Being part of the Education and Training Committee, I was forced to be at the hospital during my day off. I know that this is part of what I bargained for but it really pains me to get up from bed and be at the hospital for some unofficial function.
The update was about coronary angiogram which is the Holy Grail in determining the coronary artery disease or CAD. Members of the health care team consider this procedure as the “Gold Standard” in diagnosing Coronary Artery Disease or CAD.
Coronary angiogram is a minimal invasive procedure to access the coronary circulation and blood-filled chambers of the heart using a catheter and an x-ray image of the blood vessels after there are filled with a contrast material. It is one of the several procedures to visually interpret to recognize occlusion, stenosis, restenosis, thrombosis or aneurismal enlargement of the coronary artery lumens; heart chamber size; heart muscle contraction performance, and some aspects of heart valve function. Members of the health care team consider this procedure as the “Gold Standard” in diagnosing Coronary Artery Disease or CAD.
Since it is one of the most common procedures performed to diagnose heart problems in our institution, the Education and Training Committee of the Division of Medical Surgical Care supported the cascading of the said update. Hence, my required attendance. My ranting has turned into raving as I begin hear what the expert had to say.
Being faced with situations wherein patients have to undergo coronary angiogram, it is crucial for the bedside nurses to be abreast with the information pertaining to the said procedure. Having more than the basic knowledge of coronary angiogram would enable the nurses to competently handle the concerns of the patients and their significant others before, during and after the procedure.
The clinical pathway was created in such a way that nurses will be able to render utmost patient care upon admission all throughout patient’s discharge. The lecture encompassed the preparation of the patient upto the postprocedure where in the patient has been sent to regular room. This include the readiness of the patient and/or significant others financially, physically and emotionally.
Participants in the lecture were walked through the equipment and materials used during the coronary angiogram procedures some of which were brought in by the speaker for better appreciation. Another good thing to note during the presentation was the discussion of the results of the said procedure performed. How to differentiate normal, insignificant and significant lesions from one another. Also highlighted are the postprocedural complications that will enable the nurse to competently intervene and refer if the need arises.
The lecture was really enlightening as it gave me the answer to every pulsating question I had about coronary angiogram.

One of the good things about making rounds with the doctor is you get to peek on their brains. Well, not at all times that is why I am hands down to doctors who take time explaining things to the patient and their significant others the things they need to know about their condition and the things that may affect or might have caused the present condition.
The patient was an 80-year old man who was known hypertensive for 30 years. Few days prior to admission, his blood pressure (BP) shot up to 220 systolic. His left-sided body weakness occurred followed by slurring of speech. He was then brought to the institution and was diagnosed to have hemorrhagic stroke.
He was confined in the Neurology ICU on mechanical ventilator. After a weak of intensive care, his vitals have become stable and he was weaned from the ventilator hence the order to transfer to a regular room.
The patient is being trained by an occupational therapist to try on clear liquid to soft diet. His response to the program is very remarkable that his nasogastric tube has been ordered to be removed prior to his discharge.
Going back, as I joined the doctor in his rounds, the neurologist asked the daughter to continue assisting the patient in performing ankles pumps. This is to prevent formation of blood clots that may cause another stroke or worse pulmonary embolism.
It is interesting to know that pulmonary embolism is a known cause of death among passengers on economy flight. It is referred to as economy flight syndrome since the passengers have little leg room that they cannot move their legs to stretch. This lack of leg activity causes blood clot formation in the legs called thrombosis and the dislodgment and travel of the clot, called embolism, to the lungs (called pulmonary embolism) causes sudden shortness of breath and in seconds patient may die.
It is my first time to hear this fact and it is pretty informative.

It was around 3:00 in the morning when Mrs. S’s condition has deteriorated.
We have just finished tranfusing another set of 6 units of platelet concentrate. She reported that she is having difficulty breathing and the pulmonary fellow on duty ordered for an IV push of Furosemide, a diuretic that was supposed to ease her pulmonary congestion.
She did not recover, the fellow ordered for an NIV or the Non-invasive ventilation but as the respiratory therapist was starting to set it up, it did not work immediately. While the RT was trying to jump start the machine, the fellow prompted us to prepare for an intubation. I wheeled in the crash cart in the patient’s room. Everything happened so fast. She crashed and so we called code blue.
Resuscitative measures brought her back and as we prepared for her to be brought down to the medical ICU, she crashed again. At that time, relatives have told the code team to stop. They want a DNR.
We let her go. I shook my head in disbelief.
She has just been diagnosed to have Idiopathic pulmonary fibrosis

My headnurse and I sat down for the discussion of my 6th month exam. She voiced out how disappointed she were about the turnout of the said exam. I felt like I was a butter melting under the sun as she tackled each of the item in my revalida. Honestly, I was and still am ashamed that I have not grasped the concept of cardiac medicines and the procedure and diagnostics related to cardiac diseases.
I know that I still have so much to learn and I am willing to engage in a serious one-on-one lecture in order for me to learn more. I am serious about my profession and I shall do anything to keep me knowledgeable anything that has to do about the human heart.
I owe to myself and to the institution.

Nah, this is not about the protection one wears during an intercourse. This has something to do about the recent needle stick injury I have sustained after giving an insulin dose to my patient.
Learning that things that I have to go through after reporting the incident, I begin to have regrets. I should have kept mum about it.
Hepatitis B blood panel is the type of blood test to determine hepatitis B. There are three tests that complete the panel to complete the diagnosis:

1. Hepatitis B surface antigen (HBsAg) tests for the presence of virus. A “positive” or “reactive” HBsAg test result means that the person is infected with the hepatitis B virus, which can be an “acute” or a “chronic” infection. Infected people can pass the virus on to others through their blood and infected bodily fluids.
2. Hepatitis B surface antibody (HBsAb or anti-HBs)- A “positive” or “reactive” HBsAb (or anti-HBs) test result indicates that a person has successfully responded to the hepatitis B vaccine or has recovered from an acute hepatitis B infection. This result means that you are immune to future hepatitis B infection and you are not contagious. This test is not routinely included in blood bank screenings.
3. What is the hepatitis B core antibody (HBcAb) is an antibody that is part of the virus- it does not provide protection. A “positive” or “reactive” HBcAb (or anti-HBc) test result indicates a past or present infection, but it could also be a false positive. The interpretation of this test result depends on the results of the other two tests. Its appearance with the protective surface antibody (positive HBsAb or anti-HBs) indicates prior infection and recovery. For chronically infected persons, it will usually appear with the virus (positive HBsAg)

Source hepb.org

Anyway as far as I can remember I was reactive to Anti-HBs with 56 level of titer. What worries me right now are the questioning I have to go through regarding the incident. Why do I feel that they are indifferent about me not taking extra precaution in handling needle sticks. The department head has questioned me saying that I should not be in that situation since the precaution is very basic and I am already 6 months in the ward. The supervisor on duty told me in an ironic manner to have my other nine fingers pricked also.
I have to face the wrath of my headnurse who already called in and voice out her frustration about the matter and I have to report to the Infection Control Office.
I should have kept it to myself.

Just before I capped off my night duty. I went into my patient’s room to take his capillary blood sugar (CBG). After that, I gave his pre-breakfast dose of Novomix via Flex Pen which is reusable. As I tried to recap the pen and secure the silicon cover, the needle went through the silicon cover piercing through my right finger. It bled. I was panicking I immediately rinsed my finger with alcohol.
I reported the matter to the supervisor on duty. She asked me to fill out the Needle Stick Injury form and submit it immediately and then to go to the infirmiary to see a doctor.
The doctor has requested for an HBsAb or Anti-HBs (hepatitis B surface antibody) test.
Not that I wanted but it is good to know that this kind of test is covered by the disability insurance of the hospital I work for.

I thought it will all end in the submission of incident report regarding the medication error until I got a text from my headnurse. There was a scheduled meeting with the medication error committee. I did not know that there was such a committee and it seems that they would not let us off the hook although there was nothing serious happened to the patient.
We were from the PM shift and we were prioritized among the 9 offenders.
It was the second to be roasted. As expected, it did not go well. We were judged before we could defend ourselves. We were asked to make a correlation between the withholding of Plavix and the left side body weakness of the patient.
It is due to be submitted on Monday.
And yes, we still have to await the sanction for the error that we committed.
Although I did not take full responsibility for the offense, I did not bailout on anyone.

My headnurse has tasked me and my colleague to come up with a presentation about the Coronary Artery Disease. She knows that we already have basic knowledge about it and she wants us to have thorough knowledge about it.
She requires a comprehensive discussion about it and we need to present it in our next unit meeting.
We sure can come up with what is expected of us. The problem is we do not have common day off to discuss what we are going to write.
She is giving us a run for our money and we need to work our rears off to meet her expectations
I will be posting here what we have come up soon.

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.

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.