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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Mrs. Anne Dixon is an 87-year-old female who has been admitted to the medical unit. She is diagnosed with hypertension, osteoporosis, osteoarthritis, mild cognitive impairment, and Type 2 diabetes. She ambulates with a walker and requires Helpance with ADLs, bathing, grooming, and toileting. On Day 1, Mrs. Dixon experienced a fall while trying to get up from her bed to read a magazine. She sustained a 2 cm abrasion on her right forehead, bruising on her right shoulder, and complained of pain at 6/10 for a sore right shoulder. Her vital signs were stable, and she was conscious and alert. The physician was notified of the adverse event, and the appropriate orders were received.
Safety checks and plan:
Upon admission, the care provider ensured that the patient’s bed was in a low position, and side rails were raised to prevent falls. The care provider also introduced herself to the patient, informed her of the care plan, and assessed the patient’s understanding of the plan. The care provider instructed the patient to ask for help when getting up to read or use the bathroom and to call the care provider if she experiences any pain. The care provider also informed the family of the adverse event and the current care plan. The care provider will continue to monitor the patient’s vital signs and neuro vital signs, pain level, and mobility. The patient will receive the prescribed medication and x-ray as ordered by the physician.
Day 2:
I completed a head-to-toe assessment and a focused assessment on Mrs. Dixon’s right shoulder. I documented her skin integrity, color, temperature, and moisture, and her head-to-toe assessment revealed no other abnormal findings. Her right shoulder assessment revealed a large amount of bruising and tenderness upon palpation. I noted all my findings and will report them to the physician.
Day 3:
With the knowledge gained from the assessments, I developed two care plans for Mrs. Dixon. The first care plan is focused on pain management and includes administering the prescribed medication and monitoring the patient’s pain level. The second care plan is focused on fall prevention and includes frequent monitoring of the patient’s mobility and education on calling for help when getting up to read or use the bathroom.
Day 4:
I completed all documentation and Assessments, including SBARs used, 24-hour flow sheets, and vital signs.
Day 5:
Through this process, I learned how to perform a head-to-toe assessment, a focused assessment, and develop care plans.
Next time, I will ensure that all the necessary safety measures are in place to prevent falls.
The primary health concern is Mrs. Dixon’s fall and her right shoulder injury.
My approach was patient-centered, which means focusing on the patient’s needs, concerns, and preferences. I used this approach because it is essential to ensure that the patient receives individualized care that meets their specific needs and preferences.
My primary goal was to manage the patient’s pain and prevent falls. I administered the prescribed medication and educated the patient on calling for help when getting up to read or use the bathroom.
I learned the importance of communication, collaboration, and documentation in ensuring that the patient receives quality care.
I prioritized care for the patient by focusing on pain management and fall prevention. Pain management is essential to ensure the patient’s comfort, while fall prevention is necessary to prevent further injuries.
I expect the patient to demonstrate a reduction in pain and improved mobility based on my interventions.
My internal factors that influenced my decision-making include my knowledge, skills, and values.
My external factors that influenced my decision-making include the patient’s condition, the physician’s orders,
