Station 1: Part 2

 

Functional Nursing

Kadalasang set-up namin pag pm (Pwedeng wag mo na to basahin at mag proceed ka na sa routine proper) are madalas, so minsan nag aasign pa din depende sa staff na kasama, ay kusang loob. Yung tipong nd na sasabihin sayo ng staff kung san ka assign yung pinaka maaga dumating madalas nag start na mag prepare ng oral meds o IV. Pero hindi ibig sabihin sya na din naka assign dun, sa team namin bigayan. Lahat mararanasan mo kung gusto mo kung ayaw mo may sasambot para sayo. Hindi rin ibig sabihin na dun ka naka assign yun lang gagawin mo., I’m thankful for the group where I belonged for I never ask for help, they do it voluntarily. There was a time that I remarked that simple gesture, I was assigned at TB ward and two more wards, there were too many patients and one vomited blood, to put it in the right way he actually cough blood almost half a bucket, due to it, it was almost 9:30pm and I will just be starting with my 16 charts, one of my groupmate saw me with the pile of charts beside me. He was already through with his, then he asked if where were the charts that I’m through, he picked some of the charts that are unfinished, visited my ward and started charting, another saw us and did the same. In a matter of almost 45 mins we were through. Just  imagine if the two of them just starred at me while I’m in agony to do charting for 16 patients aiming to make it on time, kawawa tlaga. Kaya guys thank you and love u all 🙂

 

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Bedside Care

  • Vital sign and I&O
  • Monitoring
  • Referral of untoward signs and symptoms, as in makikipagtalastasan ka tlaga sa doctor
  • Changing of IV fluids; maawa sa IV meds maglagay ng IV tag, tas sa dami ng pasyente. Endorsement pa lang magcompute na ng to consume para hindi mapagalitan pag napabilis o napabagal. Wag din basta mag change, tingnan muna kung yun nga ang to follow baka shifted o to consume and changed to heplock.

Oral meds

  • Prepare oral meds that are due at pm, 6-8-9. If I remember it right green, red and pink cards
  • Pag walang meds magtingin sa lalagyan ng excess
  • Give meds at due time telling patients what they are for, swerte mo kung nd ka tanugin eh kung magtanong. Tameme na lang, alamin mo na din para sure di pa sasama ang loob mo at loob nya pag nd mo nasagot.
  • Ipirma sa chart

IV Meds

  • Check injection list and collection boxes(4pm, 6pm at 8pm)
    • Double checking, minsan kasi nasa collection box na bigla naman discontinued or decreased, sayang naman pag nabuksan tapos nd nagamit.
    • Halimbawa wala syang meds sa collection box pero due yung med sa shift, tingnan nyo sa tackle box nya, hindi dapat nilalagay dun ang IV meds at oral meds lang at neb dapat pero minsan pag may excess mas palagay ang loob mong ilagay sa tackle box kesa iwan sa may tabi kahit pa sabihing may nakalagay ng name dun sa box ng gamot.
    • Sa mga antibiotics o sa lahat ng meds pag walang nabili magtingin sa mga boxes sa baba o sa tackle box ng excess ampules and vials. Minsan kasi pag discharge na ang patient may naiiwang gamot, minsan binigay nila yun. Kasi hindi din naman nila magagamit sa bahay yung IV meds. Pwede ibalik sa botika but there are really kind hearted people that despite the situation of being not so well off still has the guts to give. Yun, specifically sa antibiotics, pag may namiss kang dose, maliban sa nababawasan ang chances of effectivity tumataas din ang chances for drug resistance. If he continually misses the dose and developed resistance to the drug  masasayang lahat ng binigay at ibibigay pa sanangg dose nung gamot pag nagkapera sya. Tapos bibigyan sya ng wider spectrum, bukod sa mas mahal mas malakas-kewewe naman yung patient.
    • Pag magpreprepare ng meds double check ang injection list, minsan may mga alangang order; yung tipong kalahati lang ng vial o ampule. Kasi minsan we have the tendency to just prepare and preapare, bukas lang ng bukas dilute lang ng dilute, we have to be careful under dosing and over dosing is still both wrong. Ipapacheck mo naman  yun sa staff at sasamahan ka nya but if you can do it right on the first shot, di ba less hassle malamang maaga ka pa matapos. D/S X Q
    • Sa prep, may choice ka naman to open ampules and dilute there and then pero kami just to make sure na walang sayang na gamot, sa bedside kami nagpreprepare dun na kami nag babasag at nagdidilute. Kasi you still have to check the patency of IV lines before giving. Natulo ba at may backflow. Hindi ka dapat makuntento sa natulo lang dahil ang infiltrated natulo din kaylangan may backflow ng blood. Ibaba mo lang yung bote lower than the insertion site tapos fast drip, tapos regulate mo na lang uli may iv tag naman. Once kasi nadilute mo na o nagbukas iisipin mo pa viability nun, kung IV out at 1 hour lang viability ng gamot, kelangan mo pa mag pabili ng insyte at magtusok within the one hour period you prep the meds, sira ang ikot mo. Bukod sa sobrang delay malamang panis din yung iba mong gamot.
    • Ang ginagawa namin nilalagyan namin ng name room number at drug name yung syringe. Kung ampule walang laman kung vial kung ilang cc ang diulution. Sunod sunod ang patas ng syringes by room para nd nakakalito at madali mag bigay.

Common meds:

Diuretic

Furosemide-20mg-3cc syringe

-40mg-5cc

With BP precaution hold if ≤ 90/60

Mannitol, at bedside. Fast drip at naka soluset.

Cardiotonic

Digoxin/Lanoxin-50mcg/2ml-3cc

Antibiotics

Slow IV 40cc PNSS from soluset plus 10cc ng meds

 

Ceftriaxone-10cc->slow IV push

PipTaz(Piperacillin + Tazobatam) 1gm-10cc

Meropenem 1gm-10cc

Proton pump Inhibitor

Omeprazole- 10cc 2 common order: IV push or drip

  • 40 mg omeprazole + 90 cc of PNSS x 5hrs for 72 hrs- meaning maglalagay ka sa soluset ng 90 cc of PNSS + 10cc ng dilution mo ng omep to consume for 5 hours pag naubos ulit ulit, continuosly running for 72 hrs. dapat makaconsume ka ng 14.4 vials. Meron to separate IV flow sheet

Anti-pyretic

Paracetamol 300mg-3cc*hindi sira ang syringe malapot lang tlaga yun, ≥37.8 ang temp na kadalasang order neto as prn if less TSB

Corticosteroid

Hydrocortisone- 3c syringe:2ml dilution

Neurotonics

Citicoline 1gm vial-10cc

Pain reliever

Ketorolac

Tramadol         3cc

  • After prep ipacheck sa staff.
  • Make sure na lagging updated ang injection list
  • Difference lang ng IV meds ng umaga at pm, ang umaga nagsusulat pa ng injection list ang pm  nd na tas mas madami ang kinocollect ng am kesa sa pm
  • Sa IV meds din ang reinsertion at blood transfusion
  • Sa bulsa dapat may prescription ka para sa pag reseta ng insyte at syringes, badtrip kung mula sa TB ward babalik ka pa sa station para lang kumuha ng prescription

CBG Monitoring

  • Acquire list of pts with CBGmonitoring
  • Check injection list for prn Insulin and referral value
  • Giving of long acting and very long acting prescribe insulin na halos laging HS

Discharge and Admission

  • Same lang ng Gawain ng am

Mas mabilis matapos kapag functional, tried and tested. Syempre may mga namiss ako, yung ibang trouble shooting kayo na bahala dumiscover., diskartehan nyo na lang, pwedeng gawin ang mas madaling way na mali, depende na yun sa moral conscience mo 🙂

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