Nurse's First Week: A Frustrating Stroke Patient - Essay Sample

Introduction

During my first week of the nursing rotation, I encountered a patient who came into the emergency department after she lost sudden movement on the left side of her body. After running diagnostic tests in the emergency room (ER), she was diagnosed with hemorrhagic stroke. Upon further evaluation, she was identified that no necessary interventions were needed, and thus she was transferred to ICU for other observations and stabilization. The patient's daughter, upon arrival, got very frustrated with the situation.

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In my second week at the clinic, a 40-year-old male came in for bilateral leg cellulitis, which was not healing. The patient was a war veteran; thus, he had post-traumatic stress disorder (PTSD); he was morbidly obese and had a history of obstructive sleep apnea. The patient had been admitted five days prior and was placed in the medical unit. The patient was also found to have pneumonia. However, due to multiple infections, the patient had to undergo further tests, which confirmed that he had Acute Myeloid Leukemia and a bone marrow biopsy.

The third week at the clinic introduced me to a client who was a 78-year-old woman who was admitted for CHF and fluid overload. The patient was placed on IV Lasix and prophylactic antibiotics to prevent pneumonia. The patient was very argumentative about the IV therapy, and she took her medication one at a time after an explanation for each drug. She also complained of pain during every IV flush or infusion.

During the fourth week, I encountered a 25-year old female who suffered from severe cerebral palsy and had to be admitted for altered mental status. The patient was extremely agitated, while at the same time, she could not follow commands. While in the ED, the nurses had to intubate her to protect her airway. Her lab reports indicated that she had extreme hypernatremia of 187, which was the cause of her altered mental status as well as agitation.

During the fifth week, I had had a patient who was brought in due to an acute GI bleed, anemia, and elevated ammonia levels. During my final week at the clinic, I cared for a patient who was hospitalized for an MI and needed a Coronary Artery Bypass Graft.

Background

During my first week, my relationship to the patient was a student nurse as I did not have sufficient previous experience, and it was my first time encountering the patient and the family member. However, I was able to care for the patient, including how to assess the progress made by the patient, to turn and reposition, administering hourly neuro assessment, as well as prepping the patient for different interventions such as CT and MRI scans.

During my second week, I already had adequate exposure, hence was able to establish a relationship with my patient as that of his nurse. When the patient came in, I noticed that he was short of breath and had a high-flow cannula on at 28L/min, which was at 92%. I adjusted the high-flow to 30L/min and placed him in a tripod position, and he was able to improve his SAT to 96%. This reaction illustrated my experience in dealing with patients who are in respiratory distress as the past experiences helped to guide my actions that facilitated immediate care to the patient.

During the third week, I was introduced to a new aspect of nursing, whereby I had to take more time with the patient than usual. I had to develop a close relationship with the patient as a way of improving their medical outcomes and experiences. There were times that I did get frustrated while dealing with the patient as her particular needs made it difficult to manage my time acutely. As a result, I felt guilty as I thought that my other patients were neglected. However, I learned about dealing with needy patients, controlling my mood, and overcoming the feeling of helplessness.

When I was introduced to my patient during the fourth week, I established an effective nurse-patient relationship. Upon auscultation, I heard rhonchi, particularly on her left side. She also had a lot of mucus and secretions, clogging her airway whenever she tried to cough. Even though I had several patients, it was uniquely different working with this patient as I was able to see multiple interventions made for her. I was also able to see her improvement as she progressed towards healing visibly.

The patient I received during my fifth week was new to us even though he had been in the hospital for 15 days. The patient was confirmed to be an IMU status, but there were no available beds, so he was moved to the ICU. This was no new scenario as I had been presented with numerous end-stage cancer patients. When I received the patient during the final week, the patient had to be evaluated for a STEMI as well as a cardio angiogram, which revealed a distal lesion of the left main artery, which required a Coronary Artery Bypass Graft (CABG) procedure. This was my first pre-CABG patient. However, I was confident in my abilities to handle the patient as his care involved managing his earlier medical conditions that were hypertension and diabetes.

Noticing

During my first week, I initially noticed that the patient was confused, agitated, and combative. However, after spending time with her, I noticed that she gets upset and combative when she is experiencing discomfort or when she is wet. During my second week, I initially noticed that the patient had frequent moments where he would experience difficulty in breathing. However, after spending more time with him, I noticed that he was very anxious due to his history with PTSD. During my third week, I initially saw that when the patient's husband was around, she would not call on us too much as she relied on her husband to feed and care for her. When we spent more time with her, I realized that she might be lonely whenever her husband was not, and thus, her need to call on us every time.

During my fourth week, I initially noticed that the patient had rhonchi on her left side as well as mucus and secretions that clogged her airway. However, after the doctors performed bronchoscopy, and I spent more time with her, I noticed that her lungs sounded clear, and she did not struggle too much with coughing. With my patient during my fifth week, I initially noticed that the patient was breathing heavily with periods of apnea. The patient was also challenging to arouse, and when he was excited, he was incoherent and very agitated. However, upon spending more time with him, I found ways to help him relax even though his breathing remained the same. For my final week at the clinic, I initially noticed that the patient was attentive, oriented, and seemed at ease. He seemed more informed about his condition and was very cooperative. Upon spending more time with him, I noted that he was doing his best to reassure his family that he would be okay.

Interpretation

As I mentioned earlier, all through my experience, I have had previous exposure to patients who had suffered similar ailments. Therefore, I was confident in my abilities to care for the patients, all through the time I was assigned to them. The patients also had support systems in terms of family and friends that ensured the patients were well cared for by providing consent and support where needed. I also had very supportive preceptors who were readily available and supportive of my response to every situation. For each data interpretation and rationale of an intervention, I confirmed with my preceptor who would guide me or consent to my actions.

Response

In all the situations, my goal was to ensure that the patients obtained adequate care and comfort. At any time, I ensured that they had someone to provide much-needed care. Even though the situations required attentiveness towards the patients, there were few instances where I was stressed. For instance, in my third week, I had to deal with the needy patient. Furthermore, I had very supportive staff whom I collaborated with to achieve a common goal, which was the best patient outcome.