It’s my second day of being a charge nurse, first at night shift. Tasks are more demanding as doing the 24-hour check of the chart making sure that all the doctors’ orders were carried out, medications on the Kardex and the medication sheet are updated, line dues have been changed, diet and attending lists and so much more!
Good thing my preceptor’s schedule was still structured with mine and there’s another senior staff who’s willing to guide me.
There were no attendings who made their rounds when my shift started so I was able to start with my 24-hour check at 10:00 pm. Before the stroke of midnight, the phone rang, on the guy on the other line asked for a roll call of patient, I hesitated because he sounded like the supervisor on duty but yet he introduced himself as the guy from the admitting group asking for a roll call. I started to read patient’s names and as I was about to read the third patient, he passed the phone to someone else whom I recognized the voice as my preceptor when I was still an orientee. I immediately burst their bubble. They were having a shot session at a colleagues house and they have decided to play prank call on me.
They almost got me there!

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.

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.

In the hospital, continuing education is one of the requirements for the performance appraisal. I was really surprised learning about this. For one, I really have plans of taking up my master’s degree but I did not think that it has a huge bearing in the performance appraisal. With the busy sked I have in the hospital that demands physical and mental stamina, I do not think going to school for the continuing education is feasible.
Some education institutions has already spotted on this problem that is why online university has become a huge industry today. Now that options are here, the question that faces me and the rest of busy people like me is which is the best school?
I for one does not just want to get master’s degree just to have a title or additional MAN or MS at the end of my name. I surely want to further my knowledge. That is why I also did my homework.
I came across the website of Western Governos University that offers online degree programs including Masters in Science in health professions. This school holds up its reputation as an educational institution founded by 19 US governors. It promises an outstanding quality education through the guidance of dedicated mentors.

A day after my birthday, I am still required to go to the hospital for our unit meeting. To avoid being penalized, I came in early and when I arrived I was told that a patient gave me a cake as a birthday present. I was trying to dish out the idea until I opened up that box and saw this:

That patient was the one who underwent Bentall procedure for his triple A and will be discharged today. I hurriedly went to this room to thank him. He barely recognized me because I was not in my uniform and I was wearing eyeglasses. After a few seconds of recalling who I was, he told me: You’re the one with the sad eye.. The one who almost cried with me when I was at te lowet part of my life.
Seriously, I cannot remember being emotional when I was his bedside nurse although I was told during the tran-in admission from the surgical ICU that he has had episodes of depressions there reaching the point of being combative.
I am glad that he’s okay and I also found out that he lives a few blocks from home.

It is my birthday and I am supposed to be chillin’ but since I was given the most difficult task of my life, as yet, I ended up having a pick me up at Figaro. AT 7:00 am I was already there rehearsing my lines while sipping their version of caramel macchiato. Caffeine always gives me a kick as it calms me down.
At 6:30, I received a text from my headnurse reminding me of my hosting duty. I told her that I was already within the hospital premises and that I am already freaking out. I started to calm down when she said that she believed in me that is why she chose me for the job.
The lecture started at 9:00 am with my invocation. At first, I felt like my chest is about to explode as my heart is pounding so hard. I started to take deep breaths and reasonable amount of pauses. I was able to finish the prayer. Next thing I know, everything went smoothly.
I got to seat with the division head and had some chitchats. It really helped me to relax and pull it through the entire program.
Another experience that can be added to my accomplishments…personally

It only about three days before my birthday but I am not really excited about it. I am actually feeling like I am sitting on the edge of my seat because that day is the day that I will be having my first ever hosting gig. It is a half-day lecture and asks for a smart-casual attire not a tuxedo event really but seriously, it still gives my nerves a chilling sensation every time I think of it. And guess what, I was told that it is going to be the start of everything… or the end depending on whether or not I peed in my pants.

I had a patient prepped for Bentall procedure. He is diagnosed to have abdominal aortic aneurysm.
He works for the World Health Organization and although he is regarded VIP, he never made us feel that he is a VIP, He and his brother are so grounded and loves to communicate with people.
What I love about my job is that every is an opportunity to learn. I am being rpesented with interesting situations that challenges me to think critically.
I have learned that I should not contain myself in the information that is being placed on the table. I should make my way out to discover information for my own good.
It was my first time to come across this situation and the outgoing nurse who made the endorsement is also at a loss when I asked what is Bentall procedure.
This is the question I had in mind until I got home and googled for some information.
Below are some of the details that made me understand the whole thing:

What is an aneurysm?
An aneurysm is an area of a localized widening (dilation) of a blood vessel. It came from the Greek “aneurysma” meaning “a widening”.

What is an aortic aneurysm?

It involves the aorta, one of the large arteries through which blood passes from the heart to the rest of the body. The aorta bulges at the site of the aneurysm like a weak spot on an old worn tire.
Rupture of an abdominal aneurysm causes profuse bleeding and leads to shock. Death may rapidly follow. Half of all persons with untreated abdominal aortic aneurysms die of rupture within five years.(medicinenet.com)

What is a Bentall procedure?
Bentall procedure is a type of open heart surgery in which the ascending aorta and aortic valve are replaced. It is performed for patients who have aneurysms. The aorta sometimes needs to be replaced to prevent the aorta from dissecting (splitting open).
Traditional AAA Repair is an open-abdomen surgery. The bulging aneurysm part of the aorta is removed, an artificial graft is put in its place, and the remaining aortic end-pieces are reattached to the graft. Alternatively, a less invasive surgery involves placing a stent graft to cover the aneurysm. Blood flows through the stent, entirely bypassing the aneurysm, thus preventing rupture, excluding the aneurysm from the circulation. This less invasive procedure can decrease length of stay and recovery time significantly. (meriter.com)
I am still trying to wrap my mind around this thing but then again, I have so much on my plate. Icould only pick one at time to digest.

On my way home, I had this thinking about loosing our patient who has been confined for more than two years. She has been in and out of the intensive care unit since then. She has just turned 95 on March 10th.
This morning I woke so early and punched in at 6:10 am. I came in early to get the bedside-to-bedside endorsement done before the grand endorsement. While on my way, the caregiver of our resident patient texted me to bring her some cheese, to which I replied that there was none left. It was 5:30 am.
As I reached the ward, I was informed that the said patient was hooked to mechanical ventilator late last night de to difficulty breathing and for some reason it suddenly stopped working so the charge nurse was doing the ambubagging. I hurriedly entered her room and she’s becoming cyanotic (bluish discoloration) showing signs of respiratory distress. The pulse oximeter does not register pulse rate nor oxygen level in her body. No blood pressure can be acquired even on palpatory way. I and the bedside nurse tried but to no avail.
The charge nurse asked me to page the cardio and pulmonary fellows. The bedside nurse did it. But as we waited for the fellows to arrive, her condition got worse, the charge nurse asked me to call the code. I dialled 7 and in a heartbeat the PA summoned the code blue team to our ward. I wheeled in the crash cart into the room. The team was there in less than a minute.
They hooked her to cardiac monitor and four doctors tried to start peripheral line. One has started cardiac compression and was shouting to push to epinephrines. It started at 6:31 am and ended at 6:37 am. After the fourth epi has been pushed, she showed sign of revival.
We felt relief. She’s prepped to be wheeled in to the medical ICU again.
out of silence, the tension was pulsating. We love our abolita (as I fondly call her).
At past 2:00 pm I texted the caregiver asking for the patient’s condition and they said that she is stable. A few minutes after that, the PA summoned code blue team to medical ICU. We became worried. I called the medical ICU and as if a large rock was removed from my chest, it was not our beloved patient.
I learned from the medical ICU nd the caregiver that she will be wheeled in to her favorite room in our ward once she has tolerated the weaning process from the mechanical ventilator.

What I find challenging about the nursing profession is, apart from dealing with the patients and their relatives, is knowing the disease and the disease process. What are the symptoms and how to deal with it. A lot of patients do not throw questions at the doctors as they seem to be intimidated. So as soon as the doctor steps out of the patient’s room, the patients and relatives begin to bombard you with questions regarding the patient’s confiment.
Since I am just new to this profession, I really find it hard to answer most of their questions that is why I always tell myself to find time researching. As much as I want to dedicate some time to it, my physical and mental strength are always drained right before I punch out. I almost always miss my bus stop especially when I came from PM shift.
I wish I could squeeze in the research task. I have to. I am planning to take my master’s degree so I need to improve my pacing.