Second Day

Today we started with four patients.  Three of which were admits from my first day so it was nice to be familiar with the background and see the progress.  Of the three previous patients the dx were an incisional hernia for one and a ileocecal mass for the another and the last a left pneumothorax.  The newest admit had appendicitis and was post op for a lap appy.

It was nice to be remembered by the patients I had in my first day and have them interested in you as much as you are interested in learning about the dx and care planning.  We had a lot of expected admits and were expecting to discharge three of the four which we did.  It was nice to feel busy and have a little more stress to get multiple tasks done while discharging and in preparation for a new admit.  The time really flew by there when we were going from one thing to the next.

There was  JP drain in the patient with the incisional hernia that I was able to remove while being observed by my preceptor.  The patient was ambulating well and their pain no longer was being controlled by a PCA and was managed well through po meds.  This patient was discharged today.

The patient with the left pneumothorax no longer had a chest tube and was being dicharged after a chest x-ray.  We spent some time doing some teaching for the follow up visits that the Dr needed for the pneumothorax and further instructions.  While this was being done the lap appy/appendicitis pt wanted to leave right then and there and was pressuring us to get out.  They had a long drive ahead of them so we did our best to hurry up the process.

During these two discharges a new admit with a  lap coly/ and lap appy arrived.  I did the initial assessment and aldrete scores.  My preceptor even mentioned that my charting was getting better and faster by the end of the day.  So I feel I am getting more familiar as well as understanding what needs to be charted and not forgetting other things that take up time to go back and get.

The last admit was a sysoscopy that I also did the assessment and aldrete scores.  This patient was experiencing nausea and vomiting coming out of surgery and we did our best to help with some meds for that.  Pain management was one of the main priorities for all of our patients to get them ambulating feeling better.

The patient with the ileocecal mass was not expected to leave for a few more days but was able to be taken off the PCA and transition to PO pain and other meds.  Helping them stay comfortable and keeping on top of the pain was a priority here.  It was nice to transition from PCA to PO pain meds because that means the patient is making progress as well as no longer needing to chart all the PCA checks.