Todays clinical experience was an inspiration.

I was able to meet a few of my behavioral

competencies and with the help of my preceptor, I gained the confidence I needed to do so.
Today I provided care for an 81-year-old woman in intensive care. She had been admitted the
following evening with uremic encephalopathy and anasarca due to chronic kidney disease.
While receiving shift report, I learned that the patient had come from a long-term care facility
and had been refusing her usual dialysis treatments for the past two weeks. As a result, her
electrolytes were off balance and I received orders to draw labs every four hours.
A nurse from dialysis came later in the morning to remove six liters of fluid from the
patient. Before the process began, my preceptor instructed me to draw blood from the patients
right femoral central linethis was my first time accessing an intravenous line to remove blood.
After running the samples to the lab, the dialysis nurse guided me through the set-up process.
The patient had a left arteriovenous fistula, which I had never seen before. I learned that lower
extremity access is not common in the United States but is seen frequently in Europe. I also
learned about the significance of skin discoloration over the access site and that it is important to
avoid the scarred areas over the fistula to avoid the possibility of an aneurism. Once dialysis was
complete, my preceptor instructed me to draw labs again to evaluate the effectiveness of the
dialysis.
After lunch, my preceptor had received orders to administer two units of PRBCs since the
patients hemoglobin and hematocrit were low. The attending physician also ordered a CT-scan
of both the head and the abdomen to rule out a suspected bleed. Later in the evening, the
patients son stopped by to follow up on his mothers situation. I assessed his knowledge of the
patients condition and the need to continue treatment with dialysis and to maintain scheduled
appointments.