graft site wound bed is pink with tissue granulation noted. The learner is expected to prepare the patient for discharge. This SCE prepares the learner for the following items of the NCLEX-RN test format:

As a clinical requirement for my Adult 1: Medical-Surgical course, I had the opportunity to observe a patient in the Operating Room and in the Post Anesthesia Unit of Advocate Good Samaritan Hospital. The procedure that I observed was a left total knee replacement. The patient needed this surgery because she was experiencing osteoarthritis, and this surgery could alleviate her pain and discomfort. I was with the patient from the end of her stay in the pre-operative holding area to the Operating Room, and then to the Post Anesthesia Care Unit. This paper will include background inquiry, preoperative and operative

Information to patient: Indicated for hypertension and angina. Reduce the blood pressure and risk of stroke and heart attack. They are calcium channel blockers which works by widening your blood vessels making it easier for your heart to pump blood around the body and help increase blood and oxygen supply to the heart. Taken once daily with or without food at the same time each day. Swallow the tablet whole with a full glass of water. Taking the tablet at the same time each day will have the best effect. It will also help you remember when to take it. You are currently on 5mg but your doctor might increase this depending on how you respond to the medication. Tell your doctor

I care for a patient’s well-being by gathering their vitals, performing point of care tasks like checking their blood glucose levels, phlebotomy, transporting them, and anything else that might be needed to ensure wellness. This summer, I have also been shadowing several neurosurgeries, the first of which was a complete cervical disc replacement. Then, I was able to shadow a lumbar fusion, cranial incision, and post-op follow up for issues like occipital neuralgia. This opportunity gave me insight into how the surgical world of medicine runs, and it allowed me the opportunity to ask any pertinent questions about the career, and the daily routine in general. These meaningful experiences have helped me become a more well-rounded person in general. They have also taught me to take a more individualized approach to medicine, which has helped to prioritize patients’ specific needs, while keeping an even-keeled and friendly mindset with them as well. Even though there may be a large number of people with similar ailments, their medical, social, and mental statuses are all going to vary. Thus far, I have been able to use what I have learned to create a more conducive healthcare environment, which I believe promotes the patient’s healing

Filing records. Checking documents. Delivering materials. The elements of a classic volunteering experience at the hospital. I anticipated the same dull tasks as I walked into the Day Surgery department at the Baylor Scott & White Medical Center in Irving. Instead, my fervor for neurosurgery was met with an opportunity to watch a craniotomy. An enduring desire to observe a surgeon was actualized and I was delighted.

Microvascular reconstructive flap surgery is an effective way for the medical team to improve the appearance or functionality of a surgical or existing tissue defect. Microvascular free tissue transfers, or free flaps, are monitored for arterial and venous insufficiency for several days during the post-operative period. The gold standard for flap monitoring includes the clinical inspection of color, capillary refill, temperature, and turgor of the transplanted tissue involved. Due to limited alternative reconstructive options available to patients, accurate and timely flap assessments are critical to the viability of the flap. Unfortunately post-operative complications are sometimes unavoidable, however monitoring by a trained clinician is associated with early flap salvage rates that in turn improve patient care outcomes (Salgado, Chim, Shoenoff, & Mardini, 2010).

Initially, the dressings were dry and intact while the patient was still asleep. After 15 minutes of transition, Miss T was gagging, straining, and acted nauseated. I immediately inspected the wound sites and noticed a slight bloody discharge on one of the dressings. Alerting the PACU nurse was my immediate action to alert her of a possible bleeding as I had handed over the intraoperative bleeding in that area. As I continued observing, I noted an increase in the discharge. Hence, my inspection on the wound site which had its tape stripped off and active bleeding was noted. Slight wound dehiscence was apparent. I did all less invasive measures such as cleaning the incision site and the application of pressure dressing initially but to no avail. Notification of the surgeon all throughout was done and given importance. Immediately, I acted on stopping the bleeding through suturing of wound with a deep-

I get to see various types of wound, from pressure ulcer of different stages, unbelievable edemas, arterial and venous ulcers, diabetic ulcers, and many other wounds of uncertain causes. I have never expected to see those kinds of wounds. I have seen different drainage amount, color, and odor, various shapes and location of the wounds, and amputated edematous legs. I have learned also the different types of dressings and antibacterial ointments used. I had given the chance to observe a client on their high-tech hyperbaric oxygen therapy which makes the wound healing even faster. The most important lesson I have learned from the team members was, “DO NOT GET

With this in mind, I entered my last clinical rotation on the OR floor in a large teaching hospital. It contained 19 operating room suites and personnel included a VP of surgical services, a unit manager, a supply manager, an education coordinator, a few supervisors, and an array of surgeons, anesthesiologists, circulating nurses, scrub nurses/technicians, unit clerks, and surgical aides. My preceptor trained me in the position of circulating nurse. As the circulating nurse, I acted as the patient’s advocate while the patient was under the influence of anesthesia. During surgery, I was delegated the task of anticipating needs and trusted to use my clinical judgement when split second decisions were required.

The main reason that skin grafts are conducted is to prevent infection from growing and spreading throughout the body. In reality, skin grafts increase the patient’s possibility of acquiring an infection. The procedure takes a large area of skin from one side of the body, and creates another open wound. As a result of this surgery, the patient has two wound sites, which makes him twice as likely to get an infection. Moreover, the body is put under a tremendous amount of stress because it is trying to attach new tissue to the surviving tissue at two completely different sites. This causes the healing process to progress slowly because two wounds require more energy than one. Traditional skin grafts are also a disadvantage to burn victims with substantial burns covering the majority of the body. In this situation, there are limited areas of unburned skin that can be transplanted to the compromised areas.

Access to care, long wait times, and rushed visits comprise a few ongoing complaints about the current US health care system that has fueled one of the three major initiatives- to improve the patient care experience (Berwick, Nolan, & Whittington, 2008). A patient’s experience, though multifaceted, is heavily influenced by face-to-face communication with his/her provider, which in today’s healthcare environment includes not only a physician, but also a nurse, nurse practitioner (NP) or physician assistant (PA). The presence of EHRs has undoubtedly affected this face-to-face interaction which was demonstrated in a study done by Alsos et al. where they found that use of a paper chart lead to better “verbal and non-verbal

I’ll never forget a particular patient encounter I had in medical school was with a college student diagnosed with schizophrenia and major depression disorder. I was working with a mobile intensive outpatient treatment team, IMPACT, that focused on helping high-risk individuals and specifically those with psychotic illness get their medications and resources in the community. With IMPACT, the team met him at his college to give him his medication refills and to see how he was doing. We brought him containers of more than 10 different medications and asked him if they were working or if he was having any problems. He stated many of them were making him tired, making it difficult for him to study and to listen during class. As the encounter went on, the patient became more comfortable with us. He

There is no better teacher than experience itself. This statement holds true with regards to acquiring knowledge and necessary skills in the nursing profession. Clinical rotation is when theories are actually put in to practice and competencies acquired. Indeed, during this clinical rotation I felt like I gained a whole lot of understanding about the nursing process, the legal and ethical matters surrounding the practice, and the public health nursing as a profession.

In 2009, a close family member became extremely ill, underwent various surgeries, and was hospital bed bound for 6 months. Following her surgeries, she developed a very large wound that ran across an area of her body. I watched nurses come into our home day after day to treat the wound and assist her with the wound cleaning and healing process. It was through my daily observations that I became fascinated by wound care and the wound healing process. Towards the end of my family member’s recovery process, I was able to identify all of her dressings and change/treat the wound myself. It was then that I realized that I highly enjoyed wound care and that I wanted to enter in a health care fields that heavily involved wound