August, another leap of the year.

Just when August is making its way through the month, I made a huge decision for the upcoming year... A choice which has been wandering in my mind for years, for me to decide on whether to take it or leave it.

The big interview was on the 21st July, an interview which is not so big after all.. because I took it lightly, without expecting much, by the grace of God, I was informed on 29th July that I am chosen and offered the job to work in Mount Elizabeth Novena's ICU next year. I officially accepted the job offer on 3rd August.

I had been struggling to choose whether to go to the Middle East or the neighbourhood country which has the similar culture and lifestyle as KL. My heart is heavy and I hope I won't regret my decision even though it may seemed that I can still go to the Middle East for the big bucks after I secured the Singapore nursing licence.

I have to seriously start processing the documents needed to apply for the Singapore nursing licence as it will take months to process and approve.

Aiming to start working in SG in April. Fingers crossed, faith held high. It won't be an easy journey and I hope it'll be a smooth one. Looking forward to the adventure which I have been wanting to experience :)

My favourite biblical statement for nurses

Remember who’s in control. 

This is a hard one for nurses. Nursing is a field where your actions and decisions are a huge deal, and in reality they can mean life or death for someone. In that line of thinking it’s easy to become stressed out as you feel you must manage and control everything. But when it comes down to it you don’t have control. You just don’t. 

While this is a hard thing to admit, I find it’s actually easier when I can remember that the outcome of my patient isn’t really in my hands. I can do the best I can do, but in the end I have to surrender my performance into the Lord’s hands. And when I do that I can actually catch my breath. He’s in control; he’s got this! Thank God.

Isaiah 55:8-9

“My thoughts are nothing like your thoughts,” says the LORD . “And my ways are far beyond anything you could imagine. For just as the heavens are higher than the earth, so my ways are higher than your ways and my thoughts higher than your thoughts.”

Isaiah 41:10

So do not fear, for I am with you; do not be dismayed, for I am your God. I will strengthen you and help you; I will uphold you with my righteous right hand.

Article adapted from:

http://briegowen.com/2015/07/13/5-biblical-truths-to-encourage-nurses/

1st post on 1st Sunday of 2013

1 week has passed.
Let's have a lil recap on what I've done in the past 1st week of 2013..

1/1 - I went for the 1st jogging of the year with beloved bestie in the morning!! *Proud* =p
- Packed the famous Chicken Rice + Char Siew + Siew Yuk for lunch with the special one before my noon shift. Was quite furious to know that this PH on 1st Jan is not a mandatory payment day which means I won't get the PH bonus pay but a replacement holiday (RH) later on... I figured I MUST at least go for NYE countdown on 31/12 (before I get older, though I used to sepnd NYE at Bukit Bintang with family when I was in secondary school) and enjoy off of New Year day =)

2/1 - On noon shift... 1st thing I heard from my 'sifu' after greeting her Happy New Year was 'do u know the 28yrs old Ms Goh passed away this morning at 0400hrs at your department??' Thoughts ran in my mind was, 'man, not deaths again on the 1st week on the new year?? it has been happening since the 1st year I stepped into my nursing journey where patients who are close friends pass away..'
- Went to pay my last respect to her at Nirvana Memorial Park at Sg Besi after my noon shift with the 'sifu'.

3/1 - Had my first morning shift of the year after not having it for at least 2 weeks before Christmas.
- Finally watched Life of Pi at night.

4/1 -Working noon shift again...
- Then started on working as an editor for a dear friend's thesis. I finally understand why people tend to be so stressed up during their finals, especially when they had to work on a thesis.

5/1 - Off day for the week! Tried out this awesome Malaysian French baker @Tommy Le Baker...
Details here : http://www.facebook.com/TommyLeBaker
And today... here am I typing away on my 1st working Sunday...
- Went to church this morning
- Had lunch with #w11cg
- Work - currently on noon shift -> 5 minutes CPR done on the PR with autonomic dysreflexia at 1630hrs.
_________________________________________________

What's my NYE???It has been more or less the same every year...such as... loving God more, spend more time with family, be a better person, earn more, work harder, travel to more places, save more and bla bla bla... But Ps Kevin has reminded me something important in service this morning : 2013 is gonna be all about FOCUS! =)

Besides thinking hard on this particular matter : To wear braces was a must last year... should I start studying again this year? Guess I should before I get older...

Yours sincerely,

Pic taken with Nokia Lumia 900 at Strait Quay, Penang on 19/11/12
One of my fave pic of the year =)

Have a great great 2013 peeps!
The best is yet to come! Hope for the best!
xoxo

No one will ever go through the life of a nurse like mine. Complicated but yet, I'm contented :)

Another 1st experience

Feeding a baby via NGT :)

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Nursing blog

As I worked OT for the very first time yesterday for afternoon shift and continuing my night shift right after, I have a glimpse of thought prompting me to start writing a blog regarding my journey of nursing career.
Eg: cases I look after or interesting/rare cases

Encourage me to write, will ya? =)

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Neurological Assessment

Changes in behavior are an early sign of neurologic compromise. They are not specific to neurologic problems, but they are the earliest sign. Keep a close eye on the patient for problems with speech and disorientation. Many nurses start assessing neurologic function by pulling out their penlight and checking the patient's pupils. This is very stimulating to your neuro patient and is not the first thing that is going to change.

If your patient is alert and oriented and you are just trying to follow him to see if his condition is getting worse, the first thing that is going to change is his behavior. Behavior is the highest level of function. Next the patient will have changes in his speech. Speech patterns and the ability to perform speech tell you a lot about the patient's neurologic function. The third level down is content of arousability, and this is what is referred to as orientation. The forth level is arousability; whether or not the patient wakes up when you walk into the room or you have to touch him or use painful stimuli.

If your patient is already unconscious, assess systolic blood pressure as an indicator of intracranial pressure. As intracranial pressure increases, systolic pressure has to increase to continue to perfuse the brain. The very lowest level is the pupil reflex. Changes in pupils do not tell you much about the patient. Pupil changes indicate a very small lesion that is right around the optic nerve or a huge lesion that is causing the patient to herniate.

Check speech first. Put down the penlights and watch the patient's behavior changes.

Article courtesy of Ed4Nurses.com

Facts on taking blood pressure

Previous studies have shown that there is a difference between the blood pressure that you'll get using an automated cuff on the forearm versus the upper arm. However, in some of your patients, their arms are just too large to fit your cuff and you might need to use the forearm as a measuring area.

Understand that there will be a difference in pressure between the forearm and the upper arm. In general, the blood pressure you get from the forearm will be higher than the blood pressure you get from the upper arm. Additional differences that can affect forearm blood pressure values; the most important being head-of-bed elevation. The greatest differences between forearm values and upper arm values occurred when the head of the bed was elevated by 30 degrees. In addition, patients with a large body mass and patients on vasoactive medications were also more likely to have big differences between the forearm and the upper arm values.

The take-home point here is that the forearm is an acceptable method of monitoring blood pressure. Understand that the pressure from the forearm is probably higher than it would be from the upper arm. If you're dealing with a patient who is borderline hypotensive with a forearm blood pressure measurement of 90 mmHg systolic, that patient could actually be in shock since blood pressure measurements typically are going to be higher in the forearm. This is more likely if the head of the bed is elevated by more than 30 degrees, the patient has large body mass index, or the patient is on a vasoactive medication.

How true is this?

Use a two-sided stethoscope.

Accurate blood pressures are taken using the bell not the diaphragm. As you have probably learned at some point in your career, the function of the bell and the diaphragm are different. The bell is better at picking up low-pitch sounds; whereas the diaphragm is better at picking up high-pitch sounds. Therefore they're going to have two different functions.

The bell is better for assessing a patient's blood pressure. If your patient's blood pressure is very easy to hear then you'll do fine with a diaphragm; but if you're having difficulty flip it over and try the bell - it's better at picking up the low pitches that you hear when a patient has an abnormal blood pressure. Also use the bell when you're listening to a patient's lung sounds or a patient's bowel sounds. Both lung sounds and bowel sounds can be high in pitch or they can be low in pitch. You could get additional information by using the bell on those patients.

Use all the capabilities you have and that way you'll have the best assessments on your patient. You'll pick up complications and problems early and your patient won't crash. You may even avoid having to resuscitate that patient later in the day.

An article from www.Ed4Nurses.com

Drug errors

Did you know that over 770,000 people are injured or die in hospitals each year from adverse drug events (ADEs)?

And did you know that...
-The costs associated with ADEs could be as high as $5.6 billion annually?
-ADEs can increase your patient’s hospital stay by 8-12 days?
-Or, that nurses may be responsible for as many as 38% of ADEs?

Obviously ADEs are a major concern to nurses in any setting. But, just knowing more about your medications is not enough to prevent complications; you must know how drugs interact with your patients, and their lab tests.

Routine diagnostic tests such as the metabolic panel, blood count and arterial blood gas give you important clues about your patient’s underlying illness, his response to care and complications of medications. To provide the best possible care to your patients, it is imperative that you know these connections.

Imodium

Contents	Loperamide HCl
Indications	Symptomatic control of acute & chronic diarrhea; reduce number & vol of stools & harden their consistency in patients w/ an ileostomy.
Dosage	Initial dose: Adult 2 cap, childn ≥5 yr 1 cap. Followed by 1 cap after each loose stool for acute diarrhea or adjusted to 1-6 cap/day until 1-2 solid stools/day are obtained for chronic diarrhea. Max: Adult 8 cap/day, childn 3 cap/20 kg body wt.
Overdosage	For action to be taken in the event of accidental overdose ... click to view
Administration	May be taken with or without food
Contraindications	When inhibition of peristalsis is to be avoided. Not for use as primary therapy in: Acute dysentery, acute ulcerative colitis, bacterial enterocolitis or pseudomembranous colitis. Infants <24>
Special Precautions	Patients w/ AIDS, hepatic impairment. Pregnancy & lactation. Childn <6>
Adverse Drug Reactions	Constipation, dizziness, nausea, abdominal cramps. Click to view ADR Monitoring Website
Drug Interactions	[Click For Detailed Information] Click here for more Interaction Checks
Pregnancy Category (US FDA)	Category B: Either animal-reproduction studies have not demonstrated a foetal risk but there are no controlled studies in pregnant women or animal-reproduction studies have shown an adverse effect (other than a decrease in fertility) that was not confirmed in controlled studies in women in the 1st trimester (and there is no evidence of a risk in later trimesters).
Storage	For special storage condition to ensure optimal shelf-life of medicine... click to view
Mechanism of Action	For Details of the mechanism of action, pharmacodynamics and pharmacokinetics ... click to view
MIMS Class	Antidiarrheals
ATC Classification	A07DA03 - Loperamide ; Belongs to the class of antipropulsives. Used in the treatment of diarrhea.
Poison Schedule	C