A. Clinical Strengths & Needs:
• Strengths: Today, was an extremely busy day caring for 3 residents; but I learned a great amount of information. Even though, I was busy, I feel fortunate I got this opportunity to work with three different residents. I learned who needs more assistance than others, which resident want to visit with me, and/or which resident wants their space. I have to respect those wishes of each resident while still completing the necessary task I need to get done. I am pleased to say I was able to do so but it did take me longer; which is all part of the learning curve. Objectives I met today were demonstrating professional values of caring and holism in nursing practice, communicating effectively with clients, and demonstrating …show more content…
Well dressed and groomed, no odor; Alert * Orient to name, time, and circumstance; Affect: appropriate for the situation, pleasant; no signs of distress; no involuntary movement. Overall body structure: lean, symmetrical and proportional; sitting hunched over leaning to the left. Focused assessment: resident unable to ambulate independently; wheelchair bound; unable to test gait, Romberg, and LE; Hand grips 5+ and = Bil; UE gross and fine motor coordination intact = Bil. All DTR’s intact 2+, = Bil; Babinski Negative. UE & LE sharp/dull discrimination Intact = Bil; UE & LE Light touch intact = Bil; Vibratory Sense intact on right; able to identify vibrations on left foot, difficulty identifying when vibrations stopped; Monofilament sensation intact = Bil. CN’s I-VII and IX-XII intact, PERRLA Pupils 3mm, EOM’s intact, no nystagmus. CN II: Visual acuity; Rosenbaum- R. eye- 20/50; L. eye- 20/50; both eyes- 20/40. CN VIII: Not intact. T. Zakrajsek, SN, …show more content…
I have completed 5 hours of clinical make up time in the skills lab. During this time, I practiced skills that I felt I needed more experience/haven’t had any opportunities to complete in the clinical setting. These skills include medication administration- oral, IM, SQ, ID, Insulin, NG medication, cath. care, wound care, transferred patient from wheelchair to bed, bed pan, PPE, replaced old O2 tank, made an occupied bed, and bed bath. I was also able to practice immunizations during skills lab and during clinical. I am feeling more confident but still would like to gain more which I will achieve by continuing to practice my technique. I met my third goal by meeting with you last Tuesday and started skills last Wednesday; I am scheduled to complete two hours tomorrow 11/10 and two hours Friday the 13th. I will complete my make-up house on Friday the 13th. Like I mentioned before being successful in this course is extremely important to
• Strengths: Today, was an extremely busy day caring for 3 residents; but I learned a great amount of information. Even though, I was busy, I feel fortunate I got this opportunity to work with three different residents. I learned who needs more assistance than others, which resident want to visit with me, and/or which resident wants their space. I have to respect those wishes of each resident while still completing the necessary task I need to get done. I am pleased to say I was able to do so but it did take me longer; which is all part of the learning curve. Objectives I met today were demonstrating professional values of caring and holism in nursing practice, communicating effectively with clients, and demonstrating …show more content…
Well dressed and groomed, no odor; Alert * Orient to name, time, and circumstance; Affect: appropriate for the situation, pleasant; no signs of distress; no involuntary movement. Overall body structure: lean, symmetrical and proportional; sitting hunched over leaning to the left. Focused assessment: resident unable to ambulate independently; wheelchair bound; unable to test gait, Romberg, and LE; Hand grips 5+ and = Bil; UE gross and fine motor coordination intact = Bil. All DTR’s intact 2+, = Bil; Babinski Negative. UE & LE sharp/dull discrimination Intact = Bil; UE & LE Light touch intact = Bil; Vibratory Sense intact on right; able to identify vibrations on left foot, difficulty identifying when vibrations stopped; Monofilament sensation intact = Bil. CN’s I-VII and IX-XII intact, PERRLA Pupils 3mm, EOM’s intact, no nystagmus. CN II: Visual acuity; Rosenbaum- R. eye- 20/50; L. eye- 20/50; both eyes- 20/40. CN VIII: Not intact. T. Zakrajsek, SN, …show more content…
I have completed 5 hours of clinical make up time in the skills lab. During this time, I practiced skills that I felt I needed more experience/haven’t had any opportunities to complete in the clinical setting. These skills include medication administration- oral, IM, SQ, ID, Insulin, NG medication, cath. care, wound care, transferred patient from wheelchair to bed, bed pan, PPE, replaced old O2 tank, made an occupied bed, and bed bath. I was also able to practice immunizations during skills lab and during clinical. I am feeling more confident but still would like to gain more which I will achieve by continuing to practice my technique. I met my third goal by meeting with you last Tuesday and started skills last Wednesday; I am scheduled to complete two hours tomorrow 11/10 and two hours Friday the 13th. I will complete my make-up house on Friday the 13th. Like I mentioned before being successful in this course is extremely important to