Harsh CI Love

As a student nurse I have encountered so many kinds of clinical instructors (CI's). There are CI's who are very friendly, there are CI's who you admire so much for their intelligence and skills, but the CI's that you might want to get away from are the "terror" CI's with matching tiger-looks hahaha!

Who are these "terror" CI's? They are the ones who will not hesitate to shout at you in public, fail you, and even throw heavy steel patient charts (you must evade to avoid serious injury hehehe). But I understand why CI's may sometimes be strict and uptight. This is because their hard-earned professional license is on the line. So if ever students become lax in the hospital student nurses might do more harm than care to patients. and who would suffer the consequences? Not the students but the CI's because what will you take away from student nurses they don't even have any license yet. So if you hate your CI go kill a patient, joke. ^_^

But if CI's are not strict with their students the clear line that marks authority is broken and student nurses won't show respect and won't follow the instructions of CI's. Plus if our CI's don't care about us then they would just leave us making a lot of mistakes. If CI's don't inform us of our mistakes then we would never learn.

But at the end of the duty or class CI's are more friendly because they don't have to be the authority after class hours, they are now our friends. I'm really going to miss my clinical instructors especially Ma'am Asne who has always been a mother figure to us. She has always been so generous with us in terms of time and food (hehehe). I will try to be like my clinical instructors and I will make them proud me, their student nurse who gave them trouble once in a while...

Please Honor the Milk Code!

It was in the OB Ward when I was on duty that I first heard of the "Milk Code". Executive Order No. 51 (Philippine Code of Marketing of Breastmilk Substitutes) or more commonly known as the "Milk Code" protects babies from dying by barring milk companies (like Nestle) from promoting their product as a substitute for breastfeeding which of course is morally wrong!

The milk code clearly states that breast milk should exclusively be given to babies younger that the age of one and that milk substitutes is a big no-no! Why? Because failure to breastfeed leads to the deaths of 16,000 children in the Philippines each year and 1.5 million infants die around the world every year (from The Manila Times and Baby Milk Action).

So why is breastfeeding so important that taking it away may lead to the numerous deaths of infants around the world? Here are the reasons:

1. The babies immune system is still inactive and they only get their protection from a great number of childhood diseases EXCLUSIVELY from breast milk, specifically from the colostrum. Antibodies are passively given from the mother to the baby. Without these antibodies babies could die!
   
2. Breast milk is the ONLY COMPLETE source of nutrition. Artificial food supplements that Nestle and other milk companies could never be a substitute no matter how many minerals and vitamins they add to their formulas.
3. Formula milk is NOT STERILE! It’s been proven that some infant formulas contain enterobacter sakazakii, a highly lethal pathogenic microorganism. Milk formula labels don’t have warnings on these (from UNICEF).
4. ONLY breast milk contain necessary growth factors that help babies develop physically, mentally, and emotionally!
5. Bottle feeding will confuse the baby and will prefer to be bottle fed than breast fed making it very difficult to return to breast feeding.

Aside from protecting the baby from dying from diarrhoeal diseases, breast feeding has countless benefits not only for the baby, but for the mother, and society as well. You don't only strengthen family ties with breast feeding, you also help the government save a lot of money! Don't believe me then visit MotheringFromtheHeart.com for the list of some of the numerous benefits of breast feeding!

So why is Nestle an INFANT MURDERER? It's because their infant formula advertisements present artificial feeding as healthy and comparable to breastmilk therefore discourages mothers to breastfeed. Health claims such as “contains all the nutrition babies need for all-around visual, mental and psychomotor development” or “helps your baby fight against harmful free radicals of the environment” manipulate mothers. “Formula milk does not provide babies immunity from infection. It provides inadequate level of nutrition making babies susceptible to infection, malnutrition and death” stresses Sterken, a key player in the 20 country two-decade international boycott against Nestle & breast feeding advocate (from UNICEF). And with all said, Nestle even has the audacity to counter and challenge not only the Milk Code of the Philippines but of the codes of the World Health Organization (WHO) and United Nation's Children's Fund (UNICEF)!

Help protect our babies from greedy unethical companies like Nestle! Join the boycott and spread the word that breast milk has no substitute! For student nurses and nurses, or any medical professionals working in the hospital especially in the Philippines, always confiscate milk bottles from mothers! We are the empowered deputes who will enforce the Milk Code. If the mother says that she is only using the bottle but the milk is breast milk and not formula, inform her to use droppers or tablespoons instead because again, using baby bottles for infants below age confuses them and makes breast feeding difficult.

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Breast Feeding Resources:

• Baby Milk Action
• Department of Health (EO 51 or Milk Code)
• UNICEF
• Manila Times
• Mothering From the Heart
• Infant Feeding Action Coalition Canada

Skipping a Meal Leads to Brain Death

Hypoglycemia is the medical term for a level of blood glucose (blood sugar) that is too low to meet immediate energy needs of the body. Glucose is a sugar that our bodies use for energy. A normal level of glucose in the blood is between 60-110 mg/dl . If you are hypoglycemic you will encounter the following symptoms: sweating, feeling warm, dizziness, difficulty speaking, inability to concentrate, hunger, drowsiness, anxiety, confusion, nausea, trembling and headaches.

There are two types of hypoglycemia. And these are:

• Fasting hypoglycemia can occur when a person goes without food for eight or more hours. It can be caused by certain underlying diseases (tumors of the pancreas, severe liver disease, adrenal failure) that upsets the body's ability to balance glucose.

• Reactive hypoglycemia is when blood glucose levels fall too low within a few hours after eating. This type rarely has a serious underlying cause. and is not easy to diagnose.
  

But I guess that the type of hypoglycemia that students are more associated with is Fasting Hypoglycemia. Nursing students are guilty of skipping breakfast especially if the duty is very early in the morning and don't expect them to eat lunch either. My duty mates said that they don't want to eat because they want to finish whatever they are doing first. But I wonder what makes them so busy that they don't eat lunch? But I can never go on if I don't eat lunch. I can skip breakfast (I'm used to it) but I can never skip lunch because if I do I'll just end up very grouchy because as shown in the symptoms above, I get a headache and my body weakens because there isn't enough energy being created because of a rapid decrease in blood sugar.

But skipping a meal is not the only cause of hypoglycemia. Other causes are: alcohol on an empty stomach, taking too much insulin, exercising hard without eating a snack first, eating excessive amounts of carbohydrate foods.

But if you think that hypoglycemia can only lead to headaches and body weakness, think again! Hypoglycemia an lead to the decrease supply of glucose as fuel to the brain, resulting in impairment of function (neuroglycopenia). Derangements of function can range from vaguely "feeling bad" to coma (rarely) permanent brain damage or death.

So never skip a meal guys! If you do skip meals because of uncontrollable circumstances then always bring food with you that are high in sugar like candy or chocolates so that you can have something to munch on even when you are on duty.

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SOURCES:
University of Iowa
Wikipedia

Weekly Evaluation

This week of duty may perhaps be the most exciting and memorable as compared to all the other rotations. This may be because of the fact that this week is the last time that we will have to sleep late at night for the following day’s requirements, wake up early in the morning to prevent being late and incurring extensions, and be stressed out from the day’s duty. But it was quite sad that instead of rejoicing we were reprimanded because we were not courteous to the patients and staff nurses, I don’t really know much of this issue because I was late for the post-conference because I wasn’t informed that we were going to have the post-conference already.

This was my first time to handle three patients at a time. Thank God we didn’t have to administer meds for this day, or else it would be quite a mess. I have to prepare the meds, do a drug study with my PCI then CI, and then administer them, and finally document the procedure. I was also quite lucky that I didn’t have to take in the newly admitted patient into my care since we were already about to go home at the time she was admitted. I admit that there are still areas that I need to update myself and be more familiarize with like the IVF for example. I need to learn how to be more accurate in reading in reading my IVF levels and be more mindful of the input and output values of my patients.

For this rotation, I give myself 7 out of 10 with 10 as the highest. Although I wasn’t able to make any serious mistakes or errors in this day I am not satisfied with my performance and I know that I could still improve in the future.

Weekly Evaluation: Medical Rotation

This week was a full of firsts for me. It was my first time to have ever go on duty at Madonna & Child Hospital and it was my first time to have been under my current clinical instructor and practicing clinical instructors for this rotation.

Although everything was new to me, I was able to adapt and carry out my nursing responsibilities. I was also blessed to have been assigned such wonderful patients who were very cooperative and very welcoming. I really did not feel awkward as I stayed in their rooms for the whole day as their student nurse. I was also quite glad that I didn't have to chart any nurse's notes (because it takes so much time, not to mention effort ^_^) and all that was required of us was a sample nurse's notes.

For this week I had two patients. A 6 day old baby girl with septicemia neonatorum and a 51 year old woman with pneumonia. I am glad that they are not that toxic and that they are already getting well.

For both case, it is important to note the presence of a bacterial infection. So basically the medications that I have administered had a common factor, which of course is being an antibacterial medication.

The baby girl had to have continuous phototherapy because she had jaundice caused by hyperbilirubinemia. I of course had to protect the eyes by securing an eye shield. I'm glad that the baby's vital signs were all normal during my shift. I am very edgy when I am with babies (especially newborns) because they are so delicate and one false move from me like failing to regulate the IVF properly could cause serious complications like hypervolemia and cardiac overload.

For my patient with pneumonia, I made sure to position her in a moderate high back rest to promote proper lung expansion and I taught her deep breathing and did chest physiotherapy after nebulization to promote removal of secretions.

So all in all this week was a very productive week for me. To add to my enjoyment is the fact that I wasn't late for this week of duty! Yeay me! I made sure to have set my clock at least 1 hour before the pre-conference and I agreed to carpool with my dutymates so that I would have more reasons to wake up early. ^_^

There's A First Time For Everything

Never in my wildest dream would I expect to be late in my duty days!

And sadly my worst fear came true...

My duty would start at 5:45 AM and I woke up at 6:15 AM! Imagine that! I was 30 minutes late for my first day of duty at the surgical ward. Being late brought about a weird feeling. I woke up feeling tired and sleepy because I stayed up until 4 am to finish my requirements. At first I didn't think that I was late. I looked out my window and told myself, "Hmm... it's finally morning..." and then I suddenly realized that I had duty and I couldn't help but mutter the words, "Oh God, all the angels, and saints I hope that I'm not late!" Yeah right! I wish!

I was lucky though that a taxi just passed by my boarding house when I went out and boy the adrenaline rush didn't feel good at all. I was worried and I was sweating... and oh boy... I didn't take a bath.

My duty mates were already taking down their endorsements when I arrived. I was a mess and I expected my clinical instructor to shout at me or something but strangely enough he was very cool tempered, lucky for me.

Although I got 8 hours extension (which hopefully I won't have to serve) the day was quite good. I promised my self that I wouldn't be late for the next day but guess what, I was late. But I caught up to the pre-conference during the second day so it was ok.

So this time, I promise myself to always finish my requirements as early as possible and I should sleep early too so that I could still wake up!

NGT Feeding

It was quite amazing to have actually been able to feed someone through a nasogastric tube (NGT). To those who don't know what a nasogastric tube is, it is a tube that is inserted in the nose that passes at the back of the mouth, through the esophagus and opens directly into the stomach.

Tube feedings are given when a person is unable to eat or tolerate enough food and/or oral supplements to meet his/her nutritional needs.

It's quite easy to feed a patient via NGT. Just make sure that the tube is patent and is correctly positioned in the stomach by injecting air and auscultating (listening with the use of a stethoscope) the right upper quadrant of the abdomen for a whooshing or gushing sound. If there is the sound then pour the nutrient mixture or "bolus" into the asepto syringe and allow the bolus to flow through the tube. Just remember to kink the tube when opening or adding a bolus to the syringe to prevent air from entering the tube and causing stomach distention. And to finish the feeding, flush the tube with 30cc or 30 ml of water.

There's nothing hard with NGT feeding. It's just that your arms would really ache especially if the bolus would flow very slowly because it's too viscous or the patient requires frequent feedings.

My First Surgical Case

I am quite lucky to have been able to have my first surgical case at Xavier University Community Health Care Center. I was able to scrub in an excision or removal of a fibroadenoma at the left breast. A fibroadenoma is actually a sort of cyst or mass in the breast. It's actually benign so there was nothing to worry about. I was fortunate to have worked with such an intelligent, skillful, and understanding surgeon. The surgeon has showed me great surgical techniques that I thought I would only see on TV. It was amazing that I actually helped him do those procedures. Actually he could have done it himself. I wasn't really that helpful. Like it was my first time to scrub-in and it really took some time for me to think of what to do next. Dr. Perez was very understanding and he really helped in guiding me what to do. He must have empathized with me since he was also a nurse. He is actually still very young for a talented surgeon. I really had a difficulty in addressing him because I keep on calling him sir instead of doctor. Always remember to call doctors doctor because it is a bit degrading to be called sir because sir is only for male nurses and patients. Its a complex world of medical professionals. Anyway it was quite embarassing when I broke my sterility (that's the absence of microorganisms) but I won't say how because people might use it against me in the court of law. Hehehe. But my mistake wasn't that bad and the operating room nurse was kind enough to let me of the hook that time. The operating room is very amazing. Kind of like a magical place. Imagine in the morning I had to work in the ward and them in the operating room in the afternoon. I was so tired and I wanted to go home but once I entered the operating room adrenaline rush swept all over my body as an operation was actually already begun. It was a shame that I wasn't able to take pictures of the operation but we actually didn't think of taking pictures that time. We had several minor operations and each operation was like a new experience. If I were given a choice to choose where I would specialize, I would definitely say the operating room.