¶ … traumatic experience with a patient a few years ago that still left me with a bad feeling. It was a hit-and-miss instance, and the fact that it was so, more closely being miss than hit, has stayed with me ever since. It was the first time that I ever came so breathtakingly close to being implicated in causing another to die. I hope it will be the last. As to the lessons that it can teach me -- there are several.
The story was the following: It was one fine, not especially busy Saturday morning when this patient was wheeled in for a percutaneous transfemoral aortic valve implantation. While the cardiology team was inserting the femoral guide wires and sheath for valve placement the ventricle was perforated. Usually we have more time and can proceed more placidly, but in this particular case, we had to rapidly respond and open the sternum due to the patient's unstable hemodynamics.
Unfortunately, the equipment needed for the conversion i.e. sternal saw, retractor and miscellaneous supplies to achieve homeostasis...
The critical condition necessitated that we all be there.
Meanwhile, the patient's arterial blood pressure were 60 systolic / 40 diastolic and rapidly declining without adequate management. Two 16 gauge IV's were placed and rapid blood transfusions were administered, but, despite, our hardest and most strenuous attempts, we depleted the entire blood bank with this patient. At the same time, we were afraid to overload the patient with the volume.
Suddenly the patient's arrhythmias became erratic from PVC'S to VFIB and we were at our wit's end: we had no form to defibrillate the patient due to the fact that it was still a percutaneous approach. More so, the R2 pads had been placed incorrectly. It seemed as though everything was going against us. The placement of the pads was too inferior and lateral to the apex of the heart for proper shock (conversion) defibrillation, and, before we could catch our breaths, the next thing that went wrong was…
Clinical Experiences Journal For ten minutes, I just held her hand while her eyes slowly opened and closed. The first patient I worked with was a woman in her seventies. She had had a whole host of physical problems. Her back went out; she had a hip replacement. Now it seemed she might have dementia or Alzheimer's Disease. The medication the head nurse gave her was strong and made the woman
Clinical Experience Sunrise Clinical System Version 6.1 The Emergency Room: Hybrid System Meetings and Collaborative Care Councils Workflow of the EMR The KBC ( Knowledge Bas Charting) 3.4 Upgrade 6 The Role of the Nurse Informaticist Comprehensive Analysis of my Clinical Experience After completing 100 hours of practicum in informatics, the following will show the time at the site with my preceptor. The practicum took place at Franklin Hospital - North Shore Long Island. North Shore-LIJ which
Even as the United States struggles to cope with a critical nationwide shortage of nurses, existing nursing education programs are unable to meet the demand for unlicensed nursing students to gain real-world clinical experiences. In response, a growing number of vendors and nursing education programmers are integrating virtual clinical experiences in the nursing curriculum. Moreover, these virtual clinical experiences are especially effective because many young nursing students have grown up
Clinical Theory Practice 21st Century Points: 50 Due: Day 7 Directions: •Reflect type theory (grand, mid-range, situation-specific) applicable clinical nursing practice 21st century. •Include rationale type theory chosen. Nursing theories are conditioned by practice and research, which clarify and modulate it for the final purpose of building a theoretical framework to guide general clinical practice (Meleis, 2011). The present paper is focused on presenting situation-specific theory as ideal for nursing clinical
Their satisfaction is the only true test of the effectiveness of the organization and its staff. But unless these needs and preferences are promptly and adequately communicated to the right recipients, the objective cannot be achieved. The head of clinical audit must posses this attribute because he must be able to transmit the goals of his section clearly to those under it, those above it and those with which
27). The proficient nurses perceive situations as wholes rather than in terms of distinct aspects, and performance is determined by maxims. Perceive or perception is the main word: The perspective is not thought out but presents itself based on experience and earlier events. Proficient nurses understand a situation because they perceive its meaning in regard to long-term goals. Because of their experience, proficient nurses can recognize when the expected normal