Chronicle #56: Just Call Me...and I'll be there!

pauerish was lost in reality at 05:43 AM on December 2, 2008 in Nursing Chronicles.

1 saw the illusion

Chronicle #57: Butas!

pauerish was lost in reality at 10:31 PM on November 29, 2008 in Nursing Chronicles.

Just finished a 3-day course on Enterostomal nursing. The seminar was like an escape from duty. We were just a selected few, 16 to be exact, wherein each nursing unit had a representative. Kasama ko si David and Ted. Halos kami-kami rin ang magkakasama nung sa Oncology seminar. We started around 8 am and ended around 3. The burden of patient care is then lifted from us for a short while. Hindi naman actually toxic sa floor, we only have a 15++ census on the floor because of the ongoing construction beside our first wing.

We were taught basic stoma care--how to change flanges and bags, skin care, trouble shooting ostomy problems and as well the psychologic impact of having stomas. FYI, ang stoma ay isang butas sa katawan (see wikipedia entry below). Hindi lang ito confined sa colostomy at ileostomy. Pwede ring urostomy, esophagostomy, gastrostomy at kung anik-anik pa. I've learned so much. Sulit ang three days.

Nakakatuwa, onting step nalang, after the 5-day practicum at Jose Reyes Memorial Hospital on January and the Paliative care seminars eh pwede na kaming i-page sa TMC: "paging ostomy nurse on duty, unit __ please". Hehe. We're also allowed to put ET nurse notes at the Order sheet and of course do our SOAPIE and thank the attending/admitting doctor/surgeon for the referral. I'm soooo excited!

Ayos, oncology nurse na, ostomy nurse na. Maningil kaya ako ng PF?

***

Dr. Chang on the nomeclature of stoma sites:

"Jejunum + stoma = Jejunostoma = Jejunostomy"

"Ileum + stoma = Ileostoma = Ileostoma"

"Colon + stoma = Colonstoma = Colostomy"

(hehe, with the chinoy accent)

Dr Chang when asked how to manage prolapsed stomas:

"Chop it off!"

(hehe, kagulat)

***

Stoma (medicine)

From Wikipedia, the free encyclopedia

In anatomy, a natural stoma is any opening in the body, such as the mouth. Any hollow organ can be manipulated into an artificial stoma as necessary. This includes the esophagus, stomach, duodenum, ileum, colon, pleural cavity, ureters, and kidney pelves.

One well-known form of an artificial stoma is a colostomy, which is a surgically-created opening in the large intestine that allows the removal of feces out of the body, bypassing the rectum, to drain into a pouch or other collection device. The historical practice of trepanation was also a type of stoma.

Stoma (Anatomy), a stoma refers to a mouthlike part. In particular it relates to a procedure involving the gastrointestinal tract (GIT) or gastrointestinal system (GIS). The GIT begins at the mouth or oral cavity and continues until its termination, which is the anus. This surgical procedure is invoked usually as a result of and solution to disease in the GIT. The procedure involves bisecting this tube, usually between the later stage of the small intestine (Ileum) and the large intestine or colon, hence colostomy, and exiting it from the body in the abdominal region.

The point of exiting is what is known as the stoma. For greatest success and to minimise bad effects, it is preferable to perform this procedure as low down in the tract as possible, as this allows the optimal amount of natural digestion to occur before eliminating fecal matter from the body. The stoma is usually covered with a removable pouching system (adhesive or mechanical) that collects and contains the output for later disposal. Modern pouching systems enable most individuals to resume normal activities and lifestyles after surgery, often with no outward physical evidence of the stoma or its pouching system.

Examples of stomata

***

I'VE GOT MY STARBUCKS 2009 PLANNER ALREADY! YIPPEEE!

***

I've brought 3 books today as a well deserved reward for myself:

The Hound of Roran: Book 1 of the Tapestry series by Henry Neff

Inkspell and Inkheart by Cornelia Funk

Nawiwili na me sa mga books na ganito...may magical background.

Searching for reality in Nearly done with Brisingr
Trying to see reality through Imbestigador
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reality check

Chroncle #56: Bunutan Blues

pauerish was lost in reality at 10:00 PM on November 24, 2008 in Nursing Chronicles.

Unit meeting namin kanina. Wala naman mashadong "issues" na na discuss. Meron lang onting mga alitan regarding auxillaries' attitudes and the monthly schedule in general. Natagala kami sa bunutan ng kung anik-anik--nagbunutan kung sinong magduduty ng Christmas (Dec 24-25) at New Year (Dec 31-Jan1), usually kasi kung duty ka ng Christmas, off ka na ng New Year and vice-versa; nagbunutan din kung sino ang magduduty sa Unit 4A kapag nakipagexchange duty kami para makapag Christmas party; nagbunutan din kung sino ang makakaexchange gift at kung anong team ka sa Christmas party (Red or Green). Nakakalurkay!

Ang outcome:

Duty ako ng December 24-25, 10-6 shift

Sa 6A ako magduduty sa December 17 at hindi sa 4A

Sa RED team ako napunta at

ang nabunot ko ay si....(secret!)

Shempre, pancit nanaman ang pagkain after duty. Magiisang taon na ata na puro noodles ang pagkain namin--kung hindi pancit bihon or palabok eh spaghetti. Ang dami pa namang birthday celebrants ngayong December pero ang onte lang ng food, pero enough naman for everyone. Hay, pasalamat nalang at may nakain kami.

***

I had a follow-up check-up at the proser clinic after duty. As expected, I had UTI...eeew. WBC's 20-25 which normally is 0-3 and occult blood is (++++). I was prescribed with Ofloxacin 400mg to be taken once daily for one week, then I was also advised increased oral fluid intake and to repeat urinalysis after treatment. Ayan, hindi pa tuloy ako cleared sa annual PE. hayayay!

Searching for reality in Brisingr parin! shucks!

1 saw the illusion

Chronicle #55: Sharper shooting

pauerish was lost in reality at 05:22 PM on November 22, 2008 in Nursing Chronicles.

I was challenged again by several IV insertions in the unit today. Since I'm the senior staff nurse during the shift, junior nurses are privileged to ask me to help them during IV insertions (na hindi ko naman talaga tatanggihan especially if it's a difficult case). I'm really glad that they consult me and ask for help during such instances because I feel experienced but I do keep my humility when I have to tell them that I can't do the insertion (because of reasons like: demanding patients and parents watching over their kid). I'm just happy today that I was able to do an insertion on a 2-year-old pediatric patient. I was quite pleased with my work because the resident who tried the insertion before me failed to shoot the vein. Hehe. Nakakaboost ng self-esteem and ego na rin on the side. I'm looking forward to more challeging insertions. I'm now thinking if there is a direct relationship with the length of tenure to the determination and skill of initiating IV lines.

Searching for reality in Brisingr by Paolini
I am currently feeling drained

1 saw the illusion

Are They Worth It?

pauerish was lost in reality at 06:28 PM on November 21, 2008 in Sugar, Spice and everything nice.

Matagal ko na silang nakikita sa NBS shelves pero hindi ko mawari kung bibili ako o hindi...to buy or not to buy, that is the big question. Pero game na kaya ako na basahin sila ngayong nalaman kong ang istorya ay tungkol sa vampires? Nyaiks, never ako naging fan ni Anne Rice at hindi ko alam kung magugustuhan ko ang mga vampires sa series na ito. Nothing has appealed me more than Harry Potter and the Inheritance Series which I grew fond of lately. Game na kaya ako? Okay lang kaso ang mahal--its a whopping 3000+ for the whole series kaya I'm left with the one and only question of:

Sino kayang napakabait na magreregalo sa akin ng:

Hmm, am I that good to reward myself with these stuff??? or eto nalang:

3 saw the illusion

Chronicle #54: Extra Challenge

pauerish was lost in reality at 04:21 PM on November 20, 2008 in Nursing Chronicles.

As a nurse here in the Philippines, one has to learn and master the art of juggling tasks between 8-13 patients per shift for private hospitals and as many as 25-50 patients for government run ones. Sometimes the task of taking care patients becomes too much of a burden in institutes where there is a shortage of experienced nurses. It's a sad fact that one of the least compensated jobs here in the country is that of nurses and other allied health professions (Let's exclude doctors because we all know that they earn bigtime when they get to be consultants). No wonder that the exodus of nurses has become severe that the brain drain has turned into a brain hemorrhage.

When I started working as a registered nurse, I realized how heavy the responsibility nurses have on their shoulders. During the first several weeks in the hospital, there were days when I wished that I had a different profession. There were days that it took me all the strength that I had to get up from bed and get ready for work. There were days when I counted the hours till my shift ends. It was really difficult adjusting at first. I got sick at times, my back pain worsened and eventually I got hospitalized for a long time and was terminated from work. Depression seeped in after several weeks and I had a difficult time dealing with the losses that I had. I recovered after four grueling months after series of psychotherapy and medications. When I had the strength to pick up the scattered pieces of myself, I went to apply to another hospital and was luckily accepted. TMC gave me another chance at life, another chance to prove myself as a nurse. As expected, adjustment was difficult but was less compared to my previous work. During the probationary period I nearly burnt out because of the patient load. I struggled to love my work, to love my patients, to love my co-workers and especially to love myself. It took sometime to work through the system but eventually, with dedication and patience I was able to pass the probationary period and was regularized after six gruelling months of hardwork.

When I look back at all the things that I have done during the last two years as nurse, I can say that I have done so much to deserve more than a tap on the back. When we have trainees or new nurses on the floor, I always ask them the big question which is "Do you really want to be a nurse?" I ask them this not to scare them away but to make them realize the responsibility they are given as health care professionals. I ask them this as a measure of their committment to their chosen profession. In the two years that I have spent in The Medical City, I've learned a lot more than pathophysiology, pharmacology and the like. I've learned to value patience and hardwork. I've learned how to manage patients, juggling them between tasks and ensuring that our service exceeds expectations. I learned how to be humble and own my shortcomings as a nurse.

Lately, the unit has been quiet because one wing is closed (due to construction) meaning that our census only totalled to 18 patients. I enjoyed working with only 5-6 patients per shift and I am proud to say that I have given my patients the best care I can give. It only proves that less patients equals more care. I'm not saying that we cannot render quality care when we have more patients, what I'm pointing out is that we, nurses are able to function better when our loads are rational. With less workload, I am able to interact morewith my patients, organize nursing tasks, chart better and have time for personal needs such as toileting and eating. Deep within the recesses of my soul, I want to change the system. It's difficult to make things happen. It's difficult to ask the hospital management to do such because of the cost of hiring more nurses. I don't know where to turn to but I am hoping that the government will do something about our ailing health care.

***

I had a patient who underwent explore laparotomy due to small bowel obstruction secondary to post-operative adhesions. I will confess that she was a difficult patient at first and I hated her for that. She had so many contraptions that prohibited her from moving about--an NG tube to a gomco suction, a JP drain, a subcutaneous drain, two IV lines a foley cath and a big post-op incision on her abdomen. Despite the fact that she was a demanding patient, I took care of her with all my might. I took it as a challenge and eventually I won her support and won her heart as well. At times, it is difficult to understand patients but when we look at it at another angle, when we look at the situation from their standpoint, we'll realize why they act in such way, why they become demanding. After handling her for three days I told her that I'd be gone for quite some time because I'll be going on leave. I felt that she was sad about me leaving however, at the back of my mind I was pleased because somehow I know that I have done a good job taking care of her. At this time I am not sure if she has been discharged already. I will be coming back to work on Saturday and hopefully she's not confined anymore.

***

Hindi na ako takot maginsert ng IV sa pedia patients nandyan man o wala ang bantay/parents sa bedside. Ang lakas na ng loob ko ngayon maginsert na pinapatulan ko na ang children below 3 years old. Pero pag tipong 1 year old lang eh hinahayaan ko na ang resident ang maginsert, baka kasi maburdahan ko lang ang kamay o paa ng patient. Kakaiba pa naman ang feel ng gauge 24/26 na neoflon compared sa venflon na pang adults. Mahirap din minsan maginsert sa pedia kasi matataba pa ang mga kamay at paa. Pinakikiramdaman ko rin muna kung toxic ba ang parents o hindi kasi baka sabihin eh pinagpapraktisan ang kanilang mga chikiting.

***

I had some blood test done early this morning. As I had expected, the med tech had a difficult time locating viable veins under the thick adipose tissues that I have. Hehe. She ended up picking the veins on my left had and filled up 3 different colored vials. The experience made me all the more frustrated in shedding some weight.

***

I'd be retaking my IELTS on December 6th and I'm nervous. It's has been two years since I had taken the exam which had expired already. HCCA was kind enough to lend me a review manual for the exam and tomorrow I'd be taking a dry-run exam in preparation for the actual one. I had a 7.5 during the first exam and I'm hoping to get an 8 or higher. Hehe, dream high!

Searching for reality in Brisingr by Paolini
I am currently feeling accomplished

1 saw the illusion

A Few More Cups

pauerish was lost in reality at 03:55 PM on November 19, 2008 in Sugar, Spice and everything nice.

I am a coffee addict.

When I am on duty, I start the day with a tumbler of coffee with 2 packets of instant coffee in it. I usually have an iced cofee in the morning and another during lunch time. I found it as a good way of keeping me alert and awake especially when I had a hard time sleeping during the night before. When I have extra cash, I go to Starbucks after my duty and enjoy a Java Chip or a Dark Cherry Frappucino.

I saw Ted's entry about the Starbucks planner just a while ago. It's really quite disappointing that the freebies are gone now. A few years back, you could get a free drink almost every month. Oh well, I guess they have to cut costs during these hard times. I have 5 more stickers to get and hopefully by December I'd get to have my planner.

Searching for reality in Brisingr by Paolini
I am currently feeling calm

4 saw the illusion

You Got to Move It Move It!

pauerish was lost in reality at 07:41 PM on November 8, 2008.

After splurging at Sbarro's and doing some window shopping, Leah, Mark and I watched:

Feel good movie...funny with lots of crazy antics with a tinge of love story on the side and lots of courage on the crust.

Searching for reality in Paolini's Brisingr
Trying to see reality through Celebrity Duets
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2 saw the illusion

Collection Begins

pauerish was lost in reality at 10:03 PM on November 5, 2008.

November 4 is the day when Starbucks' sticker collection for the 2009 planner begins. The planner comes in three colors--blue, black and red. It looks like the planner 3 years ago without the free drink coupons with it. This year, only 16 stickers are required to get the planner. I'm hoping that I'll get one before the end of the year. They also have a new drink for this season which is the Dark Cherry Mocha Frappe. It tastes good but I like the Dark Mocha Frappe better.

reality check