Yelsy Rivas

04/11/2021

Journal #6

Patient description: 38 years old Caucasian female patient. Allergic to penicillin, admitted for
endocarditis and osteomyelitis of the lumbar vertebrae. Health history of anemia, anxiety,
cerebrovascular stroke, heroin, and cocaine use.

What did I do to demonstrate evidence base practice in this scenario? /What else could I have done to
demonstrate evidence base practice? The medication administration for this patient included three
patches (lidocaine, nicotine, and nitroglycerin). I had the opportunity to place theses in the patient’s
back, right and left arm taking into consideration placing them in a different place to prevent irritation in
the skin. However, I did not realize at the time the importance of writing the date it was place, with the
initials until later. This is an action that I could have done to ensured that the nurse in the upcoming shift
will recognized when the patch was placed.

What content area was my weakness? One of my weakness in this scenario was dealing with the
patient. This clinical was my first time dealing with a patient who had a history of drug overdose.

What content area was my strength? Taking into consideration that it was my first time assessing a
client with a history of drug overdose I felt anxious of not knowing how the patient will react. However,
during the morning assessment I gained confidence of talking and examining the patient.

Was I able to prioritize safely? The medical admission for this patient was the endocarditis and the goal
for her was to treat the infection with antibiotics (vancomycin and rifampin). The patient also presented
with chronic sharp pain located in the back due to the osteomyelitis of the lumbar vertebrae but due to
the drug overdose history we were only able to administer lorazepam per doctor’s order.

Was I able to delegate safely? The patient had also a history of hallucinations in the previous dates.
Thus, she always had a sitter in the room. As a safe delegation the sitter will help her eat and move
around the room.
 Yelsy Rivas

04/11/2021

Journal #7

Patient description: 80 years old Caucasian female patient. Allergic to aspirin, penicillin, and prednisone,
who was admitted due congestive heart failure. Health history of chronic cardiac failure, hypertension,
chronic obstructive pulmonary disease, acute kidney disease, and diabetes mellitus.

What content area was my weakness/strength? One of my weakness in this case was not knowing the
different treatments for a patient with bilateral leg blisters due to edema. At first this patient was
treated with zinc oxidate topical bandage, which I had the opportunity to put on the patient. Since the
blisters on the patient’s leg were healing the wound nurse recommended her to use tubigrip. However,
the patient refuse, she said that it hurt her skin and created too much pressure on her legs. She also
asked me if I knew the purpose of the tubigrip. I told her that it was needed to make pressure and
improved circulation which promote healing.

Was I using good clinical reasoning (using the data available)? This patient also presented with
pulmonary hypertension and we were treating this with bumetanide and sildenafil. One of the clinical
reasoning that I reinforced in this clinical experience was the complications of treating the edema and
fluid overload with diuretics. Diuretics damages the kidneys, but they are also necessary to treat the
patient cardiac failure.