Ambulance Nurse

The first time I rode an ambulance back then was in the Philippines. We have a simple ambulance car with just have enough equipment for transporting a patient. As I can remember, it is always a bumpy ride with your patient who is very critical that needs care while traveling. Usually, patients were transferred according to their own choice or the patient needs a higher facility to take care of his/her condition.

Now, I am working in a country with a very good ambulance vehicle highly equipped with machines needed by the patient during transport. I am very ecstatic to experience riding their ambulance. This time, we took a patient from the airport sent by Medevac. Medevac means a transfer or evacuation of a patient going to the hospital through helicopter or airplane, along with nurses and doctors for critical patients.

Prior transport, you need to double check that all the equipment inside are functioning. Know the case and status of the patient you are going to send or fetch because you need to secure all fluids and medications needed.

Since the patient that we were going to fetch from the airport was unstable and ventilated, we rode along with the respiratory therapist and a Doctor aside from EMS staff.

As nurse inside the ambulance, of course, i got nervous of what might happen to the patient along the road. I had a colleague while taking the patient from the airport and transferring to the hospital, the patient crashed and they had to do CPR along the way. Thinking about it sends chills on me.

But thank God, we arrived at the hospital safe and the patient was sent directly to the ICU for management and treatment.

Happiness and satisfaction were what I felt that time since we transported the patient safe and nothing unwanted happened along the way.

just got another experience to share, thanks for reading. :)

The nurse transporter.

Why you need Magnesium in your Diet?

Magnesium is not commonly discussed in a diet specifically for its purpose and benefits to your body. Magnesium is a mineral usually present in the body. For critically ill patient,  it is very essential in maintaining good blood pressure and heart rhythm.

Nursing responsibility, we should always inform the Physician for its abnormal result. Patient monitoring and proper dosage and correction of this electrolyte should be followed along with the Doctor's order.

Normal magnesium level is 0.8mmol/L. For patients with heart problems, it should have a level of 1mmol/L. Patients in ICU, if magnesium level is low, it should be corrected as soon as possible to avoid complications according to Doctor's order/prescription. 

Why do we need to maintain its normal level?

Decreased in magnesium level or hypomagnesemia will result in having insomnia or inability to sleep, mental disturbances, irritability, anxiety and depression, muscle spasms, noise intolerance and increased level of stress.

Foods with high magnesium contents are  bananas, dark green leafy vegetables, dried fruits, fishes, beans, nuts, seeds, avocado, yogurt, dark chocolate and whole grains.

Enough amount of magnesium containing foods in a diet is a great way to maintain a healthy body.
Excessive or too much magnesium consumption might cause diarrhea since body will eliminate excessive magnesium.

If you have symptoms that might represents low magnesium level in the body, seek for Doctor's advice for treatment.

Why should you have more tomatoes on your diet

Tomatoes has many health benefits that can help maintain the wellness of a person. One serving of tomato-containing foods will have beneficial effect on your health.

Tomatoes contain vitamin A, vitamin C and vitamin K. Vitamin A helps to maintain good vision. Vitamin C aids in immune system and Vitamin K helps maintain the blood coagulation of the body by preventing excessive bleeding.   

Tomatoes contain antioxidants called lycopene. It is also rich in potassium which is usually found in bananas. Potassium aids in muscle function, especially in heart muscles.

For breastfeeding moms, when eaten, it should be cooked. It is known to increase the lycopene concentration into their breastmilk.

Other people doesn't like the taste of tomatoes for its sour-sweety taste. Try to cook for a better taste. But once you knew its beneficial effect in our body you need to love this fruit/vegie.

Fruit "slash" vegie since it has a debate if it is a fruit or a vegetable, nevertheless, it is very healthy to start your diet with tomato.

Have a fun and enjoyable meals with tomatoes!

Hyponatremia, our Nursing Responsibilities

I had a patient with severe electrolyte imbalance. Hyponatremia is not as simple as it is. Close observations and monitoring should be done for patients with this case. We usually think, hyponatremia is easy to correct, yes, but not all. It is very fatal if not treated well. 

This may cause demyelination leading to paralysis of the patient due to rapid correction of hyponatremia. Demyelination is neurological disease caused by severe damage of the myelin sheath of nerve cells in the brainstem.

For a patient, Mr. X with these laboratory results:

One might think, is this patient still alive? yes he is, thank God, He was found unconscious on his car and now needs critical management. This laboratory results usually represents Acute Kidney Injury if not Chronic Kidney Injury/ESRD since no known history for this patient upon admission.

On nursing side, i will be focusing on hyponatremia. Yes, the patient has a lot of imbalances that needs to be corrected but i will emphasize more on nursing responsibilities for severe hyponatremia.

These includes:

1. Electrolytes monitoring every 3-4hours.

2. Gradual increase of sodium level of at least 14-16mmol/L within 48hours, is the target goal.

3. When starting continuous renal replacement therapy, strict monitoring and reporting of laboratory
    results should be done, since CRRT may cause rapid correction of electrolytes which is not good
    for the patient. CRRT may be done for 6-12hours on strict reassessment as ordered by the
    Physician.

4. Proper IVF along with the right amount of free water should be followed as ordered by the
    Physician to avoid rapid correction of sodium.

5. Level of consciousness should be strictly evaluated.

With proper management, gradually, patient has improved, electrolytes, BUN and creatinine were corrected. He has gained consciousness and was extubated.

;-)

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Operating Room Nurse

A bladder stone was removed from patient.

                           

One of the things i missed and loved in nursing career was working in Operating Room as OR nurse. As an Operating Room Nurse you are expected to be always on the go. It has always emergencies any time. Successful operations were the only thing we could pray for, in an event that serious complications may arise if no immediate intervention will be done.  

Harmonious team in OR vastly affect the work flow. As a nurse, nursing skills, knowledge and attitude is important in achieving a good work flow inside the theatre.

There were on calls during the night, calls even in the middle of the night. But it is a satisfying job once you were able to help a patient survive during emergencies.

A Heart-Touching Letter of a Patient's Daughter to the Nurse

Not in a day Nurses were usually appreciated. But a simple thank you will bring comfort to our exhausted hearts during toxic days. I would like to share a heartfelt letter written by a patient's daughter who loves his father so much towards my colleague.

It was written on a piece of paper and it says,

Good evening, Dear nurse. I am sorry I don't know your name, it is not like me to not know. I am not myself recently as my father is my life, and light and strength.

He is a very kind and funny man, if he was awake you would become friends. 

He would ask about your family, your life and wellbeing every day. 

Thank you for taking care of him. I will not forget every effort you made

the precious nurse with the glassess too. I trust you very much and I am grateful that you two are so kind and gentle with my father. 

When he wakes up, I will have you two meet him and laugh with him. 

Thank you for taking care of my soul. He is everything.

Love, Leena. 

Thank you also for appreciating the Nurses' efforts.

An inspiring story for Nurses. Share the love.

Credits to the two nurses, Leonil and Arlene.:)

Not The First Time but My First Reality in ICU

As a nurse, we have different fields to choose from and we have an option which department we're comfortable to work with. You can choose Emergency Department, Intensive Care Unit, Ward, Operating Room, these were only the most common areas I will mention but too many to mention.

Sometimes we choose an area that we like but regret it afterward. In each area, the struggle is real but backing out is not an option. It is always difficult at first but in the end, if you were shaped and mold with so many experiences, hard work will be worth it.

For new nurses, it is an exciting phase of our lives where we can choose or either we will be assigned to a special area. We felt very ecstatic on how it feels being there. Others may feel that it is not their chosen area, but all I can say is, we all experienced that. Just think of how you will be taught where you were assigned now. All knowledge and skills will not be acquired only in one area. It is still a ladder in becoming a competent one. Ups and downs are our partners.

Even if we have a long time experience, we will always meet something new. As a Nurse that specializes in Critical Care, I think it is one of the most challenging areas one could be assigned. It is the end stage of patient care if I may call it. Hundreds to thousands of things you need to consider when handling critically ill patients. This is the point where I can say that nursing is really a "calling".

Knowledge, skills, and attitude are your topmost armor. Everything is critical, you need to think fast and your best judgment is important especially in the matters affecting your patient. 

At first, everything is new. It seems like your mind is floating everywhere how to handle such equipment.

Code blue will be your best friend. :D when we are new in this field, it feels like we're the one needed a shock at 200joules. :)) kidding aside, reviving a patient is very satisfying when you see him coming back. Having your friends in the unit during a code blue, even if everything in your room was a mess, it is totally okay. 

Unlimited patient's bowel motion, every positioning comes with great responsibility. We are a self-proclaimed superhero. :))

Morning care, afternoon care or any care you may call it, "call a friend" is our favorite tag line. ICU life is difficult if you will work all by yourself. It is always a team. 

For others, first thing in the morning, checking an allocation is not about the patient's acuity, it is about who will be your team in your station. :))

Always ask if you don't know something, it is always the life of our patient.

For nurses who will about to embark on their chosen area, don't be afraid. There is always a time to learn everything. Start your journey, it might be a bumpy one, but still you will be proud of yourself after all.  You may cry and about to give up, just stay strong, it is part of learning process and you are not alone. "Been there, done that".  

So this is my chosen journey. 

Thanks for reading.:D

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When the Nurse became the patient

Being a nurse has complexities to consider. Lots of challenges to encounter, be it mentally or physically. It is not just about taking care of our patients but also taking care of ourselves. 

From the toxicities of our patients to not being able to notice that you did not eaten your meal or haven't gone to comfort room just to pee.

A nurse has a lot in his/her mind going on, since time is very essential. We have goals to meet at the end of the shift. 

When i had my dose as a patient, realizations sink in. Hard work is vital but your vital signs were also important. :D

To my colleagues to the other side of the world, don't forget to place your health at the top of your priority.

Proper meals, vitamins and adequate sleep should be our goal. For 12 hours shift, at least a target of 7 hours sleep is already nutritious for our soul to get us going.

Healthy diet leads to healthy body. At least no instant meals. Most of the nurses has no time for cooking, but at least plan ahead what to cook even an easy meal.

Lots of sleep on your rest day is the best.

Increase fluid intake, advisable not just for your patients.

Take time to value exercise. 

Just a friendly reminder from a nurse on the other side of the world. :D

What is fasciotomy?

Working in a Critical Care setting, I had the privilege to handle a patient with a case of lower leg swelling. The patient had a crushing injury to his left lower leg.

Fasciotomy is a limb-saving procedure to be done for compartment syndrome. Compartment syndrome usually develops when one of the veins or muscle has an insufficient blood supply. This condition usually associated with numbness and swelling of the affected site since circulation was impeded. Other indications of this procedure are for those who were obese and with severe burns.

The next picture is a case of a severe burn. In severe burn injury, there is an increase in vascular permeability, increased interstitial osmotic pressure and cellular edema. Due to fluid shifting, there are translocations in the distribution of water and solute. In order to prevent compartment syndrome, fasciotomy is the best procedure to be done.

I had the chance to assist with the procedure at bedside since it was an emergency procedure. This procedure is usually done by a Vascular Surgeons. I was astonished as of how the procedure was done.

If not done as soon as possible, impede blood circulation, will cause amputation of the affected leg. This is done to relieve pressure to the patient's leg with severe swelling. More often than not, a patient with compartment syndrome, the affected site has greater than 2 seconds capillary refill and nail-beds appears dusky or cyanotic.

As a Nurse, we have duties and responsibilities for cases like this.

Monitor vital signs to include Blood pressure, respiration, pulse rate and oxygen saturation.

Sterility is our utmost priority when assisting the procedure and dressing.Monitoring of patient's coagulation profile.
Monitor signs of bleeding to the operative site.

Measurement of the post fasciotomy site should be done daily, once swelling improved, sutures will be tightened little by little.

Hope I have given you some input.  Feel free to comment below for additional ideas.

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OFW Feels

It's been a long time since i post on my blog site, my heart and mind kept looking for it. Been busy focusing on my work since i went abroad 3years ago.  :) 

I would like to share how it is being an OFW. 

 

As a Nurse you will face lots of challenges, mentally, physically and most of all emotionally. At first, you will thought going out there is fun and enjoyable thing especially if you will earn money bigger than what you've earned in your country. Its true, yeah it is! ;)

 

But wait a minute, prepare yourself for life a changing experience. From different environment to language barrier to different culture. These applies to any other countries you are planning to work or migrate with.

 

I learned that it is difficult to argue when you've brought up to a different cultures, so better not. ;D

 

You will learn that you are extraordinary when faced with difficult situations thinking you are on your own.

 

You will appreciate what we have back in the Philippines especially "sardinas and tuyo", you will miss the simple foods cooked by your mother. :) 

 

You will appreciate the saying 'an egg a day, keeps the Doctor away'.  i know its an apple :)) Kidding aside, but if you're on your own, an egg a day keeps you alive everyday. Pritong itlog  keeps you from being late :) And of course, you will perfect how to boil.

You'll cry in the middle of the night knowing you missed them, your family and friends. Seeing them happy on facebook makes you feel real sad, why? because you're not there. You will miss every fun, outing, birthdays and events. 

 

You leave your country with a nephew you took care of for months, when you get back home, he cannot even identify you. Masaklap!:D  I am so proud of those OFW who were brave enough to leave their children at a young age just to provide a comfortable life for them. 

 

You will realize you are taking care of other people that you cannot even took care of your own mother and father.

 

You will realize that going back home during vacation is a sad thing knowing it's only a short one. You will get excited yet sad 'cause in reality you are already thinking about the moment when you get back for work and leave them again.

 

Christmas will be different. All you have will be memories how you have spent it with your family. But still you can celebrate it with friends and most of all video call is there so don't be too upset. :)

 

You will truly appreciate the "hilot" of your mom when you felt exhausted and tired from work and will missed how it was being cooked with breakfast by your mom. 

 

You will learn how to manage your time on your day off from cooking, laundry and of course, facebook and leisure! :D

 

You will appreciate the microwave oven, with all your meals cooked good for 3days, reheat, reheat and again reheat. Funny isn't it? :)) 

 

You will realized that it's too cold to take a shower and too hot not to. I experienced that during winter and summer. :)) But still we are Filipinos, even weather temperature at 0 degree we really have to take a shower before going for work.  

 

You will be amazed how other cultures lived, how they eat, what they eat and how they communicate with gestures.

 

You will learn to say 'I Love You' to your family over the phone and appreciate it so much when you heard it from them.

 

Balat-sibuyas no more if you were on your own, you will become stronger and learn to cope to your environment. You will become a better person with better understanding to every situation, you will know how to rationalize things in a rational way.  

 

You will be a good baker on your own. You became a chef that you didn't expect you to be. 

 

It is not easy, yes, but in the end, you will realized it is really fun and enjoyable thing when you saw the happiness lit in the faces of your family. It is not just about the struggle, it is about how you will make your family happy by providing them enough comfort.  

 

It is still rewarding, i tell you. God is there, Don't be scared, get out from your comfort zone and grow up. :)

 

                when it's already night time down there, yet you can see the sunset up here.

#leavingphilippines

TOP 5 Paraphernalia in your pocket as a Nurse

Every nurses has their own  choices of paraphernalia depending on which department you were assigned, and you're good to go!

I am an ICU Nurse so here's my List:

1. Penlight

There's nothing more important than this paraphernalia. Once you're in ICU, nothing beats the pupil assessment q 1H! (every hour!)

2. Pen

The all time favorite to lose! As what my colleagues were saying, better to leave your cellphone ('cause nobody will snatch it) rather than your pen, because everybody needs a pen especially during toxic moments, 1 minute you leave it and voila! Its gone. :D Kidding aside, this is very important for consents.

3. Scissor


For the soldiers, this is also our weapon, not just syringes. Because in every situation, there is something you need to cut, better be ready at all times.

4. Plaster

Every time and all the time, you will need this! ;)

5. Identification Card

Of course, it's an SOP, usually it comes along with your keycard for you to enter your unit.

What yours? Just comment below. You can also comment your designated department as it varies depending on your unit assigned. :) love to read it.