Ivo Caldera

Nursing Leadership Journal

01/09/16
Since today was the first day of the clinical rotation we met at 0800, an hour later than we
normally would report to the hospital. We met the professor in the lobby of Jackson South
Community Hospital and the class proceeded to the cafeteria to discuss the semester ahead.
Once in the cafeteria, we went around the room and all 8 students introduced ourselves to the
professor speaking about ourselves. Professor Russell finished by formally introducing herself
and spoke about her work and teaching experiences. We also went over the nursing criteria and
what was required to obtain a C, B, or A grade in Leadership as well as the schedule for
the rest of the semester. The members of the group who had a Jackson Health System badge did
a brief tour of the hospital and then we took a break for lunch of about 30 minutes. After
returning from lunch we met once again and the professor gave us some time to write our 4
course objectives which were due the following day. Once all the students were finished writing
them we discussed the objectives as a class to ensure each objective was appropriate and
achievable by the end of the semester. Once we went over the objectives for all students, the
professor made sure we knew what was expected of us to complete tonight and turn in tomorrow
morning and we were dismissed for the day.

Ivo Caldera
Nursing Leadership Journal
01/10/16
Today was the first day we would be taking care of patients this semester. I was placed in the
intensive care unit and was assigned to take care of 2 patients under the supervision of my nurse
preceptor. One of my patients was an 81 year old female that had been admitted the previous
day with shortness of breath and stated she had been feeling ill for the past 5 days with flu-like
symptoms. She was on a bipap with the setting at 12/5/40. Throughout the day the patient
would request the mask be taken off and she would be on a nasal canula set at 2L. While on the
bipap her O2 sat would be at 100%. On the nasal canula it would drop to 96 to 97%. This was
within acceptable limits, so she would be on the nasal canula for about an hour before she would
request the bipap mask again because she would feel short of breath.
The second patient was a 41 year old male who had been experiencing altered level of
consciousness from 4 days prior and had been in the hospital for 2 days. The patient was
experiencing dysphasia. He would be able to communicate certain things, but others he had
trouble communicating. He wanted to go home, but I was able to speak to him and explain that
it was better to remain in the hospital since he was being cared and evaluated to see how his
altered level of consciousness progressed. The doctor on the unit that day determined this patient
was stable enough that he could be transferred to the regular nursing unit and he was moved at
1415.
At 1530 we received another patient that came in to the hospital via the emergency room. This
patient was found unresponsive in his house. The patients ex-wife came to the emergency room

and stated that he had started dialysis but had only done one treatment and had missed one or two
appointments. Once in the intensive care unit, dialysis was performed for this patient. The
patients blood pressure was low, therefore norepinephrine was being administered to him to
maintain his blood pressure while the dialysis treatment was taking place. After the dialysis was
finished, my nurse preceptor and I cleaned the patient, since he had soiled himself since his
arrival at the intensive care unit, so he could be ready for the night-shift nurse. Since we were
turning him to clean the patient properly, the nurse preceptor and I took this opportunity to take
pictures of wounds the patient had so they could be added to his records for documentation. By
the time we were finished it was 1900 and my shift had ended.

Ivo Caldera
Nursing Leadership Journal
01/23/16
After having last week off from school due to the Martin Luther King Jr. Holiday, we were back
at Jackson South for our first full weekend of clinicals. Last time we came was our first time
meeting this semester and the first day was an orientation day, so there was no patient care that
occurred the first day.
I was placed in the emergency room and I was assigned to a nurse preceptor. The nurse
preceptor and I were in charge of caring for 5 rooms. Initially we had a patient in every room,
but one of the patients was transferred to the intensive care unit and a room opened up. Shortly
thereafter this room was used for a patient that was brought in by Miami-Dade Fire Rescue
Department through the ambulance bay. This patients family had called because the patient was
unresponsive. When the patient came in to the emergency room, the Fire Rescue Department
had already been performing ventilation and CPR compressions with a Lucas CPR machine for
over 30 minutes, so the emergency room physician declared him deceased. This was the first
time I had been in such a situation and it will be an experience I will always remember.
Throughout the day I was also helping other techs and nurses besides my nurse preceptor. This
allowed me to see more patients and gain more experience than had I only been involved in the
care of the 5 rooms my nurse preceptor had been assigned. I was able to start IV lines, draw
blood, and perform ECGs.

When our shift finished at 1900, my nurse preceptor and I saw 13 patients in the 5 rooms he was
assigned to, I was able to participate in the care of 24 patients.

Ivo Caldera
Nursing Leadership Journal
01/24/16
I was back in the Jackson South Community Hospital this Sunday morning for another clinical
day in the emergency room. Coming back for my 2nd 12-hour shift in a row, I did not feel as
tired as I expected I would be. I also felt more comfortable since I was back in the emergency
room, just as the previous day. Most of the staff from the previous day was also back. The
charge nurse was different, so I made sure to introduce myself as soon as I knew who it was.
This day the ER was not as buy as it was on Saturday, therefore first thing in the morning another
student and me restocking the supplies in the emergency rooms. This was specifically useful for
me later, when the charge nurse and I were drawing blood on a patient, we needed some supplies
and I knew exactly what we needed and where they were. The blood was being drawn from a 75
year old patient that had come to the ER accompanied by his wife and was complaining of
abdominal pain. Upon admission to the ER the patient and he was able to answer all the
questions the nurse and he was oriented as to where he was and why he was there. About 3
hours later, this same patient was having flight of ideas and was often not aware of where he was
or why he was there. He would speak about a job he had when he was in his 40s, some
incoherent sentences, and about railroads. He would move around in the bed constantly and we
had to secure the IV catheter with extra tape to ensure it would not get dislodged from the
constant pulling as he would reposition himself in bed. I was able to speak to his wife and she
shared with me some of the struggles she faces at home when her husband. She stated that at

home he is usually ok, but when he has his periods of dementia she would have trouble dealing
with him.
We had 2 patients come in this Sunday complaining of shortness of breath. One of these patients
stated she had never felt so short of breath and she has never been diagnosed with asthma. Upon
admission when I placed her on the pulse oximeter, her Sa02 level was at 93%. The ER doctor
quickly prescribed a respiratory treatment and the respiratory tech was called. The blood tests
revealed her blood pH was 7.34 and her PC02 was 48. These values indicated the patient was in
respiratory acidosis related to her impaired gas exchange as a result of her constricted airway.
After the treatment was completed, the patient was placed on 2L via nasal canula. Although
another blood test was not done before the end of my shift, after the respiratory treatment and
nasal canula intervention, her oxygen saturation improved to 98-99%. The patient was no longer
looking pale and she stated she was not feeling short of breath anymore (objective #1 met).
After coming back from break, the charge nurse and I were speaking about my schooling and
how far along the program I was. I mentioned to him that this was the last semester and soon I
would be taking HESI end of course exam. He proceeded to quiz me on how I would react to
certain scenarios and ask me what some medications were for and what side effects to look for.
He asked me to name to him the peak times of different types of insulin, since he said this was
very important to know because a large percentage of patients coming into hospitals are diabetic.
I was able to correctly and confidently answer all his questions and he gave me some advice on
what and how to study for the NCLEX exam, which I was grateful to receive (objective #4 met).
Throughout the last 2 hours of my shift I had to return a few times to the room of the
aforementioned 75 year old patient and help the wife calm the patient down and talk him into

staying in bed so he would not fall and hurt himself. I also tried to speak to the wife every
chance I went into the room and relieve her anxiety. When I was leaving for the end of the day I
made a point to go see her one last time and she thanked me for all the help I had provided to her
and her husband, and especially for all the support I had given her that day. Her words made me
feel good and the experience provided me with a greater understanding of the toll dementia can
place not only on an individual, but on the family as well (objective #2 met).

Ivo Caldera
Nursing Leadership Journal
02/06/16
Today I was placed in the intensive care unit on this our final weekend of nursing leadership
clinicals. My nurse preceptor was the same nurse I had on our first weekend in Jackson South
Community Hospital. Since I was in a unit that I was familiar with and paired with a nurse that
knew what I was capable of made me feel very comfortable. I felt like I was able to be more
useful and anticipate the needs of my preceptor and of my patients.
In the intensive care unit nurses have either 2 or 3 patients. My preceptor and I were taking care
of 2 patients. One patient of note had been recently admitted to the unit because of a fall at home
and suffered a subdural hematoma. The neurosurgeon was called to evaluate her and he
prescribed medication to control her pain and antiseizure medication to prevent any seizures
secondary to the head trauma she sustained from the fall. This case was unique in the sense that
if she had suffered the fall last month, she would not have been brought to Jackson South
Community Hospital. Only recently has this hospital started having a neurosurgeon on the staff.
I learned from the staff that the first craniotomy was performed at Jackson South just this
previous week.
It was exciting to think that I was being a part of a new service being provided at the hospital and
because of this new service, their ability to serve patients was expanding.