In line with the compliance to Accreditation Canada International, the management also need to provide for their hospital staff a lounge. So, our management has decided to convert our morgue-like pantry into a room with homey atmosphere. They commissioned an interior designer that will put our dream into reality. They started to put in sofa, a dining table and they have changed the wash tub into a single bowl undermount sink. It is lovely!

One has undergone transradial coronary angiography that revealed one-vessel disease of the left anterior descending artery (diagonal). As he was sent back to his room, the management to his disease was discussed.
The order says possible FFR (fractional flow reserve/transradial PCI or percutaneous coronary intervention.
According to ptca.org Fractional Flow Reserve, or FFR, is a guide wire-based procedure that can accurately measure blood pressure and flow through a specific part of the coronary artery. FFR is done through a standard diagnostic catheter at the time of a coronary angiogram (a.k.a. cardiac catheterization). The measurement of Fractional Flow Reserve has been shown useful in assessing whether or not to perform angioplasty or stenting on “intermediate” blockages.
Stenting is one of the interventions considered to open up a narrowed vessel to increase the blood flow that goes in and out of the heart.
The first instinct or consideration made is to stent a block that is more than 50% to give in the “oculo-stenotic reflex but if FFR is done, blood flow in the affected vessel could be determined and will further call for a more sound decision of whether or not to stent the vessel.
A stent would cost around P80,000 – P100,000 and additional fee for the FFR would not as expensive as that .
The special guide wire crosses the lesion and is able to measure the flow and pressure of the blood. Results are displayed on a special monitor (left) along with the “FFR value”. Studies have shown that an FFR value less than 0.75 or 0.80 corresponds to inducible ischemia, and most likely will require interventional treatment. Blockages that score above this threshold can be safely and adequately treated by medical therapy without the need for angioplasty. (ptca.org)
This has been existing along with the discovery of angiogplasty but due to size in circumference that will fit in a vessel it has somehow virtually died. Recent innovations though gave birth to devices that uses smaller Dopplers which does not need any balloons.
As mentioned, it is usually done during the coronary angiogram but for some reason, the interventionist has reserved it to be done after it and before considering transradial PCI.
I was the charge nurse one night and in my rounds I mentioned to the patient the preparation for the procedure including the needed downpayment. Although he is under an insurance company, he said that they are still to decide if they will be going for the procedure. That is what I endorsed to the incoming charge nurse and the next day that I came in, the patient has been discharged.
I hope that he made a very wise decision as his condition needs special attention.

I really love the sporty atmosphere in the ward. My colleagues are into maintaining a healthy lifestyle amidst the sticky situation in the hospital. Since it is raining, I did not have the luxury of time doing my routing run. I offered my water proof MP3 to my colleague who plans to run 21k in the next leg of the Unliab Run. He politely declined my offer and said that he just need to find water proof accessories for ipod so he could have has MP3 playing even in the rain.

The surveyors for the Accreditation Canada International are finally here in our institution. Our hospital is gearing for the Diamond category which is the highest grade the ACI gives. Last year we scored Gold which means that we have process that we apply. The Diamond standard means that we have the check and balance for the said process.
The surveyors have been to various department and wards in the hospital and I was so lucky that they did not drop by the ward yesterday in the midst of the chaos. I was picked to be the frontliner and I do not think that I could pull my acts together when I had so many things in my hands yesterday.
I heard that apart from the questions they actually get through the patient’s charts and check the document management. I just hope that they would not concentrate much on the appearance of our charts as they look very awful.

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.

Right after our night duty, I and my 2 colleagues braved the rain and flood in the metro to reach the recruitment agency. We responded to their advertisement for nurses needed in USA.
We reached the agency just right after they opened so we were among the first to be entertained. We went through the first interviews and we thought the we went well. My two colleagues were ahead of me and they were put on the call back list to under another interview on August 22. I was the last to be called for the final interview and after a few minutes I was told by the interviewer that I am qualified for the position except that my religion seemed to be a big problem.
She told me that we did not have church in Corpus Christi , Texas and they have had previous experience when some of the employees who belong to the church I am in had serious problems finishing their contracts due to spiritual issue. Their inability to find a church in their area of deployment caused them to breach their contract with the employer there.
I was put on the second priority list. I asked what it meant. I did not get a clear answer.
I told her that since the last time they hired an nurse having the same religion as mine was in 2004, there is a big change that our church administration has found a way to put up a congregation there. So I told her that I will look for one. She said I could try.
I actually did not have a heavy heart leaving their office. I know for a fact that religion should never be an issue. Religion should always come first.
As soon as I got home, I searched the internet and I was not surprised to find out that we have a church in Corpus Christi along with the other states the recruiter have mentioned during our interview.
I texted the interviewer right away about the good news. She replied that she will let the sponsor in America know.
End of conversation. While I am uncertain about the call back, I am certain that I would not trade my faith for anything in this world.

There many promos circulating the net or just simple requests to like a particular page. There are time that I pass on to some requests but there are times that I give in. I checked out the happyeasterstore page on Facebook and I am surprised at the Easter favors that they offer. Easter is one of the most celebrated holidays of the year and being stress free yet keeping the personal touch in sending out your love and concern to everyone is really a big thing.

I was really thrilled by the news I received from a friend. Her status on Facebook says” Bun in the oven” and everybody went crazy posting congratulatory comments. It is really nice how creative people are in terms of letting others know about their situation like baby announcements. I hope that I could think of better ways of making them when the right time comes.

One of the seniors in our ward was so furious. He was apparently scolded by our headnurse during the grand endorsement. As the outgoing nurse, he needs to endorse all the patients to the incoming nurses and that includes the headnurse.
Our patient was a 22-year-old female who was diagnosed to have Ventricular Septal Defect or VSD who came in due to complaint of fatigability. VSD is a congenital disease or present at birth and is characterized by a hole or a shunt in the lower chambers (right and left) of the heart.
Anatomically, the blood flows from the superior and inferior vena cava to right atrium down to the right ventricle going to the pulmonary artery to the lungs for oxygenation then to the pulmonary vein to the left atrium down to the left ventricle then pumped out to the systemic circulation. With the VSD, the oxygenated blood coming from the left atrium leaks back to the right ventricle which mixing with unoxygenated blood then goes back to the lungs that cause too much blood pressure in the lungs that causes pulmonary hypertension. Also, the shunt allows for the poorly oxygenated blood to enter the left ventricle that causes the blood to circulate the system.
Our female patient was diagnosed to have Eisenmenger Syndrome which is associated with the high blood pressure in the lungs or the pulmonary hypertension caused by the VSD. The mean pulmonary artery pressure (mPAP) is ≥25 mmHg at rest or ≥30 mmHg with exercise (Barst et al 2004).
Eisenmenger’s Syndromes signs and symptoms include:
• Abnormal heart rhythm (arrhythmia)
• Bluish lips, fingers, toes, and skin (cyanosis)
• Chest pain
• Coughing up blood
• Dizziness
• Fainting
• Feeling tired
• Shortness of breath
• Stroke
• Swelling in the joints caused by too much uric acid (gout)
Complete blood count revealed increased levels which is common presentation of the syndrome. She underwent phlebotomy. Older children with symptoms may have blood removed from the body (phlebotomy) to reduce the number of red blood cells, and then receive fluids to replace the lost blood (volume replacement).
Heart murmur or an abnormal heart sound can also be heard and this was among the questions of our headnurse. I do not know but based on the feedback I received from my co-staff nurses, what our headnurse did was a bit out of bounds. The senior nurse felt belittled. It is one thing that she knows something that we do not know but it is another to guide us to learning the ropes of cardiac nursing.
Searching the internet, I landed on kidshealth.org. A heart murmur is a whooshing sound between the beats that a doctor hears through a stethoscope. The whoosh is just an extra noise that the blood makes as it flows through the heart. Normal heart sounds are called “lub-dub”.
The heart makes a “lub” sound with the closing of the valves that control blood flow from the upper chambers to the lower chambers. Then, as the valves controlling blood going out of the heart close, you will hear the sound “dub.”
Murmurs have grades. Grade 1 is the softest-sounding murmur, and Grade 6 is the loudest. A murmur graded 4, 5, or 6 is so loud you can actually feel a rumbling from it under the skin if you put your hand on the person’s chest.
There is no treatment for this type of condition and the treatment is palliative or based on the presenting complication. The pulmonary hypertension may be treated with prostacyclin and endothelin antagonists.
Viagra, which is the common form of Sildenafil is used to treat pulmonary hypertension that helps dilate the pulmonary arteries.
Prophylaxis against endocarditis is also recommended. Once developed, life expectancy for patients with Eisenmenger Syndrome depends on the type and severity of the underlying defect and right ventricular function, and ranges from 20 to 50 years.
According to Mayoclinic. Com, doctors do not recommended surgery once Eisenmenger syndrome has been developed although some may benefit from heart and lung transplantation or lung transplant with repair of the hole in the heart.
Next time that our headnurse will throw a big stone of a question at us, I will make sure that I have my armor.

I did not notice how time flew so fast. Almost a year and seven months ago, I started as an orientee in this hospital. I was being guided by my preceptor, who actually, I did not regard as one. I remember that during that time, he just deflects or asks me back every question that I threw at him. He even sarcastically tells me to research on some questions that I ask and get back to him about it. So arrogant. He is brilliant as he was on the list of those who topped the critical care course.
I know for a fact that it is not the right way of mentoring a newbie or any person for that matter. Show them the tricks of the trade, teach him thing that he or she might not know or enhance the things that he already know.
Now that I am in line to be the next preceptor, I will assure that I will leave something for preceptee to cherish. Something good that is.
The preceptorship training will help me in becoming the best preceptor I could ever be.