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STUDENT’S CLINICAL FOCUS

Clinical Area: Emergency Room


Agency or Hospital: Mandaluyong City Medical Center

Area Description: The 2 weeks clinical exposure in the Emergency Room includes wide range of clinical
learning experiences on the care of patients with various health disorders, applying the nursing process, the
core of the nursing practice and application also of related skills learned during the previous years with the
clinical Instructor and staff’s supervision. Likewise, discussions will also be included which would mainly
revolve on diagnostic tests or procedures in relation to the organ systems involved to such cases in the area,
the use of appropriate care plans and application of independent and as well as dependent interventions.
Review on the medical and therapeutic concepts together with acquisition of current trends in the medical
field will also be incorporated during the 8 hour shift together with the integration of holistic care and Christian
concern care to specific clientele/patient.

General Objectives: Within the two weeks of exposure in the Emergency Room, at least 95 % level of
performance are expected to the students and be to carry out the following tasks:
1. Utilize appropriate knowledge, attitude and skills that the students learned in order to render right
and appropriate nursing care
2. Be oriented with the hospital policies, clinical set– up as well as the medical staff and non
medical personnel as well
3. Gain skills with accuracy in providing nursing care in areas such as:
a. Admission care in the E.R.
b. Assessment of medically ill patients
c. Accuracy in taking the vital signs and the need of continuous monitoring.
d. Taking ECG
e. Medication Administration
f. Placing NGT, Foley Catheter, Intubation etc..
g. Nebulizing and Suctioning
4. Apply those nursing theories learned in the classroom at the clinical area
5. Promote and provide to their patients a competent, standard quality nursing care by ensuring
themselves the ethical standard in the nursing school and as prescribed in the nursing code.
6. To promote and adhere to the process specifically and correctly.

Week I
Day 1 (November 23, 2009)

Time
Specific Activities Specific Objectives Evaluation
Table

6:00 1. Checking of attendance, uniforms At the end of the Shift, the student A short (action,
AM and paraphernalia’s. will gain and strengthen reflection, feed
confidence in performing different backing)
2. Short prayer before beginning duty nursing procedures with the evaluation by
application of the following: sharing what
3. Pre conference. has learned
1. Building and knowing the especially in
4. Listening to endorsement made by importance of building rapport to the emergency
outgoing staffs. the patients room set up,
personnel and
basic nursing
5. Group Orientation 2. Giving due respect to the patient procedures.
1. expectations in all aspects.
2. requirements
3. Assessing correctly the condition
of the patient.

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STUDENT’S CLINICAL FOCUS

6. Orientation to the area: 4. Assessing and identifying Discussion on


1. Ward set – up, SOP’s, policies presence of danger signs and the cases
2. Medical, surgical staff and other referring immediately if encountered,
necessary.
professionals Problems and
3. Equipments and Facilities 5. Proper documentation of all experiences
procedures done and during the first
7. Students focus: observations on the client. day of duty.
a. distribution of task
b. triage nursing 6. Assisting subordinates and co
c. taking vital signs of the patients workers in the area in the
d. reviewing list of medications to be execution of nursing procedures.
given.
e. carrying out doctor’s order 7. Rendering health teachings in the
f. giving oral / parenteral meds / area.

treatment and other procedures 8. Observing the basic rights of the


g. arranging/ reviewing complete data patients especially in giving
medications or performing
of the charts procedures.
h. nursing interventions
> curative
> educative
> promotive
> rehabilitative

8. 30 mins. break for the 1st batch while


the remaining students will take
charge in the area.

9. 30 mins. break for the 2nd batch while


the 1st batch take charge.

10. Making of sample chartings.

11. Continuation of providing nursing


care.

2:00 12. Checking of individual charting.


PM
13. Preparing for the endorsement to
incoming shift.

--End of Duty --

Day 2 (November 24, 2009)

Time
Specific Activities Specific Objectives Evaluation
Table

6:00 1. Checking of attendance and Within the shift, the student will Pre Test: A
AM paraphernalia. expand their knowledge, recall multiple choice
concepts and strengthen type quiz
confidence in performing the regarding the
2. Short prayer before the duty following: cases
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STUDENT’S CLINICAL FOCUS

3. Pre conference. 1. Building and express the encountered


importance of building rapport to in the area,
4. Listening to the endorsements the patients important
made by outgoing staff diagnostic
2. Continue familiarizing with the E.R. procedures
5. Initial rounds and assigning set up, SOP, policies, nursing and
individual assignments/tasks. personnel and other health pharmacologi-
professionals cal concepts.
6. Triage Nursing
3. Assessing clients with respiratory
7. Taking initial V/S and general disorders and recognizing patient
assessment and charting. needs and problems of the client
and referring immediately if
8. Students focus: necessary.

a. admission procedures 3. Proper documentation of all


b. carrying out doctor’s order procedures done and observations
c. proper med. administration
c. giving oral / parenteral meds / for the management of client with
treatment respiratory diseases.
d. ECG, oxygen and IVF monitoring,
nebulization and surgical 4. Assisting subordinates and co
procedures workers in the area to provide
e. health teachings treatment.

9. Making of sample chartings. 5. Sharing of knowledge regarding


the case of the day.
10. 30 mins. break for the 1st batch
while the remaining students will 6. Observing the basic rights of the
take charge in the area. patients especially in giving
medications or performing
11. 30 mins. break for the 2nd batch procedures.
while the 1st batch take charge.
7. Utilizes the existing chain of
12. Ward Class: Respiratory Disorder command in implementing
activities.
13. Continuation of providing nursing
care.

14. Checking of individual charting.

15. Post conference: Pre-test.

16 Preparing for the endorsement to


incoming shift
2:00
PM --End of Duty --

Day 3 (November 25, 2009)

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STUDENT’S CLINICAL FOCUS

Time
Specific Activities Specific Objectives Evaluation
Table

6:00 1. Checking of attendance and During the shift, students will be A multiple
AM paraphernalia. able to do the following : choice type
quiz on the 3rd
2. Pre conference 1. Doing appropriate assessment day regarding
especially for patients with respiratory
3. Short prayer before the start of duty respiratory disorders. diseases,
important
4. Listening to endorsement made by 2. Gathers data using interview, diagnostic
outgoing staff observation, records review and procedures in
reports. the ward and
5. Assigning individual assignments. pharmacologi-
3. Follows principles of time cal concepts.
6. Triage Nursing management.

7. Taking of initial V/S and general 4. Accomplishes delegated tasks


assessment. within prescribed time frame.

8. Students focus: 5. Coordinates and collaborates with


a. admission procedures other members of the health team
b. carrying out doctor’s order and other administrative units in
c. giving oral / parenteral meds / the
treatment attainment of objectives.
d. discharge procedures
e. health teaching 6. Proper documentation of all
procedures done and
9. Making of sample charting. observations
on the client.
10. 30 mins. break for the 1st batch
while the remaining students will 7. Formulation of appropriate NCPs
take charge in the area. and health teachings in the area.

11. 30 mins. break for the 2nd batch 8. Drug recitation on the Drugs
while the 1st batch take charge. administered on cases handled
in
12. Ward class. the ward.

13. Continuation of providing nursing


care.

14. Checking of individual charting.

15. Preparing for the endorsement to


incoming shift

2:00 --End of Duty --


PM

Week 2
Day 1 (November 30, 2009)
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STUDENT’S CLINICAL FOCUS

Time
Specific Activities Specific Objectives Evaluation
Table

6:00 1. Checking of attendance and At the end of the shift, the 30 points
AM paraphernalia’s students will recollect concepts individual
learned from the previous week defense. This
2. Short prayer before the start of duty and will also demonstrate will be based
correctly acquired learning such from the
3. Brief pre conference and review on as: student’s
the ward routines, procedures and participation in
policies 1. Proper assessment techniques. the group
discussion,
4. Listening to the endorsement from 2. Administration of prescribed relevance of
the outgoing staff. medication. shared
concepts
5. Assigning individual 3. Performing drug recitation. regarding the
responsibilities. case handled
4. Proper carrying out of doctor’s and the
7. Student’s focus: orders and documentation of all individual’s
a. admission procedures procedures done and defense on
b. taking vital signs observations the nursing
c. carrying out doctor’s order on the client. procedure that
d. giving oral / parenteral meds / has been
treatment 5. Assisting subordinates and co rendered.
e. NGT administration, ECG taking workers in the area in doing t
and I & O monitoring. treatment and management care
f. health teaching to
clients in the area.
8. Making of sample chartings.
6. Be enriched with current trends on
9. 30 mins. break for the 1st batch
while the remaining students will medical cases and updates on
take charge in the area. nursing issues.

10. 30 mins. break for the 2nd batch 7. Establishing NPI and observing
while the 1st batch takes charge. patient basic rights especially in
giving medications or performing
11. Continuation of providing nursing procedures.
care.
8. Identifies specific and appropriate
strategies to attain objectives.
12. Ward class discussion.

13. Final checking of individual


charting.

14. Post conference and preparing for


2:00
PM the endorsement to incoming shift.

--End of Duty --

Day 2 (December 1, 2009)

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STUDENT’S CLINICAL FOCUS

Time
Specific Activities Specific Objectives Evaluation
Table

6:00 1. Checking of attendance and Within the shift, students will be A multiple
AM paraphernalia’s. able to familiarize the following : choice type
quiz on the
2. Pre conference. 1. Performing the appropriate way in regarding
heart
3. Short prayer before the duty starts. taking ECG and administration of diseases,
oxygen its concepts and important
4. Listening to endorsement made by indication. diagnostic
outgoing staff procedures
2. How to study ECG tracings and (ECG reading,
5. Assigning individual assignments determine some types of ECG oxygenation
for the day. abnormalities. therapy and
others) in the
6. Taking initial V/S and general 3. Continue formulating appropriate area and
assessment NCPs and rendering health pharmacologi-
teachings. cal concepts.
8. Student’s focus:
a. admission procedures 4. Proper carrying out of doctor’s
b. carrying out doctor’s order orders and documentation of all
c. giving oral / parenteral meds / procedures done and
treatment. observations
d. NGT administration, ECG taking on the client.
and I & O monitoring.
e. health teaching 5. Assisting subordinates and co
workers in the area in doing t
9. Making of sample chartings. treatment and management care
to clients in the area.
10. 30 mins. break for the 1st batch
while the remaining students will 6. Be enriched with current trends
take charge in the area. on
medical cases and updates on
11. 30 mins. break for the 2nd batch nursing issues.
while the 1st batch takes charge.
7. Establishing NPI and observing
12. Ward class discussion. patient basic rights especially in
giving medications or performing
13. Continuation of providing nursing procedures.
care.
8. Identifies specific and appropriate
14. Final checking of individual
charting. strategies to attain objectives.

15. Post conference and preparing for


the endorsement to incoming shift.
2:00
PM --End of Duty –

Day 3 (December 2, 2009)

Time
Specific Activities Specific Objectives Evaluation
Table

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STUDENT’S CLINICAL FOCUS

6:00 1. Checking of attendance and At the end of the shift, the student Post Test: A
AM paraphernalia’s. should be able to: multiple
choice type
2. Pre conference. 1. Utilize the nursing process in the quiz regarding
care of individuals. the cases
3. Short prayer before the duty starts. encountered
2. Assesses with client/s in the area,
4. Listening to endorsement made by his/her/their important
outgoing staff condition/health status through diagnostic
interview, physical examination, procedures
rendered and
5. Assigning individual assignments pharmacologi-
for the day. interpretation of laboratory findings cal concepts

6. Taking initial V/S and general 3. Identifies actual and at risk nursing
assessment
diagnosis
8. Student’s focus:
a. admission procedures 4. Plans appropriate nursing
b. carrying out doctor’s order interventions with client/s and
c. giving oral / parenteral meds / family for identified nursing
treatment. diagnosis.
d. NGT administration, ECG taking
and I & O monitoring. 5. Implements plan of care with
e. health teaching client/s and family.

9. Making of sample chartings. 6. Evaluates the progress of


his/her/their client’s condition ad
10. 30 mins. break for the 1st batch outcomes of care.
while the remaining students will
take charge in the area. 7. Ensure a well organized and
accurate documentation system.
11. 30 mins. break for the 2nd batch
while the 1st batch takes charge. 8. Relate with client/s and their family

11. Ward class discussion. and the health team appropriately.

12. Continuation of providing nursing 9. Observed bioethical concepts/


care. principles, core values, nursing
standard in the care of clients.
13. Final checking of individual
charting. 10. Promotes personal and
professional growth of self and
14. Post conference and preparing for others,
the endorsement to incoming shift.

2:00 --End of Duty –


PM

PRE TEST EXAM


Direction: Choose the correct answer; Except for nos. 21-23 the question should be
rationalize.

1. Which of the following arteries primarily feeds the anterior wall of the heart?
a. Circumflex artery

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STUDENT’S CLINICAL FOCUS

b. Internal mammary artery


c. Left anterior descending artery
d. Right coronary artery
2. Which of the following is the most common symptom of myocardial infarction?
a. Chest pain
b. Dyspnea
c. Edema
d. Palpitations
3. Which of the following blood tests is most indicative of cardiac damage?
a. Lactate dehydrogenase
b. Complete blood count
c. Troponin I
d. Creatine kinase
4. After myocardial infarction, serum glucose levels and free fatty acids are both increase. What type of
physiologic changes are these?
a. Electrophysiologic
b. Hematologic
c. Mechanical
d. Metabolic
5. Which of the following classes of medications protects the ischemic myocardium by blocking
catecholamines and sympathetic nerve stimulation?
a. Beta-adrenergic blockers
b. Calcium channel blockers
c. Narcotics
d. Nitrates
6. Which of the following parameters should be checked before administering digoxin?
a. Apical pulse
b. Blood pressure
c. Radial pulse
d. Respiratory rate
7. Which oxygen delivery system would the nurse apply that would provide the highest concentrations
of oxygen to the client?
A) Venturi mask
B) Partial rebreather mask
C) Non-rebreather mask
D) Simple face mask
8. A 57 year-old male client has hemoglobin of 10 mg/dl and a hematocrit of 32%. What would be the
most appropriate follow-up by the home care nurse?
A) Ask the client if he has noticed any bleeding or dark stools
B) Tell the client to call 911 and go to the emergency department immediately
C) Schedule a repeat Hemoglobin and Hematocrit in 1 month
D) Tell the client to schedule an appointment with a hematologist
9. Following mitral valve replacement surgery a client develops PVC’s. The health care provider orders
a bolus of Lidocaine followed by a continuous Lidocaine infusion at a rate of 2 mgm/minute. The IV
solution contains 2 grams of Lidocaine in 500 cc’s of D5W. The infusion pump delivers 60
microdrops/cc. What rate would deliver 4 mgm of Lidocaine/minute?
A) 60 microdrops/minute
B) 20 microdrops/minute
C) 30 microdrops/minute
D) 40 microdrops/minute
10. A client is discharged following hospitalization for congestive heart failure. The nurse teaching the
family suggests they encourage the client to rest frequently in which of the following positions?
A) High Fowler's
B) Supine
C) Left lateral
D) Low Fowler's

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11. What is the first intervention for a client experiencing myocardial infarction?
a. Administer morphine
b. Administer oxygen
c. Administer sublingual nitroglycerin
d. Obtain an electrocardiogram
12. What supplemental medication is most frequently ordered in conjuction with furosemide (Lasix)?
a. Chloride
b. Digoxin
c. Potassium
d. Sodium
13. Voluminous, watery stools can deplete fluids and electrolytes. The acid base imbalance that can
occur is:
a. metabolic alkalosis
b. metabolic acidosis
c. respiratory acidosis
d. respiratory alkalosis

Situation 9: Mr. Gerald Liu, 19 y/o, is being admitted to a hospital unit complaining of severe pain in the lower
abdomen. Admission vital signs reveal an oral temperature of 101.2 0F.

14. Which of the following would confirm a diagnosis of appendicitis?


a. The pain is localized at a position halfway between the umbilicus and the
right iliac crest.
b. Mr. Liu describes the pain as occurring 2 hours after eating
c. The pain subsides after eating
d. The pain is in the left lower quadrant
15. The doctor ordered for a complete blood count. After the test, Nurse Ray received the result from the
laboratory. Which laboratory values will confirm the diagnosis of appendicitis?
a. RBC 5.5 x 106/mm3
b. Hct 44 %
c. WBC 13, 000/mm3
d. Hgb 15 g/dL
16. What is the immediate home care management for diarrhea?
a. Milk
b. Imodium
c. Water
d. Oresol
17. Aminophylline (Theophylline) is administered to a client with COPDs. Ms. Garcia administers the
medication, knowing that the primary action of this medication is to:
a. Promote expectoration
b. Suppress the cough
c. Relax smooth muscle of the bronchial airway
d. Prevent infection
18. Theophylline tablets are prescribed for a client with COPD. A nurse instructs the client about the
medication. Which of the following nursing statements could not be a part of the teaching plan?
a. Take the medication, on empty stomach
b. Take the medication with food
c. Continue to take the medication even if you are feeling better
d. Periodic blood levels will need to be obtained
19. A nurse is teaching a patient with chronic respiratory failure how to use a metered dose inhaler
correctly. The nurse instructs the patient to:
a. Inhale to the nose
b. Inhale quickly
c. Take 2 inhalations during 1 breath
d. Hold the breath after inhalation
20. A patient with no history of respiratory disease is admitted with respiratory failure. A nurse assesses
the ABG report for which of the f following results that are consistent with this disorder

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STUDENT’S CLINICAL FOCUS

a. PaO2 58 mm Hg, PaCO2 32 mm Hg


b. PaO2 60 mm Hg, PaCO2 45 mm Hg
c. PaO2 49 mm Hg, PaCO2 52 mm Hg
d. PaO2 73 mm Hg, PaCO2 62 mm Hg

21 – 23. (3) Three points analytical question: A nurse is caring for a client who is receiving feedings via
nasogastric tube. The client suddenly begins to vomit, and the nurse quickly places the client in a high
fowler’s position. The client is coughing and having difficulty breathing and the nurse suspects that the client
has aspirated the feeding. What is the nurse’s next action?

Suction the client. The client may be suffering from aspiration. The client’s respiratory status would
also be monitored closely until respiratory pattern resumed.

24. An oxygen delivery system is prescribed to a client with a chronic airflow limitation [CAL] in order to
deliver a precise oxygen concentration. Which of the following types of oxygen delivery systems
would the nurse anticipate to prescribe?
a. Venturi mask
b. Aerosol mask
c. Face tent
d. Tracheotomy collar
25. Which of the following is not true in implementing medical asepsis
A. Wash hand before and after patient contact
B. Keep soiled linens from touching the clothings
C. Shake the linens to remove dust
D. Practice good hygiene
26. Where should you put a wet adult diaper?
A. Green trashcan
B. Black trashcan
C. Orange trashcan
D. Yellow trashcan
27. Which of the following if done by the nurse, is correct during NGT Insertion?
A. Use an oil based lubricant
B. Measure the amount of the tube to be inserted from the Tip of the nose, to the earlobe, to
the xiphoid process
C. Soak the NGT in a basin of ice water to facilitate easy insertion
D. Check the placement of the tube by introducing 10 cc of sterile water and auscultating for
bubbling
sound

Situation– Mr. Dizon, 84 years old, brought to the Emergency Room for complaint of hypertension, flushed
face, severe headache, and nausea. You are doing the initial assessment of vital signs.

28. You are to measure the client’s initial blood pressure reading by doing all of the following EXCEPT:
A. Take the blood pressure reading on both arms for comparison
B. Listen to and identify the phases of Korotkoff’s sound
C. Pump the cuff to around 50 mmHg above the point where the pulse is obliterated
D. Observe procedures for infection control

29. A pulse oximeter is attached to Mr. Dizon’s finger to:


A. Determine if the client’s hemoglobin level is low and if he needs blood transfusion
B. Check level of client’s tissue perfusion
C. Measure the efficacy of the client’s anti-hypertensive medications
D. Detect oxygen saturation of arterial blood before symptoms of hypoxemia develops
30. Discharge plans of diabetic clients include injection site rotation. You should emphasize that the
space between sites should be:
A. 6.0 cm.
B. 5.0 cm.
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STUDENT’S CLINICAL FOCUS

C. 2.5 cm.
D. 4.0 cm.
24. Which of the ff. colors would you expect a tank containing nitrous oxide (laughing gas) to have,
based on the universally-accepted color codes?
A. Red
B. Blue
C. Green
D. Orange
24. From an ECG reading, a QRS Complex represents:
A. Atrial depolarization
B. Ventricular repolarization
C. Ventricular depolarization
D. End of ventricular depolarization
25. When injecting subcutaneous injection in an obese patient, It should be angled at around:
A. 45 °
B. 90 °
C. 180 °
D. Parallel to the skin
26. The following statements are all true about Z-Track technique except:
A. Z track injection prevent irritation of the subcutaneous tissues
B. The technique involve creating a Zig Zag like pattern of medication
C. It forces the medication to be contained at the subcutaneous tissues
D. It is used when administering Parenteral Iron
27. Communication is best undertaken if barriers are first removed. Considering this statement, which of
the following is considered as deterrent factor in communication?
A. Not universally accepted abbreviations
B. Wrong Grammar
C. Poor Penmanship
D. Old age of the client

RIZAL TECHNOLOGICAL UNIVERSITY


COLLEGE OF NURSING

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STUDENT’S CLINICAL FOCUS

STUDENT CLINICAL FOCUS


(EMERGENCY ROOM)

Ncm 105 - RLE

Prepared by:

MACABALLUG, NICOLAI R.
MANUBAY, JANUS ANGELO N.

Submitted to:

Prof. Ramel B. Espares RN, MAN


Clinical Instructor

CLASS 2010

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