This unit I was in PT , the environment was really chilled and quite. Every patient was using a different kind of equipment. Some where using the bicycle machine , while others were using a medicine ball, stretchy tape, weights or stepping stools. The staff was very helping to the patients and instructing them on all the exercise they wanted them to do. They were also very encouraging to the patients.

   There were a lot of patients there so the staff had to communicate well in order to have a running unit.. Some staff members waiting their turn in order for their patient to use the equipment. Some safety procedures included just making sure the staff member put up all equipment when their patient is done using it so no one is tripping over things. Therapy included different kind of exercises with the equipment in order to get to the area they needed help with back to normal.

  I Learned different exercise to help a patient with back injuries, leg injuries, and arm injures. A skilled I learned was how to react when I patents doesn't think your helping them . I learned how you would answer without being rude to the patient but also helping them to continue listening to instruction.

   PT was a unit I wasn't interested in because I felt like it was too boring for me and too slow and not lost of commotion. But it was a good learning and a great experience to watch this unit to be familiar with what a physical therapist does. 

RESPONSIBILITIES:

• To be familiar with what goes on in pharmacy 
• was responsible to put labels on medication with pharmacist watching over me  

KNOWLEDGE/SKILLS 

• where the medication is located

BEST THING

• knowing the medication was there to help patients that needed it right there in the hospital 

WORST THING;

• wish I got in depth with the medication 

This week was FAIR because  i would to liked have have gotten a better understanding of pharmacy.

Technology observed; 

There was lots of technology in pharmacy. One machine was there to print out the medication labels. They had technology that was able to send medication down to the direct units as well. 

there were no therapeutic procedures observed 

while in pharmacy there was no first hand care to a patient. But All the medication was going to a patient that was diagnosed with a disease or disordered that needed the medication to live a better life.

There are many abbreviation in pharmacy. Such as aa, ac, which tell you when to take that particular medication. 

The environment in pharmacy could either be hectic at times or calm. Many units would call pharmacy asking about medication are anything that went wrong in the process of receiving their medication. The service provided I believed was pretty good. When the pharmacist received a call they  made sure to be helpful to whoever they were talking to. In pharmacy they had technology that was able to send medication to different units which was very helpful.

The staff was very helpful to one another. If they needed help with something they would all help each other. When they received a call they made sure they communicated well with the entire staff if needed. There were safety procedures they took. There was this room in the back where there were two people putting together iv bags and they had to be fully gowned. Also on the insulin sticks there were special stickers that went on the product to let you know that medication needed extra attention to use.

While in pharmacy I learned how they distribute medication and what stickers are  placed on the medication if that product needed further instructions. I learned what is kept refrigerated  and what isn't. I also saw how the laid out the medication on the floor. I also watched them fill up the syringes and seal them up.

Pharmacy was a unit I cant see my self doing just because it had to do with calculating to many liquids and having to be exact on your measurements. I also cant see my self being confined in the one room with out dealing with one on one care with a patient. It was pretty neat seeing how the mix things together to come up with product that is suppose to do great things for the patients health. 

responsibilities:

• observe what task are done in the ER
• watch how staff interacts with one another

new skills/ knowledge

• starting an iv on a patient.
• dealing with a patient with high sugar level when they weren't ale to get recordings on him because it was so high.

Best things

• trying to treat and care for patient right away and get to their medical issues as soon as possible
• there wasn't much drama on this day in ER like there has been in the past

worst thing:

• wasn't too busy so there wasn't much to watch and see

this week was fair because there wasn't anything interesting or out of the ordinary I have not experienced yet.

1. There is always lots of technology in the hospitals. When patients are hooked up to the monitors they are attached to technology. I got to watch them check for sugar levels on a patient.
2. There was a patient there that had came from a elderly home. He had diabetes and they had to send his blood to a lab so they could figure out his sugar level because it was so high.
3. While in ER I didn't observed any therapeutic procedures because they were still trying to figure out what was wrong with all the patients
4. Diabetes- a metabolic disease in which the body's inability to produce any or enough insulin causes elevated levels of glucose in the blood.

   The environment in the ER was pretty calm because there wasn't many patients there. The service provided in the ER was very good. The RN nurse i followed was very very friendly with the patient. he was sure to left their spirits. There was lots of technology around, all the way from how the nurse charted the patients to how doctors helped assist the patients.
   At  first the nurse all were silly, even playing around with some of the equipment near. They all communicated well with each other and I liked how they would triple check with one another in order to make sure they were doing the right procedures on the right patient. The only safety procedure I  came in connect was making sure patients had bed rile up when they were sleeping. There was  a patient that came in with the ambulance because they couldn't bring his sugar level down
   I learned how to interact with patients that had emergency problems. I also got to experience how patient must get ready in order to go into surgery. This included patient having to completely undress and only have a dress gown. Also patiens had to wipe entire body down with wipes. I didn't get to experience any knew medical terminology.
   Although I  know ER can be a pretty crazy unit at times I can never see me working in this kind of area. At times I could see how it could all be a disaster because nothing seamed to be in order. But it did look like the staff in ER was well used to it and to the commotions they can have at times.

·        Responsibilities: none; only observing

 

·        New knowledge: I learned about how nurses chart mothers, and what happens while mother is in labor

·        Best thing: Getting an idea how women prepare to give birth

·        Worst thing: Didn’t get to actually watch a patient due to mothers wanting to be alone

·        Overall: fair , didn’t get to actually see much only hear scenarios

 

·        While in labor and delivery most nurses were charting mother and baby.  They had many monitors that were able to watch mother and the baby that was soon to be welcomed into the world. The nurse informed me where the pads were placed on mother in order to tell them all the info the needed. There was a really neat device that was able to find veins fast and easy. All you had to do was hover over the skin and you could see every vein in the body making it easier to draw blood. All nurses thought this was very useful.

·        There was no diagnostic procedure that I got to experience while I was there. Nurses told me there are treatments that can be used to stop premature labor. The also told me that the opposite of that would be prolonged labor which was labor that does not progress as fast as it should.

·        Nurse told me they keep good communication with the mothers doctors. If necessary doctors will give IV fluids to keep mother from getting dehydrated. If the mother isn’t contracting the way she should doctors will give mother a drug called oxytocin. Other options doctors will give is if mother will need a c section if cervix stops dilating.

·        There were no diseases or disorders I heard of or got to experience.

·        Oxytocin- drug that promotes stronger contractions

Amniotomy- defined as the artificially rupturing of the membranes.  ( breaking mothers water)

 

 

 

1.      The labor and delivery was different from other units. You first had to be buzzed in if you wanted to go pass the double doors. The nurses here always had to be on call in case the mother needed something right away. If any monitors would go off the nurse was sure to quickly figure out the problem.  While at the nurses’ station the nurse would keep a close watch at the mother’s monitors and contraction to see how far apart they were. And also note any abnormities.

2.      The nurses communicated well in this unit making sure all the mothers were taken care of. They also had good communication with the doctors in case mother was ready to push any second. This unit was sure to be relaxing in order to keep mothers calm. All the nurses seemed enjoy and liked to be there and help each other and the mothers.

3.      I learned that delivering a baby is a very painful thing but also is a great blessing giving life. The health care professional job was to make that whole process a great experience with not much pain and discomfort. I can see how the oxytocin was a very useful drug for the mother in order to speed up the process. The doctors had an estimated time they would want mother to give birth and if they did not start by that time the doctor would take measures that would speed up this process.

4.      This was a great area in the medical field I would considered looking at even more and research more on or even shadow a labor and delivery doctor. I think a lot of the nurses on this unit cam relate to many of the mothers and I believe many of the mothers can relate to the nurse because that have gone through similar situations.

 

                                                                            GRACE CARE:

The Older Americans Act that gives authority for grants to states for community planning, social services, research and development projects, and training on aging related issues.

The Omnibus Budget Reconciliation act of 1987 is an way to protect the rights of patients in long-term care facilities such as nursing homes, and assisted living homes. This act gave the Centers of Medicare and Medicaid Services and the authority to enact key measures to reduce unnecessary costs while improving the quality of patient care in these facilities.

Ombudsman- a government official who hears and investigates complaints by private citizens against other officials or government agencies.

RESPONSIBILITIES:

• observed what goes on in postpartum
• be familiar with the care mom has with baby after baby birth
• how mom reacts in situations
• how nurses help and teach mom

KNOWLEDGE:

• proper way to breast feed
• how to read heart monitor

BEST THING THAT HAPPENED:

• family able to be there with baby
• watching the baby connect with mother
• father very helpful

WROST THING:

• mom was in pain from breast feeding

~ This issue was resolved by nurses helping mom learn how to position baby and teach mom and dad right way to breast feed baby without pain.

• this week was FAIR due to there not being lots of mothers to observed and many of the mothers were resting

TECHNOLOGY:
Technology including electronic fetal monitoring systems, fetal monitors, and physiological monitors to equip the nursing staff with information,

Baby blues which is a common temporary physical state right child birth when a new mother may have sudden mood swings, feeling very happy then very sad, cry for no reason, feel impatient, restless, anxious, lonely and sad. There was some medical terms that the nurse would use and would explain it. Engorgement is swelling of the breast and tenderness in the breast. This may be caused by a blockage of milk ductor and infection.


While In postpartum is was quite and calm for the most part. Mothers and babies were usually sleeping or feeding. The nurses there were very attended to the families. They made sure to deeply and fully explain every procedure done. They would explain all the instructions on how to care for baby and mom. One mother there thanked the nurse very much saying this was the best nursing staff and hospital she had been at to deliver baby. There wasn't too much equipment in the room the mother was hooked up tp. Of course they had them right at the mothers bed sight in case of an emergency but there was no equipment the mom or baby was hooked up to.

While observing they were very good  about also explaining to me, the student, on everything that happened and why mothers were feeling the way they were feeling. The nurses there talked a lot amongst each other that had nothing to do with the procedure or task they were working on but they did get the job done. They did have good teams skills; once when the baby was crying one nurse asked the other nurse if she could help her and she then proceeded in helping the nurse tend to the crying baby. The safety procedures included making sure all babies were accounted for. By doing this the made sure that baby had on bracelet that monitored where baby was located. Common diagnoses mothers are diagnosed with are baby blues. Therapy can be talking by having good communication  with family and friends to get over the depressing and sad emotional stages.

I got knowledge in what care is given to the mother after the birth of their child and what medications she can take while breast feeding. I learned how to read a baby's  heart monitors and what to look for when baby isn't getting enough oxygen. Skills I learned was the proper way to breast feed and how to burp baby.

Evaluating the postpartum areas was pretty good. It was neat seeing how much mothers didn't know going in to having their first child. The nurses have a huge responsibility in teaching mom everything she needs to learn in how to care for baby. It was a great education experience  to have with me for the future.



GRACE CARE:
A hip replacement  is a surgical procedure that replaces the hip joint with an artificial hip joint.
the head of the femur, which is situated within the pelvis socket, is replaced with a metal ball and stem. This stem fits into the shaft of the femur. The socket is replaced with a plastic or a metal and plastic cup. After surgery you will most likely stay in the hospital for 4-6 days. Physical therapy usually begins the day after surgery. Within days you can walk with a walker or crutches. Therapy will continue for weeks to a month.

Nursery/ NICU

 Responsibilities:

·        Observe what nurses in the NICU and nursery do

·        Be familiar with what procedures the babies needs, depending on what their needs are

 Knowledge/ Skills

·        Care for premature babies

·        When to identify when baby is too hot

·        What the monitors tell you about the baby

·        Understanding when baby needs to be discharged are stay longer

·        Understanding the procedures needed to be done when a baby is circumcised

Best thing that happened on this unit:

·        Observing the first few minutes of a baby’s life

·        Watching other people, other than the baby’s parents, care for newborn  

-        protocols  they take to discharge a baby

Worst thing that happened:

·        When the babies cried

·        Almost was a code pink

·        They couldn’t find a instrument they needed to tend to a baby

1.      The technology I observed in the NICU was very helpful for the babies there. Since they needed care the most. The babies that were healthy and born on time weren’t hooked up to any monitors. The technology observed while in the NICU were incubators, oxygenation machines, ventilator, feeding tube machine, iv machine, and phototherapy light to help with yellowish skin of the baby.

2.      Some diagnostic procedures included placing baby under a special light to help with the yellowing of their skin and if mom had diabetes they had to give baby a different type of formula due to a low sugar level

3.      Therapy in the nursery/ NICU were feeding tactics, cooling of their bodies, and treating there sugar levels.

4.      Diseases/ Disorders I observed was anemia, which was a blood disorders, and jaundice which is a high level of bilirubin in the blood

5.      BBT – baby’s blood type, BM- bowl movement, C/S – cesarean section, L+D labor and delivery, were all the abbreviations I heard in the nursery and NICU.

  The NICU / Nursery could be one of two things; either very quite or a room of crying babies. If any monitors would go off the nurses made sure to silent them so they wouldn't wake up any of the babies. On the door of the NICU, there was a sign that read ''I'm trying to sleep", this was to insure that when a guest would walk in they were influenced to stay as quiet as the could. The service provided from the nurse to baby was excellent and the service provided from nurse to parents was great as well because the were sure to inform and make good attraction between each other. The equipment there was very helpful for the NICU area, because those were the babies that needed the care the most.
  The team on the unit was very helpful toward each other. If one nurse was busy charting babies information then she would ask another nurse to feed the baby for her. If a nurse needed something to care for the baby the other would realize the problem and give the nurse what she needed. There were many safety procedures on this unit. Before you even were allowed on this unit you had to call for a nurse to let you in. You also had to wash your hands  before entering. Also each baby had a ankle bracelet to keep track of them and make sure they were  accounted for and didn't wonder off with a stranger. If they were close to an elevator entrance, or in the wrong hallway, it set off alarms and everyone was to be aware and check on the baby. Diagnostic procedures included giving baby medications they needed through an iv. Some babies had yellowing of the skin which caused them to be placed under a blue light. Some of the babies needed to be on ventilators to help their respiratory system. Some Therapeutic procedures  for the babies included placing them on a heating blanket to keep the warm.
  While on this unit I learned lots off new knowledge such as how long baby will be in the nursery or NICU, what vital signs are taken, what test the baby must pass in order to be discharge, what different formula are to be given, what the baby schedule is like, and what was done when a baby boy was circumcised. There wasn't much medical terminology I head but I did here the most common things said on this unit including   BBT – baby’s blood type, BM- bowl movement, C/S – cesarean section, L+D labor and delivery. Some skills I learned was how to tend to a  baby once they are born and exactly how to bottle fed baby and how to burp them. I also learned how patient you have to be with the baby.
   This was great personal experience, from this unit I could take a lot for the future. Maybe one day when I want to start a family once I get much older it would prepare me just a little bit about a new born. This unit was a great educational experience because most of the other units dealt with the care of older patients but in this case we were able to care for babies.


GRACE CARE:  Dinning
 Lentigines can come from size range of  .2 to 2 cm. Lentiginnes is flat to the skin and  dark area in color. Most of them are irregular in shape. Lentigines are caused by a increase in the number of pigment cells. They generally take a biopsy when there is a change in pigment or if its not flat with the skin. This is done to rule out cancer. Lentigines is benign and therefor doesn't need treatment. Some can choose to get it bleached, or removed.
  Osteoporosis is a condition the make your bones weak and more likely to break. Osteoporosis usually is more common in older women. Osteoporosis is a silent disease. Some times you might not know you have it tell you break a bone. In order to check you may want to get a mineral density test. To keep bones strong it is recommended to east a rich diet in calcium and vitamin D.
  Arthritis is a joint disorder with inflammation. Arthritis causes joint pain. There are many types of arthritis. Causes of Arthritis depends on the type of arthritis you have. Cause can include injury, metabolic abnormalities, hereditary factors, direct and indirect effect of infections, and a misdirected immune system. Treatment for arthritis include physical therapy, splinting, cold pack, paraffin wax dips, anti-inflammatory medications, pain medication, and surgical operations.
 
 

Responsibilities

•Observed nurse and patients in PACU

•Be familiar with the procedures they take once with patient

 

Knowledge or skills:

• vital signs that are taken

•How long they are in the PACU

•What instructions to give patient

•Good communication with patient

 

Best thing that happened in the PACU:

•Patient did well during surgery

•Patient did well after surgery

•Patients was aware of what was happening once awake

 

Worst thing that happened in PACU:

•Tension between staff members

•Bad communication with staff members

1. This week in the PACU was very good with a great experience.

2. In the PACU there is lots of technology around. Since the patient is taken here right after surgery they hook them up to many monitors. This include cardiac monitor, blood pressure cuff, and pulse oximetry.

3. The Diagnostic procedure included surgery on the foot to remove a screw in patient left leg. Patient had therapeutic before surgery was considered an option. Doctor recommended her to attend therapy, which she did but without any luck they went ahead and completed the surgery.

4.  When I asked the nurse treating the patient in the PACU she informed she didn't know the disorder the patient had. She only knew she had surgery on her left foot due to pain over many months.

5. There wasn't much complex medical terminology because the nurse to patient vocab can’t be much abbreviated. Nurses have to try to explain the best they can on a level in which patient can understand.

 

 

  The PACU was pretty calm for the most part. When I was present there were only about three patients. Once the surgery nurses came to transfer the patient to PACU there was a bet of commotion. And this was because the PACU nurses were trying to get all the information the needed on the patient to be able to chart. There were about 4 different types of nurses once the patient was brought back to the PACU. The service provided in the PACU, I believe was pretty good. They took great care of their patient. At many times the nurse would ask the patient questions and monitor vital signs. In the PACU there were lots of equipment and many monitors. They would take vital signs every 10 minutes and this was done by the equipment they had there. In the PACU I got to observe the care the patient received and how and what they charted. The nurses there were not communicating well together. You could tell the tension in the area. At one point they did start to raise their voices at each other because they were not happy at what was happening or how things were being ran.

   The patients that came in went into surgery due to pain in her left leg, after failure of therapy the doctors resulted to perform surgery to place a screw in her foot, after having the screw in her foot for a period of time she then went back to get it removed (which was this day). While in the PACU I got to experience everything you would do and tell a patient right after surgery. Such as their level of pain they were in, if they were comfortable, and if they had any concerns. The nurse informed me on what to look for in a patient if they weren't doing well; and who to report it to. Right out of surgery the patient has an oxygen mask and after about 20 minutes the patient was able to spit it out.  25 min after that the patient was feeling good and was able to see her family. While the patient was recovering the nurse charted all her information and all her vital signs. The nurse also made sure to chart how her foot looked after surgery, how it felt, and if there was anything out of the ordinary. The nurse had to also make sure she had all her medication ready that she was supposed to take. When the nurse and patient were ready the nurse called the doctor over to release her to day stay where she would then be reunited with her family and be discharged. Throughout the whole time the patient was very calm because she was used to surgery and what to expect once home. This personal experience was great because i got to experience what it’s like to be there as soon a patient came out of surgery.

  This week at grace care I was in activities and watched a speech therapist assist with a resident. While in activists we were able to do some arm exercises with the patients by using a parachute. We had them raise it up and down. I noticed this time around the residents was more involved and they seemed happier. I thought it was pretty cool that one of the residents in garden bridged remembered a conversation we had previous weeks ago and she had continued telling me what she had wanted to tell me. When i did go to garden bridge this week I tried to get some residents to remember what they did in high school or college. I did come across some that could tell me what they did or at least tell me some information on what they did. I feel as we go to garden bridge we think that these residents don't have much to tell us or don't have much to do with us but in reality these are some of the best people we can meet and when you’re able to sit down and have a conversation with them it makes this whole experience a experience of a lifetime. While I was in rehab with the speech therapist she was helping a resident. Her task with this resident was to help a resident to be able to drink regular liquids. Up to that point she had her on thicken liquids. It was hard for the therapist to get her to do to throat and mouth exercise but after telling and explain to the resident over and over the resident was able to finish.