Morning Sniffles

The Gold Standard of Coronary Artery Disease

morning sniffles — Tue, 31 Aug 2010 11:26:51 +0000

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.

A fortunate misfortune

morning sniffles — Tue, 31 Aug 2010 11:25:42 +0000

I was at my former office this afternoon to meet up with my former officemate when I noticed that people are starting to flock at the parking lot infront of the abandoned building. I found out that my former teammate’s back dashboard was completely broken by a makeshift chair which according to some bystanders just flew out of the window of the abandoned building. It was a windy day today due to the typhoon at the northern part of the Philippines.
The parking lot infront of the abandoned building has a park-at-your-own-risk policy and my former teammate did not appear to be worried about the situation although the damage is totally alarming. Luckily, she has gotten her car a 5th wheel warranty that will cover for all the damages this unfortunate accident has caused the poor automobile.

Up for the renovation

morning sniffles — Mon, 30 Aug 2010 15:43:30 +0000

The dorm has been undergoing section-by-section renovation. The ceiling on the hallway and the light fixtures are now presentable and they engineering team has started on renovating the other side’s bathroom. My confusion about the renovation of each room has been addressed when I asked one of the engineers how to go about it. He just said that we should request for that at the administrator’s office and they will allocate a day to finish all the repairs including the replacement of the blinds. I am really excited about it and I am willing to volunteer to stay in the room just to the repairs done.

The good times are here

morning sniffles — Mon, 30 Aug 2010 15:13:13 +0000

The rainy season is now intensifying. There is no day that it did not rain. I am loving this season as it gives me a very good time to relax and curl up in my bed during my day off. I am now unearthing my sweaters as the weather makes the atmosphere colder in the dorm. Comforters are not enough to keep me warm and I am really shaken to the core whenever I am in the dorm.

Losing the battle, ends her agony

morning sniffles — Thu, 05 Aug 2010 07:03:02 +0000

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.

The economy class syndrome

morning sniffles — Sat, 31 Jul 2010 12:01:42 +0000

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.

What is an apple bottom?

morning sniffles — Mon, 26 Jul 2010 05:49:51 +0000

There are different shapes of human in terms of body form. There are pear shapes, drumstick shape and what not but have you ever heard of apple bottom? It is something that is new to me. Apple bottom similar to round shape which means the heaviness is equally distributed from the thorax down to the bottom part of the body but in some definition it simply refers to the type of lingerie a famous brand carries.

The handy breakfast tray

morning sniffles — Mon, 26 Jul 2010 05:16:30 +0000

I got a breakfast tray for my laptop. This way I would not have to strain my back, neck and hands when using my laptop while in bed. It has been with me for more than a year and I brought it to the dorm. My roomie has asked me where I got it because she badly needs one for her laptop also. I told her that I got it from an office furniture shop more than a year ago and then it only cost less than P300.

Gone to soon

morning sniffles — Tue, 20 Jul 2010 16:54:22 +0000

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

Keeping my shape in shape

morning sniffles — Mon, 19 Jul 2010 07:44:59 +0000

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.