Student Name: Kristina Valenzuela

Date: 11/9/15

N360 Weekly Self Evaluation

1. Considering your patient's current status, list potential complications and strategies for
prevention and early recognition.
Complication

Early Recognition
Increased pulse, BP and
respirations; profuse sweating,
restlessness, confusion, crying
Excessive bleeding, weak
pulse, increased pulse and BP,
lightheadedness, blood in
urine or stool, ecchymosis,
decreased H&H, swelling,
saturated dressing

Prevention
Pain assessments (Q1H)
Administer pain medications

DVT

Calf pain, redness, swelling,

warmth

Pneumonia

Fever, increased WBCs,

wheezing, crackles, chills,
SOB, tachypnea, dyspnea

Anticoagulants/antiplatelets
Compression device
Antiembolic stockings
Early ambulation
Monitor temperature, O2
Respiratory assessment
Monitor WBC & blood
culture
Hand-washing
Pneumonia or flu vaccine
Turn, cough, deep breathe
Use incentive spirometer
Early ambulation

Atelectasis

Dyspnea, tachypnea, cough,

fever, decreased O2 sats,
crackles

Turn, cough, deep breathe

Use incentive spirometer
Early ambulation

Infection

Fever, pain, redness, swelling,

odorous drainage, purulent
drainage, wound edges not
approximated, increased
WBCs

Antibiotic therapy
Wound care
Hand-washing
Change dressing as ordered
Monitor vital signs

Bowel obstruction

Abdominal pain, distention,

nausea, vomiting,
constipation, inability to pass
flatus or feces, diminished
bowel sounds

Monitor s/s; early intervention

NG tube

Pain
Bleeding

Monitor for s/s

Early intervention for
bleeding
Monitor labs (H&H)

Respiratory depression

Decreased rate, shallow

breathing, decreased breath
sounds, decreased O2 sats,
change in LOC,
difficulty/inability to speak,
hypotension, bradycardia

Monitor s/s; early intervention

Give appropriate doses of
opioid analgesics

2. Am I getting more comfortable with the use of the nursing process to plan and evaluate
nursing care? (Give examples of how it is better now or problems that still bother you).
Another area of the nursing process that I wanted to work on was implementing nursing
interventions. I believe I have been able to effectively and comfortably implement
appropriate nursing interventions based on each patient's individual needs. In developing my
plan of care for my patients, I prioritize their needs and utilize various resources (such as
prior nursing knowledge, lecture materials and evidence-based research) to help me
determine appropriate nursing interventions. I ensure that I do adequate research to
rationalize why each nursing intervention is important. One particular area of opportunity in
relation to implementing nursing interventions was providing patient education. That is
something I had difficulties with in the past, but now I feel more comfortable and confident
in providing patient education. My patient this week was diagnosed with a pancreatic
neoplasm and was s/p for a pancreatectomy and splenectomy. I had determined the
complications listed above for this patient based on her diagnosis and procedure, and used
that information to develop my plan of care, which focused on monitoring for infection,
impaired perfusion, pain management and bleeding precautions. I was able to implement all
of my planned interventions, such as monitoring vital signs and s/s of the listed
complications, applying SCDs, administering anticoagulant therapy, encouraging ambulation
and the use of incentive spirometer, and managing pain.
3. Were my nursing diagnosis and plan of care individualized for my patients? (Give
examples of how you did this.) Do I have difficulty in this area? (Explain).
Based on the preclinical information I gathered from the patient's medical chart, I tried my
best to anticipate what her individual needs would be in relation to her particular diagnosis.
She was s/p for a pancreatectomy and splenectomy, so I anticipated her needs in relation to
postoperative care. I determined I would need to monitor for postoperative complications
such as pain, infection, bleeding, and pneumonia/atelectasis. I made nursing diagnoses such
as Acute Pain, Risk for Infection, Risk for Ineffective Tissue Perfusion, Risk for Bleeding
and Impaired Mobility. By the time I started working with her, she was already post op day 3
and was very independent and well aware of what needed to be done to prevent
complications (such as using the incentive spirometer and SCDs while in bed, and getting out
of bed as much as possible).
4. How are my assessment skills developing? Am I being as thorough as I need to be?
What areas are still difficult for me and what am I doing to improve? (Be specific).
I have continued to make improvement in my assessment skills by performing more focused
assessments based on my patients' diagnoses and specific needs. In addition to a general head
to toe assessment, I knew I needed to perform a more focused GI assessment because of the
type of surgery she had. I checked for pain, bowel sounds, distension, softness/firmness,
nausea/vomiting, and the presence of flatus. Having come from a major surgery, I knew she
would also need a focused pain assessments in order to help me determine the appropriate

actions to take in managing her pain. After surgery, patients are also at risk for respiratory
complications, so I performed a respiratory assessment by listening to lung sounds and
monitoring rate and rhythm. I performed a skin assessment as well because of the presence of
a JP drain, and to check specifically for ecchymosis (a sign of bleeding).
5. What new skills did I implement this week? How did I do? What could have helped
me to improve? Did I ask for help when I needed it?
This week I was able to give a subcutaneous injection. I was able to perform the skill
efficiently and provide appropriate patient education about the purpose of the medication
being given, along with some side effects to look out for. I also gave another IVPB
medication. I did not do as well this time around because I was not as efficient and
comfortable manipulating the equipment. I have successfully and efficiently been able to
administer an IVPB that was previously set up because all I needed to do was remove the old
medication, spike the new medication and set the rate of administration. This administration
was different because the medication to be given was not compatible with the continuous IV
fluid. Therefore, I needed to disconnect the primary line, prime a separate tubing for the
medication, and connect that tubing. My inefficiency came down to not having enough
practice. I forgot many little details such as putting a cap after disconnecting the primary
tubing, turning my back after cleaning the connection hub, and flushing. In order to improve,
I will continue to practice nursing skills in resource lab and at home. Some procedures and
equipment are different from what I have worked with at other hospitals, so I will need to get
more practice manipulating this facilities equipment better.
6. How is my time management progressing? What areas of difficulty have I found and
what can I do to improve? How do I monitor my time management while in the clinical
area?
I have continued to make improvements in my time management. I utilized all the feedback I
had received in the previous weeks and feel a lot more comfortable managing my day. Some
of the things that have worked really well for me was switching from my old timetable to the
"brain" suggested by my classmate, clustering care in the AM, and charting as soon as I leave
the patient's room so that I don't get backed up.
7. Was I involved in making referrals for my client in any way? How could the nursing
role in this process have been strengthened?
I was not involved in making any direct referrals for my patient, but I was able to notice an
abnormal lab value and bring that to attention. I remembered during the AM shift report that
my patient had a lab drawn for her phosphorous levels, and it was not seen by the nurse until
hours later after it had been posted. Keeping that in mind, I made sure to check her medical
chart for updates periodically throughout the day. In doing so, I managed to find that a recent
lab draw still revealed a low phosphorous level. My patient had already been told she would
be discharged today, but I was concerned because of this abnormal level. The day before,
after they noticed the first abnormal reading, they had given her a phosphorous supplement. I
notified the primary nurse of my finding and she said she would follow up with the doctor. I
had anticipated that she may need to stay longer, or at least receive another supplement
before she leaves, but I had learned from my nurse that the doctor did not seem very
concerned with this level. My patient has been on an NPO, then later clear liquid diet, so the
decreased phosphorous level was probably due to inadequate intake. Now that she was eating
regular food again, the doctor anticipated it would normalize without any further

intervention.
8. List the specific interventions, in order of priority, for your client and explain how you
determined which interventions took precedent.
1) Monitor vital signs
--> This will indicate any abnormal values or changes from baseline, particularly in
temperature since a rise could indicate an infection, and since the patient had a major
surgery, which involved removing her spleen, her risk of infection is now increased
2) Perform respiratory assessment
--> Patient is using a PCA (respiratory depression is a complication; airway is top priority
according to the ABC model); at risk for pneumonia and atelectasis due to decreased
mobility post surgery
3) Maintain aseptic technique when performing dressing changes or manipulating drains
--> The patient has an increased risk of infection r/t splenectomy so it is even more
important to practice good infection control
4) Monitor s/s of bleeding
--> The patient had just undergone a major abdominal surgery and was receiving
anticoagulant therapy so it is very important to monitor s/s of bleeding in order to provide
early intervention if needed
5) Administer pain medications as prescribed in a timely manner
--> The patient had just undergone major abdominal surgery and was complaining of
moderate pain; pain needs to be well-controlled in order for the patient to participate in
other care such as using an incentive spirometer or participating in physical therapy
6) Assist patient with use of incentive spirometer
--> The incentive spirometer promotes deep inspiration which increases oxygenation and
prevents atelectasis and pneumonia; it would normally be of higher priority but this
patient was getting out of bed and walking the hall several times a day
7) Apply sequential compression device
--> The patient was at risk for DVT r/t impaired mobility post op, so the SCD is used as a
prophylaxis; it would normally be of higher priority but this patient was getting out of
bed and walking the hall several times a day
8) Administer anticoagulant therapy
--> The patient was at risk for DVT r/t impaired mobility post op, so the anticoagulant
therapy is used as a prophylaxis; it would normally be of higher priority but this patient
was getting out of bed and walking the hall several times a day
9) Educate patient on the use of incentive spirometer, s/s of bleeding, s/s of infection and
discharge instructions following a lap splenectomy
--> Education helps with patient understanding and compliance; this specific information
is important for the patient to know because she is receiving anticoagulant therapy and
had a splenectomy which increases her risk of infection