What resources did you have available?

Refer to the “Advanced Nursing Practice Competencies and Guidelines” found in Week 1’s Learning Resources and consider the quality measures or indicators advanced nursing practice nurses must possess in your specialty of interest. Refer to your “Clinical Skills and Procedures Self-Assessment Form” you submitted in Week 1 and consider your strengths and opportunities for improvement. Refer to your Patient Log in Meditrek and consider the patient activities you have experienced in your practicum experience and reflect on your observations and experiences. Journal Entry (450–500 words):  Learning from Experiences Reflect on the three most challenging patients. What was most challenging for each? What did you learn from this experience? What resources did you have available? What evidence-based practice did you use for this patient? What new skills are you learning? What would you do differently? How are you managing patient flow and volume? Communicating and Feedback Reflect on how to improve on your skills and knowledge and how to communicate that back to your Preceptor. How are you doing? What is missing? What type of feedback are you receiving from your Preceptor? These are 3 patient that I cared for independently! Name: I. A Age: 26years old Sex: Female Race: African American VS: B/P 105/62, PR 65, oral Temp 98.6F0; Non-labored RR 18; SpO2: 96% RM air, Ht: 5’ 2″ Wt: 140.0lbs CC: Post-op follow up from butt lift (BBL) with liposuction in Florida. The surgeon told her she has a hernia. GENERAL: Patient is A&O x4, and cooperative. Patient is here today for a follow up after surgery and complications. Patient reports feeling fatigue throughout the day since the surgery. Patient was noted having a hard time sitting down, dehydrated, abdominal hernia, and fatigue. Treatment:1. Encouraged to increase fluids intake 2. LABS: Abdomen X-ray, CMP, Lipid Panel, CBC with Plt, Urinalysis, TSH, 3. Follow visit in 1Week Patient Information: Name: M. S Age: 39 years old Sex: Male Race: African American VS: B/P 85/58, PR 102, oral Temp 98.8F0; Non-labored RR 18; SpO2: 96% RM air, Ht: 5’ 11″ Wt: 116.2lbs (Underweight) CC: Continued bilateral leg pain and low B/P 93/69 at home. GENERAL: Patient is A&O x4, and cooperative. Patient is here today for a follow up visit, lab review, and COVID 19 testing. Patient reports a 5/10 pain in the bilateral lower extremities, which is sharp and intermittent throughout the day. Patient was noted with UTI, low vitamin D, low b/p, tachycardia, weight loss, malaise, and fatigue. Treatment:1. Home care skilled nursing twice weekly due to rapid decline and disease management for 30days. 2. Nitrofurantoin 100mg 1 tablet by mouth twice daily X 10days for UTI 3. Florastor 250mg 1 tablet by mouth twice daily X 10days for Probiotic. 4. Vitamin D 50,000unit 1 tablet by mouth daily X 2weeks for Supplement 5. Oxcodone-Acetaminophen 5/325mg 1 tablet by mouth twice daily X 30 days 6. LABS: COVID-19 7. Follow visit in 1 month 3 Patient Information: Name: L. B. Age: 57 years old Sex: Male Race: African American VS: B/P 136/84, PR 90, oral Temp 98.6F0; Non-labored RR 20; SpO2: 98% RM air, Ht: 5’ 9″ Wt: 268.4lbs (Overweight) CC: Skin rash and lower back pain. GENERAL: Patient is A&O x4, and cooperative. Patient reports having a very painful feeling in his lower back, which may end up affecting his job as a warehouse worker that lifting is important. Patient was noted to have skin dermatitis, hypertension, and elevated blood sugar 171. Treatment: 1. Dapsone 25mg 1 tablet by mouth daily for Dermatitis X 30 days 2. Triamcinolone 0.1% cream topical daily X 30days 3. Flexeril 10mg 1 tablet by mouth at bedtime for pain X 14 days 4. Administer Pneumococcal, Tdap, and Shingrix vaccine 5. X- ray of lumbar spine due to persistent pain, CD4 count absolute, CD4 quantitative. 6. Gastroenterology referral to evaluate and treat colonoscopy. Family history of colon cancer. 7. Follow visit in 2 weeks