I did my episode of care on a stroke ward. All care was delivered under the supervision of my practice assessor. I cared for all six patients in the bay, but I will specifically talk about the care delivered to one particular patient. This patient is eighty-eight years old and was admitted for a stroke. She had L-side weakness, aphasia, and a reduction in mobility. The handover, of the patient was taken from the night nurse. Firstly, I introduced myself, asked what she preferred to be called, and gained consent before performing any duty. I always applied my hand hygiene and PPE when needed. I did my safety checks to ensure the suction and oxygen were working, and oxygen masks, yankers, and other equipment were available. I then read her care plan on the cerner to obtain more information about her. She was nil by mouth and was receiving nasogastric feed, which was started at 5.48 am. It was supposed to run for 15.4 hours when it was handed to me. This patient had a medical history of atrial fibrillation, confusion, type 2 diabetes, hypertension, and hypothyroidism. After following the eight rights of administration of drugs, I administered all her morning medications. Since she had an NG tube and the medications were tablets, I had to crush them. Her morning medications were as follows: colecalciferol, digoxin, famotidine, IPC, levothyroxine, metformin, sterile water, and verapamil. Patient observations and all the purposes, side effects, and contraindications of the medications were checked before the administration.
Personal care was given to the patient. All pressure areas were checked. The patient opened his bowel, which was documented
The patient had hyperglycemia with a capillary blood glucose (CBG) of 19.6 mmol/L when checked. My practice assessor, who was told, also informed the doctor, who increased the metformin for the patient.
200 ml of sterile water and IPC were the only prescribed medications for the patient in the afternoon. I used the purple 60 ml syringe to give the water through the NG tube under supervision with my PPE on. I did the afternoon observation of the patient. The patient’s CBG was rechecked, it was now 18.5 mmol/L. She was repositioned every two hours, her pad changed, and made comfortable. She slept a bit, and her family also visited her.
I did my risk assessments, such as the waterlow score, and because she scored 27, I ordered an air mattress for her to prevent pressure sore. I checked her skin integrity to make sure there was no pressure sore. It was intact. Fall risk assessment was also done including her careplan. I did my nursing documentation using the wards template. Everything was done under my practice assessor supervision.
I administered the patient’s evening medication after going through the eight rights of medication. The medication she had was famotidine and metformin after crushing them. I gave the drug through the NG tube. I first stopped the feed and flushed it with sterile water, gave the medication after mixing it with water, and flushed again with water after kinking the line. The patient was made comfortable with the feed still going. All care was documented and handed over to the night staff before going home.
The care delivered was evidence-based and person-centered. Although the patient was not bringing out words, she responded to communication with her hand and eyes.
What did you do well?
I independently cared for a stroke patient with an NG tube under supervision. Care was delivered according to the policies and procedures of the hospital. After checking the CBG and the observations, I reported all the abnormal readings to my practice assessor. Her CBG was 19.6 mmol. My assessor also informed the doctor, who increased the patient’s metformin. Patient CBG was later rechecked, which was then 18.5 mmol. Through the waterlow risk assessment I did, the patient was moved from a normal bed to a pressure-relieving mattress to prevent pressure sores.
What would you have done differently?
Nothing since I worked under the supervision of my practice assessor. I sought her advice and help in the decisions I made. She supported me in making sure the quality of care was delivered according to the NMC (2018) code, NICE guidelines, and hospital policies and procedures.
Describe how you have begun to work more independently in the provision of care and the decision making process.
I can care for the patient independently under supervision. After filling out the patient Waterlow risk assessment, the score was 27, which was above normal. I then discussed with my assessor that the patient should have a pressure relief mattress instead of the normal mattress. The patient was then transferred onto a nimbus mattress to prevent pressure ulcers. The patient was having high CBG, so the doctor was informed, who then increased her metformin and asked us to monitor it. While giving patients personal care, I check all the pressure areas. Throughout my care, I made sure I maintained my protective equipment when needed, especially hand hygiene to prevent cross-infection.
What learning from this episode of care could be transferred to other areas of practice?
I have acquired a better understanding of stroke. I can deliver quality care to stroke patients who have NG tube.