Nursing Assignment: Reflections on Clinical Practice in Surgical Ward

This nursing assignment is a reflective essay detailing a student's experience in a surgical ward, focusing on an incident involving a patient with post-operative intestinal obstruction. The student reflects on the administration of medications, including acetaminophen, heparin, and metoclopramide, and the subsequent adverse effects and medication errors. The essay utilizes the Gibb's reflective cycle to analyze actions, observations, and thoughts, highlighting the importance of accurate medical record review, appropriate dosage, and patient monitoring. The reflection emphasizes the need for improved pain management techniques, the use of pain assessment tools, and a proactive approach to patient care to avoid medication errors and enhance patient outcomes. The student acknowledges the impact of the experience on their future practice, including improved patient-nurse relationships and handling acute cases.

Running head: NURSING ASSIGNMENT
Reflections in clinical practice
Name of the Student
Name of the University
Author Note

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Nurses have to learn from their previous experiences to gain skills that are required for a
thoughtful practice. I will reflect upon an incident I had experienced using the Gibb’s reflective
cycle in this essay. This reflection will help me to evaluate the actions, observations and thoughts
that underpin the decisions related to healthcare. During my placement in the surgical ward, I
came across Mr. Smith in the post-operative ward following surgical intervention for intestinal
obstruction. The senior nurse-in-charge briefed me and two other nurse trainees about the case.
He was screaming for the need of pain killers to reduce abdominal pain.
I administered an oral dose of 1000mg acetaminophen (Tylenol) for every 4 hours.
Acetaminophen blocks prostaglandin synthesis, thereby lowering inflammation and pain in the
body (Blieden, Paramore, Shah, & Ben-Joseph, 2014). His pain seemed to reduce for few hours.
However, he suddenly started complaining of swelling in upper abdomen, followed by mild
bleeding from the surgical site. During handover, a second nurse trainee did not go through his
medical charts. She administered a single subcutaneous injection of 2,000 USP units/2 mL
heparin sodium to stop bleeding. This aggravated his symptoms he had abdominal cramps
(Anders & Trautmann, 2013). Finally, a third nurse used an intramuscular 10 mg dose of
metoclopramide. She repeated the process after 4 hours. His abdominal cramps and bleeding
from the surgical site reduced (Kraft, et al., 2014).
I felt that a strong analgesic was needed to be administered to Mr. Smith. Hence, I
administered an oral dose of acetaminophen (Bullock & Manias, 2013). However, the dosage
exceeded the required limits and led to the side effects. Pain is often a subjective experience and
may have psychological aspects associated (Macintyre & Schug, 2014). The poor medication
shown by one of the nurse while injecting heparin injection helped me realize that close scrutiny
of medical records is essential before any treatment. The good practice shown by the nurse who

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gave an intramuscular dose of metoclopramide helped me realize that accurate documentation of
drug activities is imperative to minimize any medical errors in a patient.
It was essential to monitor his medical history accurately before he was given any pain
killers upon complaining of abdominal pain (Coleman, et al., 2012). This would have helped to
evaluate the side effects that can occur and aggravate his symptoms. His vital signs like fluid and
electrolyte balance, dehydration and nausea should also have been looked out for before giving
the oral medicine.
My action plan will include be significantly different if such a situation arose again. I will
look at the patient’s documents and will try to increase the efficacy of pain management
techniques. I will also use pain assessment tools like verbal description scale sot evaluate the
severity of pain caused (Hill, Hall, & Glew, 2017).
Thus, it can be concluded that the reflection helped me explore and gain more awareness
on medication errors. The event helped me gather evidences that I will be able to utilize further
while working in the post-operative setting. This will help me increase my patient-nurse
relationship and deal with such acute cases.

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Bibliography
Anders, D., & Trautmann, A. (2013). Allergic anaphylaxis due to subcutaneously injected
heparin. Allergy, Asthma & Clinical Immunology, 9(1), 1.
Blieden, M., Paramore, L. C., Shah, D., & Ben-Joseph, R. (2014). A perspective on the
epidemiology of acetaminophen exposure and toxicity in the United States. Expert review
of clinical pharmacology, 7(3), 341-348.
Bullock, S. &. (2013). Fundamentals of pharmacology. Pearson Higher Education AU.
Bullock, S., & Manias, E. (2013). Fundamentals of pharmacology. Pearson Higher Education
AU.
Coleman, K. J., Ngor, E., Reynolds, K., Quinn, V. P., Koebnick, C., Young, D. R., & Sallis, R.
E. (2012). Initial validation of an exercise “vital sign” in electronic medical record . Med
Sci Sports Exerc, 44(11), 2071-2076.
Hill, R., Hall, H., & Glew, P. J. (2017). Fundamentals of Nursing and Midwifery: A Person-
Centred Approach to Care.
Kraft, W. K., Chang, P. S., van Iersel, M. L., Waskin, H., Krishna, G., & Kersemaekers, W. M.
(2014). Posaconazole tablet pharmacokinetics: lack of effect of concomitant medications
altering gastric pH and gastric motility in healthy subject. Antimicrobial agents and
chemotherapy, 58(7), 4020-4025.
Macintyre, P. E., & Schug, S. A. (2014). Acute pain management: a practical guide. . CRC
Press.

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