LEARNING FEEDBACK DIARY
Submitted by: Cathleen Joy V. Angeles Submitted to: Sir Roy Quito
BSN 3A
DATE: Feb. 18, 2013
My objectives for today is to become familiar in the different facilities in Philippine Orthopedic Center and services that are being held in this hospital and also to be able to learn and follow the rules/regulations and policies that is being implemented in the Philippine Orthopedic Center. Today, we were only having our orientation in Philippine Orthopedic Center. I have learned more about the POC. Their history, total bed capacity, different services, the administrators and the rules and regulations. My exposure in POC will help me to improve my skills in caring for a patient. This exposure will also give us great experiences that I am sure we will cherish and keep in our minds. Actually, I have no specific problem in the first day of duty (orientation). It was just the start of the clinical exposure so I think, in this day we will just be freshening up about the POC. But maybe the large number of different colleges makes it difficult for me to listen to the orientation, included also that the orientation had started late. We waited for about 2 ½ hours for the orientation In order for me to catch up in the orientation, I see to it that I was focusing only to the speaker. No interruptions are being entertained while listening and my eyes are kept open to prevent sleeping, especially when it was the time to demonstrate to all of us the application and removal of balance skeletal traction. At the last day of our duty in POC, we are going to perform BST so I intently observe the two speakers while they teach us the application and removal of BST to be able to understand the whole procedure. It really makes it easy for me to understand BST while I was listening attentively.
DATE: Feb. 19, 2013
OBJECTIVES:
To enhance my interpersonal skills
To be able to identify different types of braces, tractions and casts.
To provide proper nursing care of patient with brace, cast and traction
We have discussed about fractures and the different types of braces, tractions and casts. So today, I have learned the different classification of fractures and what are the nursing responsibilities in a patient with fracture. Nowadays, more people are becoming prone to accidents. Different nursing care of a patient with fracture is being introduced, like the application of traction, brace or a cast. Tractions are used to correct deformities; braces are used as a mechanical support for weakened muscles while casts are used for immobilization. Some types of the brace, cast and traction were not available in POC. So we didn’t see those who were not available. Another problem encountered is that some of the gadgets are not sufficient, because while we were discussing, another clinical instructor enters in our room to get some gadgets that were not available in their room. But this kind of problem is lesser only because almost all gadgets are present in the rooms; just some of the few gadgets were not. But because of our requirements in POC (pictures of different casts, braces and tractions), we were able to identify those gadgets that were not available. These pictures really help us to become more familiarize with the different gadgets. It helps us to be able to memorize quickly the different types of casts, tractions and braces.
DATE: Feb. 20, 2013
My objectives for this day are to identify different types of hardware; to be able to learn how to prioritize my nursing care to my patient and to be able to properly report HNP to my fellow classmates.
So today, I reported HNP which is also known as “slipped disk”. Our clinical instructor also discussed to us different hardwares, so, I learned for today, to identify different types of hardware including their indications. Hardware is either external or internal. Internal includes pin, wires, plates and nails etc. while external includes the RAEF, delta frame, ilizarov etc.
Problems encountered were limited time in discussing the hardwares, which is only for 30 minutes and also the unavailability of the other hardware instrument.
The pictures that we have are really helpful for us in studying different gadgets and hardwares. In case of the unavailable instrument, we can just look in the pictures that we have research and then we can now identify what is the image of that hardware.
DATE: Feb. 26, 2013
After this duty I hope I was able:
To master memorizing and familiarizing all the gadgets and hardwares
To improve my interpersonal relationship with my patient
To provide proper nursing care to all of my patient and also to attend all of their needs
To become more responsible as a student nurse
Today, we are assigned in the children’s ward. This was the area that I like the most because children are fun to take care of. Before we went to the children’s ward, we’ve also discussed “Pott’s Disease,” which is also known as tuberculosis in the spine. In the children’s ward, we have two patients with this kind of disease. I have seen that this disease really shows signs of weight loss because one of our patients is very thin. And patient with this kind of disease also experiences some signs and symptoms of PTB. We have also observed application and removal of cast in the OPD section. Problems, maybe like limited time in providing nursing care to our patient. Sometimes we were just rendering morning care to our patient. Some of our patient, we were just interviewing them about the history of their illness and we provide them health teachings and other nursing responsibilities. We provide important health teachings to our patients. Sometimes we assist them in whatever they were doing like maybe in ADLs, to prevent possible injury. Of course, developing the trust of your patient or rapport is also important so that the patient will be able to tell you all his/her concerns regarding his/her health.
CLINICAL CASE ANALYSIS
NAME: Dominador Aquileña AGE: 46 y/o SEX: Male STATUS: Married DATE ADMITTED: Feb. 8, 2013 DIAGNOSIS: Avulsed of biceps and forearm flexion with ulnar radial artery transection S/P AS Repair
Nursing History:
2 days prior to admission Patient had an accident. While cleaning a mixer truck, the left sleeve of his shirt was caught by the mixer, including also his left arm. Immediately brought to Makati Medical Center.
Feb. 8, 2013 Patient was transferred here in POC.
Surgical Procedures:
Ulnar radial artery transection
Nursing Responsibilities:
Assess the level of pain associated with musculoskeletal problems.
Encourage the patient to elevate the affected part to help relieve the pain.
Instruct the patient to do finger exercises and moved the affected part through its range of motion to maintain function or to improve mobility.
Observe the patient for systemic infection, odors from the cast and purulent drainage staining the cast.
Perform regular assessment of neurovascular status.
Monitor the circulation, motion and sensation of the affected extremity and compare them with the opposite extremity.
Keep the cast dry but do not cover with plastic or rubber which may cause condensation that will dampen the skin and cast.
CLINICAL CASE ANALYSIS
NAME: Elena Abella AGE: 68 y/o SEX: Female STATUS: Married DATE ADMITTED: Feb. 16, 2013 DIAGNOSIS: Fracture Cl. Comp. displaced intertrochanteric femur right
Nursing History:
1 day prior to admission Patient falls from standing in a chair. Patient experienced severe pain that leads to consult in POC.
Surgical Procedures:
With balance skeletal traction
Nursing Responsibilities:
Emphasize on the importance of good hygiene. o
Skin care
o
Changing of linens or slings
o
Provide bedpan/urinal as needed
o
Perineal care
Provision of exercises o
ROM exercises with the use of trapeze
o
Deep breathing exercise
o
Toes pedal exercises.
Encourage the patient to increase intake of foods rich in fiber, protein, vitamin C and calcium and to also increase fluid intake.
CLINICAL CASE ANALYSIS
NAME: Sinegunda Subong AGE: 90 y/o SEX: Female STATUS: Married DATE ADMITTED: Jan. 9, 2013 DIAGNOSIS: Fx. Cl. Comp. displaced intertrochanteric femur right
Nursing History:
3 days prior to admission Patient falls while standing on a chair. Consulted to other clinics. Then transferred here in POC.
Surgical Procedures:
Partial Hip replacement arthroplasty right
Nursing Responsibilities:
Encourage to elevate the affected extremity to immobilize.
Note odors around the cast, stained areas, warm spots and pressure areas. Report them to the physician.
Report broken cast to the physician; do not attempt to fix it yourself.
Encourage the patient to move toes hourly when awake to stimulate circulation.
Thoroughly clean the skin and treat it as prescribed.
Teach the patient with leg cast to “push down” the knee.
CLINICAL CASE ANALYSIS
NAME: Dionisio Recafor AGE: 45 y/o SEX: Male STATUS: Married DATE ADMITTED: Jan. 8, 2013 DIAGNOSIS: Lumbar spinal stenosis
Nursing History:
5 years prior to admission: Patient strained his back carrying a pump boat. No consult initially.
2 years prior to admission: Patient started limping due to his low back pain. Progressive of low back pain lead patient to seek consult at POC and admitted surgical intervention.
Surgical Procedures:
Posterior Decompression; Posterior Lumbar Interbody Fusion L4-L5, L5-S1
Nursing Responsibilities:
Assess neurovascular status.
Maintain body alignment.
Encourage for early ambulation.
Encourage to wear brace as prescribed.
Assist patient in applying the brace and to protect the skin from irritation and breakdown.
Reassure the patient that minor adjustments of the brace by the orthotist will increase comfort and minimize problems associated with its long term used.
Gradual increase of daily activities as tolerated.
CLINICAL CASE ANALYSIS
NAME: Juary Ray Gayos AGE: 9 y/o SEX: Male STATUS: Single DATE ADMITTED: Jan. 10, 2013 DIAGNOSIS: T/C Acute spinal injury inc. spinal level C6 etiology to be determined
Nursing History:
4 months prior to admission Patient strained his cervical and lumbar area due to fall in the clothes line. No consult initially.
3 months prior to admission Patient experienced numbness of the lower extremities
2 months prior to admission Patient was unable to walk lead to seek consult at PGH. Transferred to National Children’s… then to POC.
Surgical Procedures:
No surgical procedure done.
Nursing Responsibilities:
Encourage patient to ambulate with assistance. Can move as normally as possible, but avoid walking on wet, or slippery floors.
Assess neurovascular function.
Emphasize importance of proper hygiene.
Instructed to continue taking medications as ordered.
Gradual increase of daily activities as tolerated.
Encourage toe and finger exercises.
Assist patient o identify areas of self-care deficit and in developing strategies to achieve independence in ADL’s
