Purpose:
To encourage learners to explore the possible/probable client population that they will be caring for during their final Preceptorship experience
Learning Outcomes:
• Student self-Assessment of learning needs
• Preparation of a learning plan appropriate to the placement
• Review and practice relevant knowledge, skills, and abilities
• Self-reflective practice and leadership
• Review of interprofessional competencies
This activity encourages growth in the following areas:
• BCCNM LPN Entry-Level Competencies
• BCCNM LPN Practice Standards
• BCCNM LPN Professional Standards
• BCCNM Scope of Practice
Process:
• Choose 1 assignment, Long-term Care, Medical or Surgical Unit.
• Complete the following five-day assignments (1 hour each day). Once completed upload all work to the portal on Day 5.
Day 1:
Client Specifics:
• Mrs. Anne Dixon – 87 years old
• Dr. Cyril MacLeod – primary physician
• Family contact – Matthew Dixon, son and named agent on the personal directive
• Medical diagnoses – hypertension, osteoporosis, osteoarthritis, mild cognitive impairment, Type 2 diabetes
• Functional – ambulates with a walker and requires Helpance with activities of daily living (ADLs), bathing, grooming, and toileting.
What happened? Care providers are alerted by hearing a loud crash and yelling in the client’s room. Mrs. Dixon’s roommate, Emily Miles witnessed the fall. At 1300 Anne is found lying on her right side on the floor at the bedside in front of the night table. She denies loss of consciousness but is not sure if she bumped her head. She has a 2 cm abrasion on the right side of her forehead that is oozing blood. She is moving all her limbs and complains of pain at 6/10 for a “sore right shoulder”. A large amount of bruising was noted on the right shoulder. Vital signs are BP 130/86, T 37.1 C (t), P94, R 22. O2 sat is 95% on room air. PEARL. Anne also tells the care provider that she was trying to get the magazine from her night table so she could get up and read in her easy chair. When she got up, she became dizzy and fell. She is awake and aware of her surroundings after the fall. Her speech is clear and coherent and her hand grips are strong bilaterally. The physician was notified of the adverse event at 1315. Physician orders neuro vital signs for 3 hours every 15 minutes, 1 tablet of Tylenol # 3 for pain every 3 hours as required, and an x-ray of the right shoulder. Anne is Helped back to bed with a second care provider. The laceration on her forehead receives first aid treatment. The family is notified of the adverse event. Anne is instructed to ask for help when she gets up to read or to use the bathroom. She is to call the care provider if in pain. The client is left in bed in a safe position.
• Write out a complete introduction of your patient along with things like safety checks, your plan, and any other necessary requirements you deem necessary/important.
Day 2:
Complete a head-to-toe assessment and any focused assessments that are needed. Document every step taken on all assessments. (Keep notes)
Day 3:
With the knowledge gained from head-to-toe and focused assessments complete two care plans for your patient (ask the instructor for the requirements of the care plans).
Day 4:
Complete all documentation and Assessments from the assessment. This may include SBARs used, 24hr flow sheets, V/S, etc.
Day 5:
Answer the following questions with descriptive full sentences:
1) What did you learn in that process?
2) What might you do differently next time?
3) What did you find as the primary health concern?
4) How would you summarize your approach? Provide rationale.
5) What was your primary goal?
a. What actions did you take?
6) What did you learn from this scenario?
7) How did you prioritize care for your patient? Provide rationale.
8) What outcomes would you expect the patient to demonstrate based on your interventions?
9) What internal factors influenced your decision-making?
10) What external factors influenced your decision-making?
11) How did you utilize your BCCNM Scope of Practice and Entry-Level Competencies? Provide 5 examples for each document.
References:
British Columbia College of Nurses and Midwives (2021). Licensed Practical Nurses Entry Level Competencies. Retrieved from https://www.bccnm.ca/Documents/competencies_requisite_skills/LPN_Entry_Level_Competencies.pdf
British Columbia College of Nurses and Midwives (2014-2022). Practice Standards for Licensed Practical Nurses. Retrieved from https://www.bccnm.ca/LPN/PracticeStandards/Pages/Default.aspx
British Columbia College of Nurses and Midwives (2020). Professional Standards for Licensed Practical Nurses. Retrieved from https://www.bccnm.ca/LPN/ProfessionalStandards/Pages/Default.aspx
British Columbia College of Nurses and Midwives (2021). Scope of Practice for Licensed Practical Nurses. Retrieved from https://www.bccnm.ca/LPN/ScopePractice/Pages/Default.aspx
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Day 1: Introduction and Plan
Mrs. Anne Dixon is an 87-year-old female with a medical history of hypertension, osteoporosis, osteoarthritis, mild cognitive impairment, and Type 2 diabetes. She is ambulatory with the Helpance of a walker and requires help with activities of daily living (ADLs), bathing, grooming, and toileting. Following a fall, she has a 2 cm abrasion on the right side of her forehead and complains of pain at 6/10 for a “sore right shoulder,” with a large amount of bruising noted on the right shoulder. Vital signs are within normal limits except for an O2 sat of 95% on room air. The physician has ordered neuro vital signs every 15 minutes for three hours, one tablet of Tylenol #3 every three hours as required, and an x-ray of the right shoulder. My plan is to conduct a thorough assessment of Mrs. Dixon’s physical and cognitive health to develop a care plan that addresses her needs and ensures her safety. I will also communicate with the physician and family to ensure that everyone is informed of her condition and care plan.
Day 2: Head-to-Toe Assessment
During the head-to-toe assessment, I checked Mrs. Dixon’s vital signs, skin integrity, neurological function, cardiovascular and respiratory system, musculoskeletal system, and gastrointestinal and urinary function. The assessment also included a fall risk assessment, mental status assessment, and pain assessment. I documented the results of each assessment in Mrs. Dixon’s chart to help inform the development of her care plan.
Day 3: Care Plans
Based on the assessment findings, I developed two care plans for Mrs. Dixon. One plan addressed her immediate needs following the fall, including pain management, neurological monitoring, and fall prevention. The second plan addressed her long-term needs related to her chronic conditions, including medication management, skin care, and nutrition.
Day 4: Documentation and Assessments
I documented all assessments, care plans, and interventions in Mrs. Dixon’s chart. I also completed SBARs and flow sheets to provide a clear and concise summary of her condition and care plan.
Day 5: Questions
Throughout the process, I learned how to conduct a thorough assessment and develop comprehensive care plans that address both immediate and long-term patient needs. I also learned the importance of clear and concise documentation and effective communication with the patient’s healthcare team and family members.
In the future, I would prioritize involving the patient and family more in the care plan development process to ensure their needs and preferences are addressed.
