Reflective Journaling (#2)

Karli Holt 2/14/17

Noticing

Patient is 71 years old, admitted with headache, right leg pain, weakness,
dehydration, and failure to thrive. The patient is a full code with allergies to
ciprofloxacin, Keflex, sulfa, and amoxicillin. This patient has a history of breast cancer,
bronchitis, type two diabetes mellitus, dizziness, hypertension, pneumonia, and urinary
tract infections. The patient has a flat affect and is refusing medication as well as food.
She will not get out of bed or speak unless being asked a yes or no question. The most
she stated was, I want you people to leave me alone. This presentation sparked a flag
that there was a problem.

Interpreting

The patient was scheduled for discharge, however it was clear it would be a short
amount of time before she would be readmitted. Therefore, further evaluation was taken
to figure out if the patients behavior was psychological or due to a physiological
condition. The family arrived and was able to get a little more reaction from the patient
but not much. My nurse and I talked with the family about the patients status to see what
their views are and proceed from there.

Responding

We discussed with the family, including the power of attorney, the extent of care
the patient may want. They told us that the patient expressed about a week prior that she
didnt want to go on like this. The family agreed to speak with palliative care. A MRI
was also scheduled. The results showed that cancer had metastasized to the brain and
lungs. The family was shocked and upset to hear the results because they were last told
that the patient was cancer free. According to Zimmermann et al. (2014), early palliative
care for patients with advanced cancer is highly encouraged due to positive outcomes.
The power of attorney and the rest of the family agreed this is what the patient wanted. I
knew that I was making the right decisions in this case because while the whole
healthcare team was involved, the family and patient were the ones leading the decisions
in a smooth and appropriate manor. To delegate interventions I informed the patient care
technician to keep a closer eye on the family incase they needed little things such as a
blanket, box of tissues, etc. It is important to go above and beyond to provide the family
with anything possible during such a tough time. I watched closely as well and made
myself available if they needed anything.

Reflecting

My shift ended shortly after the MRI results came back and the family was still
coping with the news. While it was a very tough situation I believe that proper steps were
taken to help the family get answers and to figure out the patients status. I believe the
family will be transferring over to palliative care in the very near future, which appears to
be the patients wishes. What I did well was that I treated the patient kindly and was there
for the family members. Previous nurses were slightly disrespectful to the patient since
she would not communicate or help care for herself but I showed her respect and tried my
hardest to raise her spirits. I also made the family feel at home and did everything I could
to make things easier on them. I could have done a better job at further analyzing all of
the possible reasons the patient might be appearing as she was. Overall, it was a great
learning experience.

Resources

Zimmermann, C., Swami, N., Krzyzanowska, M., Hannon, B., Leighl, N., Oza, A., . . .
Lo, C. (2014). Early palliative care for patients with advanced cancer: a cluster-
randomised controlled trial. The Lancet, 383(9930), 1721-1730.
doi:10.1016/s0140-6736(13)62416-2