Student Name _Kristen Nii-Jensen_

Date ___11/3/14____

N360 Weekly Self Evaluation

1. Considering your patients current status, list potential complications and strategies for
prevention and early recognition.

Pt A: Possible complications include insufficient gas exchange, I would assess for CMS, LOC, change in
mentation, anxiety, pallor, dyspnea, tachypnea. I would prevent by encouraging deep breathing and
cough every hour, maintaining HOB greater than 30 degrees, and titrate oxygen as needed to keep
oxygen saturation elevated.

This patient is also at risk for infection. I should assess for change in temperature, report of malaise,
change in mentation, chills, lethargy, etc. It can be prevented by administering antibiotics on schedule,
maintain aseptic technique when administering IV medication, keeping HOB elevated 90 degrees with
meals and other aspiration precautions.

Pt B: This patient was at risk for infection s/p hip surgery. I should asses for chills, fever, malaise,
lethargy, and changes in mentation as a first intervention. She should also be turned frequently, do deep
breathing and IS every hour, maintain proper fluid balance, aseptic technique when performing wound
care and access of her PIV, and maintain proper nutrition.

2. Am I getting more comfortable with the use of the nursing process to plan and evaluate
nursing care? (Give examples of how it is better now or problems that still bother you).

I do feel I am getting better at using the nursing process. The key is to be aware of the interventions that
you have in your arsenal and then to assess what is the best intervention for the given situation. While we
are student nurses and do not have the experience to always make the best choices, assessing the
options that cause the least harm while having the appropriate therapeutic effect is something I try to
remember. Though these interventions are not always the most effective, and depending on the severity
of the problem ordered interventions may be needed, the least invasive should at least be tried. For
example, one of my patients had nausea. As her ordered antiemetic was a drug that is a vesicant and she
had a PIV in her hand, I attempted non-pharmacologic relaxing interventions, such as lights off, cool towel
on her head, and deep breathing exercises. It was effective enough such that we did not have to attempt
pharmacologic interventions.

3. Were my nursing diagnosis and plan of care individualized for my patients? (Give examples of
how you did this.) Do I have difficulty in this area? (Explain).

My nursing diagnosis focused on the age, and current status of the patient. For example, one patient
was severely underweight, due to this her focus pushed skin integrity to the top, as she was very
bony, malnourished, and with thin skin. This was in addition to her surgical wound site. As such, her
nutrition was also a very big component of my nursing diagnosis and plan. Unfortunately, she had
nausea during my shift, but once this was resolved, assisted feeding was provided several times, and
offering of a supplement drink was provided (that was dietary ordered) when she stated she was not
hungry. This was not a difficult decision considering the patients status.

4. How are my assessment skills developing? Am I being as thorough as I need to be? What
areas are still difficult for me and what am I doing to improve? (Be specific).

I feel my assessments can still be strengthened. I sometimes wonder if I am hearing things correctly,
particularly diminished lung sounds in the elderly. Though I am aware of how aeration typically is on
someone in their youth and middle age, I sometimes wonder if a patient is really diminished to bases
or if what I am hearing is the baseline for a 90 year old man. To improve I ask my nurse for
assistance, and use their experienced ear as a baseline as to what to listen for. I would attempt to
improve outside of school, but do not have a wealth of elderly people on which to listen to their lung
sounds, and realize this is something I will have to hone over time.

5. What new skills did I implement this week? How did I do? What could have helped me to
improve? Did I ask for help when I needed it?

Surprisingly for the first time this rotation, I hung an IV piggy back. It was the first time I was using the
Queens IV pumps, but I was pleased that everything was preset for me. Also, my assigned RN was
at the door informing me as to what the PIV setting should be set at. As I saw him run an IV on
another patient, I was able to correct simple problems such as air in the line, which was to remove the
cassette attempt to break up the bubble and return it into the machine. The next day I was able to set
everything with my instructor and felt it went smoothly.

Though I feel I am unable to fix many

problems with their IV pumps, and I am still unsure on all of the documentation needed when setting
various IVs, I am comfortable asking the nurses when I am unsure.

6. How is my time management progressing? What areas of difficulty have I found and what can
I do to improve? How do I monitor my time management while in the clinical area?

I felt my time management was good for the majority of both clinical days. However, a small problem
is that things do have a tendency to back up at the very end of the day. For example both my patient
had medications due at 2100. As one was a PO, I felt confident that it would not take long, and went
to this patient first. What I did not expect was it to take the patient 10 minutes to swallow two pills. It
required lots of time, lots of water, and encouragement for the patient to swallow. I suspect she
actually held the medication in the water till it disintegrated slightly before swallowing. Though no
medication was extended release, I informed that patient chewing or allowing medications to
disintegrate in her mouth may cause problems. She acknowledged this, and as I witnessed her
swallow a medication with the RN smoothly earlier in the day, I was not expecting this delay.
Thankfully, I did start administration early enough where I could expect some time delay cushioning.

Though I was able to give my other patients medication on time, I felt this causes me to feel rushed
when finishing my DAR and documentation at the end of the day.

The reality is sometimes

unexpected things happen, if I was really delayed I would have asked the RN assigned to give the
other medication or our team leader.

7. Was I involved in making referrals for my client in any way? How could the nursing role in
this process have been strengthened?

I was unable to make any referrals for my client this clinical week. I am still looking for opportunities to
make a referral.

8. List the specific interventions, in order of priority, for two of your clients and explain how you
determined which interventions took precedent.

The number one intervention for my first pt (A) was to improve aeration. On her second vitals check,
her O2 saturation was in the low 80s, after increasing her HOB to 90 degrees, asking her to deep
breath and cough she would not rise above 88%. After consulting with her assigned RN, we placed her
on 2L of O2 via NC and her saturations increased to 99%.

The interventions I took went from least invasive and not needing any standing order or additional
supplies to more invasive treatments which required a standing order and supplies. As raising her

HOB would allow increased drainage of possible secretions, increase aeration, and reduce effort of
breathing this was the first intervention. Deep breathing and cough may have broken through any
possible secretions settled in her upper airway, after these were not effective O2 then became the
necessary step.

For my second patient (B) his priority surrounded his infection. His priority intervention was to
administer his antibiotics. This is the priority in addressing his current on-going infection. The second
intervention was preventative in nature, such as deep breathing, turns, IS use, aseptic technique when
administering medications etc. These interventions prevent future or worsening infection, but the
antibiotic is the thing that will treat his current infection.