My Clinical Reflection

Record of Experience In the first day of clinical practice at week 6, I received a new patient, P.M. The patient’s admitting diagnosis was as follows: a right knee prosthetic replacement, and a multiple heart surgery history that happened about 20 years ago. Furthermore, the patient had an atrioventricular valve replacement, mitral valve replacement and tricuspid valve replacement, and other comorbidities related to the valve replacements were atrial fibrillation, cardiovascular disease, congestive heart failure (diastolic), and hypertension. I met my buddy nurse and as I introduced myself, I also explained what tasks I could perform; [LIST SOME EXAMPLES ie charting, personal care, and medication administration]. I started health problem

BP and HR are normally lower for the elderly than younger people do, due to decreased muscle mass: the body requires less metabolic activity. When the systolic blood pressure is lower than 100mmHg, and the heart rate is lower than 60bpm, I must hold the antihypertensive medication. I must know the most recent vital signs trend before measuring the patient’s vitals; otherwise, I will need to look at the chart again. If the measured BP&HR is in the trend, it is considered safe to administer the medication. When the measured vitals are lower than the trend, I would need to reevaluate in 5-15mins. However, it was my first time experiencing the patient dropped BP in few minutes, and I knew that sudden drops of BP might indicate life-threatening event: such as anaphylaxis, internal/external bleeding, heart problems, and septic shock or hypertensive medications. Therefore, I reported it immediately to the buddy

These comorbidities directly affect the function of the heart: atrial fibrillation, congestive heart failure, and hypertension. I assume the patient was at risk for the valve dysfunction related to unmanaged hypertension, atrial fibrillation, and heart failure; wherein hypertension will result in heart wall atrophy or hypertrophy, and at the same time, it will damage the aortic wall rigidity. As a result, the heart will pump less blood even if it works harder. Atrial fibrillation or short hand “AFib” is an irregular heartbeat (arrhythmia) due to fast or irregular heart signals from SA node. Furthermore, AFib is the common risk factor that leads to heart failure by resulting in valve malfunction. One of the negative potential consequences of valve dysfunction is blood clot and a stroke event, therefore the patient has higher risk of needing another valve replacement