Clinical Day 3 – Student Worksheet
Read the indicated chapters below before clinical and complete the text-related questions. Complete the “at clinical” section during the clinical experience.
Chapter 26
1. Discuss your position in the family and how that has affected your relationship with siblings and parents.
2. How have your grandparents affected your life?
3. How you would conduct a review of systems in the area of sexual health with an older adult?
4. What would be the most important factors to consider when providing education about sexuality and sexual health to older adults?
5. What resources are available for older adults who identify as LGBT in your community?
AT CLINICAL: Interview a resident who is willing.
1. What is your role in your family?
2. Do you have children? Are they married?
3. Do you feel you come from a small or large family? Why?
4. Are you a grandparent? How does it feel to be a grandparent?
5. At what age did you stop being sexually active? What impact did that have on your life?
POST CLINICAL:
Case Study:
Ms. Booth, 68 years old, comes to the senior health clinic to establish care and is accompanied by Ms. Singh, her partner of 20 years. Ms. Booth has a history of osteoarthritis in her hips and knees, coronary artery disease, a chronic obstructive pulmonary disease with a 53-pack/year history of smoking, and Type 2 diabetes with mild peripheral neuropathy. Her medications include meloxicam 15 mg daily, aspirin 81 mg daily, valsartan/hydrochlorothiazide 160 mg/25 mg daily, nitroglycerin SL 0.5 mg every 5 minutes × 3 as needed for chest pain, fluticasone/salmeterol 250 µg/50 µg inhaled twice a day, glipizide/metformin 5 mg/500 mg twice a day, and pregabalin 50 mg three times per day. Vital signs include a blood pressure of 145/88 mmHg, a pulse of 92 beats per minute, a respiration rate of 18 breaths per minute, a temperature of 97.9°F, and oxygen saturation on room air of 96%.
The nurse asks Ms. Singh to leave the room during Ms. Booth’s physical examination; however, Ms. Booth asks for her partner to stay, saying they have some sensitive questions to ask and want to ask them together. Both women appear uncomfortable. The nurse sits down, leans forward, smiles, and asks how they can help. Ms. Singh looks at Ms. Booth, then says they are afraid to have intercourse since Ms. Booth’s chest pain began 6 months ago. The nurse nods then discuss with them ways to adapt to Ms. Booth’s chronic illnesses. During Ms. Booth’s physical exam, the nurse asks Ms. Singh to leave the room. Ms. Booth, however, asks her partner to stay, saying they have some sensitive questions to ask and want to do so together. Both women look like they don’t feel good. The nurse sits down, leans forward, smiles, and asks how she can help. Ms. Singh looks at Ms. Booth and says that since Ms. Booth’s chest pain started 6 months ago, they are afraid to have sexual relations. The nurse nods and then talks to them about how to deal with Ms. Booth’s long-term illnesses.
Which strategies should the nurse recommend to improve the client’s sexual health?
Chapter 27
1. What do you think your role will be when your parent or parents need help?
2. What would you find most difficult in regard to Helping your older parent/grandparent?
3. You are preparing an 81-year-old woman for discharge following a stroke. Her husband will be the caregiver. What teaching might you provide to prepare him for the caregiving role?
AT CLINICAL: Ask a nurse:
What is the process when a patient comes back from the hospital?
Is a COVID test required prior to re-admission to the facility?
What interventions are utilized when a patient comes back post-stroke?
POST CLINICAL: Research the interventions utilized by the facility. Research why the interventions are utilized, what the rationale is, why they could be utilized, and what they might help or prevent from occurring.
Chapter 28
1. Explore your response to being given a terminal diagnosis. What coping mechanisms work for you? With which awareness approach would you be comfortable?
2. Describe the priority nursing actions related to a dying person and their family when they are especially protective of one another.
3. Describe and strategize how you would bring up the topic of advance directives.
4. What advance directive related to end of life is legally recognized in your state?
5. Describe how you would introduce the topic of dying with a patient who is critically ill and not expected to live.
AT CLINICAL: Ask a nurse about the policy surrounding a death at the clinical facility.
What is the process after the body dies?
What events occur prior to the death?
What does the facility do to facilitate a good death?
Does the facility have a contract with Hospice services? What does that entail?
POST CLINICAL:
What is an ethical dilemma?
Describe or provide details of either a real or fictitious ethical dilemma you have experienced or could experience.
What were the choices or responses that caused it to be an ethical dilemma?
What was the end result?
Case Study
Mrs. Arroyo, 78 years old, is in a hospice for end-stage dementia. She lies in bed curled in the fetal position. She is on a pureed diet with nectar thick liquids. Over the last year, she has been treated for aspiration pneumonia four times. Her weight is steadily declining. Six months ago, she weighed 115 pounds (BMI 18.56 kg/m2) and yesterday she weighed 103.5 pounds (BMI 16.70 kg/m2). Her vital signs are 88/44 mmHg, heart rate of 60 beats per minute, respiration rate of 10 breaths per minute and irregular, and her temperature is 94.2°F. Her albumin level is 2.2 g/L. Over the last day, the nurse has documented the presence of a stage 2 pressure injury measuring 5 mm × 2.5 mm × 2 mm on Mrs. Arroyo’s coccyx; the wound base is pale. Her skin is cool to touch and purplish on her hands and feet. She had one wet under pad in the last 24 hours. She is occasionally restless but is not responding to stimuli and is no longer eating or drinking. The nurse has called the family to come to the bedside, telling them death is approaching.
To facilitate a good death, which nursing actions should be implemented?
What ethical considerations can be seen here with this situation or case study?
Complete During Clinical:
HEAD TO TOE Assessment Data
This is data that you collected while caring for your patient (It is not to be information from other nurses). Use appropriate abbreviations and terminology. Remember, if something is out of the normal, you may need more assessment!
Vital Signs: Can use height and weight from patient’s chart, the rest of the VS you should be taking.
Blood Pressure:
Heart Rate:
Oxygen:
Temperature:
Respirations:
Pain:
Weight:
Height:
PAIN: If they do not have pain, list out one of the PRN pain medications and what they take it for.
Location:
Intensity: (pain scale):
Alleviating Factors, treatments, and PRN medications:
Neurological Status
LOC (alert and oriented to person, place, time, situation A & O x 4 confused, etc.):
Speech (clear, appropriate, inappropriate):
Glasgow Coma Scale Score – Eye-Verbal-Motor Score: Please write this out and tell me why you chose this score:
• Eye:
• Verbal:
• Motor:
Pupils: PERRLA?
• Pupil size before light:
• Pupil size after light:
Musculoskeletal System
Bones, joints, muscles (fractures, contractures, arthritis, spinal curvatures, etc.), extremity circulation checks (pulses, temperature of skin, sensation, edema):
Cardiovascular System
Pulses (both radial and pedal):
Capillary refill (<3 seconds):
Edema (pitting vs. non-pitting, 0-3+):
Neck vein distention:
Heart sounds (S1 S2 heard, rate & rhythm):
Chest pain: Yes/No
Respiratory System
Respiratory Rate, Depth, rhythm:
Accessory muscles:
Oxygen/ flow rate:
Pulse Oximeter:
Smoking:
Lung Sounds:
Gastrointestinal System
Abdomen: inspect, auscultate, percuss & palpate:
Symptoms:
Bowel sounds:
Last BM:
Do they have an ostomy, if so provide description:
Genitourinary
Last bowel movement:
Incontinence of bowel:
Incontinence of bladder:
Products used:
Do they have a catheter, if so provide description:
Skin and Wounds
Color & turgor of skin:
Rash/ bruises:
Wounds:
Dressings:
Sutures:
Eyes, Ears, Nose, Throat (EENT)
Eyes (redness, drainage, edema, irritation, light accommodation):
Ears (drainage, external ear intact): Nose (redness, drainage, edema): Throat (sore, color):
Mouth (teeth visualized, dentures, pain, cavities):
Psychosocial and Cultural Assessment
Cultural Background:
Religious Preference:
Home Environment:
Marital Status:
Nursing Interventions
Based on your assessment and reading, write 4 nursing interventions.
List one educational needs for your patient, the plan to meet these needs, and practical ways to you can assess the effectiveness of your teaching as well as barriers to Learning
Nursing Priority Rationale Interventions and plan to determine effectiveness.
Family Involvement in Care
1.
1.
2.
3.
COPD 1. 1.
2.
3.
Topic Description Points
Clinical Pre-Work Includes reading each chapter and completing any pre-clinical work as identified in the assignments. /5
Assignment completion Completion of the assignment in its entirety. /35
Assessment & Intervention Completion of the assessment in its entirety. /40
Grammar & Punctuation Utilizes complete sentences, utilizes a source of proof-reading such as another classmate, instructor, professor, librarian, or online source such as Grammarly. APA formatting and reference page. /10
Clinical Performance Clinical attendance, arriving on time, punctuality, and professionalism. /10
Total /100
