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June 2008 Philippine Nursing Licensure Exam Result

Congratulations to our new Nurses!

Click here to see the result.

http://media.inquirer.net/inquirer/examresults/NURSE/20080724/

Labels: medicine, nursing

Last week, I was pulled-out to ward due to understaffing. The last time I have my duty to ward was long time ago. From only three patients in ICU, I was back to handling 10 patients. Honestly, I missed having my duty in the ward because there, I am free. I can go to any hospital departments and relate with my co-staff nurses unlike in ICU where I am always locked inside and alone.

During this duty, I had an admission. It was a hypertensive patient with a difficult and demanding watcher/relative. (Nurses, it’s a toxic wife.) The patient’s wife keeps on asking me to come over with lots of questions and requests. I accentuate to her that they are confined in the ward and that I can’t give much attention to her patient. I make cleared that I have plenty of patients and that I have to prioritize them. And still, I told them I will do my best to attend their needs.

On that evening duty, this wife keeps on asking me to bed bath her “ambulatory” husband. I told them I can assist them after I am done with my routines. Watchers here in Philippines usually do the bed bath for their patients and nurses assist them. But this wife, she wanted only me to do it all. And so when his husband purged, she called me and told me to clean him. Though there were caregivers, I did all the cleaning. Good thing the patient is cooperative unlike her wife. I told him to clean his ass while I was assisting him with the soap, water and things. Even though I was wearing a thick mask, his sh*t was very smelly.

And just yesterday, I was pulled out again. And guess what, I handled this patient again. Good thing they are already for discharge. They are not as demanding as before. Yes, Lucky me!

After I gave them the home medication instructions, they thanked me for the service I rendered. They apologized for being too demanding and gave me an endowment. It was a pack of 16 treat size Cadbury Chocolate TimeOut. I refused to receive it but since they insisted, I accepted it. Haha! Happy.

Labels: food, happy, health, life, me, medicine, nursing, sick

Someone I hardly know went our house this afternoon. She’s from the farthest compound of our barangay; very far from our house. She said, she was looking for a nurse and found me. Her purpose for her visit was to ask favor if I can insert an IV line (dextrose) on his sick father. Her father is bedridden and needs vitamin infusion. And so, I said “yes.”

After a very long walk to their house, she introduced me to the patient and gave me the materials needed. I was saddened when I saw the needle I’ll be using. It was a butterfly IV, an old and nearly faced off needle use in IV insertion. I was worried ‘cause I seldom used this kind of needle. Insytes or introcan are the IV canulas commonly use nowadays.

While I was preparing the IV line, I was shocked when she told me to add vitamin c on the dextrose. As nursing standard, I asked if there’s any prescription so I can give the medication. The lady showed me a prescription saying, “Infuse 1 ampule of Vitamin C to D5LR to run for 20gtts/min.” The order was clear. But when the lady gave me the vitamin, I was surprised again. She handed me a bottle of vitamin c capsules, branded “Vital-C”. On a nice manner, I clearly state that I can NOT give that medication. It was not as prescribed by the doctor. So, I refused to give it. But they insisted that the doctor instructed them that if ampule is not available they may use diluted vitamin c capsule instead. That was COMPLETELY strange. I never heard nor learned that an oral medication may be given through IV injection or infusion.

What I did was to explain clearly my side and reasons why I can’t give that medication. I don’t want to take any risks.

Then, she called the doctor who gave the prescription. The doctor clarified the order. “I understand why the nurse wouldn’t give it because it is unusual…but it may be given that way,” the doctor said. I never knew this doctor and this ‘Vital-C’ and so I still refused to give the drug. But they seem so sure. She even told me that the nurse yesterday just did it. Since they insisted, I gave them an option.

The option was that I will insert the IV (since there is an order) but I won’t give the medication. I said, it’s up to them to give the drug and I won’t give any responsibility in it. So, I explained the legality again CLEARLY, and they understand that I have no legal accountability. I successfully inserted a butterfly needle on the patient’s right hand vein, aseptically. And SHE gave/incorporated the said vitamin on the dextrose solution. Not me.

Labels: health, life, me, medicine, nursing, opinion, sick

After my journey to Bicol, here comes our trip to Batangas.

Because we haven’t been to any beach last summer, we decided to do it this June. I know we might be late for the summer. But at least, the weather these days are still hot. We’ve been preparing for this for a long time. It’s our only chance for this year—before the rainy season comes.

The meeting place was again in front of our dearest alma mater, our former school. I was the last one to come because I wasted my time searching for the camera’s USB port. And I have no cash yet, so, I have to go to an ATM. I thought I’ll be left behind. I am glad I still made it.

Because some of us haven’t seen ourselves for a long time, there were endless chit chats inside the van. The road was clear. It took us more than two hours to get to the beach. We looked for a good-looking beach resort with a good cost too.

We rented a tiny house with a kitchen, dinning table, room and comfort room. The cottage is comfy enough. And we got it for a cheap price of Php700. We also rented a boat bike for us to wander around beaches all day long for a cheap price of Php700 too. Because there’s less expenses for our stay, we have plenty of budgets for foods.

Before doing any beach activities, first, we settled and grab plates. We didn’t prepare any food for this outing; everything was bought at the nearest talipapa or small market.

With our stomach full and recharged bodies, we did the first activity—site seeing. We wandered, felt the fine sand with our feet, relaxed our eyes with the blue horizon and smelled the fresh sea breeze. Of course, there were endless picture takings.

Then, we drove the boat bike. This ride has pedals for two persons and a steer. It can accommodate up to 7 persons. While on the boat, we can see the sea bed and the corals under. The water is so clear.

The next activity was body henna tattooing. There are lots of designs to choose from. I decided to have a tribal tattoo on my nape. A boy, about 10 years old, drew the pattern on my back with a pen. Then, his older brother did the henna tattooing. My other friends have their tattoos at their biceps and on around their ankles.

We have to let the henna dried up first. So, the next activity was sun bathing. We laid and sat on the sand while letting our skins get sunburns and skin cancer. *Joking. We wore sun blocks for our protection. Then, we covered Ric with sands. We buried him alive. Haha! Afterwards, we all got sand body scrubs.

Next, we swam. The water is cool enough and colder below. You can swim well because there are only small waves. The sea bed’s sand is so fine. You can feel it with your feet’s soles. There are some portions that are rough because of the coral reefs under. We played, glide, float and stroked.

Afterward is my favorite part. We rode a fishing boat and sent us to The Little Cave Island. The ride only cost us Php500 back and forth, plus free snorkels for us to use. It took us about 15 minutes to the little cave. We were all stunned by the beauty of that place. The water is very clear—crystal clear. The cave is said to be the nest of fisher birds. It has awesome boulders and bounty fine-looking sea shells. The place is breathtaking…a perfect time for picture taking. Haha!

I caught live sea shells (small creatures called, “I don’t know”) which I brought home. I placed it on my small aquarium with my little soft shelled turtle.

The next best thing we did was snorkeling. We grabbed snorkels and goggles. Then, jump to the sea. Wow! The coral reef is so splendid. There are corals with different colors, shapes and sizes. There are small fishes which seem to be playing around with you. But if you tried to hold them, they would swim away. Some creatures I saw were clown fish, angel fish, sword fish and star fish. (Sigh.) The underwater world is so dazzling. It feels like were on a giant aquarium.

After that underwater adventure, we went back to the resort. We took merienda or snack. Minutes later, we went back to the water for our last swim. About 6pm, we all decided to have our fresh water bath/shower and dressed up.

We saw the spectacular sunset. The sun seems to be a giant orange basket ball. We all hate to leave but we have to say goodbye to beach…and drove way back home.

But, our journey didn’t stop there. Going back home, we decided to have our dinner on an also famous place in Batangas, at Tagaytay. The place is similar to our country’s summer capital city, Baguio. Tagaytay is a high land where you can view the smallest volcano in a middle of a lake called Taal.

We had our dinner at Mushroom Burger. It’s a popular restaurant that uniquely serves cultured mushroom dishes. I ordered mushroom beef and 100% mushroom burger, their specialty. Hmm…yummy! You must taste these burgers. They are not just delicious but nutritious as well. Trust me. (Endorser? Haha!)

We all went home safely with our body tired, hearts filled with joy, and faces painted with smile. This had been another happy and unforgettable bonding moment for us. Actually, on our way home, we are already wondering and planning for when and where will be our next outing. We all can’t wait.

For more photos, click the link below:

Nurses' Day Out at Batangas Multiply Photo Album

Labels: food, happy, life, me, nursing, sentiment, summer, travel

Kapag may sinuksok, may madudukot…
While I was ironing my scrub suit this morning, I noticed a bulky thing on its pocket. I thought it was just a shredded tissue paper which got wet and dried up from washing. I was surprised when I found out that it was a Php100 bill. Haha! My sister, who did the washing didn’t see it.

Kapag may pinukpok, may madudurog…
One of my patients this morning is lethargic and bedridden. She needed an NGT or nasogastric tube feeding . NGT is a tube inserted to the nostril, passing through the esophagus and ends to the stomach. NGT feeding is an artificial way of ingesting food/medicine for those patients who can't swallow. Tablets can’t pass through the NGT. For them to become powder-like or pulverized, you need to pound them first. We, nurses, use mortar and pestle to crush tablets. Unintentionally, I knocked one of my fingers while doing this. Ouch! It’s a good thing my precious nail didn’t die.

Kapag wala ang pusa, nagbubungkal ng pagkain ang mga daga…
Milk powder is commonly use for NGT feeding, which is the source of energy and nutrients for those who are bedridden. While I was preparing milk for my client, I was fascinated by its flavor. The milk’s can labeled, “Vanilla Flavor”. Out of curiosity, I and my co-staff planned to blend milk for ourselves. Haha! I did the mixing while she vigilantly looked for comers. We were so afraid we might get caught. We were just snooping on what it tastes like. And…yuck! We just threw it up.

Kapag may tiyaga, may nilaga…
I end up this day with a mollycoddle dinner with this very delicious bowl nilagang baboy. It’s an easy to cook Filipino food; boiled pork with vegetables. It’s a soupy kind of food dish that is good in any kind of weather. Yummy! I love nilaga.

Labels: food, happy, health, life, me, medicine, nursing

Yesterday, I was able to handle a patient with a very rare illness called Kawasaki disease. It's an illness that involves the skin, mouth, and lymph nodes, and most often affects kids under age 5. My patient was a 2 years old girl. The cause for this kind of disease is still unknown, but if the symptoms are recognized early, kids with Kawasaki disease can fully recover within a few days. Untreated, it can lead to serious complications that can affect the heart.

Kawasaki disease is very rare here in the Philippines. It is most common among Japanese children. That's why it's called "Kawasaki". I interviewed my patient's mom. I asked her if there's any Japanese descent in their family. Unexpectedly, there is none.

There is no prevention for this disease. There are also no definite diagnostic test for early detection of this disease. Doctors usually just base their impression from it's signs and symptoms.

At the first phase of the disease, which can last for up to 2 weeks, usually involves a persistent high fever. The fever lasts for at least 5 days. When I assessed my patient, I found out lots of symptoms that really indicates that she's suffering from Kawasaki. There are severe redness in the eyes; red, dry, cracked lips; swollen tongue with a white coating and big red bumps; and sore, irritated throat. She also have swollen palms on her hands and soles of the feet with a purple-red color. That's why I have hard time inserting an IV canula to her vein for IV-IG infusion.

IV-IG infusion is the usual treatment for this disease. It's an intravenous doses of gamma globulin (purified antibodies), an ingredient of blood that helps the body fight infection. For my patient's case, I need to infuse 10 bottles of IV-IG. Each vial contains 50ml of IV-IG that I need to transfuse one by one using an infusion pump. One vial of IV-IG cost a shocking price of Php15,000. So, for a total of 10 vials, my patient bought it for a more shocking price of Php150,000. That's why I am very careful of handling each vials...making sure not to break them.

A high dose of aspirin may also be given for this kind of patient. It is taken to reduce the risk of complication--heart problems. If Kawasaki disease is treated within 10 days of the onset of symptoms, heart problems usually do not develop.

Cases that go untreated can lead to more serious complications, such as vasculitis, an inflammation of the blood vessels. This can be particularly dangerous because it can affect the coronary arteries, which supply blood to the heart. In addition to the coronary arteries, the heart muscle, lining, valves, and the outer membrane that surrounds the heart can become inflamed. Arrhythmias (changes in the normal pattern of the heartbeat) or abnormal functioning of some heart valves also can occur.

Labels: health, life, medicine, nursing, sick