I felt weak in the knees learning that our patient whom I wrote about in November last year, died after undergoing another operation to close her infected chest wound.
In December of last year, she underwent coronary artery bypass graft to cure the blocked three vessels in her heart. Her peritoneal dialysis was temporarily put on hold on the day of the operation but was resumed the following day in the recovery room.
The patient was uneventful in the recovery room and in the surgical ICU. She was even transferred to our ward, in the same room about three days post operation. She was about to be discharged after a few more days and they have settled everything until on the day of her discharge, the nurses noticed heavy amount of serosanguinous fluid oozing from her operation site. The discharge order was deferred.
She was cut open again to let the tissues granulate. She was also referred to the Infectious Disease Service and wound gram stain culture and sensitivity revealed heavy growth of e. Coli (Escherichia coli). After a couple of weeks of wound dressing by the surgeons and antibiotic treatments, she was scheduled for wound re-closure. It also went well. She was transferred to surgical ICU and the unthinkable happened. Her blood pressure dropped and she crashed. There was nothing they could do to revive her . The relatives requested DNR.
I felt chills down to my spine hearing the bad news. One cannot defy fate.

In our fall risk assessment form, voiding pattern is one of the categories. I do not exactly understand its relevance to the risk it poses to a patient but I think it has something to do with making a puddle on the floor that may pose as a risk in tripping. Just my theory. So it is advisable to turn into some helpful stuff like the incontinence products that may help the patients control their urges or just help them get by with their disorder.

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.

This is a case of 31-year-old sfemale, single who was admitted for management of stage IV breast cancer. The terminal stage. She has had left mastectomy (removal of the breast) in 2009. Her family refused to go for chemo therapy and decided to treat the presenting symptoms.
The patient came in with fever and unproductive cough. She has been bedridden since February this year due to pain she experiences when walking. She also complains of constipation, abdominal pain, neck pain and has had episodes of vomiting.
Her lack of appetite has prompted the doctor to place nasogastric tube to serve as an access for her osterized feeding to meet her daily caloric needs.
The cancer cells have metastatized to her bones that cause her excruciating pain especially in the leg. She has been referred to pain management specialist and the doctor gave her Oxynorm round the clock. Her pain was too severe that she needs to be given with Nubain via IV as rescue doses.
There are times that she’s okay and conversant but most of the times, she was disoriented mumbling incomprehensible words.
She’s all being managed for infection in the blood (sepsis). Her white blood count still shoots up despite the protective environment that she has been placed in. Her red blood cells, haemoglobin and hematocrit are all going down. No blood transfusion was made although warranted because their religion, Jehova’s Witness, forbids this.
The family members were primed about the impending loss in their family. Her vitals are all going down at 4:00 pm, she was pronounced dead.
In terminal cases, the medical staff can only offer palliative management and emotional support. Her battle with cancer was over and it is sad that she has lost to it.

Last night was fun. It actually lasted until 3:00 am this morning.
The cool gang from my previous work, actually none of us still works for that company, got together at a music joint called Music Bank on Morato Street for some videoke trip.
Alongside the belting is some belching due to unending flow of heart-friendly treats. We feasted on cholesterol-induced dishes that I started to feel paranoid about clogging my arteries. During the last hour of our vocal power exhaustion session, the receptionist came in with a platter of fruits. According to her it is a complimentary treat from them. A good way to have a colon cleanse.
Right now, I am trying to detoxify with a cup of brewed coffee. I hope it does the trick.

In the midst of the summer heat, I went out and braved the sun to run some errands. Had to get money from Western Union, went to pick up my professional license from PRC (Professional Regulations Commision) and renew my driver’s license at LTO (Land Trasportation Office). I was also able to buy a cell phone and ship it to Switzerland.
I was able to finish them by 4:00 pm. I just grabbed myself a grande iced caramel macchiato and headed home.
I changed into my uniform and hit the road again for my night duty.
It was the usualy shift for me. My co-staff nurse just recognize the my left eye was red and I just dismissed the comment by telling him that it’s just irritated by the contact lense.
At 4:00 am while I was dressing the wound of the patient who has undergone coronary artery bypass graft. When I was about to drain the syringe in the comfort room, I took a glance at the mirror and was shocked to see that my left eye was bloodshot.
I hurriely went to the nurse’s bathroom and flushed it with sterile water. I even asked the help of a fellow nurse to flush it but the bleeding won’t stop so we decided to head for the ER. There, they did not do anything. They just asked me to rest. It’s useless. I decided to go back to the ward to finish my task instead.
After my shift, I went to the infirmary to see a doctor. He ordered to run some tests on me: CBC or complete blood count, PTPA and aPTT (both will check on my bleeding parameters). They all turned out tobe normal. Thank God!
I was told that it was a subconjunctival hemorrhage that will resolve on its own.
According to wrongdiagnosis.com:

Bleeding from one of the tiny, almost invisible blood vessel under the conjunctiva (the clear lining covering the eyeball and the inside of the eyelid). The condition can cause the whites of the eye to develop red patches from the blood trapped under the conjunctiva. Although the condition looks serious, it is painless, doesn’t impair vision and requires no treatment as the blood will usually disappear within a few weeks. The condition may occur for no apparent reason or may result from such things as an injury, coughing and heavy lifting

Since I am not hypertensive and diabetic, I know that it was caused by straining too much lifting a patient.

I do not know if it comes with age but I see that older people suffer more from skin disorders that the younger ones. Maybe it is because of lack of mobility being confined to bed or a wheelchair or the integumentary and circulatory systems are as vulnerable as their other systems. Some suffer from skin infections that appear to be exzema or escema.

I have come across patients who have just undergone operations asking how to build muscle fast Their relatives too are eager to have knowledge about this and as part of our health teaching program I just tell them to get good amount of protein and they need to have regular exercise routine. I also informed them that protein also help make the wounds heal fast.

Good thing about working for a hospital is that, I could at least avail of the free diagnostic procedures. Well, I am really unsure if probationary employees are included in this package but the nurse at the infirmary just stamped the lab work up prescription from my doctor and when I presented it at the pathology department, they did not ask me to pay anything. They do not have the protein-creatinine test though which I had done at the National Kidney and Transplant Institute. Anyhow, it is still best if I had cheap insurance that would cover all my medical expenses. This is the only thing that makes me reconsider keeping my callcenter job.

I woke up this morning to the voice of my dad and nieces. It is the usual morning for them, screaming running around the house being chased by my dad. With the morbid thoughts running on my mind, I could say that I have got some decent sleep after all. I just noticed that my fingers are throbbing a bit, yet again. I have stopped taking Plaquenil which is among the best yet pricey rheumatoid arthritis treatments out there.