Two to Two

We were paired by our Clinical Instructor. We were alll aqssigned to patients inside the Gyne Ward. I was paired with Aiza to tend a woman, MRS C.A.93, who delivered yesterday.

We were asked to make a Nursing plan about our respective patients which include taking some SUBJECTIVE observations (things that the client complains), OBJECTIVE observations (things that are verifiable by facts,e.g. BP), head to toe ASSESMENTS, PLANNING, and INTERVENTIONS… (our CI did not include the EVALUATION).

We were the last one to pass the paper, which was given an hour after we recorded the VS (vital signs). This is our Nursing Care Plan…

SUBJECTIVE
“konti lang po ang gatas ko at masakit ang tahi ko,” (i have only a small amount of milk and my stitches hurt.) as claimed by the patient.

OBJECTIVE
Irritable with greasy skin.

ASSESMENT
Ineffective breastfeeding R/T (related to) insufficient milk production.

PLANNING
After a series of interventions the pt. (patient) will be able to have a sufficient milk production, after two weeks.

INTERVENTIONS
Trust was established between the nurse and the pt.
Bedside care, given.
VS (vital signs) were taken and recorded.
The patient was advised to eat nutritious food like and to drink plenty of fluids.
Health teaching about breast feeding, done.

Our CI then made some comments and taught us how it is done properly. This is our NURSING CARE PLAN after she edited it;

S>”konti lang po ang gatas ko at masakit ang tahi ko,” (i have only a small amount of milk and my stitches hurt.) as claimed.

O>Irritable

>c (c means “with”) greasy skin.

>c facial grimace

>c minimal lochial bleeding.

A>Ineffective breastfeeding R/T (related to) insufficient milk production.

P>After a series of interventions the pt. (patient) will be able to have a sufficient milk production.

I>INDEPENDENT NURSING ACTIONS
Trust was established between the nurse and the pt.
Bedside care, given.
VS (vital signs) were taken
The patient was advised to eat nutritious food like….
Advised to drink plenty of fluids.
Health teaching about breast feeding, done…. such as…..
>DEPENDENT NURSING ACTIONS
Due meds given as ordered by Doctor….

Just before we had our lunch, we were also given another patient, MRS. D.A.109/119, who had a miscarriage… we left her for lunch after recording her VS (vital signs)

After lunch we went back to our second patient since the first one was already home.

She’s way better than she was an hour before. While taking her VS, I was asked to answer a 3 question computation by my CI. I answered them alll correctly…

Inside the OB Ward

i woke up today at 3, very early considering that I slept at 11 last night, though, just on time since I am 1 and a half hour away from the hospital. I immediately roused my father and told him to cook the breakfast. I volunteered to cook the rice, something that I have not than hitherto.

After all the morning rituals, I wheeled outside and happily tracked down my way to the busstop. I was beaming with enthusiasm, pride and nerves.

I was at the hospital at 7, just right in time. everyone was waiting in front of the General Hospital’s facade. All my groupmates were there already (exceptJovelle), some of the other teams who were stationed to different wards, and other nursing students from other nursing schools.

My groupmates were impressed when I showed them my notes. I made a complete table of the IV drops per minute with different hours. I did that since I didnt want to make any fuss about computing for the right number of drops per minute using the formula if ever i am instructed to regulate the IV flow.

Our CI (clinical Instructor) came when we were finally complete. She beckoned us inside the hospital after the girls put on their caps and aprons.

She acted like a tour guide explaining every wards while we’re marching to the OB GYNE ward.

After we put our things on our respective lockers, our CI made a further briefing about the hospital records which she already did last week, though it was faster today. Then she grouped us into two. Half of the students were bound for the OB ward while the other half went to the Gyne ward.

I was among the first group. I am very much lucky for I was with the OB ward team. It is much easier here that in the gyne. Alll we have to do is to tend the newborn babies and their mother, check their vital signs and hum to ease our boredom.

We all chose our own patients. But I peed first that’s why I was left with the most unhealthy looking woman with an IV dangling on her hand. I was halfway looking for her vital signs when my CI told me that the woman already has a student nurse from the green uniformed other school.

I was relieved. I have to try checking for her BP (blood pressure five times before I tried faking the outcome- ooohh baaad) since i cannot hear the systole.

My CI brought me to a young lady that delivered a baby girl last june 26.

I told her my name. Made a genuine smile then asked her if I can take her BP. she is really nice so I lose all the butterflies in my stomach immediately.

M.J.112 (that her initials and bed number), is 22 years old. Her BP was 100/60 (too low). I asked what was her former BP reading, to check if i was correct. She said that her last BP was 90/60.

Her child, a baby girl was born through a NSD (normal spontaneous delivery). The child was suffering from Physiological jaundice (yellowish skin color)… this is very common to neonates (newborn) though not normal. she was the tinnest baby in the ward.

I asked the mother why she was bottlefeeding her baby (bottlefeeding is prohibited inside the hospital) and she said that the baby wont suckle her nipple.

I look at my two patients’ vital signs again and recorded them before going out for my lunch break.

After we had our lunch and after we loitered in the corridors, we were ordered to go back to our respective wards. I had a chance to talk with H.B. who had other skeds the last semesters. We talked almost about our respective Alma mater in high school and some of the proffessors we both had (though in different skeds).

Then my CI came. She handed me an ampoule of a medicine and told me that she’s pretending to be the doctor handing out orders. She asked me to compute for the ml.

i didnt have that in my notes… what i have was the formula for IV flow regulation. I was unable to pass the exam.

Nevertheless, everything went really good. I learned a lot. And I loved the hospital more. I cant wait to come back there tommorow.

lunch

I spent my lunch today with Julie and Jovelle (the two ofmy three original blockmates, we were reshuffled) in a fastfood with a striped insect as its mascots. After we ate the not-so-”yummy” burger and salty fries we decided to stay there for a while since it was still 30 minutes before our next subject (pharmacology). We were chatting when we saw our two former blockmates Lery and Aldrin walking toward us cladded in all white Nursing uniforms, unlike us, who were wearing civillian clothings since our duty is on Thursday.

They sat on the seats beside our table.

J.L.M.’s patient died last Monday. I was deeply interested on how that happened so I started bombarding him with questions. I thought that his patient died because he left him for lunch. But I found out what really happened was a very different story.

According to him, Baby Boy S.C. was a 7 and half month premature baby. He was born last July 19. The baby left the hospital that day, I am not certain whether it was suggested by the doctor or it was a HAMA (home against medical advice) though I thought it was a HAMA case since the baby’s family is poor (the hospital is a general hospiatal, not a private). A lot of cases like this one happen since the patients’ families were unable to pay for the medicines and other hospital fees (there is no such thing as a FREE hospital service) are too expensive for people who eke their living within less trhan the minimum wage. The baby was at home when he started manifesting Severe Jaundice (a complication common to many neonates characterized by yellow colored skin and sclera).

The baby was immediately rushed to the General Hospital.

According to Lery, the baby was really in a bad situation. The RR (respiratory rate) was 2bpm (breaths per minute) which was really scary. The normal bpm of an adult is 16-20bpm and it increases the younger the person is.

The infant was unable to breathe by itself and so they put an ambu bag (a gadget for breathing). Lery was assigned to take care of the baby. He was ordered to keep the manually operate the machine (it is use by squeezing air in it).

He diligently obeyed the order and gave it to another student nurse when he was about to eat his lunch. When he returned after lunch, it was now the doctor who was manually operating the apparatus. He said that the baby’s grandmother asked the doctor to stop it since they know that the child will eventually die. And everything happened.

Yes it was a euthanasia.

I was deeply bothered by his story… I am so much against mercy killing, abortion, and even death penalty.

I strongly agree with what has been taught to us by our CI (clinical instructor) last summer…

“A nurse is his patient’s advocate.”

Meaning, we should in everyway promote our patient’s wellfare and not the welfare of his family. We should not care about the financial problems or anything about client’s family, as long as our patient is getting the ultimate care that he well deserves.

But, nevertheless, things like this, though illegal and unaccepted here in the Philippines, are inevitable… and they continue to happen.

yey…

I was succesful to be part of this org that ive been deying to join…

after the… well..”i thought he’s rejecting me because he thinks im a strut scenario”, i finally convinced them with my heartfelt plea to join the org…

I had some problems at first but everything became ok. i was briefed about some of the tasks and now… yey… i am one of the team…

The Waiting

I already bought some of the Nursing paraphernalia that I am going to need on my 7:00-3:00 duty on Thursday.

I am a bit excited but very much weary about the coming days. I know that I am not that intelligent and definitely not that knowledgeable about those Nursing interventions.
I already forgot some of the lessons that i have had, that’s why I decided to take some time last night to refresh myself… albeit my attempt was unsuccesful. I was already dosing after dinner.

I had had some really knee-jerking conversation with some of my classmates and… er… acquaintances about their respective hospital duties.

Julie already had an experience within the ICU (intencive care unit) of a private hospital near the campus. She fed a client using NGT (nasogastric tubes)- these were tubes that were put inside the pharynx with an opening outside the mouth where the nurse can put already dissolved foods. She also had a chance to suction somebody’s phelgm using the suctioning apparatus, and already tried to clean a male’s genital (hindi na raw sya virgin… he.. he.. he..).

Lery ’s neonatal patient (a new born child) died when he tooked his first ever lunch break on his first ever hospital duty.

A.D.L. gave me some tips. She told me to read my notes and try to remember all our return demonstrations. She also told me how different it is to perform all those Nursing Interventions inside the school from performing it in front of an ill client.

I am very very much nervous and I really do not know what to do.