Nursing Journal Day 5



By Roger ~ May 20th, 2013. Filed under: What's Up?.

For my May term course I have to keep a journal of daily events. It’s our first course that’s hands-on with patients. In the end we will qualify as CNAs. That’s the frame of reference for the journal, just so you don’t expect too much. Since I have to keep a journal, why not share it on my blog? This one had to be hand written and turned in before we left on Friday, so I didn’t have a copy to post here until it was returned.

SOAP and DAR narrative types added. We jumped right into vital signs. The morning meal came, and we went into the shift assessment. I forgot another major portion of the assessment, CSMs. I did remember the pulses I forgot yesterday. Between the two, I did a completely thorough assessment.

I helped reposition a patient with a jugular IV so that her pump would stop the occlusion alert. I also toileted a patient from the floor and documented her output.

I documented my patient’s output, apparently something we forgot to do yesterday. There was 3200 mls in the commode when nursing emptied it last night.
My patient got another bed bath and linen remake. Then OT and PT came, keeping her busy the rest of the day.

Yay for the weekend and sleep!

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