There’s no turning back, I was scheduled to go on board as chrage nurse. The endorsement went well for me as my tough preceptor was the one who scrutinized the endorsement for me. She made sure that every endorsement for every patient was justfied. Too bad for the outgoing charge nurse who’s also practicing because my preceptor did not let any shortcomings slide.
I was bombarded because it was the AM shift and as expected attendings flooded the ward making their rounds. I’ve got tons of doctors’ orders to carry out and I had six patients for discharge. The time flew so fast and I had so many things left on my plate.
I was really thankful that my preceptor was there to help me and acutually finish some of my tasks. She also helped me get through the endorsement.
Tomorrow’s gonna be another day as I will be on the PM shift.

Another Micronesian couple will be discharged in time for their flight back home tomorrow. Like typical locals there, their bodies are big built. Just imagine Lilo in Lilo and Stitch. The lady was fixing the clothes she got for her granddaughter. I told her that I thought it was hers then she laughed. As I handed her medication she reached for Del Monte Fit ‘n Right. I told her that I noticed that almost all Micronesians I met in the hospital love that juice. She said maybe because like her, they all wanted to lose weight. As part of my health teaching, I told her that with her present condition, it is best to modify her lifestyle and diet. She should also incorporate exercise in her activities of daily living instead of opting for the best fat burning pills

Today is the last day of our favourite Micronesian patient who has undergone coronary artery bypass graft. Luckily, it is our unit meeting so the staff members were almost complete so when they requested for a group picture, it was almost hard to squeeze in everyone in the camera phone. But just before the picture was taken, the patient’s wife has asked for a minute to say something that sent chills to our spines. She and her husband were so thankful for making our institution their second home. She almost broke down into tears saying how they appreciated what we have done for them. I almost cried myself when I saw his husband, a tall man with a body of a wrestler, wiping his tears. The man rarely speaks English and his wife usually communicates with us for him. She even added that the staff members in our institution are like loose diamonds which are hard to find.

I just came from rheumatologist today and got a very good news from my doctor.
Based on my latest lab work up, my urine protein has become negative and the blood in my urine has been reduced which are signs that I am on remission. Adding to this is having an optimal HDL and LDL levels.
I would like to think that I am on my way to recovery. He asked me how do I feel. I said that I feel better. I just wanted my face to return to its normal shape and size. My steroids have been reduced. I am now taking it every other day.
Hope that my recovery continues.

After the dreading (read: boring) charge nurse training, I am scheduled to be on board this coming Thursday. My preceptor is the toughest staff in our ward. Tough in the sense that she just does not almost perfectly carries out her tasks but she also speaks tough as if her tongue is like a newly-sharpened razor.
In my aim to prime myself of the upcoming challenge, I volunteered to be a shadow charge nurse at the end of our shift today.
I got to carry out some doctor’s orders, request some lab work ups and do the rack card printing

I have met up with my old pal tonight. He let me have a “break in” on his Loaded Fish. He’s given me until the 21st to decide whether I would keep it or let go of it. I have not given it a test drive as I am caught up with so many activities in the hospital. I do not have helmet and pads yet so I have to ride on it in broad daylight for safety reasons. The first time I tried long board skates, I really had a blast. I remember having the exact same feeling the first time I went on atv racing

This is a case of a 56 year-old retired US Air Force who came in the Philippines for a vacation. He had a heart attack and was diagnosed to have ventricular tachycardia having cardiac rate of 280 beats per minute. The normal cardiac rate is 60 to 100 beats per minute.

What’s good about being on the Medical Surgical floor is that you get different types of diseases. It is our first time to handle such a case. I was on PM shift and it was my first time to handle the said patient. During my 8:00 pm round, he’s vital signs were normal. He’s heart beat was in the 80s as shown in the cardiac monitor. I gave him his due diazepam to help him relax and keep is cardiac rate within normal limits.
At past 9:00 pm his watcher approached the nurse’s station telling that us that the patient’s heart rate has spiked up to 200. I immediately went to his room, took his blood pressure which was normal and manually checked his heart rate rhythm . It was racing and I am actually nearly at a loss of count. He’s asymptomatic, no pain , discomfort or shortness of breath. We sent an SMS to our fellow who came in immediately. We pushed the crash cart near the patient’s room but the fellow just ordered for an IV push of cordarone (amiodarone) . A few minutes after, the doctor ordered for another shot of cordarone and as I prepared to aspirate one in a syringe, he cancelled it because the monitor showed heart rate at 80s. I monitored him all through the night and his cardiac rate did not shoot up.
So what is ventricular tachycardia?
Ventricular tachycardia (VT) or V-tach is a rapid heartbeat that starts in the ventricles.
Ventricular tachycardia is a pulse rate of more than 100 beats per minute, with at least 3 irregular heartbeats in a row.
The condition can develop as an early or late complication of a heart attack. It may also occur in patients with:
• Cardiomyopathy
• Heart failure
• Heart surgery
• Myocarditis
• Valvular heart disease
Ventricular tachycardia can occur without heart disease. (Source: medline plus)
He was then advised to have an Implantable Cardioverter Defibrillator or ICD.
A preferred treatment for many chronic (long-term) ventricular tachycardias consists of implanting a device called implantable cardioverter defibrillator (ICD). The ICD is usually implanted in the chest, like a pacemaker. It is connected to the heart with wires.
An ICD is an electronic device that constantly monitors your heart rate and rhythm. When it detects a very fast, abnormal heart rhythm, it delivers energy to the heart muscle. This causes the heart to beat in a normal rhythm again. The ICD may also be programmed to send a rapid burst of paced beats to interrupt the ventricular tachycardia.

The ICD has two parts: the leads and a pulse generator

Lead(s)
Monitors the heart rhythm, delivers energy used for pacing, cardioversion and/or defibrillation.

Generator
Houses the battery and a tiny computer. Energy is stored in the battery until it is needed. The computer receives information from the leads to determine what rhythm is occurring. (Sources: medline plus and clevelandclinic.com)

The implantation was successful and a day after the procedure, the patient has been discharged. He even gave us a box of Macadamia nuts which her wife and son have brought in from Hawaii.