1. Appelhof, Steven
Professor Wilson
Ballard Rehabilitation Hospital
Inpatient Rehabilitation
Clinical Journal #4
During my fourth set of three rotations at Ballard Rehabilitation Hospital with my
preceptor, I continued to perform routine assessments, oral medication administration,
subcutaneous medication administration as well as intramuscular medication
administration and an intermittent catheterization that was due every 4 hours on a patient
who was in a motorcycle accident with paraplegia and a neurogenic bladder requiring
manual retrieval of urine. During the shift, a patient who was not my own required
immediate blood draw and straight catheterization in order to get cultures to determine
what the underlying illnesses were in this patient that were causing altered level of
consciousness in the client. This patient ended up becoming unresponsive and did not
react to the sternal rub we initiated. The patient was here for a mid brain stroke and upon
him losing consciousness, we called a code and had to med him out to a near by ER. The
patient had a blood pressure of 200/114 and was showing signs of recurrent stroke. After
the patient was transported out we returned to our normal schedule and returned to the
floor. Some patients requested more pain medication for pain control from having
therapy. Humanbecoming theory was utilized during my plan of care when the patient
who needed to be medically transported out began to decline I took his hand and kept
asking him to talk to us as well as try to keep him oriented with us. My personal
background involves stroke and Alzheimer patients so I have a particular soft spot for

2. neurological patients. I felt incredibly called to help this client because I would want all
the help I could get if it were a colleague who had a stroke or even myself. To further
improve my skills and strategies I would make it a smart goal by improving my
comprehension and recollection of the straight catheterization to where I could perform
the activity as a second nature approach with using the information I possess as well has
continuing practicing the proper techniques to make the procedure go more smoothly and
get the procedure without breaking sterile technique on the first try. I would be able to
perform this by refreshing my knowledge of the intermediate catheterization and
watching the online videos of how it is done properly. Multidisciplinary care is
implemented with the patient based off their needs and wants. 3 examples would include
the following: 1) the patient requests to focus on activities of daily living to increase
independent function so the nurse relays the request to the physician and physical
therapists to begin the independency process. 2) The physician knows what the patient’s
wishes are for respiratory reconditioning so the physician orders a breathing treatment to
be given by respiratory therapy. 3) The patient is willing to participate in ambulation post
surgery so the nurse communicates with the NAP to assist in ambulation. Reflective
question number 3 was utilized.