Week 3 and 4 Clinical Log

Integrations (West Coast University)

Week 3

Date: April 24, 2022 Hours: 12 (Clinical), 3 (Clinical Application Activity) Total Hours to Date: 41

Objectives:

1. Review UCI’s infection prevention policy and implement its guidelines during patient care.
2. Identify risk factors and interventions to prevent central-line associated infections and catheter-associated urinary tract infections.
3. Evaluate the effectiveness of infection control practices for patient care outcomes.
4. Develop assertiveness in participating in new skills or gaining more practice with existing skills.
5. Provide specific care for patients on mechanical ventilators or with tracheostomies in the Cardiovascular ICU.
6. Enhance knowledge in interpreting ECG/telemetry strips and identify necessary nursing interventions related to findings.

Outcomes:

Before starting my shift, I attempted to access UCI’s infection prevention program/policy. Unfortunately, I couldn’t gain access, even using my UCI account. I reviewed evidence-based practices regarding proper hand hygiene, isolation precautions, and prevention of HAIs, which I implemented while caring for my patient. My patient had a central line with port access, and my nurse and I followed infection prevention practices, such as cleaning the port with an alcohol swab for 10 seconds before flushing or administering medication, and flushing the line with 10mL normal saline to check its patency and ensure no obstruction. We also changed the tubing of her lines, as it was due for replacement according to the sticker label. Throughout the shift, proper hand hygiene and infection control measures were strictly followed. By the end of the shift, there were no signs of infection in the central line or to the patient overall—no redness, swelling, or warmth at the central line site, and the patient’s temperature and heart rate were baseline.

This shift challenged me to step out of my comfort zone and be more assertive with my nurse. I had to actively communicate and initiate interactions to learn and gain experience. Despite the challenges, I successfully performed patient care, administered medications through the central line and PEG tube, and conducted my physical assessment. My patient, diagnosed with colon cancer that metastasized to her kidneys and lungs, was intubated but able to respond to verbal and tactile stimuli, following commands and moving fingers, hands, and toes, although unable to move arms and legs. She was edematous in both upper and lower extremities. We changed her linens and repositioned her every two hours. I exercised autonomy by conducting hourly assessments of the patient.

Although I wasn’t assigned to the Cardiovascular ICU today, I had the opportunity to review ECG strips with the professor as a refresher. We discussed the components of an ECG strip and how to read it correctly to identify the rhythm, which I then applied to my patient’s rhythm and confirmed with my nurse.

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Week 4

Date: May 1, 2022 Hours: 12 (Clinical), 3 (Clinical Application Activity) Total Hours to Date: 56

Objectives:

1. Provide evidence-based skin care to prevent and treat skin breakdown using Agency for Healthcare Research and Quality standards.
2. Identify different stages of pressure ulcers and interventions/treatments for each stage.
3. Pay extra attention to high-risk areas such as bony prominences, skin folds, sacrum, and heels during assessments.
4. Learn how to navigate EPIC for charting assessments, medication administration, and other patient care documentation.
5. Review guidelines regarding pre-operative and post-operative nursing care in the Surgical ICU.
6. Perform necessary nursing interventions for scheduled tests, including pre and posttest interventions.

Outcomes:

This week’s clinical application activity focused on skin care and prevention of pressure injuries. My patient was paralyzed due to medication (NImbex) to reduce metabolic demand, oxygen demand, and desynchronization with the ventilator. As a result, he was on bedrest, putting him at high risk for pressure injuries. The initial assessment revealed significant edema in bilateral upper and lower extremities, scrotum, neck, and shoulders, but no existing pressure injuries or wounds. His capillary refill was over 4 seconds, indicating a risk to skin integrity. Using the Braden Scale, my patient scored a 9, signifying high risk for pressure injury. Preventative measures included applying sacral dressing, foam dressing on the forehead (due to prone positioning), and pillows under the lower and upper extremities. We also assessed his IV sites, tracheostomy, and urinary catheter for signs of infection such as redness, swelling, and warmth. Due to his paralysis, regular repositioning and skin assessments every two hours were imperative, as he was unable to sense pain or communicate discomfort.

While providing patient care and administering medication, my nurse allowed me to chart my hourly assessments, including vital signs, train of 4, BIS number, and medications administered. She demonstrated how to correct documentation when necessary and efficiently document repeated values. I gained valuable knowledge on navigating EPIC and learned how to document patient findings.

Although my patient did not undergo surgery, I witnessed and assisted during the patient’s tracheostomy change, performed twice due to an air leak. My nurse and I prepared the room for the ENT and respiratory therapist to set up the necessary materials for the procedure. I learned about the importance of the obturator, which should be kept accessible in case the patient’s tracheostomy becomes dislodged. Post-procedure, we monitored the integrity of the trach for air leaks and the patient’s respiration and oxygenation. I also learned about the purpose of proning a patient and the challenges involved in repositioning. Proning helps redistribute blood and airflow more evenly in the lungs, improving gas exchange. Initially, six people were required to perform this task, with three needed to reposition the patient every two hours.

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Online Learning Activities Completion Checklist

Learning Activity Assigned | Date of Completion/Initial

• Getting Started: 4/6/22 - 4/8/22 (Quiz Score: 0.5/1)
• Communication and Conflict Management: 4/14/22 - 4/17/22 (Quiz Score: 1/1)
• Infection Prevention: 4/22/22 - 4/24/22 (Quiz Score: 0.95/1)
• Evidence-Based Skin Care: 4/28/22 - 5/1/22 (Quiz Score: 1/1)
• Alarm Fatigue: [Pending]
• Transcultural Health Care: [Pending]
• Pain Management: [Pending]
• Fall Prevention: [Pending]
• End-of-Life Care: [Pending]