On Sunday, April 17, once again I woke up super excited about working at the emergency department at JFK. After 7 days working in this unit, I feel more confident every day and I want to be as productive as I can. I arrived to work with 15 minutes of spare time. I knew it was supposed to be a busy day as usual on the weekends; therefore, I prepared myself in anticipation to apply some of the skills I have learned. The morning was uneventful and we spent time learning how to effectively prioritize the duties. In addition, my nurse and I spent time learning about how to recognize and address child abuse and drug seeking patients in the emergency department. Around 0900 we started admitting patients.
Although is not common to follow up with patients
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Patient Presentation:
Ms. L. R., is a 17 year old Hispanic female who was brought to the emergency department by her uncle in law after she fell while walking at the park. She is 28 weeks pregnant, 5’5 tall, and her weight is 156 pounds.
Assessment:
Oxygenation: The patient’s general appearance was calm, quiet and cooperative. She didn’t exhibit any signs or symptoms of distress. Breath sounds were clear on auscultation of all the lobes, both during inspirations and expirations. The patient’s respiratory rate was 17. She didn’t exhibit any signs or symptoms of respiratory distress. Respiratory effort was minimal with small chest and abdominal movements. Heart rate was 86 beats per minute. Mucous membranes were pink and moist; capillary refill less than 3 seconds. The patient denies a medical history. Patient states that she is taking the prenatal vitamins. She denies any trauma to her belly with the fall; however, she said that her baby is not moving as frequently as she was moving before the fall. A Fetal hear assessment of the baby was obtained and the baby’s hear rate was 141 beats per minute. Patient denies any vaginal bleeding. The patient’s oxygen saturation was 99% at room
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The patients is a minor (17 year old) who was accompanied by her uncle in law and two cousins. The patient never answered a question without first looking at her uncle for approval. She didn’t have social security or driver’s license. The way her uncle was behaving was a little suspicious to us; therefore, we decided to ask the uncle to leave the room. She stated that her uncle is her legal guardian in this country and that she just moved to the United States of America. Because she reported that her baby wasn’t moving frequently, she was admitted to the OB floor at the main
It is another extremely hectic Monday in the Emergency Department. The waiting room is building up fast with many new walk-in patients. Fire Rescue trucks are calling one after the next with several medical and trauma cases. The hospital supervisor is calling to inform the Charge Nurse of the Emergency Department that the Operating Room has several cases that need beds and will supersede the Emergency Department admits. Patient through put will now be further delayed. This is just one example of a typical Monday and why Teamwork and Collaboration are vital components to run an efficient nursing unit, especially in the Emergency Department. When a common goal is created to foster teamwork, health care professionals working cohesively together
A review of the records reveals the member to be an adult female with a birth date of 08/26/1985. The member had a diagnosis of pregnancy with leaking of amniotic fluid and suspicion of rupture of fetal membranes (ROM). The member’s treating provider, Deepti Pruthi, MD ordered a ROM Plus testing, which was performed on 03/04/2015.
The film, The Waiting Room, paints a clear picture of the variety of obstacles that commonly occur in the emergency department. The majority of patients are uninsured, are using the hospital as their primary care physician, long wait times and communication challenges. This paper will outline challenges displayed in the documentary paired with different ideas working to create a more effective health care experience.
Thrown into the United State’s army in order to pay for medical school, my father experienced numerous crises. But out of seven years of service, the first crisis story my father shared with me occurred a decade later in his occupational medicine office. One quiet work night Doctor Malik, my father’s boss, chocked on his dinner and could not breathe. Celia, the difficult to work with office nurse heard gurgling in the corresponding room and began to investigate. When she found Doctor Malik, she immediately performed the Heimlich maneuver, saving his life. My father had no direct role in this crisis, but he will always remember that help came from the least expected person. Even though Celia made work difficult in the office, her previous training and readiness to act saved Doctor Malik’s life. Just how Doctor Malik needed the quick response and help from Celia, other crisis situations require quick help from others.
After graduating from nursing school with my associate degree, I began working as an emergency room nurse in a level one trauma center in East Texas. It has been 19 years now and I continue to work in emergency care. I now work in a smaller, yet still very busy emergency room. In the past, I have worked in many capacities, and now I am a staff nurse and work a peak hours shift, therefore I am busy the entire 12 hour shift, which I thoroughly enjoy. I precept new employees and students, and I am an instructor for TNCC. I care for patients that are critically ill or injured and also for those who only have minor complaints, and everything in between. I find satisfaction in caring for all levels of patients. Each patient no matter if their complaint is minor or life threatening they have come to me for help and I try and deliver the care they need. Emergency nursing is challenging in that there is always something new to learn and when you think you have seen it all, you will see something new. My relationships with my patients are brief, but I try and deliver the care that the patient needs as efficiently as possible. I feel it is important to interact with them, identify goals and react with care that will help them work towards the goals. If the patient is unable to identify their health goals due to illness then it is up to me to work with family and the physician to determine their goals.
What if I were to tell you that the waiting room of an emergency department (ED) might be the most hazardous place for your health and is considered by the CDC to be the most dangerous place in a hospital? There is a current ethical problem with delaying care for patients in the emergency department, putting patients at greater risk for harm and deterioration of outcome, which demands reform. Emergency department waiting times are a pernicious source of harm to patients that is far too common of a condition across a wide variety of hospital types throughout the United States. As an emergency department nurse, we practice beneficence which includes the removal of possible harm to patients; we are not acting altruistically when we allow these predictable occurrences of excessive wait times.
Jessica is a 22yo, G3 P1011, who was seen for an ultrasound evaluation to evaluate the fetal anatomy and growth. On an ultrasound performed in your office there was a question of a small fetal stomach. In addition, she reportedly has a history of chronic HTN but is currently not on medication. Her BP today was normal at 116/70. In addition, based on her height and weight at the start of the pregnancy, her BMI was 32. She has one previous delivery that occurred in August 2016 at 39 5/7 weeks of an infant that weighed 7 lb 4 oz. On today’s assessment, overall, she has no complaints and has positive fetal movement.
After reviewing and analyzing each patient scenario, the most challenging patient, is the patient Jasmine, experiencing contractions and increased heartburn in her third trimester. Consequently, requiring priority clinical attention and care.
As an UConn graduate, I strive to practice UConn School of Nursing PRAXIS – professionalism, respect, accountability, excellence, integrity and service. Two weeks following the orientation on postpartum unit, I knew taking care of four mother-baby couplets overnight was not going to be an easy job at a level I trauma center, where we care for the sickest of the sick. After a thorough plan of care for each patient and tailoring it to their needs for the night, I felt more confident in my skills and time management. It wasn’t until I got a call from a 14 hour post-op c-section patient at 0455 complaining of dizziness, lightheaded, blurry vision and “feeling hot”, who an hour ago was walking to the bathroom, breastfeeding baby and eating with no complains of pain. I left my workstation behind to discover a pale, diaphoretic patient with low blood pressure. I froze. Screamed for resident down the hall. Rapid response team and more professionals were there in no time while I stood by my patient holding her hand, echoing the story to residents and attending MD I’ve told previously. After twenty minutes of stabilizing the patient and diagnosing at bedside with ultrasound and abdominal x-ray, the patient suffered internal hemorrhage from tubal ligation site. She was rushed to operating room. Speaking to her husband was even harder. I froze again. I sat on my knee, held his hand and cried with him. In
Over the course of our life span our bodies are constantly growing and changing. As “EMTs we must be aware of the physical changes a person undergoes at various stages of life”(Call Jones & Bartlett Learning). Being aware of the physical changes will affect how us as emergency medical technician will respond and treat the patient. Outside of responding to a love one or friend and pediatric patients, I feel that responding to the older population will be dificult because they are defined as being 61 years and older, and currently the life expectancy is flip flopping but the average age is about 78 with the maximum of 120 years old. It is critical to keep in mind when treating these individuals of their overall health, medical conditions, and
For the past three years, I have been an emergency room technician at Baton Rouge General Hospital. There, I assisted patients with activities of daily living, assist nurses and doctors with procedures, and assist with resuscitations. I also provided continuous observations for at-risk patients. Currently, I work for a non-profit organization as a community living supporter in the state of Texas. This program offers services to at-risk youth while collaborating with their families, agencies, service providers, and communities. I have the privilege of facilitating empowerment sessions with youth of various ages and mental
The blood pressure of the patient on admission was 85/45 mmHg. Other vitals were, respiratory rate 25 /min, pulse rate 132/min, temperature 1010F and Oxygen saturation was 93% with face mask. An ECG does not show any specific changes except sinus tachycardia. As the patient deteriorate further transferred to the ICU. Resuscitation according to early goal directed therapy was
Over the past two years, I volunteered in the emergency department at Presence Saint Joseph Medical Center. However, this past summer, my duties at the hospital changed slightly after another volunteer joined me in the emergency department. It was her first time volunteering at this hospital, so she knew very little about the hospital’s logistics. Being highly experienced in the emergency department, I acted as her mentor.
Emergency Medical Services are a system of emergency services committed to delivering emergency and immediate medical care outside of a hospital, transportation to definitive care, in attempt to establish a efficient system by which individuals do not try to transport themselves or administer non-professional medical care. The primary goal of most Emergency Medical Services is to offer treatment to those in demand of urgent medical care, with the objective of adequately treating the current conditions, or organizing for a prompt transportation of the person to a hospital or place of greater care.
My overall learning experience during my preceptor shifts was amazing. The first day I walked into the Emergency Department for my shift, I was having anxiety through the roof and very nervous. I felt like I did not know anything and it was a completely new environment then I am use to. At this point I feel very comfortable in the environment and felt like I have gained the knowledge to be a competent nurse in practice. I owe a lot of the success I have had in the ED to my preceptor Sam. He was seriously great and very patient with me when I was trying to learn something. He really pushed me every day to be confident and comfortable taking care of patients on my own. I have gained a vast knowledge of skills, procedures, policies, documentation,