Reflective Journal Older Adult Cedar Hills Langley Student Name Dermot Connolly Stenberg College

Monday Sept 17th 2012 I have noticed that my confidence levels have increased since your midterm and I think it is because I had a favorable review from Mary. I find that whenever I am attempting something new, my anxiety levels tend to be elevated so its nice when you receive positive feedback. I was disappointed last week when I did not get a chance to complete a mini mental status exam (MMSE) on Bessie, so I was determined this week to get it completed. My day on Monday was an interested one. Shortly after giving Bessie her personal care, the resident in the next bed, Joan began throwing feces onto the floor beside her bed. The incident was first noted by one of the care aides whose response did nothing to alleviate any distress, anger or embarrassment that Joan may have felt. The care aide screamed and went to the corridor where she explained to the other care aides what had happened. This discussion was quiet loud and was carried into one of the other residents rooms. Within minutes Joans bed was surrounded by several care aides who appeared to be horrified by what they saw. They first questioned Joan as to why she had thrown her feces before one of them asked me for my explanation from a psychiatric perspective. Joan did not answer their questions and my response was to explain that we need to understand why Joan felt she had to throw her feces, perhaps she is angry over something which would need to be investigated. Joan was clearly in distress as she frequently swore at the care aides. Her agitation was compounded when the care aides began to restrain her as they cleaned and changed her. The use of restraint I felt was excessive in the absence of any dialogue which I felt could have alleviated the situation. While I felt the situation could have being handled better by the care aids, I was however very impressed by the physical assessment that they completed on Joan while changing her. They noted that both of Joans feet were very cold and blue in color. They escalated this to

Debbie, the registered nurse on duty. The response I witnessed from the care aides was in stark contrast to the response I witnessed from Debbie. When Debbie arrived into the room, the first thing she did was to draw the curtains to the windows outside where some people were standing. She next drew the curtain around Joans bed and proceeded to check for her dorsalis pedis pulse. She was quickly able to locate a pulse in Joans right foot but not in her left. She suggested wrapping her foot in a warm blanket to help improve her circulation and then she left. I felt she handled the situation very professionally and efficiently without making Joan feel uncomfortable or shamed. Later in the afternoon, I completed a MMSE on Bessie. I began by asking her if I could ask her a few questions to check her memory and she complied. I was conscious not to relay too much information as to the nature of the test as I did not want to cause her any anxiety. Bessie did not score very high in the exam, scoring only 12 out of a possible 30. Bessies score did not surprise me as she frequently gets confused when asked to recall events from memory and often forgets which room she is in. I noted while I was completing the MMSE that I felt a little guilty asking her questions I knew she could not answer. I sensed her embarrassment at times and I frequently tried to reassure her that she was doing great. The MMSE was a real eye opener to me, as it gave me a true understanding as to Bessies true cognitive abilities. As I reflect on it now, I think it would have been better to complete a second MMSE on another patient for comparison. For the remainder of the afternoon, we took part in a conference where we discussed several case study examples and brainstormed ideas back and forth as to the best way to deal with each case study. I found this conference very beneficial as it really started to get me thinking about the level of nursing knowledge I needed to get too. This gap in knowledge is one I

am keen to bridge quickly which causes me anxiety on one hand but on the other hand, drives me. Tuesday Sept 18th 2012 Tuesday was our first evening shift and I was quiet excited about it as I was curious to see if we would see any different behaviors in the evening time when compared to the day shift. I had being a little anxious about giving personal care and medications to two patients during the day shifts as I was afraid I would run into time management issues and issue some of the medications too late. I used the evening shift as my dry run at giving both Bessie and Reta their medications. I felt the medications went quiet smoothly and I felt my good techniques help me identify a suspected missed medication entry on Bessies MOR where her first dose of 3mg Rivastigmine medication was not charted. I reported this error to Mary before highlighting it on the MOR. Later into the shift, a new physicians order came in for Bessie to monitor her for hallucinations. The order was written as there has being a notable increase in the amount of hallucinations being reported, including dead children and guns in patients beds. The physicians order noted that the hallucinations could be a result of Bessies macular degeneration or a side effect of her Rivastigmine medication which was just about to be increased. There were two things that concerned me about the physicians note, 1) if the medication could be causing the hallucinations then why increase the dose and 2) from looking at the drug guide for Rivastigmine, increasing the dose in older adult >85 should only be pursued with caution. Bessie is 94. This got me wondering about how much thought is really given by physicians when prescribing medication and if the patients and families are made aware of these risks. Overall I

really enjoyed the evening shift this week, I enjoyed the slightly slower pace as it gave me more time to investigate questions in more detail.