Melinda Blanco

Day #1: June 19, 2017

Today was the first day of my leadership clinical rotation. I was extremely nervous, not knowing what to
expect. My professor assigned me to Ryder Trauma center 3A. I was introduced to the nursing manager,
who then assigned me to my preceptor. My preceptor for the day was amazing. She began by giving me
report on our four patients. She had already completed her assessment rounds prior to my arrival so the
next step was medication administration.

My first patient was a young 16 year old black male with a multiple GSW admitting diagnosis. To prevent
any HIPPA violations lets just refer to him as patient W. Patient W has a hx of ADHD and is a temporary
paraplegic due to ballistic injuries to the upper thoracic spine (T5-T6). Patient W has no known drug
allergy. Patient W has a colostomy bag which we emptied twice during our shift. Once at 0800 and again
at 1330. Around 1055, we administered his medications which included Docusate 100 mg, Celecoxib
100mg, bacitracin topical to his face to treat the GSW, gabapentin 900 mg and one packet of
polyethylene glycol (laxative).

Our second patient was a 57 year old male who is allergic to Lisinopril. Lets refer to him as patient X. His
room was a little intimidating to walk into. As we reached his room there were 3 correctional officers,
two outside the door and one at bedside. He was an inmate who was admitted to treat alcohol and
cocaine withdrawals, and encephalopathy. X was noticed experiencing tremors due to the withdrawals.
He was shackled to the bed because he kept trying to get up. Patient appeared to be slightly agitated.
He kept stating, Hurry this up, I want to go home. Patient X had an NG tube which was used for
medication administration. Prior to administering his medications, my preceptor asked me to please
assess the placement of the NG tube. I then had to auscultate his abdomen while pushing in 30 mL of
air. I heard the gurgling which would confirm correct placement. Following the confirmation, I
proceeded to administer his meds which included Librium (sedative) also used to treat alcoholism.

My third patient - patient Y, was a 22 year old male who was admitted to the floor with a GSW to the
head and chest. This patient had undergone a craniectomy with no bone. You could just see how his
scalp was sunken in. Patient Y had a trach but removed it himself out of frustration. He was verbally
impaired due to his injuries and would become easily agitated and aggressive. My preceptor and I
dressed the trach site to prevent infection after speaking to the physician. The physician consented to
the discontinuation of the trach and confirmed that it was no longer necessary because his respirations
were stable. We had to dress the trach site about three times. Every time we had finished, patient Y
would remove it once again. He appeared to be extremely upset and aggressive to the extent that we
had to restrain him using cuff restraints trying to prevent him from harming himself. This patient
appeared to be behaving like a toddler which is expected because of the extent of brain damage
brought on by the GSW.

My last patient was a male in his mid-thirties who had been admitted with a diagnosis of multiple facial
fractures. Patient Z, as I refer to him, had been badly assaulted. Patient Z was supposed to have left the
floor for surgery but did not. The surgery had been postponed by the surgeon because the nurse on the
previous shift had administered Lovenox to the patient which can cause risk of bleeding during the
 Melinda Blanco

surgery. Patient Z was placed on a mechanical diet and was able to drink his medications orally. At 1220
we administered two tablets of Percocet, Unasyn 1.5 mg IV, and oxymetazoline nasal spray (Afrin). By
far he was the easiest patient of the day. He was extremely polite and soft spoken.

As we got close to ending our shift, my preceptor turned to me and said Thank you Melinda. You have
been great. I am going to train you correctly so that you can take my job in the future. I believe she was
impressed by the way that I carried myself and handled any situation that was put in front of me.
Overall, my experience on this floor was great. I was extremely busy and enjoyed every minute of it. It is
a very interesting floor where something is always going on. I cannot wait to see what tomorrow has
instore for me. Going forward, I no longer find myself nervous, instead I am excited to see what
challenges await.