CRITICAL THINKING AFTER CLINICAL

1. Prioritize all patient care.

The nurse had 3 patients to take care at the ER

Patient #1 is a male diagnosed with COVID 19, he can not breathe on his own and he was
complaining of shortness of breath and chest pain
Patient #2 is a stable COVID 19
Patient #3 is a hypertensive.

2. Which patient will you care for first based on the patient’s needs/diagnosis?

I will apply the concept of ABCs to each patient situation. I will prioritize by determining
immediate threats to life as part of the initial assessment based on the ABC mnemonic
focusing on the airway as priority, moving to breathing, and eventually to circulation.
At today’s clinical we had three patients: Patient #1 is hypertensive with BP of 231/144,
Patient #2 is a stable COVID-19 patient, and Patient #3 has O2 sat of 81% due to COVID-19
induced pneumonia and could not breath properly. We first attended to the Patient #3 because
his case was the most dire and he had to be intubated. We then provided pharmacologic
interventions to Patient #1 with the goal of lowering his blood pressure and finally attended
to the needs of Patient #2.

3. What specific needs (concerns/issues) will you address in order of need/issues

related to patient/labs etc.

I will first intervene in an acute problem over a chronic problem. For instance, I will first
attend to somebody that is choking over somebody with a migraine.
If I have a choice between two interventions and they can both equally benefit the patient, I
will do the fastest/easiest one first.
At today’s clinical, we decided to address Patient #3’s condition because he was gasping for
air. Patient #2’s had been admitted for three days with elevated BP, which can thus be treated
as being chronic.

4. Do you know the pathophysiology of each disease/condition for all your

patients?

Pathophysiology of hypertension: Blood vessels become less elastic and more rigid as
patients age, which reduces vasodilatation and increases systemic vascular resistance, leading
to a higher systolic blood pressure (often with a normal diastolic pressure). In contrast,
hypertension in younger patients tends to be associated with increased cardiac output, which
can be caused by environmental or genetic factors.
Pathophysiology of COVID-19: The life cycle of the virus with the host consists of the
following 5 steps: attachment, penetration, biosynthesis, maturation and release. Once viruses
bind to host receptors (attachment), they enter host cells through endocytosis or membrane
 fusion (penetration). Once viral contents are released inside the host cells, viral RNA enters
the nucleus for replication. Viral mRNA is used to make viral proteins (biosynthesis).

5. Who will you consult related to your patient diagnosis?

For my Patient #3 who was intubated, pulmonologist will be consulted. For my

Patient #1 who is hypertensive, cardiologist will be consulted.

6. Does your assessment match the previous nurse report? What will you report

to the oncoming nurse?

No previous nurse report was provided. I will detail the diagnosis for each patient, the

interventions form each patient and their body responses to the interventions via their

vital signs.

7. What could you have done different today in order to perform better patient

care from now on?

8. When administering medications

A. Did you know the classifications? Explain in detail

Patient #1 was given Amlodipine which is in a class of medications called

calcium channel blockers. Amlodipine dilates blood vessels and improves blood

flow.

I did not provide any medication for the COVID-19 Patient #1. I only

administered Amlodipine.

B. Did you know if the medications were compatible with other medication you

administered?

None of the drugs were contraindicated

C. Did you know what to monitor?

 Side effects of Amlodipine would be monitored. These include pounding

heartbeats or fluttering in the chest; worsening chest pain; swelling in the feet or

ankles; severe drowsiness; or light-headed feeling.

D. Did you check lab values related to your patient care, explain low and high

values for the lab values?

I checked the lab values for Patient #3 who is hypertensive.

His sodium ion level is 145 mEq/Liter (Normal range = Low of 135 mEq and

high of 145 mEq).

His potassium ion level is 3.5 mEq/Liter (Normal range = Low of 3.5 mEq and

high of 5.5 mEq).

His glucose level is 94 mg/dL (Normal range = Low of 90 mg/dL and high of 110

mg/dL)

E. Do you know the type of IV fluids being administered, how do these types of

fluids help the patient?

No IV fluids were administered to my patients while I was there today.

F. If you do not do you know the type of fluids, did you look them up or depend

on the nurse to give you answer?

No IV fluids were administered to my patients while I was there today.

G. Do you have a pathophysiology book, drug book, lab book to use for

reference and patient teaching?

Yes, I had my handbook of pathophysiology, drugbook and Mosby’s diagnostics

and laboratory reference books with me during the clinical.

H. Did you wear your surgical mask, N-95 mask, wash your hand before and

after entering the patient’s room? Explain?

Yes, I wore a surgical mask over N-95 mask at the clinical today because we were

dealing with COVID-19 patients and had to protect ourselves from the airborne

virus. I also religiously washed my hands on entering and exiting all my patients’

rooms.

I. Did you learn anything new today relating to patient care and medication?

Yes, I learned how to insert central line on patients.

9. Will you obtain the pathophysiology/ drug book or cards to help you

understand the disease process and how medication work in the body? Explain

I already have pathophysiology handbook, drug book and lab book for my clinicals.

10. If you feel overwhelmed now, what will you do today and in the near future

to cope with difficult situations?

I was not overwhelmed at the clinical today. However, if I ever get overextended, my

coping mechanisms will include listening to good music during my break time.

11. What do abnormal high and low labs indicate relate it to your patient?

An abnormally low sodium ion lab value can lead to signs and symptoms of

hyponatremia. These may include nausea and vomiting, headache, confusion, loss of

energy, drowsiness and fatigue, restlessness and irritability, muscle weakness, spasms

or cramps, seizures and coma.

 On the other hand, an abnormally high sodium ion lab value will lead to signs and

symptoms of hypernatremia. These may include excessive thirst, lethargy or extreme

fatigue, lack of energy, and possibly confusion. Severe elevations of sodium may lead

to seizures and coma.

12. Do you know how to recognize or identify telemetry strip for patient on

telemetry?

No, I did not work at the telemetry unit, I was assigned to work at the emergency unit

(ER).

13. What are the heart rhythms you should recognize right away?

The most common types of abnormal heart rhythms are: tachycardia, atrial

fibrillation, atrial flutter, bradycardia and ventricular fibrillation

14. What is the nurse responsibility while caring for a patient in telemetry?

Nurses monitor a patient's heart and vital signs remotely using EKGs and other

medical equipment to ensure that their condition does not worsen while a diagnosis is

reached

15. Did you ask to perform any treatment such as respiratory, trach care or

wound care?

No, I did not ask to perform any such care at the clinical today.