Mrs. M is an 86 year-old retired public school teacher who admitted due to sepsis secondary to coronary artery disease, type 2 Diabetes Mellitus, Chronic Kindey Disease (CKD)
She has necrotic non healing wounds on bilateral legs down to heels of her feet. She also has grade 2 bedsores at the sacral area that are about 8 cm in diameter.
She was on dopamine, dobutamine and furosemide drips when she was transferred to our ward from the suite room.
When her blood pressure has stabilized, the dopamine and dobutamine drips were taken out accordingly. And when the edema has subsided, furosemide drip was shifted to oral. She was then ordered to get out of bed and sit on bedside chair which she did but during her activity, she bled to much forcing her to stay in bed.
Within the week, her appetite has decreased resulting in decreased oral food intake. Nasogastric insertion was made to give way to osterized feeding to meet her daily caloric requirements.
Her oxygen saturation through arterial blood gas has deteriorated requiring her to be hooked to mechanical ventilator. Her increased mucus sections required frequent suctioning but being traumatic as it is, it was hard to introduce the oral airway as she bites it.
The family requested for DNR, no intubation, no suctioning, no chest compression no IV insertion attempts and what not. A couple of days passed and she was weaned off the ventilator. She was on oxygen per nasal cannula. Her vitals were stable but despite oral diuretics, she continuously retains water advancing to anasarca and deterioration in her level of consciousness was noticeable. Despite that, the family has decided to take her home with NGT and oxygen support on. It was not clear to me if she has brought home against medical advice but one thing is for sure, they will just wait for her to flatline at home which is equivalent to pulling a plug of a patient who is on life support machine.
I understand that they would not want to add more pain to patient by declining all invasive measures that could save or prolong her life, but still, is it right to just let her suffer until her last breath?

Family day was over for a few days already but the kids in the house just can get enough of the fun. They constantly pretend that they are still at Enchanted Kingdom posing with the characters there wearing Victorian costumes. At home, my nieces would wear improvised corsets and would dance the waltz mimicking the characters the saw in the theme park.

My friend left for the US yesterday and I was surprised to receive a text from here that he had a layover in Singapore. He took the opportunity to tour the country and he was astounded by its night life. He even called it the circuit city as the lights appear to be burning flames. Since I am having my four days off, which he rants about because it is gonna happen right after he left, I am thinking of givinga surprise visit there.

I have been using Pond’s night eye cream for the longest and being the usual me, I am starting to get tired of it that is why I am in search for its replacement. I have been checking on wrinkle cream reviews in my hope to find a perfect match. I am paranoid of getting crow’s feet on my face and I sthink I am now racing against time to prevent them from surfacing.

During my visit to college friend in the province , I discussed with her the medical practitioners viewpoint on organic prenatal vitamin. Being an OB-gyn herself, she said that personally, she is uncertain about prescribing those to her patients as its effects to augment or supplement one’s health are still yet to be proven. For now, she just sticks to giving out medications that are proven safe and effective.

I remember that I used to suffer from withdrawing from steroids before. I was so depressed about my body image that I tried to induce my appetite for food by popping an unrecalled dose of steroids. Thinking I had enough appetite, then I immediately stopped taking them not knowing the danger that it posed for my life. Good thing that I only had breakouts all over my body which I endured for almost a year. I had desperately wanted to get rid of the pimple marks that I went in every clinic that has acne scar removal here sign.

I have tried somehow to cut on carbs and calories. I know that these two sinful words have great impact one’s physique, mine in particular. Abstaining from any of these is equivalent to getting an instant Lipofuze and since I opt for a natural method of shedding my excess lbs, I couple the abstinence with a walk from our hospital’s basement upto the fourth floor.

Dubs, my sorority sister has not changed a bit. Her face is still the same as we were in college. She could still pass for a college student even if she has the OB-gyn title under her belt. She also has an eight-year old daughter that she raised all by herself while finishing her residency and specialization.
After our long day and night out, we went to her place to rest. Before we called it night we talk on some beauty products. I learned from her that he only uses sun block and cheek blushers on her face. She does not wear any make up or even loose powder. She keeps her face shine free by using the oil blot film. She is not comfortable putting gunks on her face as they give her horrible breakouts.
She asked me about the undereye cream that she saw I was using. I told her that I am no longer conscious about the brands of the beauty products. As long as it works for me meaning it does not give me breakouts, I will stick to that product like the eye creams that work for me for over a year now.

I have not seen this sorority sister of mine for almost four years, so I decided to pay her a visit during my long days off. She lives in San Fernando, Pampanga. Almost an hour drive from the busy streets of Manila.
Pampanga being known as the food capital of the country, has so may ntive delicacies to offer that I am craving for.
I made her promise that we will forget about our diet dramas and dig in to the mouth-watering dishes this side of the island.
I completely forgot about my I-want-to-lose-my-excess-baggage rants when I started to sink my teeth in the sinful offerings of this town.
After a day of pigging out, I am back on the road to the chaos and heat of Manila. I am beginning to think of coming back again but then again, I need to shake off some fats naturally and do away with the instant weight loss effect of diet pills

I had my three days off interrupted because I was scheduled to attend the nurse anesthetist lecture program.
At the onset, there is no nurse anethetist in the country but being in the team during the operation and being a bedside nurse to a patient who has undergone an operation, it is imperative for us nurses to have an idea on the after effects of anesthesia. It also gives us an overview of what is to expect in the pre-, inter- and post operative phases.
What is nurse anesthetist?

a registered nurse qualified by advanced study in an accredited program in the specialty of nurse anesthesia to manage patient care during the administration of anesthesia in selected surgical situations. Educational requirements include a baccalaureate degree in nursing and a minimum of 1 year of acute care nursing experience, plus a 2-year or longer master’s program in anesthesia. Nurse anesthetists are primarily involved in the direct administration of anesthesia to a single patient but often have other duties such as airway management in emergency situations. They practice under the supervision of an anesthesiologist.

Mosby’s Medical Dictionary, 8th edition. © 2009, Elsevier.
Our speaker was a nurse who has served as nurse anesthetist in Washington USA for over 25 years.
I learned that not just temporary memory loss would occur while the general anesthesia but also a patient may experience depression as it targets the central nervous system to block the pain sensation of the patient.
This has shed light on my questions as I have handled patients who have experienced post operative depression.
There are different types of anesthersia discussed ubt what I found interesting is the explanation on the difference between the spinal and epidural anethesia. The is the common question we receive from the patient although the anethesiologists are the ones who should discuss this with the patients, most of our patients do not raise question during the anesthesilogist’s rounds. They shoot the question at nurses right after the doctor has left their room.

Spinal Anesthesia: This is medicine put into your back through a shot while lying on your side or sitting up. You are awake during surgery but may be given medicine in your IV so that you are sleepy. You are numb from about the nipple line to the waist and down. How high the numbness goes depends on where your surgery will be. You are not able to move your legs when the medicine starts to work. You can move your legs in 1 to 4 hours when the medicine wears off. Spinal anesthesia is best for surgeries below the waist.
Epidural Anesthesia: This is medicine used to numb you from about the nipple line to the waist and down. While lying on your side or sitting up, a catheter (tiny tube) is put into your back through a needle. The needle is then taken out but the catheter is left in place to give you more medicine if needed. You are awake during surgery but may be given medicine in your IV so that you are sleepy. Your lower body is numb and you may be able to move your legs but should not feel pain. Feeling returns to your legs when caregivers stop putting medicine in the catheter and when the medicine wears off. Epidural anesthesia is good for procedures below the waist. Epidural anesthesia can give longer lasting pain relief than spinal anesthesia.

Source: http://www.drugs.com
The lecture has given me information that is very useful in handling patient and their concerns.