Indus College of nursing & midwifery

Pediatric Health Nursing

Clinical portfolio

Inamullah

ID: 0002150

BSN Sem V year III

Date: 23-5-2022

Facilitator: Sir Aihtisham Ahmad

 WEEKLY OBJECTIVES

OBJECTIVE #1

Principal of growth and development

 Growth and development are continuous, orderly, sequential, genetic factors.

 All human follow the same pattern of growth and development

 The sequence of each stage is predictable.althoug the time of onset.the length of stage
and affect of each stage vary with the individual.

 Learning can either help or hinder the mutational process depending on what it learned

 Each developmental stage has its own characteristics for example,piaget suggested that
in the sensorimotor stage (birth to 2tear) children learn to coordinate simple moter tasks

 growth and development occur in a cephalocaudal direction that is starting at the head
and moving to trunk the legs and feet ,this pattern is particularly obvious at birth when
the head of infant is disproportionately large.
Growth and development also occur in proximodistal direction that is from the center of the body
outward for example infant can roll over before they can grasp an object with the thumb and
second finger.
. Development processed from simple to complex or single acts to integrated acts to accomplish
the integrated act of drinking and swallowing from a cup for example the child must first learn a
series of single acts eye hand coordination, grasping had mouth coordination controlled tipping
of the cup and then mouth lip and tongue movement to drink and swallow.
Development becomes increasingly differentiated development begins with a generalized
response and progresses to a skilled specific response for example an infant initial response to a
stimulus involves the total body a 5-year old child can respond more specifically with laughter or
fear.
Certain stages of growth and development are more critical than others.it is known for example
that the first 10 to 12 week after conception are critical The incidence of congenital anomalies as
a result of exposure to certain viruses chemicals or drugs is greater during this stage than others .
The pace of growth and development is uneven it is known that growth is greater
during infancy than during childhood asynchronous development is demonstrated
by rapid growth of head during infancy and the extremities at puberty
 OBJECTIVE #2

Identify the impact of hospitalizations on child and family and utilize the strategies to decrease
the stress of hospitalizations
Effects of Hospitalization on Children and Families
CHILD
Scared about being separated from their family
Distressed from unfamiliar surroundings
Don’t understand the pain
Scared of the unknown
Can be upset about the changes to their body and not being like other kids
Not understand how something that hurts can actually help them
Be afraid of being left in hospital
Possible regression – they may begin to suck thumb, wet bed, want bottles and old comforts
again
Disinterest in eating
Become more sensitive than usual
Can become withdrawn, hypersensitive or act out
Refuse medication – even if they normally wouldn’t
FAMILY
Worry
Fear
Distress
Apprehension
Helplessness
Lonely or isolated
Anger
Unfamiliar surroundings
Caught between not enough information and information overload
Loss of privacy
Stress of trying to manage life at home as well as life at the hospital
Strategies to decrease the stress of hospitalizations

 developed trust with family and child

 take care is privacy of patient and child

 take care of religion and culture

 Play role is a advocator

 explain about the disease and it prevention

 give good quality of Care

 provide safe and healthy environment

 give financial support

 Play music 🎵

 give mental and physical support

 OBJECTIVE #3
Gordon’s Health Pattern
1 - Health Perception and Health Management Pattern.
Data collection is focused on the person's perceived level of health and well-being, and on
practices for maintaining health. Habits that may be detrimental to health are also evaluated,
including smoking and alcohol or drug use. Actual or potential problems related to safety and
health management may be identified as well as needs for modifications in the home or needs for
continued care in the home.
Example of Health Perception and Health Management FHP Assessment Questions:

What is your opinion about health?

Are you immunized about seven target diseases?
Last immunization?
Do you have any allergy? If yes then type of allergy.
Any surgery in past? What type of surgery?
Last physical examination & for what purpose.
Are you using any medicine recently?
Do you know about these medicines?

2 - Nutrition and Metabolism Pattern

Assessment is focused on the pattern of food and fluid consumption relative to metabolic need.
The adequacy of local nutrient supplies is evaluated. Actual or potential problems related to fluid
balance, tissue integrity, and host defenses may be identified as well as problems with the
gastrointestinal system.

Example of Nutrition and Metabolism FHP Assessment Questions:

Ask about their skin, scalp and nails?

What is your diet menu?
Any food restriction regarding disease point of view?
Any food restriction regarding religious point of view?
Any food like or dislike?
Any food allergy?

3 - Elimination Pattern

Data collection is focused on excretory patterns (bowel, bladder, skin). Excretory problems such
as incontinence, constipation, diarrhea, and urinary retention may be identified.

Example of Elimination FHP Assessment Questions:

Color of urine, amount, frequency, odor and any discharge.

Any urinary problem, dysurea, Anurea, Oligourea, , polyuria.
Are you using any laxative? If yes which?
Any problem during passing defecation?

4 - Activity and Exercise Pattern

Assessment is focused on the activities of daily living requiring energy expenditure, including
self-care activities, exercise, and leisure activities. The status of major body systems involved
with activity and exercise is evaluated, including the respiratory, cardiovascular, and musculo-
skeletal systems.

Example of Activity and Exercise FHP Assessment Questions:

Do you any breathing problem? (In which apnea, hypoxia, hypoxemia, hypercapnia.)
Do you have cough? (Productive or non-productive)
Any changes in heart beat during exercise?
Do you feel pale during exercise?
What type of exercise you do or any problem during exercise?

5 - Cognition and Perception Pattern

Assessment is focused on the ability to comprehend and use information and on the sensory
functions. Data pertaining to neurologic functions are collected to aid this process. Sensory
experiences such as pain and altered sensory input may be identified and further evaluated.

Example of Activity and Exercise FHP Assessment Questions:

Orientation about time place and person.

Any difficulty in sentence making?
Loss of memory.

6 - Sleep and Rest Pattern

Assessment is focused on the person's sleep, rest, and relaxation practices. Dysfunctional sleep
patterns, fatigue, and responses to sleep deprivation may be identified.

Example of Activity and Exercise FHP Assessment Questions:

Sleeping hour?
Are you using nap (evening type sleeping).
What do you feel after waking? (Fresh, headache, drowsy).
Are you using any medication for sleeping?
Do you have any exercise or walking at night?
7 - Self-Perception and Self-Concept Pattern

Assessment is focused on the person's attitudes toward self, including identity, body image, and
sense of self-worth. The person's level of self-esteem and response to threats to his or her self-
concept may be identified.

Example of Self-Perception and Self-Concept FHP Assessment Questions:

What is your self-perception about yourself?

Are you satisfied with your self-body image?
Do you like grooming?

8 - Roles and Relationships Pattern

Assessment is focused on the person's roles in the world and relationships with others.
Satisfaction with roles, role strain, or dysfunctional relationships may be further evaluated.

Example of Roles and Relationships FHP Assessment Questions:

What is your role in family?

If you are in hospital then who will perform your responsibilities?
All the family members are cooperative with you?
Who is decision maker in your family?

9 - Sexuality and Reproduction Pattern

Assessment is focused on the person's satisfaction or dissatisfaction with sexuality patterns and
reproductive functions. Concerns with sexuality may he identified.

Example of Sexuality and Reproduction FHP Assessment Questions:

When you first notice changes in your menarche (first menses is called menarche)
Do you have any sexual problem? (Loss of libido)
Active sex (direct sex with male and female)
Passive sex (sex without male and female partner)
Digital sex
Reproductive: Infertility

10 - Coping and Stress Tolerance Pattern

Assessment is focused on the person's perception of stress and on his or her coping strategies
Support systems are evaluated, and symptoms of stress are noted. The effectiveness of a person's
coping strategies in terms of stress tolerance may be further evaluated.

Example of Sexuality and Reproduction FHP Assessment Questions:

If you have stress then what is your coping mechanism towards stress?
Crying, angry, violence, (what is your opinion regarding that)

11 - Values and Belief Pattern

Assessment is focused on the person's values and beliefs (including spiritual beliefs), or on the
goals that guide his or her choices or decisions.

Example of Sexuality and Reproduction FHP Assessment Questions:

What is your religion?

Do you offer prayer?

OBJECTIVE #4
‘’Utilize communication skills that facilitates therapeutic relationship with children their

families and health care team members’’

Communication skills

Verbal Techniques:

“I” Messages 

Relate a feeling about a behavior in terms of “I.” 

Describe effect behavior had on the person. 

Avoid use of “you.” 

“You” messages are judgmental and provoke defensiveness. 

Example: “You” message: “You are being uncooperative about doing 

Your treatments.” 

Example: “I” message: “I am concerned about how the treatments are going because I want to

see you get better.” 

Third-Person Technique 

Express a feeling in terms of a third person (“he,” “she,” “they”). This is less threatening than 

Directly asking children how they feel because it gives them an opportunity to agree or disagree

without being defensive

Example: “Sometimes when a person is sick a lot, he feels angry and sad because he cannot do

what others can.” Either wait silently for a response or encourage a reply with a statement, such

as “Did you ever feel that way?” 

This approach allows children three choices:

(1) to agree and, one hopes, express how they feel;(2) to disagree; or (3) to remain silent, which

means they probably have such feelings but are unable to express them at this time. 

Facilitative Response 

Listen carefully and reflect back to patients the feelings and content of their statements. 

Responses are empathic and nonjudgmental and legitimize the person's feelings. 

Formula for facilitative responses: “You feel _________ because _________.” 

Example: If child states, “I hate coming to the hospital and getting needles,” a facilitative

response is, “You feel unhappy because of all the things that are done to you.” 

Storytelling 

Use the language of children to probe into areas of their thinking while bypassing

conscious inhibitions or fears. 

The simplest technique is asking children to relate a story about an event, such as “being in

the hospital.” 

Other approaches: 
• Show children a picture of a particular event, such as a child in a hospital with other people in

the room, and ask them to describe the scene. 

• Cut out comic strips, remove words, and have child add statements for scenes. 

Mutual Storytelling 

Reveal the child's thinking and attempt to change his or her perceptions or fears by retelling

a somewhat different story (more therapeutic approach than storytelling). 

Begin by asking the child to tell a story about something; then tell another story that is similar

to child's tale but with differences that help the child in problem areas. 

Example: Child's story is about going to the hospital and never seeing his or her parents again.

Nurse's story is also about a child (using different names but similar circumstances) in a hospital

whose parents visit every day, but in the evening after work, until the child better and goes home

with them.

Bibliotherapy 

Use books in a therapeutic and supportive process. 

Provide children with an opportunity to explore an event that is similar to their own but

sufficiently different to allow them to distance themselves from it and remain in control. 

General guidelines for using bibliotherapy are: 

1. Assess the child's emotional and cognitive development in terms of readiness to understand

the book's message. 

2. Be familiar with the book's content (intended message or purpose) and the age for which it is

written. 

3. Read the book to the child if child is unable to read. 

4. Explore the meaning of the book with the child by having the child: 

○ Retell the story. 

○ Read a special section with the nurse or parent. 

○ Draw a picture related to the story and discuss the drawing. 

○ Talk about the characters. 

○ Summarize the moral or meaning of the story. 

Dreams 

Dreams often reveal unconscious and repressed thoughts and feelings. 

Ask the child to talk about a dream or nightmare. 

Explore with the child what meaning the dream could have. 

“What If” Questions 

Encourage child to explore potential situations and to consider different problem-solving

options. 

Example: “What if you got sick and had to go the hospital?” 

Children's responses reveal what they know already and what they are curious about, providing

an opportunity for them to learn coping skills, especially in potentially dangerous situations. Ask,

“If you could have any three things in the world, what would they be?” 

If the child answers, “That all my wishes come true,” ask the child for specific wishes. 

Rating Game 

Use some type of rating scale (numbers, sad to happy faces) to have the child rate an event

or feeling. 

Example: Instead of asking youngsters how they feel, ask how their day has been “on a scale of

1 to 10, with 10 being the best.” 

Word Association Game 

State key words and ask children to say the first word they think of when they hear the word. 

Start with neutral words and then introduce more anxiety-producing words, such as

“illness,” “needles,” “hospitals,” and “operation.” 

Select key words that relate to some relevant event in the child's life. 

Sentence Completion 
Present a partial statement and have the child complete it. Some sample statements are 

• The thing I like best (least) about school is _________. 

• The best (worst) age to be is _________. 

• The most (least) fun thing I ever did was _________. 

• The thing I like most (least) about my parents is _________. 

• The one thing I would change about my family is _________. 

• If I could be anything I wanted, I would be _________. 

• The thing I like most (least) about myself is _________. 

Pros and Cons 

Select a topic, such as “being in the hospital,” and have the child list “five good things and five

bad things” about it. 

This is an exceptionally valuable technique when applied to relationships, such as things

family members like and dislike about each other. 

Nonverbal Techniques 

Writing 

Writing is an alternative communication approach for older children and adults. 

Specific suggestions include

Keep a journal or diary. 

• Write down feelings or thoughts that are difficult to express. 

• Write “letters” that are never mailed (a variation is making up a “pen pal” to write to). 

Keep an account of the child's progress from both a physical and an emotional viewpoint. 

Drawing 

Drawing is one of the most valuable forms of communication—both nonverbal (from looking at

the drawing) and verbal (from the child's story of the picture). 

Children's drawings tell a great deal about them because they are projections of their inner

selves. Spontaneous drawing involves giving child a variety of art supplies and providing the

opportunity to draw. 

Directed drawing involves a more specific direction, such as “draw a person” or the “three

themes” approach (state three things about child and ask the child to choose one and draw a

picture). 

Guidelines for Evaluating Drawings 

Use spontaneous drawings and evaluate more than one drawing whenever possible. 

Interpret the drawings in light of other available information about child and family, including

the child's age and stage of development. 

Interpret the drawings as a whole rather than focusing on specific details of the drawings. 

Consider individual elements of the drawings that may be significant: 

• Sex of figure drawn first: Usually relates to the child's perception of his or her own sex role 

• Size of individual figures: Expresses importance, power, or authority 

• Order in which figures are drawn: Expresses priority in terms of importance 

• Child's position in relation to other family members: Expresses feelings of status or alliance 

• Exclusion of a member: May denote feeling of not belonging or desire to eliminate 

• Accentuated parts: Usually express concern for areas of special importance (e.g., large hands

may be a sign of aggression)

Absence of or rudimentary arms and hands: Suggest timidity, passivity, or intellectual

immaturity; tiny, unstable feet may express insecurity; and hidden hands may mean guilt

feelings 

• Placement of drawing on the page and type of stroke: Free use of paper and firm, continuous

strokes express security, whereas drawings restricted to a small area and lightly drawn in broken

or wavering lines may be signs of insecurity 

• Erasures, shading, or cross-hatching: Expresses ambivalence, concern, or anxiety with a

particular area 
Magic 

Use simple magic tricks to help establish rapport with child, encourage compliance with

health interventions, and provide effective distraction during painful procedures. 

Although the “magician” talks, no verbal response from the child is required. 

Play 

Play is the universal language and “work” of children. 

It tells a great deal about children because they project their inner selves through the activity. 

Spontaneous play involves giving child a variety of play materials and providing the opportunity

to play. 

Directed play involves a more specific direction, such as providing medical equipment or

a dollhouse for focused reasons, such as exploring child's fear of injections or exploring family.

Reference: Wong's Essentials of Pediatric Nursing (Third Edition)

Page (165 – 170)

OBJECTIVE #5

What is play therapy?

Play therapy is a form of therapy used primarily for children. That’s because children may not be

able to process their own emotions or articulate problems to parents or other adults.

Play is the universal language and “work” of children. 

It tells a great deal about children because they project their inner selves through the activity. 

Spontaneous play involves giving child a variety of play materials and providing the opportunity

to play. 

Directed play involves a more specific direction, such as providing medical equipment or

a dollhouse for focused reasons, such as exploring child's fear of injections or exploring family

Explanation

Play 

Play is a universal language of children. It is one of the most important forms of

communication and can be an effective technique in relating to them. The nurse can often pick

up on clues about physical, intellectual, and social developmental progress from the form and

complexity of a child's play behaviors. Play requires minimum equipment or none at all. Many

providers use therapeutic play to reduce the trauma of illness and hospitalization and to prepare

children for therapeutic procedures. 

Because their ability to perceive precedes their ability to transmit, infants respond to

activities that register with their physical senses. Patting, stroking, and other skin play convey

messages. 
Repetitive actions, such as stretching infants' arms out to the side while they are lying on their

back and then folding the arms across the chest or raising and revolving the legs in a bicycling

motion, will elicit pleasurable sounds. Colorful items to catch the eye or interesting sounds, such

as a ticking clock, chimes, bells, or singing, can be used to attract infants' attention. 

Older infants respond to simple games. The old game of peek-a-boo is an excellent means

of initiating communication with infants while maintaining a “safe,” nonthreatening distance.

After this intermittent eye contact, the nurse is no longer viewed as a stranger but as a friend.

This can be followed by touch games. Clapping an infant's hands together for pat-a-cake or

wiggling the toes for “this little piggy” delights an infant or small child. Talking to a foot or

other part of the child's body is another effective tactic. Much of the nursing assessment can be

carried out with the use of games and simple play equipment while the infant remains in the

safety of the parent's arms or lap. 

The nurse can capitalize on the natural curiosity of small children by playing games, such as 

“Which hand do you take?” and “Guess what I have in my hand,” or by manipulating items such

as flashlight or stethoscope. Finger games are useful. More elaborate materials, such as puppets

and replicas of familiar or unfamiliar items, serve as excellent means of communicating with

small children. The variety and extent are limited only by the nurse's imagination. 

Through play, children reveal their perceptions of interpersonal relationships with their

family, friends, or health care personnel. Children may also reveal the wide scope of knowledge

they have acquired from listening to others around them. For example, through needle play,
children may reveal how carefully they have watched each procedure by precisely duplicating

the technical skills. 

They may also reveal how well they remember those who performed procedures. In one

example, a child painstakingly reenacted every detail of a tedious medical procedure, including

the role of the physician who had repeatedly shouted at her to be still for the long ordeal. Her

anger at him was most evident during the play session and revealed the cause for her abrupt

withdrawal and passive hostility toward the medical and nursing staff after the test. 

Reference: Wong's Essentials of Pediatric Nursing (Third Edition)

Page (170 – 172)

OBJECTIVE #6
‘’Identify need and give health education to child/ family at their level of understanding to

promote health and prevent disease’’

The basic principles of patient and family education and support. The major focus of health

education is to help patients and their families to assume greater responsibility for their own

health. Patients and their families need to work together with health care professionals to

establish a partnership to accomplish health care goals.

The basic goals of patient and family education are:

(1) To increase knowledge and clarify misconceptions about medical condition

(2) Implement new behaviors to adapt to medical conditions and physical limitation

(3) Learn strategies to cope up with psychosocial responses to disease and disability

(4) Overcome barriers to compliance by articulating

(5) To master behavioral changes required to implement and continue with a treatment plan. The

support group provides medical treatment of osteoporosis by educating members and adds a

personal dimension to health care by addressing the needs of body, mind, and spirit. Therefore,

the main objective is to provide information and education, outlet for feelings, emotional support

and coping strategies, and to support members in their efforts to lead productive lives.

Reference:https://www.sciencedirect.com/science/article/pii/B9780120885695500358
 REFLECTIVE LOG 1

Description: What Happened?

On 2nd of feb Our clinical was placed in NICVD Peads department, sir Maqsod was invigilating us so he placed us in
different wards of the department. They briefed us about how things were done over there on daily basis. I was stationed
in peads triage ( peads ER).
In my ward during my clinical one of the nursing staff was practicing wrong IV cannulation. she was not following all
the precuations and she did not prepare any tray for cannulation as we have been told by our teachers that before doing
any procedure we should be prepare first but she Was not prepare . she did no hand washing
Feelings: What were you thinking and feeling?
: I was feeling very happy and was feeling Excited as it was my first day of clinical in NICVD. As the time passes my
excitement was increasing because I was experiencing different things which I never seen before
Being nursing student I was feeling very bad for the patient because the nurse staff who was an experienced staff but
still she was practicing wrong and also she was giving infection to the patient by not maintaining hand hygiene . we
have been taught by our teachers that we should be prepare before doing any procedure and we go to clinical to learn
something from the senior staff but if they are doing wrong practices then what we will learn from them .
Evaluation: What was good and bad about the experience?
The good experience about the incident was I observed her and I decided that I will not repeat the same mistake in my
life .
The bad experience was I felt guilty for the patient because already she was experiencing health issues and due to staff
negligence she could get more infections and skin problems.

Analysis: What sense can you make of the situation?

The sense I can make from the situation is that every individual should know their responsibilities and act upon it. Its
nurse duty to deal with the patient wisely and feel her situation as already the patient is in bad condition, its nurse duty
to give her good care .

Conclusion: What else could you have done?

I could have done at that time is that I could stopped her and told her to do hand hygiene before performing iv cannula
or I could asked her if she is doing wrong procedure or wright because our teachers has taught us to follow a proper
protocols before doing any procedure .

Action Plan: If the situation arose again, what would you do?
If thus situation arose again in my presence I am going to stop her and try to correct her . at least I will try my best to not
let her do wrong cannulation again as this act can damage the patient skin and also can give many infection to the patient
.
 REFLECTIVE LOG 2
Description: What Happened?
Answer: Our clinical was placed in NICVD Peads department, sir Maqsod was invigilating us so he placed us in
different wards of the department. I was stationed in general ward.
In the general ward I saw a patient who was suffering from irregular breath patterns. The doctor told the staff to do
suctioning to the baby who was only 1 week( neonate ). But the staff was following the wrong practicing by putting the
same tube in nasal cavity as well as oral cavity. The suctioning tube was surrounded by the blood because the staff was
forcefully putting the tube in mouth and nose.
Feelings: What were you thinking and feeling?
Answer: I was feeling very embarrassed and annoying because the baby was crying with pain and I was not able to do
anything except assessing them.

Evaluation: What was good and bad about the experience?

Good Things: 1) Staff coordination was really good. They enjoyed each other’s company. 2) Daily consultants’ visits
were done on time.
Bad Things: 1) hygiene maintenances and unethical behavior of hospital staff with patients and attendant
2) Patient and staff coordination was not good. Staff behavior was not good with the patient. They ignore patients.

Analysis: What sense can you make of the situation?

Answer: The wrong practice of health care provider can takes the patient into pain and bruising was there and when his
attendant told him about it, the staff didn’t gave proper attention and ignore them by saying that go and ask from the
doctors. The patients also irritate the staff by asking the same question again and again.

Conclusion: What else could you have done?

Answer: As a student we cannot do much but to learn from the situation and not to repeat the mistakes the staff did.

Action Plan: If the situation arose again, what would you do?
Answer: If the situation arose again we will follow the protocols. we will make sure that we will keep us save and
follow standard precautions.
 REFLECTIVE LOG 3
Description: What Happened?
Answer: Our clinical was placed in NICVD Peads department, Sir Maqsod was invigilating us so he placed us in
different wards of the department. I was stationed in ICU. In the ICU I saw a newnate who was about 3 days old. He
was admitted with the disease of Ectopia Cordis. ( Candrels Pantalogy ). The heart was placed above the chest, with no
sternum present. Doctors order was to clean and chanfe the dressing on regular basis but the staff showed such a lazy
behaiour that pus formed on the heart area. When the doctor assess the heart he found pus formation. Then the doctor
did the C&S test. The baby was crying with pain this causes low survival chances for the baby.
Feelings: What were you thinking and feeling?
Answer: I felt very bad for that baby, her mother was continuously crying and worried about her child. Doctor told to
take him home. But she refused. I counselled her..

Evaluation: What was good and bad about the experience?

Good Things: 1) Staff coordination was really good in between each other including doctors.
. 2) Daily consultants’ visits were done on time.
Bad Things: 1) improper hygiene maintenances, unethical behavior of some staffs with the patients.
2) Patient and staff coordination was not good. Staff behavior was not good with the patient. They ignore patients.

Analysis: What sense can you make of the situation?

Answer: The wrong practice of health care provider can takes the patient into pain and bruising was there and when his
attendant told him about it, the staff didn’t gave proper attention and ignore them by saying that go and ask from the
doctors. The patients also irritate the staff by asking the same question again and again. The staff do not guide and
counsel the patient which was really very bad experience for me,.

Conclusion: What else could you have done?

Answer: I have some complains related to the staffs but being a students I was not able to tell the staff that they are
going unethical and wrong things. But after the staff went off I helped the patients by counselling them and guiding for
their best. The next time the patient requested the staff to that she need my help she discussed some important things
that should be kept confidential.
At that time I was feeling glad that I have won the patients feelings. From that time I kept her confidential from others
and helped her in a medical procedure.
Action Plan: If the situation arose again, I will talk freely with the staff in a decent way that the staff also not feel
embarrassed and also the patient feels good. This experience taught me many things which I need to implement in my
personal and professional life.
 REFLECTIVE LOG 4
Description: What Happened?
Answer: Our clinical was placed in NICVD Peads dep, the HN of the department placed us in different wards of the
department. They briefed us about how things get done over there on daily basis. I was stationed in general ward.

Feelings: What were you thinking and feeling?

Answer: I was feeling Excited on the first day of my clinicals.

Evaluation: What was good and bad about the experience?

Good Things: Staff coordination was good.
.
Bad Things:
Patient and staff coordination was not good

Analysis: What sense can you make of the situation?

Answer: The wrong practice of health care provider can takes the patient into pain and bruising was there and when his
attendant told him about it, the staff didn’t gave proper attention that.

Conclusion: What else could you have done?

Answer: As a student we cannot do much but to learn from the situation and not to repeat the mistakes staff did.

Action Plan: If the situation arose again, what would you do?
Answer: If the situation arose again we will follow the protocols.
 REFLECTIVE LOG 5
Description: What Happened?
An infant name hamza came in Peads ER .He was 2 months old he was cyanosed and came with tachycardia. the head
staff came and maintain his iv fluids and oxygen saturation and done ECG to know his cardiac rhythms .a staff came
and did his suctioning he passed tube to his nose and without cleaning the tube he pass that tube to his mouth .then a
group of doctors came to assess the child .and one of the doctor came and pass him NG tube without any precaution
and without protocols she just pass the NG tube to the baby.

Feelings: What were you thinking and feeling?

I saw the unprofessional behavior of both staff and doctor. And I saw that the baby was in pain and I saw the pain in
the eyes of baby parents still the staff and doctor don’t stopped their wrong practices.
I tried to say that staff that’s not the right protocol but they didn’t listen.

Evaluation: What was good and bad about the experience?

The thing that was good that at the time of emergency all the staff gather and help other staff to cover the situation .but
the bad thing was their wrong practices.

Analysis: What sense can you make of the situation?

Proper counselling wasn’t give to the patient’s attented as per his right because they are already suffering from
depression and anxiety .

Conclusion: What else could you have done?

I have told them that they are using wrong pratcise but didn’t listen and as being I student didn’t have any other option
to use ….

Action Plan: If the situation arose again, what would you do?
If the situation appears in the future I will use the proper PPI and use the hygiene and use the proper procedure and
teach the patient parents also about the procedure.
 REFLECTIVE LOG 6
Description
During my duty when I was working on a emergency ward, I was working under the supervision of staff
Ali , caring for a 52 year old lady, Miss Fatima , who had diabetic foot . I had been asked to remove his
wound dressing so that the doctor could assess it.I removed the dressing under staff Naima supervision,
using a non-touch procedure,and cleaned the wound.While we waited for the doctor to come to see
her .The doctor had been with another patient, examining their wound, and I noticed that she came
straight to Miss Fatima to examine his wound, without either wearing gloves or using alcohol gel first.
Feelings
Later, I spoke to my mentor about the incident. She suggested that we should speak to the doctor
together about it. Staff Naima took the doctor aside, and asked her whether she had used gloves before
examining patient. She looked quite shocked. She said that she had been very busy and forgot about it.
Staff Naima discussed the importance of hand hygiene with her, and the doctor assured her that she would
wear gloves before examining every patient.
Evaluation
I regret that I did not act to challenge the doctor's practice before she examined patient. However, I am
pleased that the doctor responded so positively to the feedback of staff Naima and I have observed that
she has now changed her practice as a result of this incident. I too
Conclusion
Looking back on this incident, I can see that I should have acted sooner, and that I should have ensured
that the doctor washed her hands before examining patient. I can now see that my in action in this
incident put patient well-being at risk. After discussion with staff Naima I realized that I need to develop
the confidence to challenge the practice of colleagues.
Action Plan
In future, I will aim to develop my assertive skills when working with colleagues, in order to ensure that
the well-being of clients is maintained. In my next placement, I will make this a goal for my learning, and
will discuss this with my mentor to work out strategies for how I can achieve this.
 REFLECTIVE LOG 7
Description
My name is Inamullah I was assigned in hospital for clinical practices in ortho ward with another nurse
who actually work there as a staff told me to do a vital of this room . I followed her command and did the
same as she told me to do . I almost done with all vitals as per patient present there but when I was about
to do the vitals of samia bibi who’s age was 45 years old got a fracture in long bone and was
completely unable to move with the attachment of urine beg on other side. The Diana map was not
working well and showing the sign that battery was getting lower . I told to staff that its best to do
manually but she refused and suggested to write by myself because the time is getting over and its already
too late for the morning vitals to upload on system. In replied I said its not correct to do because morning
vitals are one that’s give the picture of patient ‘s health status if we don’t do it in correct way or put
something by ourself . it definitely will have a bad consequence on patient ‘s health. She ignored me and
did according to her will.
Feeling
I felt very bad and embarrassing by looking her act on this situation and completely unauthorized to took
any action on this unbearable condition . I put a glance on patient with deep emotion with a lot of love
and good feels.
Evatution
The act was absolutely very shameful and unethical for our profession because its our obligation to be
responsible for all we do on clinical side . this experience made me not to use any illegal practices on
patient no matter that what’s the thing, time and work stuff on me . I should always be very possessive
and responsible for my patient ‘s life .
Analysis
the wrong performance by health provider will definitely cause a bad significance on patient health.
Starting duty on time its also our obligation but unfortunately some of our staffs in hospital use to start
their duty after the set time that ultimately will increase their work load and also give initiate to wrong
practices . on the other hand wards are over flowed with patient ‘s that gradually increases work load on
staff. This habitual practices of staff should be improve in order to get a good out put for our patient ‘s
healthier life.
Conculsion
I felt the way I talked to her was not productive and there must be some other approached for this act. I
probably talk to someone else like the head nurse or the in charge of that area not in a way that cause bad
impact on her joy but something which should be lessonable for her not to repeat this thing in future
because not just only being a nurse but being a human its our obligation to act wisely , correctly and must
arise our voice in time of danger sign.
Action plan
If in future I will be on her place I will definitely don’t do such thing especially when it’s all about
saving life. I will start my work on time or if in case I don’t due to abundant of work so I will take
someone’s help or I may contact to head nurse to reduce the work load or assign someone with me for
the help.
 REFLECTIVE LOG 8

DESCRIPTION
On my clinical duty I noticed one major thing of our health care provider that all health care
providers totally ignored and run from changing the pamper of their patients this thing included
in nursing care but staff do not do this .
FEELINGS
As being a professional health care we soul dive comfort to our patient because patient comfort
and care is our first priority.
EVUALTION
This thing teaches me humanity towards the patient.
ANALYSIS
I will take care of my patient in my duty hours and make them mentally relax and happy.
CONCULSION
In the future I will give my patient comfort as being their health care provider.
ACTION PLAN
I will give nursing care with professionally to my patient.
 REFLECTIVE LOG 9

Description
Mehak was 3 years old child admitted with chest congestion in peads ward of NICVD hospital.
The staff was doing her suctioning when I meat with her and I saw then staff doing her
suctioning very badly .he did not lubricate the tube and inserting it the suctioning tube in very
bad way . mehak was caring and shouting but staff did not stop his wrong practice in fact in said
to staff that this is a wrong practice but he ignored me . I saw anxiety in mehak’s parents eyes.
Feelings
I feel pain in mehak’s parents eyes and am very disheart with kind of act of staff.
Evaluation
It was a wrong practice of staff and it was totally non acceptable practice in nursing profession.
But this incidence teaches humanity towards patients and gave me a professional thinking
regarding to my profession.
Analysis
The wrong practice by health care provider is totally shameful because it was very harmful for
our patient.
Conclusion
In the future when I will become a health care provider. I will give comfort to my patient and
give them a professional care in my duty hours.
Action plan
I will do my best whenever this kinda situation will in front of me and gonna handle it in very
professional way.
 REFLECTIVE LOG 10

Description
On my duty a female was come in ER complaining with severe pain in chest as well as she was
in anxiety but when she admitted no doctor and staff taking care of her. They said when the
blood reports of patient will come after seeing the reports will treat the patient I think this is a
very bad thing because the patient was crying with pain.
Feelings
I saw tears in patient’s eyes and I was trying to give her comfort and then she feels better.
Analysis
The patient was very calm when I was taking care of her and she was feeling good.
Conclusion
This incidence teaches me humanity towards the patient.
Action plan
I will always my best for my patient comfort.
 DCM 1

Causes

Aplastic anemia .

Sickle cell anemia

Vitamin deficiency anemia

Sign and symptoms

Treatment
Iron supplements taken by
mouth.
Foods that high in iron and
foods that help your body to
absorb
Anemia
 Fatigue
is a condition in which you lack enough
healthy blood cells to carry adequate oxygen  Weakness
to your body tissues
 Pale and yellowish skin

Prevention

Following owing a healthy diet .

Exercise regularly

Drinking enough water to stay hydrated

 DCM 2

Causes

Allergies.

A cold.

The flu.

The sinus infection.

Infected or enlarged adenoids.

cigarette smoke.

Sign and symptoms unusual

irritability.
Treatment OTITIS MEDIA
Difficulty sleeping or staying
High-dose amoxicillin (80 to 90 Is the inflammation of the middle ear can asleep.
mg per kg per day) is the occur as a result of cold, sour throat or
respiratory infection. Tugging or pulling at one or both
antibiotic of choice for treating
ears.
acute otitis media
Fever.

Prevention

wash hands and toys frequently to reduce

your chances of getting a cold or other
respiratory infection.

avoid cigarette smoke.

get seasonal flu shots and pneumococcal

vaccines.
 DCM 3

Causes

 Decreased blood clotting

ability.

 Diarrhea or vomiting.

Treatment
Blood plasma transfusion .
Platelet transfusion.
Red blood cell transfusion
Hypovolemia
Sign and symptoms
Hypovolemia is a decrease in the volume of  Anxiety and agitation
blood in your body,which can be due to blood
loss or loss of body fluid.  Cool ,clammy skin.
.  Confusion.
 Decrease or not urine output

Prevention

Any underlying causes of hypovolemia,such

as injury,must also be treated to prevent
ongoing fluid losses.In some
circumstances,body fluid loss such as caused
by vomiting and diarrhea
 DCM 4

Causes

TB is caused by a type of
bacterium called Mycobacterium
Tuberculosis

Treatment

The first line anti-TB Sign and symptoms

Tuberculosis (TB) : is a potentially serious
Isoniazid  Coughing that lasts three or
infectious disease that mainly affects your
more weeks.
Rifampin lungs
 Coughing with blood.
Ethambutol

Pyrazinamide

Prevention

Always cover your mouth with tissue when

you cough or sneeze.

Wash your hand after coughing or sneezing.

 DCM 5

Causes

Allergies.

A cold.

The flu.

The sinus infection.

Infected or enlarged adenoids.

cigarette smoke.

Sign and symptoms unusual

irritability.
Treatment OTITIS MEDIA
Difficulty sleeping or staying
High-dose amoxicillin (80 to 90 Is the inflammation of the middle ear can asleep.
mg per kg per day) is the occur as a result of cold, sour throat or
respiratory infection. Tugging or pulling at one or both
antibiotic of choice for treating
ears.
acute otitis media
Fever.

Prevention

wash hands and toys frequently to reduce

your chances of getting a cold or other
respiratory infection.

avoid cigarette smoke.

get seasonal flu shots and pneumococcal

vaccines.
 DCM 6

Causes

An object blocking airway.

Swelling in your throat or upper

airway.

Treatment
Sign and symptoms
Provide oral or injected
Stridor Difficulty breathing
medications to decrease swelling
in the airway. is a high pitched,wheezing sound caused by Wheezing
disrupted airflow.
Refer you to ear ,nose,throat Drooling
specialist

Prevention

Require more monitoring.

Recommend hospitalization in severe cases.

DCM 7
 DCM 8
Causes

 Malaria is caused by plasmodium

parasite.The parasite are spread
through the bite of infected
female mosquitoes .

Sign and symptoms

Treatment  Fever.
Malaria
 Antavaquone-proguaanil.  Chills
Malaria is disease caused by a parasite.The
 Quinine sulfate with parasite is spread to humans through bite of  Headache
doxycycline. infected mosquitoes.
 Muscle aches

 Tiredness

Prevention

Stay somewhere that has effective air

conditioning and screening on doors
windows.If you’re not sleeping in an air
conditioned room ,sleep an intact mosquito
net.
 DCM 9

Causes

 .Is most often caused by common

viruses,but bacterial infection also
can be cause.

Sign and symptoms

Treatment  Fever.
Tonsillitis
 Get plenty of water.  Sore throat .
Is the inflammation of the tonsils,the two oval
 Drink cold drink to soothe the shaped pads of tissues at the back of the  Fever .
throat. throat..
 Bad breath.
 Take paracetamol .
 Red swollen tonsils.

Prevention

Wash your hand often,especially before

touching your nose or mouth.

Avoid sharing food,drink or utensils.

 DCM 10

Causes

Having a respiratory
infection,such as cold ,bronchitis
Causes
or sinusitis
 Abdominal surgery.

 Alcoholism.

 Certain medications.

 Cystic fibrosis

Treatment
Sign and symptoms
Laryngitis
 Breathe moist air.
 Hoarseness.
Is an inflammation of your voice box from
 Rest your voice as much as
Treatment overuse ,irritation or infection.  Signvoice
Weak and symptoms
or voice loss
possible.
Pancreatitis
 A hospital stay to treat  Upper abdominal pain.
Sore throat
 Drink plenty of fluid .
dehydration with intravenous Is inflammation of the pancreas.It happens
 Fever
Dry throat
fluids and,If you can swallow when digestive enzymes start digesting the
them by mouth. pancreas it self.  Rapid pulse

 Nausea

Prevention

Avoid smoking and stay away from

secondhand smoke.

Limit alcohol and caffeine.

Prevention
Drink plenty of water.
Limiting yourself to no more than two
Avoid cleaning
alcoholic drinksyour throat.
per day nay significantly the
chances of developing alcoholic pancreatitis.
 DRUG CARD 1

USES: Rifampicin is also as known as rifampin is an antibiotic used to treat  or prevent

tuberculosis rifampin may also used to reduce certain bacteria in your nose and thorat that can
cause meningitis and other infection .

MoA:Produces the antimicrobial activity by inhibition of DNA dependent RNA polymerase

(RNAP)either by sterically blocking the path of the enlongating RNA at the 5 end by decreasing
the affinity of the RNAP for short  RNA transcripts.

PRECAUTIONS: Do not use this medicine together with praziquantel If you or your child need

to  take praziquantel ,you should stop using rifampin 4 weeks befory  starting praziquantel.You
may restart rifampin one days after last dose of praziquantel.

CONTRAINDICATIONS: It should not be taken in patient witn diabetes, porphyria,decrease

blood -clotting from low vitamin K,alcoholism,liverproblems ,abnormal liver function test.

DOSING:   

Adults:  Capsule 150 mg / 300 mg and injectable 600 mg .

Geriatric:    In geriatric patient  600 mg oral dOse in healthy adults.

CONSIDERATION :Do not interrupt prescribed dosage regimen.

Be ware that drug may impart a harmless red orange colour to urine ,feces suptum sweat tears.

ADVERSE EFFECTS
●Lack of coordination
●Temporary  discolouration of your skin ,teeth,urine,salvia,stool,sweat and tea.
 DRUG CARD 2

USES :Biguanides are the class of medications used to treat type 2 daibetes and other
conditions they work by reducing the production of glucose that occurr during digestion
metformin is the only biguanide currently available for diabetes treatment

MoA:: work by preventing the liver from converting fats and amino- acids into glucose they
also activate enzymes (AMPK) which help cell to respond more effectively to insulin and take
in glucose from the blood

DOSING:

Adults:500mg(twice daily)give with the morning and evening meals or 850 mg once a daily.

Geriatric:Smaller doses may be necessary monitor closely and adjust slowly.

Considerations: History allergy to metaformin diabetes complicated by fever severe in

infection ,severe trauma ,major surgery ,ketosis ,acidosis ,coma type 1 diabetes serious hepatic
or renal impairment , uremia, thyroid and endocrine impairment , gylcosuria ,hyperglycaemia
associated with primary renal disease.

CONTRAINDICATIONS:Acute and chronic acidosis with or withoutcoma(including

ketoacidosis)renal failure severe renal or hepatic acute condition which may effect renal
function dehydration severe infection or shock cardiac failure CHF ,IDDM, severe
impairment of thyroidFunction .

ADVERSE EFFECTS
⚫Anorexia.
⚫Nausea.
⚫Vomiting.
⚫Diarrhoea.
⚫Wt loss.
⚫Flatulences.
⚫Chills.
⚫Headache.
 DRUG CARD 3

 
USES:Meglitinides make up a class of drug used to treat diabetes type 2 . They bind to an
ATP- dependent K+ channel on the cell membrane of pancreatic beta cells in a similar manner
to
sulfonylureas but have a weeker binding affinity and faster dissociation from the SUR1
MoA: The mechanisms of both sulfonylureas and meglitinides to inhibit adenosine
tri phosphate dependant K + channels in pancreatic beta cells which result in
insulin from pancreas .This action is dependent upon functioning beta cells
in the pancreatic islets. Insulin release is glucose dependent and diminishes
at low glucose considerations.

CONTRAINDICATIONS: Diabetic ketoacidosis with or without coma.This condition should

be with
insulin .Type 1 diabetes .Co- administration of gemfinrozil. Known hypertensitivity to the drug
or its
inactive ingredients .
PRECAUTIONS: Meglitinides do not directly redu blood sugar levels and therefore are not a
substitute fo insulin’s they should be taken in conjunction with making lifestyles changes such
as follows a low crab diet and increasing physical activity .

 
 DRUG CARD 4

USES: Digoxin is a type of medicine called a cardiac glycoside. It's used to control some heart
problems, such as irregular heartbeats (arrhythmias) including atrial fibrillation. It can also help
to manage the symptoms of heart failure, usually with other medicines. Digoxin is only available
on prescription.

MoA Digoxin: two principle mechanisms of action which are selectively employed depending
on the indications positive ionotropic .It increases the force of heart contraction by reversiby
inhibiting the activity of myocardial Na - K pass pump an enzyme that control tha movement
of heart.

DOSING: 

Adults: Loading dose of digoxin range from 0.1 to 0.15ug/kg

Geriatric: In geriatric patient use lean body weight to calculate the dose

CONSIDERATION: Monitor Apical pulse for one full min before aadministrating .With
dose and notify health care professional if pulse rate is < 60bpm in and adult, <70 in an Child
and <90 in infants.Notify the changes in rate, notify the pulse.
 CONTRAINDICATIONS: Are contraindicated in patient with Ventricullar filtration or in
patient with hypertensitivity to digoxin. A hypertensitivity reaction to other digitalis
preparationusually constitutes a contraindications todigoxin.

ADVERSE EFFECTS
⚫Irregular pulse

 
⚫Confusion

 
⚫Fast heart beat

 
⚫Nausea

 
⚫Vomiting

PRECAUTIONS: Monitor BP periodically in patient reciving IV digoxin.Monitor ECG during

IV administration and 6 hours after each dose Notify health care professionals .

DRUG CARD 5

USES: Sulphonylureas are a class of oral (tablet) medications that control blood sugar levels in

patients with type 2 diabetes by stimulating the production of insulin in the pancreas and
increasing the effectiveness of insulin in the body.
 sulphonylurea act mainly by increasing the release of insulin from the pancreatic β-cells in
response to stimulation by glucose. They bind to the sulfonylurea receptors SUR1, which closes
the K ATP channel in the β-cell membrane.

 DOSING:   

Adults: 20 mg/day PO for conventional glyburide (e.g., Diabetes); 12 mg/day PO for

micronized glyburide (e.g., Glynase).
Geriatric: 20 mg/day PO for conventional glyburide (e.g., Diabetes); 12 mg/day PO for
micronized glyburide (e.g., Glynase)

Considerations:  Hepatic Impairment: Use conservative initial and maintenance doses of

glyburide to avoid hypoglycemic reactions. Consider an initial adult dosage of 1.25 mg/day PO
for conventional glyburide

products (e.g., Diabetes) or 0.75 mg/day PO for micronized glyburide (e.g., Glynase), then titrate
carefully to attain clinical goals.

CONTRAINDICATIONS: It is contraindicated in the patients with kidney dysfunction,

accumulation of the parent drug and of metabolites of some sulphonylurea compounds can lead
to hypoglycemia. Consequently, these first-generation sulphonylureas.

 ADVERSE EFFECTS

 Signs of low blood sugar

 Sweating , dizziness
 Hunger 
 Weight gain
 Skin reactions