On The Job Training Experience: Being a Caregiver (4)

Fourth day of duty, March 24,2006:

My new assignment was at the Female Ward II. The patient was a woman aged 52, married, admitted on March 22, 2006, and was diagnosed of Shortness of Breathing (SOB). The procedures I did were: To make up the bed but the husband refused, and made a close monitoring of patient's blood pressure for it was found out to be unstable. I had in mind to invite the patient for a stroll down the hallway back and forth, but I realized it was not fitted for the her B.P. was unstable. So, I did not pursue what was in my mind.

As an SOP, I took her vital signs and regulated the I.V. fluid drops.

My evaluation:

My physical examination to the patient started since I introduced my self to her and when she started talking to me (indirect PE). I did a close observation on her physical condition just because I thought the SOB diagnosis or information from the clinical instructor before coming into the ward was something like a critical one. During the course of our conversation, it came out from her words that the diagnosis was caused by asthma. She had been suffering from it since she was 16 years old. Hence, at her age 52, chubby physique, active and conversant, I found a way to limit her talking due to her respiratory problem by means of doing other bedside care.

Through the presence of two nursing students who were assigned to do monitoring of the patient's condition, I learned that the patient was hypertensive. So, I decided to do the BP taking every hour and I tried to compare it with their results.

During the changing of bed sheet, I offered to do it by myself but the patient's husband refused. So, I let him did it by himself by respecting his right to independence. I did not insist. Though, thee were still some aspects that the patient could do things with higher degree of independence like getting up or getting out of bed, especially when she was going to urinate on a plastic pail which was kept covered under the bed when not in use. The patient could change positions by herself from turning to sides in bed, sitting on the bed to lying on her back in bed as long as it did not complicate to her difficulty in breathing. In this case, I saw and felt that the situation was tolerable and I had nothing to worry about her.

Furthermore, the patient said that at times when there is an asthma attack she could not easily breath in supine position but rather on an upright sitting position. In relation to the patient hypertension, she had no complain about her condition despite of the unstable BP. Although, I suspected that prolonged sitting position caused the increase of blood pressure as well as her exertion to breathe during asthma attacks.

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