Smoother Head Toe Reflection

Clinical this week went really well, I had my patient both days which was really nice because I was able to see the change in his recovery progress and follow up on concerning issues that my patient had after the first day. I was able to look at his labs and see how his body was adjusting to the medications he was receiving and see how he was recovering two days’ post surgery. I was able to bundle my care better and have a smoother head toe assessment because I had the added bonus of previously taking of him care. Additionally, I also got to know him a little better and not just focus in on his diagnosis and disease states but take a step back and look at him holistically. During the first day, I took care of my patient he was having trouble voiding and still could not pass gas even though he felt cramping pain.

He initially tried voiding in the restroom for a good hour and a half and was only able to void a small amount.

We followed up by doing a bladder ultra sound and finding out that he was retaining 440 ml. The nurse and I discussed our next step and we decided against re-catheterizing him right away since he was able to void a small amount and his catheter had been removed at 11:15 am the same day. Instead we instructed our patient to void in his urinal so we could measure and keep track of the amount of output he was voiding. Within 2 hours he voided 300 ml and by the end of the shift he had voided 550 ml. The other main issue that my client was having trouble with was his inability to pass flatus. On the first day that I took care of him he did not have any bowel tones all through out the shift. However, during the second day he did have active bowel tones in all four quadrants but he still was not able to pass flatus by the end of the shift. Some interventions that we performed were encouraging him to ambulate as well as eat the clear liquid foods that he was allowed to help stimulate and wake up his

bowel.

Overall this week went really well I was able to apply the information I learned in theory to the clinical site and enhance my learning. In particular, looking at my patient’s lab values and there change from the first day to the send day to see the status change of my patient’s health. One the first day he had an elevated WBC, Glucose, and elevation in temperature from the previous shift and so I started think that my patient might potentially have a infection or be at greater risk for infection. Thus I was even more diligent in making sure that continually monitor his pain level and his vital signs to see if anything was changing from were he trends. Additionally, looking at his lab values I noticed that his INR was 1.2 and that they have doubled his dose of Coumadin from the amount that he takes at home to try and get his INR in the therapeutic range of 2-3. His INR of 1.2 is concerning because it means that he is not getting the maximal therapeutic effect of the Coumadin and is at an increased risk of having potential clots. I really enjoyed clinical and applying the knowledge that I have learned so far.