Dimsum Galore!

Yesterday, I and the bf went to our favorite place (Greenhills) to unwind. I've been off-duty since Sunday and just got my second paycheck yesterday. Daiso is my new favorite store and bought plastic boxes and a mickey mouse keychain. The Booksale has nothing for me that day. I was hoping to find One Hundred Years of Solitude (one of my friends borrowed my copy lost it) but to no avail. Hungry and tired from walking in the tiangge, we dined in Le Ching Tea House. We ordered hakao, steamed pork spare ribs, beef tripe, and beef brisket noodle. Ang dami nito pero taob lahat ng plato pati iced tea! Katakawan is our favorite sin.

Beef brisket noodle (ang sarap nito, promise!)

Hakao

Spare ribs (eto rin masarap!)

Chilli (eto ang nagpapasarap sa lahat!)

*Photos taken from here

Life of a Nurse Reliever

I'm working as a Nurse Reliever with a contract of 3 months. Reliever means you'll be reporting for work only if there is a need. Just like the staff nurses, I have a 2-week schedule plotted in the calendar. My schedule becomes insanely favorable when the census is low and that's the time that I would get a text message from the Nursing Service Office that I won't have a duty.

A while ago, the most anticipated text message came and I couldn't be any happier! That means I have 3-day vacation! No, make that 7-day vacation because I have been off-duty since Saturday! Yay! It has been like this most of the time. So, in every rotation (that's 2 weeks) I'll be working for an average of 8 days only.

The downside of it is that I earn so little I can't afford to pay my own insurance. I still have to rely on my dad on this. Thanks, Daddy. I'm just so grateful that I'm employed as a nurse now, instead of me paying for the training.

Anyways, Nurse Relievers are the ones being pulled from her turf to other areas. In my case, my homecourt is 4A. When the census is low in 4A, I will be pulled out to other areas like ICCU or 4B. I love working at ICCU because my focus is only on 1 patient. I just have to be careful in ensuring that everything that needs to documented is documented by me in the Kardex and chart, and that every abnormal condition of the patient is being relayed to the doctor.

So far, I have earned 1 strong warning in my almost 2 months as a nurse reliever. Hopefully, there will be no other warning or incident report for me. That's why after the shift, I always double-triple check the doctor's order, medication sheet, nurse's notes, Diabetic Sheet, etc. to make sure that I have closed my charting, I have carried out all the doctor's orders, I have signed the medication sheet, and I have relayed the CBG monitoring. Because the image of a nurse reliever is magnified and is under the scrutiny of every staff, supervisor, even NA's and orderlies in the area.

My Reviewer: Dosage and Calculations

Before going to the topic, here's an addendum to my previous blog about what's written at the back of San Mig Light's label: "When the work is done and it's time for rest, Let there be San Mig Light." Ngayon ko lang naalala :)

In our previous lecture, we discussed again dosage and calculations. Everything about this topic seemed much clearer to me now. We had a post-test, as usual, and I'm happy to pass all the exams.

Here are some of the questions on dosage and calculations:

1. IVF 1.5 liters to run for 94 cc/hr
a. no. of hours to be infused
b. gtts/min

2. IVF 1 liter to run for 25 gtts/min
a. no. of hours to be infused
b. cc/hr

3. 1 liter of an IVF to run for 3 hours with an infusion set that delivers 10 gtts/ml. 400 ml remains after infusing for 1 hr and 15 mins. Find the gtts/min needed so that the IVF finishes in the required time

4. 100ml of an IVF to run for 2 hours via soluset.

5. Dopamine* 2 amps (ampules) in 500 ml D5W to run for 12 mcg/kg/min. Patient's weight is 60 lbs.

6. ISDN* (Isosorbide Dinitrate or Isoket) 2 amps in 100 ml D5W to run for 2 mg/hr.

7. KCl* (Potassium Chloride) 30 mEqs in 1,000 ml IVF. How many ml of KCl will you incorporate?

8. Drug available is 20 mg/5 ml. Prescription is 40 mg. How many ml will you give?



*In answering items #5-7, you must know by heart the stock dose of those emergency drugs:

Dopamine is 200mg in 2ml ampule
ISDN/Isoket is 20mg/ampule
KCl is 40mEqs in 20ml vial


Solution #5:

Formula:

Order (mcg/kg/min) x weight (in kg) x 60 min/hr)
---------------------------------------------------------
concentration of drug in IVF

Order: 12 mcg/kg/min
Pt's. weight (must be converted into kg): 60 lbs /2.2 kg = 27.2 kg
Dopamine 2 amps (must be converted into mcg):
200mg x 2 amps x 1,000 mcg = 400,000 mcg
Concentration of Dopamine in 500 ml D5W:
400,000mcg
--------------- = 800 mcg/ml
500ml

Solution:
12 mcg/kg/min x 27.2 kg x 60 min/hr
--------------------------------------- = 19,584 / 800 = 24.48 or 24 ml/hr
800 mcg/ml

Your final answer needs to be rounded off to eliminate the decimal numbers because we're talking about the drip rates here (there's no such thing as 24.4 drops, right?)

Tips: So you won't be bugged by what formula to be used in solving these IV drip rates of emergency drugs, just look at the units of measurement in the order. In this case, the order is "12 mcg/kg/min,"

so the formula will be:

mcg x kg x min
-------------------
concentration

the divisor, which is the concentration is always solved by:
drug x no. of amps (x 1,000 if needs to be converted from mg to mcg)
--------------------------------
no. of ml of IVF



Solution #6:

Order: ISDN 2 mg/hr
Concentration: 2 amps of ISDN 20 mg in 100 ml in D5W = 20 x 2 =40 mg / 100 = 0.04 mg/ml

2 mg/hr
--------- = 50 cc/hr
.04 mg/ml


Now, try answering the other items :)

Backtracking

I miss all the fun I had back then when I was 20-something, the age when you feel you're invincible.

Back then, twice a week kami nagpupunta ng Tagaytay. Twice a month kami nakakapag-beach sa Puerto Galera. Safe pa tumawid ng dagat ang mga katig na bangka dati. Hindi pa laganap ang global warming.

Weekly din ang inuman kasama friends sa bar, sa bahay, sa gasolinahan, sa beach, sa bar ng barkada, at kung saan-saan pa. Lahat ng happenings ginagawang okasyon para mag-inom--bday, graduation, despedida, departure, arrival, mga ganon.

Hindi pa uso facebook noon, Friendster pa lang. Pero sa barkada namin hindi uso Friendster. Dapat Friendster Live! Ang dami namin nakikilala sa gatherings pero hanggang inuman lang. Favorite ko ang San Mig Light. Sa likod ng sticker ng San Mig ang mantra namin ng friend ko: "When the night is ___ and it's time for rest, Let there be San Mig Light" or something like it. Iniipon namin label ng San Mig kada inuman dahil sa mantrang nakasulat sa likod nun.

Madalas kami mag-emote, umiyak, mang-away ng mga umaaway sa friends namin. Minsan, we do things para makapaghiganti sa mga heartbreakers na yan. Tao lang din kami na marunong masaktan.

Nakakapagod din naman ang ganung buhay. Nakakasawa din ang puro fun. Nakakasawa din ang puro heartbreaks. Hindi pa ako marunong mag-alaga ng relasyon noon. Selfish and childish ako. Puro ako lang dapat masunod. Ka-immaturan kumbaga.

Hanggang sa darating ang araw na biglang mababago ang lahat. Kakabahan ka kase baka hindi mag-work ang lahat ayon sa plan mo pero you gotta do it para maiayos ang lahat sa iyo. You need to get out of your comfort zone, to be away from your friends.

Everything changed when I went back to school to pursue nursing. Hindi ganun kasaya, hindi siya fun pero at peace naman ako. May sense of contentmen, may sense of fulfillment. Pagod sa duty pero ayos lang.

Nakakapagod din pag ganun ang buhay. Pagkatapos ng gimik, what's next? Where to after here? Vicious cycle.

Learnings in the Ward

Being almost 3 months in the ward is not enough for me to adjust in the ward. Honestly, I feel stupid in my job most of the time. I hate to bug the staff nurses with my questions. But after the Nursing Supervisor talked to me regarding my first strong warning on a documentation error and advised me to "always ask if in doubt." I don't care anymore if nakukulitan ako basta kapag hindi ako sure or hindi ko mabasa ang sulat doctor ng mga doctor, nagtatanong talaga ako. Sabihin na nilang toxic ako. Minsan, some of the doctors do get annoyed by me if I notify them about my patient's conditions. What's important is that I made them aware and that's one of my toughest jobs--to deal with tyrant doctors.

I've got so many learnings to share with you in the next few days. I need to sleep now. I don't have a duty tomorrow but I will be attending a lecture in the hospital. Goodnight guys!

My insatiable appetite for books

I've never skipped a trip to Booksale whenever I'm in SM, Greenhills or Cubao. Broke or not broke, I go there just the same, satisfied to just see or peek the best novels out there or if I'm lucky (like I was last week!), I take home some of my favorite novels/authors.

I'm reading now "Memoirs of a Geisha." It made me cry in the first chapter, spoiler alert! I won't tell why. Hihi! Sad story of the 2 siblings being . . . Ok, I'll stop there.

I have so many books in my mind that I OUGHT to have, fiction, non-fiction, medical nursing, and whatnots. I already saw some of it in the shelves. Probably in my next payday I'll go grab a copy if they're still there.

My iPod shuffle is back from the ashes!

I used to have a 1st-generaion 8GB iPod and an iPod shuffle. The shuffle was a gift to me from my Dad and the 8GB was just an upgrade. The 8GB died because it was accidentally dropped during my nursing review at SEAMED. What was left of me was the Shuffle but was also busted --it can't be recognized by any PC. The Shuffle was officially pronounced "busted/corrupted" by an Apple service center in Greenhills 3 years ago.

The other night when I couldn't bring myself to sleep and I've got to sleep because I supposedly have duty at 6 a.m., I tried listening to it again, after almost 3 years of hibernation in my drawer.

Irritated by the same old RnB songs in my playlist, I tried to tinker the iPod and plugged it in my Mac.

Lo and behold, it was recognized by my Mac!

I thought it's a miracle because the Apple service center used an iMac in diagnosing my iPod a couple of years ago. In an instant, I deleted all the songs in it and happily added songs which give meaning to every moment of my present life. Yihee!