During our dinner after our jogging session in UP, we talked about our funny and serious incidents in the hospital. We talked about those who were admitted on a wheel chair or on a gurney and discharged walking and those who were admitted ambulatory but were discharged on a wheelchair or worse dead. We talked about their rights and right to offshore injury lawyer to know if what they got in terms of medical attention was right.

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.

I was again the charge nurse. One of my patients had an order for Troponin I and so I made a request, a charge slip actually and the whiny nursing aide asked me to make another charge slip as what I did was for the ER department. So succumbed to her howling. I was pretty sure that I charged Troponin I but I was surprised to learn the following day that what I requested was for Troponin T.
Troponins are protein components of striated muscle. There are three different troponins: troponin C, troponin T and troponin I. Troponins T and I are only found in cardiac muscle. troponin T (cTnT) and troponin I (cTnI) are released only following cardiac damage.
• Trop T – 84% sensitivity for myocardial infarction 8 hours after onset of symptoms (1); 81% specificity (1)
• low specificity – 22% for unstable angina
• advantages
o highly sensitive for detecting myocardial ischaemia
o levels may help to stratify risk afterward
• Troponin I or Trop I on the other hand has 90% sensitivity for myocardial infarction 8 hours after onset of symptoms (1); 95% specificity (1)
• low specificity for unstable angina – 36% – note however that there is evidence that (2)
troponin I elevation is useful for predicting in-hospital risk for unstable angina patients admitted to a community hospital. The association of ECG changes and high troponin I identifies a population at very high risk; however, the absence of both variables in patients with a diagnosis of unstable angina does not preclude the development of events
Source: www.gpnotebook.co.uk
In a nutshell, Trop T is very useful in determining myocardial ischemia while Trop I is widely used in determining unstable angina after the onset of chest pain.
It is a good thing that the patient had negative result for Trop T and the requesting doctor, who’s a pulmonologist did not make a fuss about the mistake.

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.