This is the assessment data for the journal which should be 2 pages. it is a reflective journal. Then it will need 5 power point slides following the rubric below.
Below you will find some of the assessments done in this class. The journal is to be reflective so you can see what I assessed and the slides should have an AHA moment on assessment which can be the importance of education for patients. without education patients will end up back in the hospital and will not be able to live a healthy positive lifestyle.
Tina is a 28 year old girl with an infected right foot. Smart goals are:
Smart goal 1. Tina will have a pain level of 2 during 12 hour shift.
Pain will be assessed every 2 hours and pain medications will be given s ordered. Decreased pain will increase Tina’s ability to learn how to effectively control her glucose. No grimacing will show a decrease in pain level and using a 1-10 pain scale will help Tina communicate her pain level. Reassessing the pain level before and after all interventions is important in order to determine the effectiveness of your interventions (Jarvis, 2015).
After my HEENT and Skin Hair and Nails assessment of Tina I would report at shift change that Tina is 28 year old female with normal vital signs, a history of diabetes and current complaint of headache and healing wound to right foot. I would also include that she has minimal pain that is controlled with pain medication. Tina is not able to bear full weight at this time and has had some visual changes. Tina could use education on diabetes, diet and the importance of diabetic foot and eye care.
Diabetes and eye complications are vert serious. Even if your blood glucose levels are steady, diabetic eye disease can still develop. However, carefully managing blood sugar levels may slow the onset and progression of diabetic retinopathy (RNIB, 2006). Tina needs to see a specialist and a have a nutrition consultation to help her control this before she has more complications.
Tina Jones is a 28 year old African American female with a history of asthma. Her assessment revealed wheezing with rhonchi to her lower posterior lobes. She also seems to have some tightness in her chest. This is consistent with patients who have a diagnosis of asthma. Asthma is increasing in the U.S. with minorities having more complications plus decreased use of medical care (Jarvis, 2015). Educating Tina will help with her knowledge deficit of this disease process.
My cardiovascular assessment shows that Tina is a 28 African American female with a history of diabetes and an ulcer to her foot who now shows signs of high blood pressure. Diabetes increases her chance of high blood pressure as does having a close relative, poor eating habits, not enough exercise, high cholesterol and being overweight (Jarvis, 2015). Tina’s family history reveals hypertension on both her paternal and maternal sides including parents and grandparents. Tina is overweight and is not active for her age. She drinks socially but does not smoke. The doctor is considering starting her on medication. Tina also shows signs of possible poor circulation in her right lower extremity.
Practice Experiences Reflective Journal Documentation Form
This is the form required to document most Practice Experiences in the Nursing Programs at American Sentinel University. Please refer to the “Practice Experiences Reflective Journal Instructions: for guidance.
Demographic Information:
• Student Name ___StaceyJames_______________________________________________________
• Course ____BSN437PE____________________________________________________________
• Preceptor, when required _____________________________________________
Provide a statement of all actual completed practice experience activities:
Type of Practice Experience Activity
Nutrition Assessment
Skin Hair and Nails Assessment in Shadow Health for Tina Jones
Respiratory Assessment in Shadow Health for Tina Jones
Cardiovascular Assessment in Shadow Health for Tina Jones
Focused Assessment in Shadow Health for Danny Rivera
Musculoskeletal and Neurological Assessment in Shadow Health for Tina Jones
(This should provide a quick snapshot to your faculty of record of what you did for this practice experience. Add more lines if needed.)
Reflective Journaling
(Reflective Journaling should be approximately 2 pages per 8 hours of practice experience activities; See “Practice Experiences Reflective Journal Instructions” for detailed instructions of what to include in this section of your documentation.):
Include:
1. A synthesis of your reflections of the learning experiences.
2. Your achievement of university principles, program outcomes, and course learning outcomes.
3. Application of theoretical content from the course to each practice experience reflection.
4. Reflection of potential impact on your future professional nursing practice.
5. All cited references should be in APA format.
Practice Experiences Reflective Journal Documentation Form
This is the form required to document most Practice Experiences in the Nursing Programs at American Sentinel University. Please refer to the “Practice Experiences Reflective Journal Instructions: for guidance.
Demographic Information:
• Student Name ___StaceyJames_______________________________________________________
• Course ____BSN437PE____________________________________________________________
• Preceptor, when required _____________________________________________
Provide a statement of all actual completed practice experience activities:
Type of Practice Experience Activity
Nutrition Assessment
Skin Hair and Nails Assessment in Shadow Health for Tina Jones
Respiratory Assessment in Shadow Health for Tina Jones
Cardiovascular Assessment in Shadow Health for Tina Jones
Focused Assessment in Shadow Health for Danny Rivera
Musculoskeletal and Neurological Assessment in Shadow Health for Tina Jones
(This should provide a quick snapshot to your faculty of record of what you did for this practice experience. Add more lines if needed.)
Reflective Journaling
(Reflective Journaling should be approximately 2 pages per 8 hours of practice experience activities; See “Practice Experiences Reflective Journal Instructions” for detailed instructions of what to include in this section of your documentation.):
Include:
1. A synthesis of your reflections of the learning experiences.
2. Your achievement of university principles, program outcomes, and course learning outcomes.
3. Application of theoretical content from the course to each practice experience reflection.
4. Reflection of potential impact on your future professional nursing practice.
5. All cited references should be in APA format
Reflection
The presentation is clear, focused, and compelling – holds the reader’s attention. Includes significant, intriguing details – the “Aha!” factor Ideas are supported by specific examples from the physical assessment. When appropriate, rich use of figurative language and imagery to convey ideas. Overall, demonstrates depth of thought and rich use of language.
VoiceThread Presentation
Presentation is a minimum of 5 slides and discusses the learning moments from the weekly self-reflection activities.
Self-reflection Entries
6 reflections present.
Format
Organization is logical, ideas are clear, and transitions are smooth. Spelling, grammar, punctuation, mechanics and usage correct and consistent with Standard American English. No typographical errors
Last Completed Projects
topic title | academic level | Writer | delivered |
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