Daily Goals The Differentiated Essential Competencies (DECs) made by

Daily Goals

The Differentiated Essential Competencies
(DECs) made by the Texas Board of Nursing (BON) were initiated throughout the
clinical rotation at Las Palmas Medical Center Intensive Care Unit. On November
20, 2017 the seventh goal was to assume accountability for individual nursing
practice (Competency I Member of the Profession B5A. pg.24). This goal was met
AEB the documentation after any intervention was completed by explaining what
was done and the patient’s response. An example would be the student nurse
administering morphine and checking back to see if any respiratory depression
occurs. A modification could be to stay with the patient for five to ten
minutes after so that the student nurse can intervene more quickly for a
reaction.

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The eighth goal took place on November 21,
2017 and it was to comply with professional appearance requirements according
to organizational standards and policies (Competency I Member of the Profession
B8. pg. 25). This goal was reached AEB the student nurse’s appearance wearing
scrubs that were properly fitted, white shoes, no nail polish, and name tags
showing. Something that can be different is to have the hair up in a high bun
instead of one that is loosely done at the bottom of the neck to avoid it
getting exposed to bodily fluids. 

November 22, 2017 the ninth was done by
following confidentiality regulations (Competency IV Member of the Health Care
Team 4A. pg.78). This goal was completed AEB patient’s charts being placed
inside a drawer that contains a lock. Another example is logging off the
computer anytime the student nurse needed to step away so that no one can
access the files unless they had the password. Something that can be improved
is to not just turn the computer screen off but to completely log off because
anyone can turn it back on and see information that should be kept private.

Goal ten was on November 29, 2017 on
manager observation day dealing with time management (Competency IV Member of
the Health Care Team F3. pg. 87). This goal was illustrated by the
administrator on duty by her doing certain tasks before having to attend
meetings. She did everything by schedule and completed each task as expected.
The AOD demonstrated how time management played a huge role because the tasks
assigned needed to be addressed as soon as received in case there was a code or
MRT that she must attend. The way she scheduled herself was successful AEB her
completing everything needed, and I felt there was no modifications to be made.

November 30, 2017 goal eleven was to
recognize and manage conflict through the chain of command. (Competency IV
Member of the Health Care Team D5. pg. 83). On this day the goal was achieved
AEB the student nurse seeking out their preceptor to ask a question over
documentation that two other staff nurses disagreed on. The problem was whether
to document a patient as alert and oriented or not because there were times the
patient was involved and other times he would act as if no one was there
ignoring all questions. The preceptor sided with one nurse but ultimately the
charge nurse was brought into the situation in order to see what he would
choose. The director of the ICU was also involved because he found
discrepancies in the documentation and wanted to clarify the status of the
patient. In this situation I feel the chain of command was reached
appropriately but upon speaking to them the student nurse should have been more
prepared for the questions asked about the interactions with the patient.

The last goal took place on the last
clinical day December 1, 2017 and it was a self-evaluation, staff evaluation,
and peer evaluation process (Competency I Member of the Profession B5A. pg.22).
This goal was met AEB receiving my evaluation that had my personal critiques
that I felt I can work on and what my preceptor felt I lacked in. I also gave an
evaluation on the hospital staff which included my peers in my overall clinical
experience and what a significant impact they each made on me. I feel the
evaluation sheets were thorough in the questions asked to get a good
understanding of my experience. Possible modifications can include more
in-depth questions concerning the clinical process with more surveys to fill at
the end.

Case Discussion

One patient came into the emergency room
with a chief complaint of shortness of breath and chest pain. It was an
84-year-old man with a history of hypertension, diabetes mellitus type II, and
hyperlipidemia. The patient was admitted with congestive heart failure and
pneumonia and transferred to the ICU for careful monitoring. The patient
presented with dyspnea, jugular vein distension, orthopnea, tachycardia, use of
accessory muscles and upon assessment crackles were heard, and pitting edema
was a 2+. The vital signs were BP 158/92, respirations 22, O2 saturation 82,
heart rate 110, temperature 36.7 and on a pain scale of 1/10 a 7 was noted at
admission. Throughout the day the patient had poor urinary output ranging in
the 20’s each hour. Three priority nursing diagnosis is ineffective airway clearance,
impaired gas exchange, and decreased cardiac output. Ineffective airway
clearance R/T mucous secretions and trapped fluids AEB crackles, dyspnea, and
orthopnea. For this diagnosis aspiration precautions were initiated to maintain
an open airway, the head of the bed was elevated at least 40 degrees in order
to open the lungs for greater breathing, and suctioning as needed to clear
mucous that the patient was unable to cough out independently. Impaired gas
exchange was R/T CHF and pneumonia AEB crackles, O2 saturation

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