After my long three days off, I am back on track.
I was pleasantly surprised that the young Micronesian girl has been brought back to a regular room. The girls was the one who undergone MVR, AVR left thromboeectomy and IOTEE.
She is no longer on mechanical ventilator. She is now on oxygen per nasal cannula and she has a nasogastric tube for feeding. Her Glascow coma scale (GCS) is 10. She opens her eyes spontaneously, no verbal response and only withdraws to pain.
Since she cannot move on her own, frequent turning is required. Also she needs frequent suctioning of oral and nasal secretions.
Her mom, in broken English continuously expresses her gratitude to the ward nurses as she feels our care for her daughter.
The bedside rehabilitation is ongoing and at the moment, her legs seem to be powerless.
As I browsed through her chart, I saw that she has had subdural hematoma and they also performed emergency by pass on her.
According to Medline Plus Subdural hematomas are usually the result of a serious head injury. When one occurs in this way, it is called an “acute” subdural hematoma. Acute subdural hematomas are among the deadliest of all head injuries. The bleeding fills the brain area very rapidly, compressing brain tissue. This often results in brain injury.
I remembered the neurosurgeon telling the mother before that the fluid accumulated in the brain was negligible and does not require surgery.
What puzzles me is that the girl was ambulatory before the operation and now, her GCS is only 10. I also wanted to know why there was a need for emergency by pass.
Nancy Drew investigates

I am still a bit half hearted about moving into the dorm. What holds me back are a few comfort things like the internet, cable TV and home cooked meals. Petty but for me relevant considerations.
I was in the AM shift yesterday when I got a text from my sister that it was raining hard outside and she suggests that I stay in the dorm. Thinking of the good things awaiting me at home, I braved the rain and headed home.
It is really rewarding to kick back in the warmth of my own messy bed while savouring my favourite creamy soup instead of sipping on instant broth bullion. There is no place like home.
I just love this bed weather

I was preparing to watch Avatar on DVD on my laptop in the dorm when my co-staff nurse texted me to rush to the 8th floor for the free facial, foot and hand spa. I went immediately and to find out that I have to wait for at least thirty minutes for my turn since all the staff who will do the services are all attending to other guests.
I learned that it was a promotional service of a company making beauty products.
When I had my turn, I knew that the service will not be a pleasant one as I see the frustration on the girl’s face learning that she still have me to do service to.
When she doing my facial, she asked me if I had oily face as said I do not then she asked again why do I have I have pimples. I just smiled instead of slapping her face.
I lack sleep that is why I am having breakouts and as far as I can remember I only had only huge pimple then. I have my usually share of breakouts but it cannot be considered as adult acne.

Exactly a week ago when the medication error occurred.
I was on 7 to 3 p.m. schedule then and since I feel indifferent about the outgoing bedside nurse who will endorse the patients that I will be handling, I just did not pay attention to what he was saying.
I made my rounds and gave medications to my patients without any problems.
The nurse who will receive my endorsement was late so I decided not to read the latest orders to her.
The following day, it was night actually, the ever insistent relative of a patient of have undergone heary by pass, was questioning why we are still giving Plavix to the patient when the doctor has told that them that it will be stopped already. We just told her that if the doctor did not write any order about it, we shall still stick to the status quo.
The relative did not stop there so we brushed through the chart and BAM!
The doctor has ordered to hold giving of Plavix on June 19th and the said antiplatelet medicine with generic name of Clopidogrel Bisulfate helps prevent clot formation which is indicated to prevent heart attack or stroke.
It was already June 21st meaning the two doses of Plavix have been given to him. The doctor called in and spoke to the outgoing bedside nurse. He was mad and so frustrated about the incident. Although there was nothing serious happened to the patient, mistakes that could jeopardize the patient’s health.
The following morning, the doctor checked in. He was already calm and just asked if giving of Plavix has been stopped. No further issues to him but our headnurse did not let slide of this medication error that she demanded for an incident report.
I personally learned my lesson here and promised to be extra vigilant in carrying on my duties and responsibilities.

In the dorm, any electrical appliance that you shall bring in must be declared so that charging for electricity use could be imposed upon the person who shall be using it.
I learned from the other tenants there that they are actually bringing in some appliances without declaring them such as small TV, oven toaster and even rice cooker. For one, I actually sneaked in my coffee maker. I was wondering how on earth could I sneak in any fitness equipment such as the treadmill. Think…think…think…

I went to the Professional Regulations Commission to renew my license. It  was already 3:00 p.m. and I was  so  surprised  seeing the very long line at the cashier. I noticed that  the cashier was manually issuing the receipts. When I said manually it means that she is actually writing the payment details on the receipt. This long and tedious procedure causes the slow movement at her station hence the long line. If only the said government agency could allocate a portion of its earnings in investing in machinery that would speed up the receipt issuance process, like the epson receipt printer everybody  would be happy.

Instead of having her checked in a hotel, the insurance company serving the daughter who has undergone MVR, AVR, thrombieectomy and IOTEE, has decided to have the mother(a Micronesian) admitted to the hospital. She is actually occupying the room in our ward her daughter has vacated when transported to OR.
Since there was a complication, the girl was placed on heart pump and mechanical ventilation. The neuro-surgeon wanted to talk to the mother of the patient and we informed him that the mother barely understands English hence a need for an interpreter. Despite our attempt to convince him to get an interpreter, the doctor went on with his plan of talking to the mother. He just informed us that he’ll try to act and we obliged.
He let him inside the mother’s room and he introduced himself. At first the mother looked okay but when the doctor acted out as if he chopped his skull and stood still and closed her eyes, the mother began to panic. That was our queue to stop the doctor and call the interpreter in the other hospital.
The co-staff nurse and I were actually fighting hard not to laugh at the moment. Seeing a hardcore surgeon doing the “charades” is ridiculous.
We reserved our laughter until we punched out of the hospital.
Kindly check my story on The great barrier for the details about the girl’s story.

Mrs. S was admitted due to shortness of breath. She is a dentist and I do not know if she knows that her case is considered a pulmonary tuberculosis. She is to paranoid about catching nosocomial infection or hospital acquired infection that she does not want people, including nurses, who have cough or cold to come in her room.
She placed herself on reverse isolation or in a protective environment when in fact she should be placed under airborne precaution as she is a carrier of a communicable disease.
Anyway, mini thoracotomy was scheduled and right after the procedure, a chest tube was inserted in her left thorax to drain off excess fluid and blood from the operative site.
There was an order to change the one way chest tube to a two-way suction equipment. A few minutes the patient complaint of difficulty breathing. The doctor asked for an oxygen saturation spot check and as I went out of the patient’s room, the patient informed me that she has her own pulse oxymeter. It was a relief to know that patients have their own pulse oximeters as this will speed up the assessment process.

My co-staff nurse was beaming every so often and we are just puzzled by her consistent glowing aura.
She was extra cheerful and helpful that day and wondering continued until the end of our shift. As we were on our way to punch out, she whispered to me that her boyfriend has finally proposed. I looked at her finger and saw this sparkling huge rock on it. I am no gemmologist but I think that one that her boyfirned has gotten her is one of the certified diamonds. Isn’t sweet and fabulous?

Mr. R, 56 years old, married, was admitted due to fall. He claims to be paralysed from the neck down hence quadriplegia as a result of spinal cord injury.
MRI, CT scans and other tests required have been performed on him and these ruled out his claims. Also, some physical reassessments proved that this might be a case of malingering.
I even actually saw the man pulling the blanket up his shoulders one morning.
The DSM-IV-TR describes malingering as follows:
The essential feature of Malingering is the intentional production of false or grossly exaggerated physical or psychological symptoms, motivated by external incentives such as avoiding military duty, avoiding work, obtaining financial compensation, evading criminal prosecution, or obtaining drugs.
The doctors are suspecting depression that is why he has been prescribed with antidepressant drugs. I do not know if this is what he wants.
What this man is up to? Only he and time can tell.