September 29, 2004 Reflection - 2
September 29, 2004
Reflection – 2
On Wednesday, September 29/ 2004, I was carrying for a patient (who was 89 years old) and was admitted to York Central Hospital with stroke. The night before I read the “Medical Surgical Nursing” textbook and used RNAO Best Practice Guidelines to come with effective time plan for my patient. I selected “Preventing Pressure Ulcers” from RNAO Best Practice Guidelines and I thought it was relevant for my client, since she was weak and couldn’t move very well and most of the time was lying in her bed.
On Wednesday morning, when I came to introduce myself to my patient, I didn’t follow my time plan the way I planned. Instead of doing a bed bath at 0930h, I had to do it at 0800h. When I met my patient, she had asked me to changer her brief since she had urinated from last night and the brief wasn’t changed. While I was washing her, I found that the Best Practice Guideline was effective. As I was washing her, I used mild cleansers and avoided hot water. Also, I avoided using force and friction, and instead I was her very gently. When I asked my patient to turn, in order that I would be able to wash her back, I noticed that she had red spots on her buttocks. Therefore, I applied a barrier cream and I avoided rubbing and massaging the cream.
As the breakfast came in at 0830h, I asked my patient if she needed my help to feed her, since she had a stroke and couldn’t move her right arm very well. She told me that she can feed herself but she needed help in opening a milk carton and as well as preparing a coffee. After breakfast, my patient asked me to do her a favor and to go to buy a “Toronto Star” newspaper for her to read. As I came back, I took her vital signs, since in the early morning I did a bed bath and while I was doing, a nurse came to take her vital signs. Therefore, I didn’t want to ask her to do again right after the nurse, instead I decided to do 45 minutes later (after breakfast). I monitored her blood pressure closely, since on Tuesday it was very low. Her blood pressure was better than it was on Tuesday, but still low (90/60). I informed my nurse about my findings and she told me that she was aware of her low blood pressure.
After I took vital signs, my patient informed me that she was getting tired and wanted to sleep. I wanted to put pillows under her ankles to prevent the two ankles rubbing together, however she told me that she wasn’t comfortable and she didn’t like the pillow being in between her legs. I found that this practice guideline wasn’t really helpful, because my patient didn’t like the idea and I didn’t want to argue with her, since she knows what she likes or what she doesn’t like better than I do.
After she woke up, I told her that if she wanted that I could move her to the chair instead of lying all the day in the bed. First, she didn’t want to, but as soon as she saw her roommate sitting on the chair, she loved the idea. I asked my friend to help me move her to the chair, since I knew I couldn’t do it alone because she was very weak (had a low blood pressure) and was potentially at risk for falling.
While she was sitting on her chair, I did some range of motion exercises on her right hand and leg. She told me that she found it very useful and I taught her the steps, so she would be able to practice them on her own.
Overall, my day wasn’t very bad. I learned how to use RNAO Best Practice Guidelines and apply them in real life situations. I found that not all of them work, since each patient is different and has different opinion but most of the Best Practice Guidelines do work. I also learned that when taking patient out of the bed and moving them to a chair, their bed must be made and ready for them to return back to their bed. At the beginning of my day, my patient didn’t trust me and didn’t like the idea of me taking care of her. But by the end of my day, she grew to love me and realized that I was their to take care of her and to harm her. As I was saying goodbye to her, she hugged me and it was an amazing feeling to have inside of my heart. I wish that all my future patients would be similar to that lady that I had.
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