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Clinical Assignment Nov13-19th

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1 Clinical Assignment Nov13-19th on Mon Nov 21, 2011 11:51 pm

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11/21/2011 Michael McDonald
Clinical Assignment for Nov 13th-19th
Last Thursday I was Catawba Pediatrics Associates. While there we, as nursing students check patients in, obtain height weight and BP, update the health history, if it is a sick visit assess the main complaints,and give a lot of vaccinations. The article I found was on the benefits of prophylactic acetaminophen (called paracetamol in this article), to reduce fevers after the injection of a vaccine. The article notes that reactions to vaccines, including fever, are common in children, although usually benign. However this discomfort leads many parents to forgo the vaccinations and it became common to give acetaminophen to assuage the feverish discomfort associated with the immune response from a vaccination. The paper describes an effect that shows prophylactic acetaminophen is effective for reducing fever post vaccination, however it also reduced the antibody responses to several vaccine antigens after primary vaccination and boosting. The drug does work as an antipyretic, but it also lessens the immune response generated by the body. The paper recommends advising parents to avoid using both acetaminophen and ibuprofen in healthy children receiving vaccinations.

http://ebn.bmj.com/content/13/3/76.full.pdf

I think what stood out to me in the first 2 chapters of Marcus Engels book, was his bewilderment during the emergent phase of his medical treatment. He describes sounds and flashes of light, pain everywhere, and people touching him, ripping off his clothes. I can easily see how we as providers, especially in emergent situations get so focused on treating the patients we could forget that they are still there, still conscious, and still human. It reminded me that even when I think my patients cannot understand me, I still need to explain my actions and address them like a normal person. The other item that struck me was Marcus’ response to the nurse asking how he would like to be addressed. I have always referred to my patients as Mr. or Ms., usually using their last name. It never occurred to me to become familiar enough to address them by their first name, or nickname. I think I will try asking my next patient how he likes to be addressed. The last item that caught my attention was his description of how comforting it was to just hold someone’s hand in a moment of extreme pain and fright. I will try to, appropriately, use a reassuring touch more often.

2 The Other End of the Stethoscope on Tue Nov 22, 2011 12:18 am

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Like you I also thought how Marcus (Marc, with a C)pointed out the importance of him being asked what name he likes to go by, to me this shows how the nurse cared about him as a individual . Also how he mentioned they treated and talked to him as you would talk to any other 18 year old was significant. To me it recognized his situation, and displayed an age appropriate interaction, which helps establish the patient trust.

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