Stacy Lopez

January 9, 2016- Journal Entry

This was the first day of my Leadership Clinical Rotations. Our class met with Professor
Angela Russel. We have an in depth discussion on the course expectations and all assignments
that would be due throughout the course. We were given a course schedule and outline of
assignments.
Following our class orientation, we took a small break for lunch and then had an
orientation of Jackson South Community Hospitals; other students, including myself, were at this
facility for the first time. The units that were introduced to were the ICU, Medical- Surgical of 2
Tower and 3 Tower, and the Emergency Department. Professor Russel explained that we were
going to be assigned to a unit but she would try and rotate us around so we could have a wellrounded experience.
Professor Russel explained that our clinical day would go as such; we would walk in
through the main hospital lobby directly to our unit for morning report. We would spend our day
with our proctor, assigned by the charge nurse, and take on the proctors work load under his/ her
supervision. We would stay on the unit until change of shift and give the incoming nurse report
on the patients.
After going over course requirements and explanation of our clinical day, we sat down
together as a group to go start writing our personal objectives. We were given a few minutes to
write our objectives quietly to ourselves and then, those who were open to share and receive peer
criticism, shared our objectives. It was great to listen to everyone in our group discuss our

personal objectives and we helped those who had trouble writing their own objectives, to word
them correctly.
We concluded our day and were told to meet promptly at 0645 the following day.

January 10, 2016- Journal Entry

I was assigned to the Emergency Department at JSCH. In the emergency department the
nurse receives patients either from triage, who walk in on their own, or those who are picked up
by ambulance. My nurse was handed off one patient from the night shift. We received report
from the night nurse and then went into the patients room where I took the patients morning
vitals. Shortly after my nurse proctor began to receive new patients.
Our first patient came in from the triage with a chief complaint of Sickle Cell Crisis.
When she came into our ED room I took her vital signs and took the patients history. The
patient was a young female who the nurse was familiar with because she ends up in the
emergency at least once a month with a crisis. Once my nurse proctor and I took her vitals and
health history the physician in the emergency department went into the patient room for an
evaluation. The physician order Morphine every 4 hours for the pain and 1000 mL of 0.9%
normal saline for hydration. My nurse proctor had me prime the saline bag and I watched as my
nurse proctor pushed the Morphine. We evaluated the patients pain level following the
medication administration, the patients pain decreased.
The next patient my nurse proctor and I received was a middle aged man that was
brought in by ambulance unresponsive. The patient was found unconscious in his home, alone.
The certified nursing assistant started an IV line in the jugular vein. The respiratory therapist
came into the room with the physician in the unit, the physician ordered for the patient to be
intubated and to be placed on a ventilator. My nurse proctor and I inserted an indwelling
catheter, did a head-to-toe assessment on the patient, and cleaned the patient. A family member
of the patient came into the emergency department and told the staff that the patient was new to

dialysis treatment and probably missed an appointment. The physician ordered dialysis STAT.
Once a room opened up in the ICU the patient was transferred for further treatment.
With the next few patients we received the certified nursing assistant taught me how to
start an IV. I watched as he inserted the first one and with the second patient I was able to
perform the procedure on my own and obtain a blood sample for testing that was ordered on the
patient. I successfully fulfilled my nursing objective of at the end of this six-week clinical
rotation I will effectively take a blood sample or perform one invasive procedure on a patient.
I really enjoyed my time in the emergency department of Jackson South.

January 23, 2016- Journal Entry

Today I was on the second floor in ICU; I was assigned with my nurse proctor Grace.
When I got to the unit the nurse was receiving report on the one patient she had. The patient was
a 96-year-old woman that was brought up from ER. The patient was brought to JSCH because of
shortness of breath and altered mental status. In ICU the patient does total patient care. After
receiving report my nurse allowed me to do a full head to toe assessment on the patient. I took
the patients vital signs and did my head to toe. The patient was sedated with propofol because
she was on a ventilator. We had to withhold the patients 0800 medication because it was a betablocker and her heart rate was less than 60. My nurse and I began to chart our morning
assessment and monitor the patient. Shortly after the patients family began to arrive, she had a
big extended family visiting her all through out the day. Around noon the physician ordered for
the patient to be weaned off the propofol and the ventilator in hopes of being able to remove the
breathing tube. Once the patient began to regain consciousness and recognize her family
members she became anxious and it was evident by her vital signs, the physician saw that she
was going to be incapable of breathing on her own and said they would put off removing the tube
until tomorrow, if she was successfully demonstrating the capacity to breath on her own. My
nurse began the propofol drip once more and we continued to monitor the patient. At around
1700 my nurse and I did perineal care on the patient. We changed soiled linens, gown and
cleansed our patient with special wipes they have for bed-ridden patients. I was also able to
perform oral care; there is a special suctioning device that is similar to a tooth brush, it was
dipped in chlorhexidine and then connected to the suctioning device, the toothbrush is placed in
the patient mouth and suctions any secretions in the mouth. Then I applied a moisturizer on the

patients lips and protruding tongue to avoid drying up of the mucous membrane. I then
continued to chart with my nurse.
At 1200 my nurse received another assignment from the ER, a 76 year old woman who
was brought to the ER because of weakness. The patient was previously on hospice care, her
proxy (granddaughter) expressed that she was not receiving appropriate care and when the
patient demonstrated signs of distress she called 911 and had her taken to the ER. The patient
was intubated upon arrival at the ER and when she was brought to ICU a central line was placed
in the left femoral area. With this patient I was able to put into play my second personal
objective, at the end of this six- week clinical rotation I will have better communication with
families of the patients I am assigned. This patients family arrived at the unit about 3 hours
after the patient was transferred because they live in Key West, during that time my nurse was
taken a lunch break and asked me to monitor the patients and to find her in the Nurses Lounge is
an emergency presented itself. When they arrived one of the granddaughters immediately burst
into tears, the other granddaughter, the proxy was more open to communicating and kept herself
composed and the patients daughter began to ask questions for which I did not have answers, is
my mother going to die? Why is she so cold? Is it normal to be so cold or is she dead? I had to
be professional yet at the same time compassionate because of the situation they were facing. I
explained to the patients proxy that I was the student nurse and I would find nurse Grace for her
to speak with. In the meantime I tried to make the family member comfortable. Once Grace
arrived I took note in the way she spoke to the family members. Throughout the rest of the day
the family members continued to be at the patients bedside and would have moments in which
they were calm and other moments in which they all cried and were upset when they saw the
state in which the patient was. Whenever I walked into the room I would explain the procedure I

was going to perform; taking vital signs and glucose readings, I would reassure them their family
member was receiving the best care possible.
I had a good day at the ICU, I do not think its the kind of environment I would like to
work in all the time but it did help me to grow in my skill of dealing with family members when
their loved one is in a critical state.

January 24, 2015- Journal Entry

This was my second day in the Critical Care unit at JSCH. I was assigned to a different
nurse and received report from the night shift for two patients. One of my patients was brought
in from the ED for pyelonephritis. The patient was stable and awaiting a room in the MedicalSurgical floor. The second patient was critically ill. This 70-year-old woman had been in the ICU
for a week on the ventilator with no sign of progression. My nurse proctor gave me a brief
history on my patient; diabetes who was receiving peritoneal dialysis, the area around the
catheter became infected and the patient went in for a procedure to debris the area, during the
procedure the patients colon was nicked and the patient developed peritonitis, from which she
did not recover. The patient had become septic and was critically ill in the ICU. The patient was
placed on a ventilator and without it she would be unable to continue breathing. What was most
difficult about this patient, for me, was how the patients husband has been unwilling to extubate
the patient and let her go. I knew that through out the day I would have to learn to speak with
the family and exercise my empathetic side.
My nurse proctor allowed me to do a head-to-toe on the patient. I was able to identify
different conditions that I had only seen in my textbooks: petichae, ecchymosis, pitting edema of
the lower extremities, mottling skin, a patient on DIC, and renal failure. My nurse explained to
me some of the settings on the ventilator, what was most important to note was that the ventilator
was set to give 14 breaths, however the patients respiratory rate was between 23- 25 breaths, my
nurse explained to me that the difference in breaths was the patient making an effort to breathe.
The patient was receiving norepinephrine and morphine. Around 1000 the nurse received a
phone call from the patients husband, he said that he was ready to take out the tube, he would
arrive later in the day with his sons would wanted to be present when his wife was extubated. My

nurse called the attending physician, who also spoke with the patients husband and then placed
the order for removal of ventilator tube, do not resuscitate and comfort measures only. I
continued to monitor the patient and document hourly vital signs until the patients family
arrived at 1520.
Following the arrival of the patients family, the respiratory therapist came into the room
and removed the breathing tube and disconnected the ventilator. My nurse had administered a
dose of morphine prior to the arrival of the respiratory therapist; she told me that it was for
comfort measures, in order to make the client comfortable and not struggle as she took her final
breaths. We left the patient and her family alone and monitored her from outside of the room
keeping our eyes on the cardiac monitor in the nurses station. My nurse showed my the ECG
monitor, we were able to see that the patient had sinus bradycardia, then she showed me how the
T wave in the strip began to become flattened, and 37 minutes after the arrival of the family and
the disconnection of the ventilator the ECG showed asystole. The patient was declared dead by
the intensivist at 1557. I went into the patients room with my nurse proctor; we gave our
condolences to the family and then gave them sometime to grieve. The patients husband came
out of the room and told us he has made arrangements with a funeral home. We began the
process of calling the funeral home and shortly after the patients family left. My nurse told me
about how some families spend hours in the room with the body to grieve, others leave quickly
and that I needed to be aware of cultural differences especially when dealing with the death of a
patient. I assisted my nurse with post mortem care and prepared the body for pick up from the
funeral home. After the body was retrieved we cleaned up the room, because the patient was
septic everything in the room would have to be thrown out and special cleaning instructions were
given to environmental.

I was glad to have been a part of the experience with my nurse. At first when the nurse
explained to me what could happen, I was a little apprehensive because I have never dealt with
the death of a person let alone having to do post mortem care. I was very proud of myself in the
way I handled the patient and her family.
I came home and reviewed my ECG and learned about the different things that
could cause: bradycardia, inverted or flattened T-waves, and what to do in the case of a asystole
in a patient that is DNR and one that is not. I believe I accomplished my first personal objective
set out at the beginning of this clinical and will continue to enhance my ECG reading skills.

February 4, 2016
For my last weekend in Leadership rotation I was placed in a Medical- Surgical unit of
JSCH. At first I thought the day would be slow and nothing exciting would happen. I have
been in order med-surg floors during other clinical rotations and I expected this day to just go by
the same way. I received report with my nurse proctor on six patients. Four of our patients were
status post some kind of surgery, one was a new admit, and the last patient was admitted from
the ED for observation.
My nurse had me start the day by doing the newly admitted patients admission
assessment. I was able to put my assessment skills to work as I did a full head to toe assessment
and intake interview. I learned that the patients was admitted for nausea and vomiting and was
to be seen by a colorectal surgeon for consultation. The physician, who ordered antibiotic
treatment and by the end of the shift was discharged home, saw the patient.
The order patient I was assigned was an 87-year-old female patient who had a history of
colorectal cancer. She had a stoma formed 10 years ago with no reversal surgery. The patient
was admitted for cellulitis around the stoma. The patient was a very anxious woman. I assisted
my nurse proctor to change the patients ostomy. What proved to be the most challenging was
the patients anxiety. During every intervention, hanging fluids, stoma care, and even feedings,
the patient would begin to cry. The attending physician ordered alprazolam for the patients
anxiety. With this I met my fourth and final objective. Before giving the patient this medication I
reviewed benzodiazepines and their use for generalized anxiety disorder. An hour after giving
the medication to the patient I was able to go into the patients room and feel the difference in
her mood and receptiveness to care. Sometimes we can be quick to judge those who may take

medications for disorders such as anxiety, but it really did make a difference for this patient and
how she was able to handle care from us for the remainder of the shift.
I enjoyed being in the medical- surgical unit. The staff was great and very receptive and I
was able to have a lot of hands on experience with my patients. I look forward to ending this
rotation and continue in my journey to becoming a nurse.