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.

I have been thinking about what the dressmaker has told me. Of course nothing beats the natural way of loosing weight like cutting on carbs, eating on moderation and getting up on my feet doing cardio workouts. Then again, with my erratic sked I came to considering popping some weight loss supplements to shed off some pounds.
I need to keep my shape in shape to fit in my clothes.

I have asked the hospital’s official dressmaker to sew me another set of uniforms. Unfortunately my old uniforms are close to not fitting me anymore. Even with my erratic hospital sked and the toxic shifts which do not allow me to eat on time, I still continue to put on some pounds.
I have been giving the dressmaker my detailed instruction on how I would like her to sew my uniform and she has just jokingly told me to try clinicallix. I was surprised that at her age, she knows about these stuff. She told me that her daughters abroad are so obsessed with it.

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.

This is the case of a 27 year-old male who was diagnosed to have thymoma. Two months prior to admission, patient experienced on and off chest pain associated with occasional cough. Pain relievers prescribed by a doctor on private consult gave temporary relief for a month. The symptoms persisted accompanied with a gradual weight loss . He was confined in a private hospital in Manila where he had CT scan that revealed mediastinal mass. Biopsy revealed thymoma and was advised to have thoracic surgery hence the admission to our institution.
The contemplated surgery was put on hold as the attending wants clearance from the oncologist. The oncologist wants the patient to undergo chemotherapy.
Thymoma is a type of cancer that begins in the thymus. The thymus is located in the upper chest just below the neck. It is a small organ that produces certain white blood cells before birth and during childhood. These white blood cells are called lymphocytes and are an important part of the body’s immune system. Once released from the thymus, lymphocytes travel to lymph nodes where they help to fight infections. The thymus gland becomes smaller in adulthood and is gradually taken over by fat tissue.
Cancer begins when normal cells begin to change and grow uncontrollably, forming a mass called a tumor. A tumor can be benign (noncancerous) or malignant (cancerous, meaning it can spread to other parts of the body).
Although rare, thymomas are the most common type of thymic tumor. The term thymoma traditionally refers to a non-invasive, localized (only in the thymus) type of thymic tumor. Thymomas arise from thymic epithelial cells, which make up the covering of the thymus. Thymomas frequently contain lymphocytes, which are non-cancerous. Thymomas are classified as either noninvasive (previously called benign) or invasive (previously called malignant). Noninvasive thymomas are those in which the tumor is encapsulated and easy to remove. Invasive thymomas have spread to nearby structures (such as the lungs) and are difficult to remove. Approximately 30% to 40% of thymomas are of the invasive type. (Healthline.com)
Thymoma is generally a slow-growing tumor that does not usually spread outside of the thymus. Occasionally, it can spread to the lining of the lung, called the pleura. Less often, it can spread to other parts of the body. (Cancer.net)
The symptoms in 60% of patients with Thymoma are caused by pressure from the enlarged thymus on the windpipe (trachea) or blood vessels which explains the difficulty breathing or pain being experienced by the patient.
Other symptoms of thymoma may include:
• shortness of breath
• swelling of the face
• coughing
• chest pain
• muscle weakness (especially in the eyes, neck, and chest, causing problems with vision, swallowing, and breathing)
• weakness
• dizziness
• shortness of breath
• fatigue
Of these, Mr. P. only manifested the chest pain and coughing.
Thymoma is categorized into four stages (I, II, III, and IV) which may be further subdivided (A and B) based on the spread of cancerous tissue. The Masaoka staging system is as follows:
• Stage I. The thymoma lies completely within the thymus.
• Stage II. The thymoma has spread out of the thymus and invaded the outer layer of the lung (pleura) or nearby fatty tissue.
• Stage III. The thymoma has spread to other neighboring tissues of the upper chest including the outer layer of the heart (pericardium), the lungs, or the heart’s main blood vessels.
• Stage IVA. The thymoma has spread throughout the pericardium and/or the pleura.
• Stage IVB. The thymoma has spread to organs in other parts of the body.
• The treatment for thymoma cancer depends on the stage of cancer and the patient’s overall health. Because thymomas are so rare, there are no defined treatment plans. Options for treatment include surgery, radiation therapy, and/or chemotherapy. Surgical removal of the tumor is the preferred treatment. Surgery is often the only treatment required for stage I tumors. Treatment of thymoma often relieves the symptoms caused by paraneoplastic syndromes.
• A treatment that is intended to aid the primary treatment is called adjuvant therapy. For instance, chemotherapy may be used along with surgery to treat thymoma. Stages II, III, and IV thymomas are often treated with surgery and some form of adjuvant therapy. However, in the case of Mr. P, the oncologist prefers chemotherapy.
Also, since the patient is already immunocomprmised or has low level of immune system, I have advised the patient and the visitors to wear mask. The patient has been place on reverse isolation or protective environment.
Source: Healthline.com

Most of Filipino men are ashamed to discuss about the decline in their sexual desires. I had one patient who has been treated for his depression due to impotence also know as erectile dysfunction or ED. ED according to NKUDIC, ED is the repeated inability to get or keep an erection firm enough for sexual intercourse. The word “impotence” may also be used to describe other problems that interfere with sexual intercourse and reproduction, such as lack of sexual desire and problems with ejaculation or orgasm.
Damage to nerves, arteries, smooth muscles, and fibrous tissues, often as a result of disease, is the most common cause of ED. Diseases—such as diabetes, kidney disease, chronic alcoholism, multiple sclerosis, atherosclerosis, vascular disease, and neurologic disease—account for about 70 percent of ED cases. Between 35 and 50 percent of men with diabetes experience ED.
Oral drugs such as Viagra, Levitra, and Cialis are being used to treat ED. Some use oral testosterone booster that can reduce ED in some men with low levels of natural testosterone, but it is often ineffective and may cause liver damage.
The patient is taking drugs to address his depression but according to NKUDIC, anti depression drugs may actually cause ED.

After the whole night of binging on unhealthy food, I am a bit jumpy thinking about my cholesterol level. I have stopped taking simvastatin and fish oil for more than a week now. I want to continue with the fish oil thing and I want to try on other stuff like the grape seed and all but I have to look also for some other supplement reviews to know that will best work for me.

For more than two months now, I am having 5mg steroids every Monday, Wednesday, Friday and Sunday. I have not gotten back to my doctor yet to adjust the roids dosage but I now that its effect is already wearing off. Ever since I gotten this anti-inflammatory full dose, I think for more than a year already, my sniffles have vanished. There were only very rare incidents that I sneezed. While the steroids were indicated to treat my other disease, its anti-inflammatory effect has extended to suppressing my allergic reaction to certain allergents.
Last week, I noticed that once in a while, I was having spells of sneezes. Yesterday was entirely different. I got up from bed already sneezing occasionally and I had sniffles until were had our endorsement in the ward.
Right after I made my rounds, the continuous sneezing became uncontrollable. It occurred to me that my allergic rhinitis has come back. The steroids has given way. I do not know if I will feel glad that my old self is back.
I just do not know.

I was the charge nurse in the morning shift yesterday and as I expected, doctors’ order has drowned me. To prevent delay in carrying out orders, I immediately browsed on what the doctors have written and point blank shoot the one who ordered it a question about things I was unfamiliar of or I coordinate with concerned department regarding preparations for certain procedures.
Like when the doctor ordered for a hydroxycut on a patient, I immediately asked my headnurse about it and she asked me to call a certain department on proper charging and preparations.