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Reflective Journaling

Name: Kristina Maldonado Date: July 3rd, 2018

 Subjective and objective data:
o Upon shift change, my preceptor and I were told from the night shift nurse that the
patient spiked a fever of 103 degrees Fahrenheit throughout the night and was still
currently febrile. The patient’s central line had already been removed the day prior
(provider’s suspected possible infection), but the skin around the insertion site was still
warm to touch and erythema was present. The patient had stage III mucositis and
reported her pain to be a 5 out of 10. The patient was also neutropenic.
 How did you know there was a problem? Abnormal patient presentation or your “gut feeling”?
o The patient looked very ill and my preceptor and I had taken care of her previously and
this was the first time she spiked a fever. Her oral temperature was abnormal and she did
not look well.
 What other information do I need to make a decision?
o Before making a decision, we need to ask the night nurse if she already notified the
provider about the patient’s fever.
 Is there anyone else I need to involve or notify?
o My preceptor and I need to notify provider.
 What could be happening and how critical is this situation?
o This is a medical emergency. The patient is currently experiencing neutropenic fever and
potentially is septic.
 Should I do something now or wait and watch?
o Something needs to be done immediately.
 How will I know if I am making the best decision?
o This is the correct decision. The patient has a fever and is neutropenic. The neutropenic
fever protocol must be initiated.
 What interventions can I delegate to other members of the healthcare team?

o Peripheral blood draws and cultures need to be obtained, antibiotics and fluids need to be
started, and these actions cannot be delegated. The nurse should take vital signs in this
case as well. Patient output can be delegated to the patient care technician.
 The most common complication for patients receiving chemotherapy is neutropenic fever.
Neutropenic fever can consequently lead to severe sepsis, septic shock, and fatality. Improved
patient outcomes have been associated with advancements in antibiotic therapy and prophylaxis.
However, mortality can still be as high as 50% in high-risk cancer patients (Thursky & Worth,
 Watching and waiting would not be prudent because this is a medical emergency.
 Did I make the right decision?
o My nurse and I made the right decision.
 Did I achieve the desired outcome?
o The desired outcome was achieved. The protocol was implemented and followed.
 What did I do really well? What could I have done better?

o I felt like I was fully present and engaged during the neutropenic fever protocol. The
fellow was frequently in the room and that was interesting to see. I felt anxious because I
knew that the patient could be going septic. I could have improved by reviewing the
results of the cultures that we obtained.


Thursky, K. A., & Worth, L. J. (2015). Can mortality of cancer patients with fever and neutropenia be

improved? Current Opinion in Infectious Diseases, 28(6), 505-513.

Reflective Journaling Grading Rubric


Criteria S/U Notes

Did the student interpret the case situation

Did the student present evidence of data analysis?

Did the student draw logical conclusions?

Did the student decide on an appropriate course of


Did student evaluate the outcome(s) of their action?

Did the student identify their strengths and areas for


Did the student use a Peer Reviewed Journal within

5 years and did it correlate appropriately to the case