Although my name was not on the top ten list in the critical care course, I still feel elated to learn that I got a high score on my journal review. I have got the topic in my mind for a few weeks already I only had one night to search about it and basically compose my thoughts. I was not expecting for a high grade due to time constraints but I was really surprised to see that my grade was a whopping 97% and the coordinator made a comment: You a have a gift of writing. Good job!
The journal was worth treasuring.

I had a patient who has undergone coronary angiogram. His test revealed three-vessel disease with the right coronary artery totally occluded.
It was a pretty smooth shift for me. Benign patients whose only problems are fever. When the supervisor on duty made his rounds, I do not know if he was just annoyed by me butting in with his conversation with the charge nurse, but learning about the result of my patient’s coronary angiogram, he began asking me what I need to watch out for my patients with that diagnosis. I told him the usual, risk for bleeding at the puncture site, chest pain and elevated blood pressure. His poker face did not give me a hint whether I satisfied his query but he told me that since the right coronary artery is occluded, I should watch for bradycardia or the decrease in heartbeat. Sinus atrial node, the primary pacemaker of the heart is locate at the right atrium where the right coronary is occluded, as such having that occlusion, the SA node may not be able to fire at normal range which is from 60-100 beat per minute.
I am really thankful for having probing mentors. They give me the opportunity to think and learn at the same time.

I am really upset about what happened during our night duty the other day. My co-staff nurse dozed off in the nurse’s station as she cannot fight the call of sleep in the wee hours of the morning. I was busy arranging my patients’ medications that I will be endorsing the morning shift.
That night, our Division Chief’s husband was confined in our unit and she was there to look after him. At past 3:00 in the morning she went out of his husband’s room to get hot water, I saw her come out so I immediately tried to wake my co-staff nurse up discreetly. We greeted her “good morning” and as she went back she asked me how was our sleep. I felt insulted because in my almost one year of stay in the hospital, it was only once that I tried to sleep that was when I had to go straight to my night duty right after critical care course lecture.
Our Division Chief saw me standing when she went out and it is impossible that a sleeping person could be up and about at the same time.
I just wish that my co-staff nurse has a radar detector so she would have known that the DC will be coming out of her husband’s room.

After a gruelling critical care course and hospital duty, I am now down to the last leg of this situation I called adversary.
Didactics, bedside conference, ICU exposure and journal review are way behind my back. I am now awaiting the channelling out lecture and the case presentation and of course the graduation.
I have actually contacted my niece to once again to swish and turn her magic wand on me for the makeover.

I had a chat with my batchmate while waiting for the rain to stop outside the hospital. I told her that I really want to get out of the country. Of course I want to purse my nursing career so I am searching for a better medical job abroad through the internet. I am hoping that I could land on a better job before my NCLEX expires.

I am almost reaching the one year marker in this hospital but I am really itching to get out of the country to take my nursing career a step higher. I am thinking that if I do the same thing abroad I will be able to earn huge amount of money. I am resorting to free directory submission so that agencies could view my credentials. The work in the hospital is physically, mentally and emotionallydraining and I suppose that it is not too much to ask for a better compensation

After some chitchat with my best bud over light breakfast, we called it day and went our own way home. I was like on a rocking chair while on the jeepney. Although I was able to snatch some decent nap during the night shift, it was not enough to make up for the lost sleep in the past days. I find it easy to skip meals coming from my duty. I just want to lie flat on bed. Joggling the critical care course and hospital duty is the best appetite suppressant.

Having my critical care training course along side with my 8-hour duty on weekdays and 12-hour on duty on weekends, I feel like a candle that is trying to thrive on an open air.
Hitting the seventh day of my tiring routine, the pressure of getting good grades and rendering compassionate service has started to grow up on me. It is so constrictive that I find it hard to breathe.
My last shift for the week was smooth sailing. I was able to handle all my six patients well with a breeze until at past 4:00 in the afternoon, I received a patient from the neuro ICU who has underogone craniectomy to evacuate subdural hematoma. Although his stable vital signs prompted the doctor to transfer him to regular room, his level of consciousness is at grade 9 on Glasgow Coma Scale. He is breathing through tracheostomy and his airway clearance is ineffective due to excessive mucus secretions. He requires frequent suctioning and he is being fed via the nasogastric tube. Since he is unable to move for himself, frequent log rolling is also required to avoid his sacral bedsores from exacerbating.
I was able to finish suctioning him, rendering tracheostomy care andfeeding him by 7:00 pm. I had time to then to finish my chart but the pulmo fellow came in and asked for his chart so I tried to pull out the part the I need to fill out. I also prepared some forms needed to document his bedsore and surgical wound.
I did not put back the forms immediately to chart but I was able to endorse the patient and read his chart to the incoming bedside nurse. While waiting for the bedside nurse to make his rounds, I stayed in the treatment room and left the forms and my other stuff on the desk at the nurses’ station. It was just a matter of minutes and when I returned to the station, the forms were all gone and my stuff were place on the other side of the station. I asked the charge nurse what he did to the paper and he casually said that threw it all away.
I was so tried, my back was killing me because I have trained my two patients to sit at the bedside and transferred one from her bed to her wheelchair. My hands and finger felt so stiff due to the cold environment and they felt sore because I had finished documenting for all my patients except for the new one. I felt so sorry for myself because I had to accomplish new set of forms all over again. I broke into tears.

In the middle of my busy shift, my headnurse summoned me to discuss something important. It is the reprimand letter for the medication error we have committed in June. Being the bedside nurse who gave the Plavix to a patient despite the medicine being discontinued, I am now asked to join the medication reorientation. Although the reprimand was not the hard, the lesson I have learned from this mistake was very traumatizing. I am now going to be extra careful in giving out medications.

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.