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D225 Time log day 1 Emerging Professional Practice Western Governors University
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D225 Time log day 1 Emerging Professional Practice Western Governors University
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D225 Time log day 1 EmergingProfessional Practice Western Governors
University
, lOMoARcPSD|10754654
D225 Time Log
2/20 Chronic disease management: 12 hours
During my twelve-hour field experience, I shadowed a BSN nurse in the home health
setting. We saw a total of six patients. To start the day, my preceptor gave me a background of
each patient on the schedule. She reviewed the EMR system, patient medical records, and each
patient’s chart scheduled for the day, and we made a plan for the visit. The nurse and I agreed I
would take vital signs, confirm medications and allergies, and document and assess wound
measurements for each visit, when applicable.
The first patient was a 67-year-old male with type 2 diabetes, hypertension, and a great
toe amputation. This patient dropped an antique iron on his foot six months ago and required the
removal of the toe. Due to his diabetes and abnormal wound healing, the nurse is making weekly
visits to this patient’s house. This patient is a heavy smoker and frequently ambulates without
using the heel-touch technique the nurse taught him. The patient stated he walked out of his
house and hit his foot on the garage door which caused the wound to re-open. The patient states
he is feeling depressed because he is required to sit with his leg elevated and he is an active and
social person so this depresses him. I observed the nurse perform a depression screening and ask
about social support. In addition, the nurse provided resources within the community, including a
free firefighter dinner and an art show the following weekend, which excited the patient. I
observed the nurse remove the wound dressing on the patient’s foot, assess the wound, and
perform measurements. She created a clean workspace with a barrier and then proceeded with
wound care as directed by the doctor, using aseptic techniques to avoid infection. The patient is
given instruction, and demonstration, and asked to provide understanding utilizing the teach-
back method for the following: cleansing the wound, dressing the wound, proper elevation, and
heel-touch ambulation method. The nurse was pleased with the patient’s understanding.
Furthermore, the patient was running low on wound care dressing supplies, so the nurse ordered
supplies through the home health organization supplier online. I also encouraged the patient to
quit smoking and provided a list of foods to avoid with hypertension and diabetes to improve his
overall health and wound healing.
The second patient was an 88-year-old female with dementia. Under the supervision of
my preceptor, I assessed the resident. She had a decreased appetite for three days, increased
agitation with combativeness, and foul-smelling urine. The patient’s doctor was notified and he
ordered STAT labs and urinalysis with culture and sensitivity to obtain. Within the CBC, the
patient’s labs showed an elevated white blood cell count. Urinalysis detailed cloudy amber
urine, numerous white blood cells, and nitrite-positive. I contacted the MD and notified him of
the results. The patient was prescribed a one-time dose of antibiotics given intramuscularly. The
MD stated to contact him with the results of the culture and sensitivity when available. The
nurse and I then spoke with the med-assist staff member who provided us with the patient’s
family contact. I provided an update on the patient’s condition change and new orders provided
by the MD. I observed the nurse educate the staff on urinary tract infections in the elderly
population.
The third patient we saw was diagnosed with Exocrine Pancreatic Insufficiency last year.
The patient is a 75-year-old female. She stated she has fairly consistent diarrhea that occurs
approximately ten minutes after she eats or drinks. The patient smokes a pack a day, is not
interested in cessation education, and has neuropathic pain, and diabetes. After our introduction,
I took the vital signs and assessed her coccyx wound. Next, we took her weight. She is 76
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