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D225 Time log 2 - Time log day 2 Emerging Professional Practice Western Governors University
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D225 Time log 2 - Time log day 2 Emerging Professional Practice Western Governors University
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D225 Time log 2 - Time log day 2Emerging Professional Practice
Western Governors University
, lOMoARcPSD|10754654
Hospice/Palliative Care
Discuss specific details of the education, resources, services, collaboration,
communication, etc. the NURSE provides while engaging with patients during
this direct care experience that promotes the chosen sphere of care.
Today I did 12 hours of my hospice/palliative field experience hours at Gulfside Hospice- Rucki
Care Center with my preceptor, Elizabeth Wehnes, who is an ARNP. I observed her care for a
total of 5 patients during this time. The patients ranged from 65-90 years old. Their diagnosis
ranged from dementia, CHF, Malignant Neoplasm, Respiratory Failure, COPD, and Alzheimer's.
Patient A started our day as a new admission. Patient A is a 76-year-old female who was
transferred due to pain/restlessness. My preceptor started with a focused physical
assessment. Patient A was awake but very slow to respond to questions. She is oriented to
person but not place, time, or situation. Patient A has expressive aphasia, and her vitals were
as follows: PPS 30%, BP 132/80, HR 78, RESP 20, Temp 97.1. Her lung sounds were diminished,
her heart rhythm was irregular, but her bowel sounds were active. She was placed on a pureed
diet and all meds are to be crushed with AS. My preceptor then placed a Foley due to her
incontinence. Patient A has frontal lobe staples due to a craniotomy a few days prior. My
preceptor cleaned the area thoroughly and assessed the healing process of the staples to
determine when they needed to come out. My preceptor then discussed with the daughter
about end of life care and their wishes. Patient A is a DNR with a malignant neoplasm of the
frontal lobe. Her PPS
% was 30% which means she is totally bedbound but can still eat and get medication via
mouth. Patient A is on seizure precautions so my preceptor put her on Ativan 2mg injections.
She was also placed on Dilaudid 2mg PRN. My preceptor discussed with the daughter how to
keep her Mom comfortable and happy as her end of life nears.
After we left the room, we had a discussion about PP Scale. My preceptor explained to me
that hospice care may be appropriate for patients with a PPS score of less than 70%. For these
patients, survival for more than 6 months is unlikely. Next, we reviewed some labs and went
through emails and charted.
Patient B is an 89-year-old male who was transferred in for his end-of-life care. An assessment
was performed by my preceptor to see what kind of comfort measures we could provide him.
My preceptor gave him 3 LPM oxygen via NC to help with his dyspnea due to COPD. This
patient is in Respiratory Failure and his lung sounds were diminished. His PPS% is 20%, HR 84,
BP 128/70, RESP 15, Temp 98.1. He is alert with confusion and some aggression. My preceptor
ordered Dilaudid 2mg, Ativan 0.25mg,
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