Shift #8 last shift

this was my last shift. so to day i took the full pt team with out any problems. we have 4 pt most of the day then we got a 5th one. i got an IV with the new IVs and it was a hard stick. so i felt really good about myself. after it was over my preceptor said some really nice things about me. and about how i did over all the shifts.

i was able to work on Objective 5: Participate in care monitoring, quality improvement, and incident reporting. While on the 7^th floor I was able to attempt a care coordination meeting were we reported the concerns that the patient had and gave suggestions to the charge nurse one what could b done on the unit to address those concerns. Fortunately we did not have to do an incident report for any reason.  


also i finished my SMART goals 2, 3 and 5

Goal #2: I will be able to know the normal values and causes for variation for a CBC, CMP, renal function panel, pt, ptt, INR, and CRP with minimal assistance by the end of my proctorship. This goal was very valuable for me to know. At first I would always use the function on the computer to see the normal values for labs. But with this goal now completed I don’t need to do that anymore. I started off using flash cards to test myself of lab value normal range, and then I added the causes for variation in the different labs. I never realized so much that there were almost always things skewing the lab values. Whether it is dehydration, a medication, bleeding, or getting blood. There are so many things that can be confusing. I wont say that I am an expert now, however I will say that I now have a much better Idea about what to do when I see abnormal lab values.

Goal #3: I will be able to identify the adverse effects and contraindications of Zofran, Morphine, Novolog, Lantas, Metoprilol, Lasix, HCTZ, and carboplatin, with minimal assistance by the end of my proctorship. This was probably my most challenging goal that I had. I at first was just looing them up in the clinical pharmacology site at intermountain’s website, but that was not going well for me, I kept feeling that I only partially knew any other the medications. After the 4^th shift I made flash cards that had the medication name on the front and had all the other information on the back. I took these to clinicals and was able to look at them during slow times. I also had to review them at home. By the end of my preceptorship I was able to know the major side effects of the medications and any nursing implications or contraindications. A patient was prescribed Lopressor, and with out any resources I knew that we were going to make sure were checked her blood pressure before we gave it, sure enough it was low. So I knew to hold the dose. This goal was a lot more difficult then I had originally thought because there really is so much information to know on different medications.

Goal #5: I will be able to carry the entire patient load (3-5 patients) by myself with minimal assistance by the end of my proctorship. To achieve this goal I started for the first 2 shifts helping my nurse with all the patients, just getting a feel for the floor. After that I took 2 patients on my own, and then 3. On the 5^th shift I took the full team, 4 patients, and then we got an admission so I had 5 patients. Also on the six through 8^th shift I took the full patient load. At first it was not as hard as I thought, but that was because we had an easy patient load. The 5^th shift I was feeling pretty good about things, and that is where things came undone a little. I was just falling behind in the things that I had to do and I was not prioritizing  right, and my nurse had to talk to me and tell me what I needed to be doing and that I need to do things faster. Overall this was a difficult goal, but I worked up to it and accomplished it before the end of my preceptorship.