Clinical journal. 

Create a 1 page page paper that discusses clinical journal. Journal 3/26 My first day at Jefferson was very interesting. I had the opportunity to work along side with my preceptor, a very knowledgeable nurse and detail oriented as well. It was the snow day so staffing was quiet disorganized beginning with the shift. However, the teamwork was excellent, everybody was helping passing trays and feeding. Nightshift volunteers helped getting guest up for breakfast. Administrator came to see if help is needed. By 9AM the entire quest was up from the bed in the dining room eating breakfast. Blood glucose was done, coverage given as per sliding scale. Weekly skin assessment was done during shower. One of the medical doctors came to assess the new residents. Previous nurse told the doctor that the patient on Cipro did not know that it was Bactrim DS for UTI. Order was clarified by MD, but it said that it was ok if it is Cipro has to be given to empty stomach 1 hour before meals. The wound doctor came to check the wound once per week. The patient with the wound needed to be assesed was put back to bed. One patient was admitted 2 days ago with wound on the right lateral ankle. The nurse documented unstageable wound. However, during the interview, the guest informed the wound doctor, he sustained the wound because he was hit by the Hoyer lift during transfer from the previous facility. The wound doctor stated that it is not unstageable but a trauma wound. There was a confusion with the location of the wound as well. Some nurses documented left ankle, while order was stated right. Therefore, the wound doctor asked me what I would do in that situation. I told him that I would assess the patient myself to clarify the confusion and make a note on the TAR and pass on the oncoming nurse. There is no 24 hours report shift for you to read. Therefore, you have to listen carefully to the report in order not to miss anything. In-service was given to diabetic mellitus that afternoon as well. A man from Lilly, the company that makes insulin, came to conduct the in-service. The topic that was discussed is rapid acting insulin such novolog, Humalog was discussed, long acting, for example, levemir and Lantus and peak time. The staff were able to differential between the type 1 DM of the pancreas which does not procedure insulin at all, while with type 2 the body produces insulin but the body cannot properly used it efficiently. Many years ago the body did not produce insulin for instance with type 1 diabetes you die because there were no such thing as insulin to give. And now hemoglobin HA1c is done to see if one is managing blood glucose properly. High result of HA1C is the indication of poor management. The staff was very knowledgeable. The score was given if you answer the questions correctly. The wound round and diabetes in-service were very beneficial for me, because it gave me the opportunity to see how much I learned on those topic. The giving the diabetes insulin was marketing the product that 3ml is cheaper that 10ml vial since is a rehabilitation unit and patient does not stay for long time. If I have to grade him, I will have given 9/10. With no medical background I think he did very well. The only problem is that he was getting the medical technology mixed up.

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