Running Head: CLINICAL REFLECTION Patti Pittman 4/11/2012- Clinical Week 4 Clinical Reflection Week Four This week

in my clinical experience on the Medicine 1 unit I cared for a fifty year old male diagnosed with asthma, suspected pneumonia and left lower lobe atelectasis. The patient had been feeling ill for a few weeks but kept putting off going to the doctor until he had an asthma attack and was unable to breathe. He claimed that being part of a work crew from out-ofstate was a factor in his decision to put off medical care. He did not have a doctor here and his family wasnt there to see how bad his condition was getting. He said if his wife would have been with him, she would have made him go to a doctor. I was involved in the care of this patient as his nurse. My preceptor, a hospital medicine doctor and respiratory therapy were also involved in his care. This patient had a high white blood cell count, low red blood cell count and low hemoglobin and hematocrit levels. He was receiving intravenous antibiotics, intravenous steroids, bronchodilators and nebulizer treatments. His breath sounds were coarse on inspiration and expiration in all of his anterior lobes. In all of his posterior lobes there was inspiratory and expiratory wheezing which was more pronounced on the right side. Prior respiratory theory helped in this situation because I was able to teach the patient ways to facilitate breathing and correct administration of his bronchodilator. I learned from the patient that he was from out-of-state and was working with a crew that was still rebuilding after the hurricanes. He had a history of asthma and had prior hospitalizations due to his condition. My preceptor was involved with helping me correctly identify breath sounds and what lobes you could hear the sounds in.

Running Head: CLINICAL REFLECTION The patient was being treated for ineffective airway clearance and impaired gas exchange. His breath sounds and oxygen saturation were assessed frequently. These can indicate if there is any blockage in the airway and any disturbance in gas exchange (Ackley & Ladwig, 2011). He was taught to change positions frequently, deep breathe and cough, how to use an incentive spirometer and to ambulate as tolerated. All are effective in clearing the airways and increasing lung expansion (Ackley & Ladwig, 2011). He was given bronchodilators and steroids. These medications decrease airway resistance, reduce symptoms and improve respiratory effort (Ackley & Ladwig, 2011). The disease state and treatments were explained to the patient. The patients ability to learn, readiness to learn, personal needs and literacy skill level were assessed. The patient was offered resources and support services. These interventions help ensure that the patient understands the disease process and has a better chance of recovery (Ackley & Ladwig, 2011). At the end of my shift the patients respiratory status was declining. He did, however, seem to be in higher spirits because his wife had flown in to see him. This experience definitely enhanced my assessment skills. I was able to listen to multiple adventitious breath sounds and my preceptor helped me identify the specific lobes the sounds were being heard in.

Running Head: CLINICAL REFLECTION References Ackley, B. J., & Ladwig, G. B. (2011). Nursing Diagnosis Handbook (9th ed.). St. Louis, MO: Mosby, Inc.

Running Head: CLINICAL REFLECTION TEACHING AND LEARNING EXPERIENCE 1. Identify patient/family learning needs (cite specific examples). If patient is unresponsive, what would be an anticipated learning need? This patient needed to know about his specific disease process, how it is treated, any long term treatments and effects, signs of exacerbations and when to seek medical treatment. He needs to be taught proper administration of medications, especially inhaled medications. He needs to know the side effects of the medications he is on. The intravenous steroids were being administered in dextrose so he should know that his blood sugar will be increased and he will need insulin but this side effect will go away once the medication is stopped. The patient needs to know proper hand washing techniques to help prevent future infections. He needs to know that ambulation, frequent position changes, deep breathing and coughing and incentive spirometry can help improve his lung function by mobilizing secretions and increasing lung expansion. 2. How did you adapt teaching to address developmental, cultural, and socioeconomic factors that may affect patient/family outcomes? (cite specific examples) There were no factors that required me to adapt the teaching. 3. How would you optimally evaluate your teaching? How did you know your teaching was effective? (cite specific examples) I would have the patient repeat to me the things I had taught him, observe him taking his medications, make sure I answer any questions and leave the patient printed material on the teaching I had done. I would know the teaching was effective when the patient could correctly explain to me how to treat his symptoms and why he needed insulin, signs of exacerbations, how to prevent the spread of infection, how to increase his breathing effort and observe proper self medication administration.