For this fourth clinical, I was more aware of what I was expected to due. I chose two patients, both begin female. I was happy to have two female patients this time around. My primary patient for clinical was an eighty-five-year-old female who had been admitted for adult failure to thrive. I kept my patient’s admission diagnosis in my mind, and was informed that she had been previously emotional due to being discussed about her new living situation. She was now going to go live at a nursing home and she wasn’t happy about it; she was upset but hoped for the best.
I believe I was lucky with my patient as she communicated very well with me during clinical and I enjoyed my time with her. It was great watching my patient color in her coloring book, which she was doing really well with it. Noticing What I had initially noticed when I first visited her during clinical was that she was tired but alert and oriented to the situation. She was a very nice lady, who was comfortable of me being a nursing student. Each time that I conversed with her she would always mentioned about going to a nursing home, she would express how her kids didn’t want her to return to independent living.
That was something I kept noticing with my patient how she was in disagreement with her family about leaving her home, she was comfortable making a change in her life. What my patient really wanted was to go to her home and take care of her stuff. During this clinical, the family wasn’t present. Though by what my patient describes about her situation with her kids, the family is making all the decisions for the patient but don’t seem to accept her emotions and feelings about the situation. Interpreting One response that I noticed was the discomfort and pain that my patient had whenever she would move around.
The pain she would describe was pain that she felt when she would sit or move while sitting and moving to lay down. This pain was being caused by a decubitus skin ulcer that was locate on her coccyx. During the nurse report in the morning, the nurse mentioned that the ulcer had tunneling but was being taken care of. By having this type of ulcer, especially located in the coccyx was causing the pain for my patient. Knowing that she has an ulcer that was being cared for, we assessed the dressing over the ulcer to check for any drainage and cleanliness of the area.
One of the main things that I was aware about my patient was that in her current medical problems, it indicated that she had Lewy Body Dementia and depression with anxiety. I believe that by having depression with anxiety, being upset about going to a nursing home, and having Lewy Body Dementia is contributing her adult failure to thrive. One of the ways that the dementia is being cared for is by administering Rivastigmine (Exelon). The medication results with “decreased dementia (temporary) associated with Alzheimer’s disease and Parkinson’s disease” (Skyscape, 2015); this will help with symptoms of dementia.
Knowing that she won’t be able to her own home and going to a nursing home has led to having the depression, leading to not having a desire to do much in life anymore. I think that the best way I was able to individualize my patient’s care was to talk to her and help with her coloring activity which helped find a distraction from her situation. Reflecting My nursing skill of communicating and gaining the patient’s trust is something I believe I expanded during this clinical. At first, I wasn’t sure if my patient would be emotional or lack in conversing with me due to having the diagnosis of failure to thrive.
I made sure to ask each time how she was doing and complementing on her coloring with her coloring book. Allowing my patient to share her feelings with me, gave her a sense of trust. Communication and trust with the patient is an essential skill to have, and by spending some time with my patient this clinical it allowed me to learn more of how I can better communicate. If I had the same situation again, what I might do differently is to encourage her to take walk with me in the hallway. Making sure that she ambulated is an important nursing care, and that would be something I would try to implement in a future similar situation.
Some additional knowledge that would be useful in a future situation, it knowing more about Lewy Body Dementia. Having more information about this dementia and knowing how far along it is in my patient, could help me have a better understanding of how it is affecting the patient. Working with this patient made me feel different and somewhat upset. For me it was hard to hear how may patient didn’t want to leave her home and wasn’t sure how she was going deal with living in a nursing home. It was difficult for me to think about how unhappy she would be at nursing home, not knowing if this living situation will benefit the patient or not.
Tanner’s Ways of Knowing Ethical Knowing For this patient I was able to follow the ANA’s ethical principles by following the act of beneficence. I expressed my compassion towards my patient by being her support system during the clinical time as she didn’t have any family members with her. I made sure to listen and to be opened minded to what my patient had to say. We are there for the patient and making sure that my patient’s needs were taken care of, was an important aspect in caring for her.
Sometimes patient’s just need someone they can talk to, and I made to be available for my patient so she may share her thoughts and feelings; my patient did well of sharing her thoughts with me as we conversed. Personal Knowing My experience with my patient during clinical was similar to the time I spent with my Arbor Springs client. During both experiences, I tried to get to know them better and just talked to them. I remember that an important aspect of being with my Arbor Springs client was to provide them some comfort during their day.
I provided them a sense of company to help them not feel alone. My patient didn’t have anyone visitors visiting her, she was alone, and so it was important for me to spend some time with her. People enjoy having some company during their day, which for my patient and Arbor Springs client, the both appreciated the attention and company. Aesthetic Knowing Adult failure to thrive, can mean to patient that they no longer have the strength to care for their selves or do the things used to normally do. For my patient, she can feel upset at times as things are changing in her life.
This diagnosis of adult failure to thrive, may likely be due to sadness and frustration of leaving her home and going to the nursing home. She is at a loss of how she’s controlling what happens in her life as she continuously mentioned how her children were making the decision of her going to a nursing home. As my patient will be going to a nursing home, her adult failure to thrive can potentially progress as I can tell from my intuition that she will not be happy living at a nursing home. She mentioned many times she doesn’t want to go and that’s why I have that feeling she’ll be unhappy. SocioPolitical
As I’ve indicated before, my patient will be going to a nursing home and no longer to independent living. By having a change in her living situation, it may also alter her daily routines. There will be more people watching her and taking care of her; this may not be the ideal situation that my patient wants to deal with. Living at a nursing can also benefit my patient as here needs can directly be taken care of. The decision for my patient to go to a nursing home was made between the physician and family members as they felt that a nursing home would be safe place for the patient.
Clinical Judgments 1. Impaired Skin Integrity a. Outcome: Patient will display healing of skin integrity by the time of discharge. i. Keep the wound area cleaned by changing dressings and keeping the area dry. ii. Educate the patient about avoiding sliding in bed or in a chair to help prevent any further damage to the skin integrity. iii. Encourage the patient to ambulate from their bed to the chair to help release pressure from wounds or ulcers. 2. Acute Pain a. Outcome: Patient will report to have a pain score of zero by the time of discharge. i. Administer prescribed PRN pain medications to help manage the patient’s current pain. i. Encourage the patient to change positions to help relieve the pain from a certain part of their body. iii. Offer the patient a massage to help relieve tension and pain from their body.
3. Risk of falls a. Outcome: Patient will not suffer a fall by the time of discharge. i. Provide the patient with an assist of one when ambulating in the room or in the hallway. ii. Avoid any clutter from blocking the space to walk by keeping the patient’s clean and organized. iii. Educate the importance to the patient about using their call light in order to receive assistance from the nurse or the patient care tech.
