Btc-Nurs435-Weekly Reflective Log I

NURS 435: Senior Capstone Reflective Log
Completed Weekly
Student Name:___Jacob Hubert_______ Clinical Area___PACU________________

Clinical Week: ____Week 1 (Sep 3-9)___________________
Clinical Hours for Week _____19______ Leadership Hours for Week____13____
Total Clinical Hours to Date_____19_____ Total Leadership Hours _____13______
Average Number of Patients Under Your Care/Shift: _____6_______
What types of patient care issue or concerns did you encounter this week?
Was able to see a unique situation in which a case was cancelled due to excessive
amount of emesis despite the patient being NPO since 1300 the previous day. CRNA
from the case said it was the first time she had seen that much emesis when trying to
intubate the patient, expressed concern for patient going home and having
complications when trying to lie down after a big meal.
Poor communication between MUSC locations led staff legally unable to provide care
for patient for over an hour while they moaned due to pain. Patient was transferred from
MUSC Kershaw for case, not registered at MUSC DT, wasn’t taken to be registered in
the ER which PACU nurses said would have significantly reduced waiting time. After
patient finally was registered and taken to OR, no X-Ray tech to operate machinery led
to more waiting time.
Patient came back with COPD and OSA, O2 sat in the 70s, OR team reported patient
was stable at end of case. After airways were reestablished, client too drowsy to
remove airway but awake enough to try. Had to be given Narcan to help remove some
effects of narcotics.
Post-op WATCHMAN patient had groin bandage that became increasingly more
saturated with blood.
Give an example of how you handled one of these issues.
Not much could be done for patient, therapeutic communication and guided imagery to
ease patient who felt bad for canceling case.
According to PACU staff, nothing legally could be done for Kershaw patient until they
were in the system, no pain meds could be given. While the patient was stuck in the
holding bay, used therapeutic communication and guided imagery to try and distract the
patient from the pain they were feeling.
Aided receiving nurses gather materials for nasal and oral airways which were
performed by CRNA. Stood by client’s bedside to ensure airways were not removed.
Helped check math of nurse who had to dilute 0.4mg/mL Narcan into 10mL NS. Treated
patient’s symptoms of Narcan, sweating, heat intolerance, itching.
Held pressure on site for 10 mins. Held patient’s blood thinner meds. Contacted
provider.
What new skills or experiences did you gain this week?
Lots of experience with basic physical assessments specific to patient case. Cared for
patient post-op WATCHMAN procedure with complicated bleed. Applied pressure to
site. Check patient’s pedal and post tib pulses q 15min. Patient lower pulses were very
faint +1, leading to experience using doppler to find pulses. Got lots of experience telling
patients to wake up, orienting patient to situation, asking patient if they had any pain or
nausea.
What did you learn this week, either specifically related to your patients or
relevant to the overall unit that will impact your future nursing practice?
I am very interested in the anesthesia side of the OR. In my previous PACU experience
I have seen very stable patients post-op who have already been aroused in the OR. In
this facility, different policies are in place that led to patients needing a more watchful
eye. At my previous facility, the patient needed to be stable enough for their airway to
be removed before coming to the recovery area. This week I learned this was not the
policy at my capstone placement and this could have indirectly led to the OR team
rushing a patient to the recovery area before they were stable enough. Due to this,
action was required from all of the PACU nurses (there were no other patients in the
room at the time) in order to stabilize the patient and improve his oxygenation status. To
summarize, I learned that policies are different everywhere and this leads to different
scenarios taking place with certain skills being required. It is important to always be
prepared and stay alert. When the patient was being brought out the PACU nurses went
over the bay to start the usual routine of hooking the patient up to the monitors and
getting report, but it quickly developed into a deviant from normal.
What are your goals for next week (at least two goals discussed)?
I want to take a more active role in patient care now that I know more about the unit
specific policies and where equipment is kept. There were multiple examples of when I
knew what to do but didn’t know where to get what I needed.
I want to continue to identify patient complications during recovery and to take the
appropriate action of reporting to the nurse and treating the client.

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NURS 435: Senior Capstone Reflective Log

Student Name:_Jacob Hubert___ Clinical Area_PACU________________

Average Number of Patients Under Your Care/Shift: _6___

Give an example of how you handled one of these issues.

What new skills or experiences did you gain this week?

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