Surprise!

After my 2-10 p.m. duty, Ron picked me up at the hospital to tag me along in his night out with his college friends at the Harbor Square in Manila. I was not prepared so I had to go with him in my nurse uniform.

Inside the car, he surprised me with a whole cake from Starbucks called the Midnight Black Cake.

The cake tastes like Ferrero Rocher, bittersweet and with a crunchy layer. My hubby never fails to surprise me.

Sick Leave

In the previous entry, I said that I was on a sick leave. Yes it's true that I was sick due to a nagging toothache. I was procrastinating the dental check-up due to a low budget. I'm ashamed to ask my parent to pay for it. My salary is pathetic. But in the last payroll I really got a nice paycheck.

So off I went to the dentist near CEU (Centro Escolar University) in Manila. This is not my personal dentist. The bf just recommended it to me because he's good and the fee is reasonably lower than my dentist. At first I was reluctant to be "handled" by the new dentist. I wanted to see for myself first the clinic.

Well, the clinic looked nice with 2 dental chairs, autoclave machine, clean area, cable tv, etc. The dentist knows what he's doing and explains to me my case.

After the rapport has been established, the procedure started. I got an oral prophylaxis, 2 dental x-rays (for my impacted wisdom tooth and the problematic upper molar which is the culprit of my pain), temporary filling, and 21 capsules of amoxicillin which cost me less than 400 pesos ($9) all in all! What surprises me most was the cost of the dental x-ray--only 50 pesos per tooth ($1.13)! I had a dental panoramic x-ray 9 years ago in SM Megamall and it cost me 4,000 pesos ($90).

Now, the toothache is gone and I was able to buy that skirt in Greenhills sa laki ng natipid ko sa dentist. I also bought Anne Rice's "Servant of the Bones." Happy :)

Big Mistake

The biggest mistake a noob can commit is to take a leave from her duty for 2 consecutive days. It happened to me due to a major burn out. In truth, this is the first time I have experienced a burn out at work. In my previous careers as a copy editor and administrative assistant, there are stressors such as deadlines, performance evaluation, colleagues, and bosses. But being a nurse is an entirely different dimension. Buhay ang nakataya. A nurse must always have a presence of mind and common sense no matter how toxic or stressfull the situation is, ensuring always the safety of herself and her patients. Most of the time, you have to sacrifice your meals and bladder break just to serve all the needs of all your ten (10) patients. If I'm lucky, I would handle 6 patients in the least, but 1 of them is either intubated (his/her life depends on a breathing machine called mechanical ventilator) or feeds via NGT (nasogastric tube that runs from the nose through the stomach). If the patient is intubated, that means I have to go to the patient's room and suction secretions as often as necessary. And I have to feed him/her via NGT so all the medicine tablets will be pulverized by me using mortar and pestle and I have to double check each feeding the patency and placement of the NGT to make sure it's still in the stomach by auscultation using a stethoscope. Aside from these cases, there are still your other 4 patients waiting for your nursing care and other stressors (human beings at their worst) which make your entire shift horribly challenging.

Now, if you happen to be assigned in a toxic ward in every effin' work day, handling the above cases, then burning out would be your body's way of crying out and your best defense mechanism is to take a sick leave in order to survive the next 2 weeks of your contract, right? I thought I could adjust to it because I'm now familiar with the environment and the people. Yes, I handled it well, I got no warning slip or incident report, at least. But when I get home, I just couldn't shake the stress off. It made my nights sleepless. My weight went down to 104 lbs (the only thing I'm happy about). Ikaw ba naman ang hindi makaupo or kumain in 15 minutes kasama na ang toothbrush and powder. I thought of giving up. I asked my close friends' advices. I was so unhappy last week.

Sabi nila, konting tiis lang, there are thousands of jobless nurses out there wanting to have a hospital job in this country blah-blah-blah. So I listened to their blah-blahs which are relevant blahs.

Salamat sa sick leave because it helped me regained my sanity.

Congrats sa Batch 6

Marikina Valley Medical Center is continuously hiring some of my batchmates as NA's and Nurses this year. Congratulations to Miko, Jelo, Erwin, Marc, Allan, Erika, and to some who will be called in in the next few days or so. They are the people who were never absent, never been late, and are always willing to work their butt off.

Congratulations, guys!

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 :)