Professional Documents
Culture Documents
Reflective Journaling
Noticing
Subjective and objective data:
This patient was day +2 post-bone marrow transplant and upon initial morning
assessment the patient complained of chest pain that radiated to her shoulders. The
patient also reported pain in her esophagus, but had no difficulty swallowing. These
symptoms were news to the night nurse who was with us for report. The patient reported
the pain to be pressure-like, and with an intensity of about a 4 out of 10. The pain was
present throughout the night.
How did you know there was a problem? Abnormal patient presentation or your
“gut feeling”?
I was with my nurse during this initial morning assessment, and given the patient’s
symptoms my nurse quickly took the lead. Although I was not the one asking the
questions, I personally found the patient to appear particularly fatigued and pale. I took
orthostatic vitals for the patient and within the three-minute wait between taking her
blood pressure sitting and standing, the patient felt so weak and dizzy that she had to sit
back down. I knew then that the patient was not in good conditions. I did have this patient
once previously on the unit before she received her transplant. The patient’s blood
pressure readings met the criteria for positive orthostatic vitals.
Interpreting
What other information do I need to make a decision?
I would have liked to verify if she was feeling any unusual heart palpitations, but I did
not get to. I wish I had been more familiar with her cardiac history, but I do not think this
patient had any significant cardiac issues. The patient had a history of GERD, so I asked
the patient if she was experiencing any heartburn because of the pressure-like chest pain
she was experiencing, but the patient reported that what she was currently experiencing
was different than GERD. When I reflect back, GERD was unlikely to be the causative
factor here. I think my nurse and I had all of the proper information to know that the
provider must be contacted immediately.
2
The desired outcome was achieved. We closely monitored the patient throughout the day,
and all cardiac labs were within normal limits. EKG was normal. The physician wanted
the patient to rest in bed and avoid ambulation. Throughout the day, I saw an
improvement in the patient’s pain and fatigue. The patient was too fatigued to shower, so
my nurse and I wiped her down with CHG wipes. We did assess the patient’s mouth and
gave the patient Magic Mouthwash. The patient reported an alleviation of her discomfort
with this intervention.
What did I do really well? What could I have done better?
Personally, I did doubt whether the patient could be truly having some sort of cardiac
event, but I am glad I was able to witness all that I did for it was a true learning
experience for me. My nurse was a great example and she sought out her patient’s safety
first and foremost. I followed my nurse and helped her execute the orders well. Although
I had my doubts at first, soon after I appreciated my nurse’s attention to detail and the
decision she made. I was fully on board with what she did. I could have paid more
attention to the lab values that came back from the blood work we drew. Next time, I will
look out for those values and follow-up more closely.
References
accurately?