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Clinical Assignment for Nov. 20th-26th.

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1 Clinical Assignment for Nov. 20th-26th. on Mon Nov 28, 2011 1:21 pm

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11/28/11

Clinical Assignment for Nov. 20th-26th

These two chapters of our book were some of the more interesting ones for me so far. I have always wondered about the blunt aspect of bad news and how that effects a patient. I have not had the experience of delivering bad news personally to a patient, but I have been present when bad news is delivered to both patients and family members. A blunt delivery seems cruel, but Marcus says that it was for the best. I guess that the theory is that a blunt response presents the info and lets the patient immediately go into the stages of grieving needed to process the news in as healthy a manner as possible. I have noticed that my attitude has gotten a little more blunt as I have grown older, and I realize that people's feelings are best handled with honesty and realism. A patient is not different. I would hope that when it comes to be my turn to deliver bad news, that I can remain objective and real. Giving blunt information in as caring a manner as possible, not sugar coating, and not seeming uncaring. Walking that fine line between uncaring, and not sugar coating seems to me to be the balance that needs to be struck. When I am in clinical, I try to find a common ground with my patient to establish rapport. I try to do this by asking about their job, family, and hobbies. Somewhere there is something for us to talk about. I avoid politics and religion. I can tell that I have gotten better at this than I was when we first started clinical last year.


Seven interventions for a Diabetic patient. Related to Perfusion, Infection, Immunity.

1.Evaluate and document peripheral pulses, especially dorsalis pedis pulse. Diabetic patients are at an increased risk for poor peripheral circulation. Poor circulation also places the patient at risk for infection.
2.Regularly evaluate and document eyesight ability. Diabetes can cause damage to the smaller blood vessels in the body, especially the retina. Diabetic retinopathy is a degeneration of the retina due to poor circulation from vessel damage.
3.Evaluate and document peripheral sensorymotor sensation. The poor peripheral circulation leads to neuropathy which places the patient at risk for infections, due to not noticing injuries.
4.Inspect and evaluate peripheral body sites for injuries on a regular basis. Due to poor circulation and neuropathy, injuries on the extremities (especially the feet) are at an increased risk for infection. If left unnoticed these infections can result in loss of limb
5.Evaluate Lab work, especially white blood cell count, with differential. Elevated WBC count with left shift in neutrophils indicates an infection somewhere in the body. Another evaluation tool for possible infections of the extremities.
6.Evaluate and document breath sounds. Diabetes decreases the immune response and increases inflammation, this combined with the microvascular damage that can occur leaves the patient at a higher risk for developing pneumonia.
7.Evaluate heart function on a regular basis. Microvascular and macrovascular changes due to diabetes can place the patient at an increased risk for heart failure and heart attack.

Three med classifications that can potentially cause hyperglycemia.

1.Corticosteroids. An example is prednisone.
2.2nd Generation Anti-psychotics. An example is Zyprexa (olanzapine.)
3.Thiazide diuretics. An example is is Oretic (hydrochlorothiazide.)

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