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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

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