My Mentors in Nursing

As you all know, I haven’t had any work experience in Nursing since I graduated in 2011. I just started to work as an employee way back in 2016, meaning I have 5 years gap after I graduated. Mahirap mag-work ng may gap na ganun katagal.

I started my nursing journey at the New Oriental Mindoro Provincial Hospital as an Emergency Room Nurse and OPD Nurse. My mentor that I won’t forget is Sir Jericho or Jex as what others call him. He is really good in intubation and IV insertions, and he is good in dealing with surgery trauma/ ortho cases.

Then in ManilaMed, I can’t remember who my preceptor was and who I shadowed in 7th Extension and 9th Extension. I just remembered my managers that time, Sir Ken and Maam Phen. The nurses who trained us for the Athena program was Maam Kate and Sir Junmar.

In PGH -NICU, the person who trained me in NICU was Maam Magee. She is knowledgeable with newborn care. She taught me how to feed them and how to give their medications.

In St. Luke’s, my preceptor in 3 West Pedia was Maam Anna. who taught me to close the door gently; in 6th Main A – Pulmo Unit was Sir Luigi, who taught me that we have different styles in carrying out the skills, just don’t forget the basic principles in nursing; my mentor in JD-ICU was Maam Sarah; who taught me to be kind to nursing assistants and we can learn a lot from them too; and my PCS manager was Maam Jane, she taught me how trust is important. I stayed in St. Luke’s for 1 year and six months.

While at present in St. Jude, my mentors in Emergency room were: Sir Jonathan, Sir Kriz, Maam Ariane, Sir Gabriel, and Maam Hanna, while my manager is Sir Celsie.

I’ve learned from all of my mentors. Each with different good qualities and skills, and various personalities. They were all great mentors.


If you’ll ask me, bakit hindi ako nagtagal sa mga previous ko na institutions, I have commitment issues. Haha!

But there is a deeper reason why.

Don’t worry, I have no plans in resigning yet at St. Jude. Haha. I still need to rise up to the challenge.

If it’s God’s will, praying to stay at St. Jude for as long as God wants me to stay. Please pray for me. 🙂

Attitude

Dear Readers,

Did you know, I just realized lately.. how important food is, maliban sa need siya for survival.

Parang Fight or Flight lang.

Kapag naka fight mode ka with your Autonomic Nervous System, iisipin mo pa ba kumain?

I realized, kapag hindi ka kumain, mas madalas yung chances na parati kang magagalit.

Kaya importante to, “Kumain ka na ba?” hahaha.

Paulit -ulit kong naririnig to, kapag galit ka, “Magbilang ka muna ng 1-10, 1-5 or 1-3, saka ka magsalita”.

I’ve learned that phrase from Maam Christine and Maam Liwelyn, both are managers.

Tapos, hindi ka na masyadong galit pakinggan.

One more thing, your self identity is very important.

No one can refute what you say about yourself, because that’s your identity.

Knowledge. Skills. Attitude. Which is the most important?

Some people say, hire people with the attitude, because knowledge and skills can be taught.

Pero yung attitude, mababago ba?


Self introspection:

Alam niyo, hindi naman ako masamang tao. Pero I realized lately, hindi ganun kahaba ang patience ko. Tahimik ako, pero mabilis ako magalit. Dati hindi naman ako ganito. I just changed. Although, I still read the bible. I sometimes pray. It’s a daily struggle for me, to pray consistently. I’m a Christian, but that doesn’t mean that I won’t get angry anymore.

Mas grabe ako magalit after I became a Christian. I just don’t want injustice.

Hyperventilation

Hyperventilation is rapid or deep breathing, usually caused by anxiety or panic. This overbreathing, as it is sometimes called, may actually leave you feeling breathless. When you breathe, you inhale oxygen and exhale carbon dioxide.

The normal Respiratory Rate (RR) is 12 – 20 cpm.

In a worse case scenario, hyperventilation may result in to a Respiratory alkalosis which occurs when you breathe too fast or too deep and carbon dioxide levels drop too low. This causes the pH of the blood to rise and become too alkaline.

Blood pH: 7.35-7.45

Blood is normally slightly basic, with a normal pH range of 7.35 to 7.45. Usually the body maintains the pH of blood close to 7.40.

ROME: Respiratory= Opposite: · pH is high, PCO2 is down (Alkalosis). pH is low, PCO2 is up (Acidosis). Metabolic= Equal: · pH is high, HCO3 is high (Alkalosis). pH is low, HCO3 is low (Acidosis). [ACID BASE BALANCE]

Doing ABG Interpretation Easily By ROME Method
ROME ACID BASE BALANCE
ROME Blood Gas Interpretation Lesson | NURSING.com
Pin by Ashley Strait on Nursing: My future | Nicu nurse education, Nursing  school survival, Picu nurse
BLOOD GAS ANALYSIS

Scene at the ER: The other day, I had a patient in the ER, she is a teenager, running for honors. Ma’am Michiku the nurse assistant assessed her vital signs. She was sent to the ER because she was hyperventilating and crying. She was given a brown bag to somehow control her breathing and to calm her down. Sir Jonathan secured the brown bag in her face with a micropore. There were no medications given, just the brown bag. She was in a high fowler’s position. Upon interview, I learned that she was making an assignment or project I think, and she was not able to finish it before the deadline, that’s why she hyperventilated. She was with her mother, a highschool teacher.

Within an hour she was feeling well already, her heart rate stabilized, and her respiratory rate became stable too. Then she was discharged.


When I was younger, I did not ask my parents to send me to a hospital for the reason that I was not able to finish an assignment. I do things and submit them on time. However, when I grew a little older, I somehow wished I can also tell my professor in grad school that I am not feeling well, so I cannot join the class. I am planning not to enter zoom class tomorrow. Haha. Because, I haven’t finished my introduction yet for my thesis.

But, I realized that to be given a responsibility to finish a requirement is inevitable. I need to finish this already.

I was wondering if I should pursue my thesis on Covid 19.

My title is “Looking beyond the lens of caring for Covid 19 patients: a phenomenological study”

Sounds scholarly. It’s a qualitative study. hehe. Kaya ko ba ito? hahahuhu.

Note: Prioritization of needs, Jaea.

Sige, sleep ka na muna, then gising na lang ng maaga. You can do it, Jaea. You are loved, love. Aja!

Gising pa rin

Guys, it’s already the 24th of May. Ambilis ng oras, ni hindi ko namalayan na dumaan ang Abril. Mayo na ngayon, malapit na mag Hunyo.

Gusto ko lang magpasalamat sa Lord, kasi yung nawala kong 9,000 pesos, nakabalik siya sa akin. Thank You God!

So, after ko mag file ng complaint sa BPI, after 2 days, naibalik na sa account ko yung money.

But the problem is hindi pa rin ako marunong mag budget. But, I know matututunan naman yun.

Moreover, kahapon, meron akong bagong nurse na kasama sa ER. I tried to teach her. Hindi ko alam ituturo ko sakanya.. I just tried to teach her kung ano yung tinuro din sakin before ng preceptors ko at senior nurses.

This new nurse is 10 years older than me. Mejo strict ako kanina. She asked, if educator daw ako, or CI, kasi mejo strict ako. Sabi ko hindi. Tapos, sabi niya baka daw nag mamasteral ako. Sabi ko naman, oo. So, I tried to teach lang kanina. And I tried to correct her if may mali siya.

What I liked about her, nagtatanong siya if tama ginagawa niya, and magaling siya magsalita na mapapalagay loob mo sakanya. Kaso, nakita niya kanina na pinagalitan ko yung nursing assistant, after quite some time, pinagsabihan niya ako… na mejo off daw ginawa ko sa nursing assistant with the way I talked.

Ang sabi ko, minsan lang ako magsalita, so ang dating mukha akong galit. Pero, nagtatanong lang naman ako. I just needed clarity about a certain issue sa triage at ER.

I appreciated what she said kahapon sakin. Hindi ako perpekto. I learn also from other people, especially the students and mentees. I learned from her. Sinabihan niya ako, ganun din daw siya noon.. pero she changed it.

Kapag daw naiinis siya or galit, she tries to count 1 to 5 and then saka siya nagsasalita. Then, hindi na siya masyadong galit pakinggan. So, I guess, gagawin ko rin yun. Kasi daw pag hindi ko yun binago, lalayuan daw ako ng mga tao. haha. She has a point. Kaya mejo loner ako. haha. lol.

Thank you God, kasi hindi lang ako natututo sa libro kundi sa mga tao na nakakasalamuha ko.

So, after this.. I will try to sleep na. Duty pa ako mamayang morning. Good night.

Syncope

Today is a very teleserye like day in the emergency room.

After I admitted a pregnant woman in the delivery room, there came a female patient aged 73 years old, who immediately fainted after reproving two youngters who were having a fight. This sudden fainting is what we call syncope in medical term.

So what happened awhile ago, this lola was carried by her grand daughters and some guys in the emergency room.

As for the hospital’s protocol, only the patients who had undergone antigen swab test which tested negative are the only ones who can enter the emergency room. Initially, they must be handled first and seen in the triage if the patients and the relatives have no RTPCR or antigen test.

So, our security guard awhile ago, got panicky when the grand daughters were crying outside the ER, crying out to help their lola.

The security guard informed me immediately. However, he left his post to go to the triage to get a wheel chair. So, the relatives entered the emergency room without swab tests.

I was in a state of shock, not because of the person who fainted, but because of the persons who entered the ER.

Then, this grand daughter was calling my attention to help their lola. “Nurse ka, bakit wala kang ginagawa??!”

I told them, “Maam, sandali.”

I told them that they are not allowed to enter the ER but they infiltrated the door, because the guard left his post.

The Nurse Assistant Maam Michiku took the lola’s vital signs, and did her initial assessment. Then, I informed the resident on duty that the patient still had no swab and was taken inside the ER. So, the entire emergency room now was exposed. I was reprimanded by our resident. And in turn, I reprimanded as well the security guard not to leave his post. Since, it will take four hours to disinfect the ER via UV light, and there are also other patients that we need to cater.

I took the Capillary Blood Glucose of the patient. I took also the ECG. So, the result had inverted “t waves”

The orders of the resident were as follows:

Take antigen test, then…

  1. CBG,
  2. ECG,
  3. X Ray,
  4. Na (135 to 145 meq/L)
  5. K (3.5 to 5 meq/L)
  6. Creatinine (60 to 110 umol/L [Female] & 70 to 120 umol/l [Male])
  7. Troponin ( 0.00 to 0.04 ng/ml)

The result of the antigen test was negative,

CBG was 107 mg/dl,

ECG had inverted “t waves”,

X ray had slight prominent densities,

Na and Potassium were sent out from the hospital because the laboratory had no machine for it. The result after two hours of waiting was with in normal range.

Then, Creatinine was also within normal range, and troponin qualitatively was negative.

I’ve learned today that Troponin can be taken qualitatively and quantitatively. However, the hospital only has qualitative result only for Troponin.

Troponin is an enzyme or protein that is used for the evaluation of heart injury.

Moving on, the patient woke up and she had a GCS of 15, responsive, coherent and conscious. Thank God.


So, the funny part of this day was the security guard made his amends to me by giving me four green carabao mangoes before the duty ended. Para daw bati na kami. Hahaha!

I gave one mango to Sir Chrysan who was having his last day of duty for tonight, then another mango to Maam Anjo, the midwife at the triage. So I was left with two green mangoes.

I thank the guard and I told him not to leave his post anymore. I told him that it’s okay to go to the triage but it should not be wrong timing. Hehe.

So, I had a wonderful duty today. My resident doctor gave me a dinner meal of milkfish and rice. Also, another blessing awhile ago was our lunch from McDonald’s donated by a kind soul who did not tell his identity.

Thank you Lord for the sustainance. 🙂

Myocardial Infarction

I was 6pm -6am duty on a Good Friday last night. I was an on-call nurse. It must supposedly be my day off, but they told me to have my duty.

I was really not feeling well emotionally, but I still went on duty, just to divert my attention from certain events beyond my control. I am the only Emergency Room nurse on duty, but I am with a Nursing Assistant assigned at the triage, Ma’am Johannie.

So, the night went good. I thought it was going to be a benign duty. But when 2AM came, a doctor called our phone, referring a patient who had a myocardial infarction a week ago from another hospital. I told the doctor that we don’t have a functional ICU and our isolation rooms are fully occupied. So, we would not be able to admit the patient.

The patient is 64 years old having chest pains and was treated initially in our triage.

The patient had 92% O2 saturation, BP of 90/50, HR of 88, RR 19, T 36.6.

The patient was asked to undergo antigen test for COvid, and was taken Troponin I too by the Med Tech, as ordered by the resident.

Troponin I levels

Normal range: below 0.04 ng/ml

Probable heart attack: above 0.40 ng/ml

Upon waiting, I took the ECG of the patient and the Respiratory Therapist placed an oxygen 2-3 L to the patient via nasal cannula, as ordered by our resident doctor.

The ordered medications to the patient are as follows:

  1. Omeprazole 40 mg via IV now
  2. Atorvastatin 80 mg/ 1 tab taken orally now
  3. Aspirin 80 mg tab 4 tabs now, which was masticated by the patient
  4. Clopidogrel 75 mg/tab 4 tabs now, which was masticated by the patient
  5. Isordil 5mg/ 1 tab now sublingually
  6. Morphine 2mg IV now

However, we don’t have stocks for Morphine. The patient was in pain. Somehow, it was relieved temporarily by the other medications.

After a few minutes, the result of the antigen test of the patient was positive for COVID.

Our resident doctor made a referral slip of the patient for transfer to hospital of choice.

After the relatives settled the payment, the patient was discharged for transfer to another hospital.

I still learned something new today. Maybe, I should just focus in my work and studies to divert my attention from my beautiful emotional petty concerns in life.

Still, thank You God.

DRUG STUDY:
1. Omeprazole – (Proton Pump Inhibitor) – works by decreasing the amount of acid your stomach makes. It relieves symptoms such as heartburn, difficulty swallowing, and persistent cough
2. Atorvastatin – (HMG CoA reductase inhibitors) – used together with diet to lower blood levels of “bad” cholesterol (low-density lipoprotein, or LDL), to increase levels of “good” cholesterol (high-density lipoprotein, or HDL), and to lower triglycerides (a type of fat in the blood).
3. Aspirin (Salicylate) –  It works by reducing substances in the body that cause painfever, and inflammation. It is used to treat pain, and reduce fever or inflammation. It is sometimes used to treat or prevent heart attacks, strokes, and chest pain (angina).
4. Clopidogrel – (P2Y12 inhibitors) – used to lower risk of having a stroke, blood clot, or serious heart problem after a heart attack, severe chest pain (angina), or circulation problems.
5. Isordil – (Nitrate) – A nitrate that dilates (widens) blood vessels, making it easier for blood to flow through them and easier for the heart to pump. Isosorbide mononitrate is used to prevent angina attacks (chest pain).
Isosorbide mononitrate will not treat an angina attack that has already begun.
6. Morphine – (Opiod/ Narcotic) – used to treat moderate to severe pain. Short-acting formulations are taken as needed for pain.
Source: webmd.com, drugs.com

Eclampsia, a gloomy day

A gloomy day: I had a patient, 36 years old with eclampsia about to give birth G2P0, meaning she is already on her second pregnancy with no living child. She is single with no husband. Upon reaching the ER, she have no signs of labor too.

I feel so sad, because the baby inside the mother’s womb was already dead upon delivery. But then, when I assessed the mother, it still had heartbeats. Therefore, the heartbeats that the doppler detected was already the mother’s and not the baby’s.

I am so sad, but to prevent giving false hopes to the mother, it is advisable and important to check the fetal heart tone in one full minute and let the resident doctor or a senior nurse validate your assessment.

Even if I haven’t been a mother, and I have not been pregnant, but to consider the mother’s age. She is already on her second pregnancy, and she is already 36, and with no alive babies yet. I am really sad. If I were in her place, I might lose my mind. Lord, please cover the patient that I had. I really feel sad even if I am not in her position. Please comfort her. May she feel that you love her even if her baby passed away.

God is so good

Hi there! Guys, It’s been a long time since the last time I wrote to you.

So, I just want to thank God today for answered prayers.

First, I have already a work and I am enjoying it. It’s so nice to deal with patients in the Emergency Room. I am still adjusting in the ER, but I know I can do this. I can be on my own in the coming days. I just need to have an open mind with the things that I need to learn.

Most of the patients that I had encountered in the ER are OB patients. I am really happy whenever I take the Fetal Heart Tone of the pregnant patients coming in the hospital. It’s so nice, just putting KY Jelly in the doppler, and then I would manipulate the doppler to find the Fetal Heart Tone. Ang saya! Just hearing the heartbeats of the baby inside.

I remembered one patient that I had the other day, she was worried of her baby, because her bag of water just broke many hours ago from when she was brought to the Emergency Room. Then, when she finally heard the heart beats of her baby inside her womb. Her anxiety was finally relieved.

Second, I am thankful that she finally took notice of me in WeSing, after six attempts of singing with her. Haha! Her name is Alexis. She is more known as Doc Six. I like her voice, and she really sings very well. I pray to sing more songs with her.

Another thing that I am thankful for is that I ate today a Mango Graham Cake from my RLE groupmate in Nursing. Her name is Asia. Ang sarap. Hehe. Namiss ko lang.

God is so good, that despite our struggles in life; He is able to just let us realize that He is still in control, awesome in power, greater and stronger than any other.

I’m grateful for work

This week, I’m grateful for having my new work already at St. Jude General Hospital and Medical Center.

Did you know? In the Roman Catholic Church, St. Jude is the Patron Saint of desperate cases and lost causes.

Another thing that I like about my hospital is it is just walking distance from where I currently live. So I don’t need to pay a lot for transportation, unlike before that I usually ride a taxi, which is very expensive.

I have been assigned at the Emergency Room. I just started last Monday, February 1, 2021.

The patients coming are not that many, so I have so many free time.

Most of the patients that come are OBgyne patients. Since, the hospital was well known before to be catering pregnant women til now.

I have been undergoing training from my senior nurses. I like them. Even though, we are short staffed. Since, we would usually be having our duties for 12 hours a day.

In the long run, I would be expected to just have my duty on my own in the ER. I’m really scared to be on my own, but since we are lacking in staff nurses; therefore I should learn how to be independent. Since, there’s not a surplus of patients coming due to the pandemic.

So, all in all, I thank God for this new blessing. Since, I would be having 3 days of duty per week. The other remaining days are my offs. Meaning, I have a lot of time to study and do my assignments and I have time for my relaxation and time for myself.

Thank you God. God bless also my readers.

Koko Ni ItA

“Koko ni ita” is a Japanese phrase which means “been here”.

Alam niyo ba, tinanggal na ako ng manager ko sa Patient Care Services Department Viber group because of my unauthorized absences and my issue with a patient complaint. I have not even read the complaint of the patient I handled in the Neuro Critical Care Unit. Maybe, if I have the courage once I get my renewed license tomorrow. Hopefully.

Meron din akong assignment na hindi ginawa para sa Master’s degree ko. Reaction papers for three journals in Nursing about Academic Freedom na topic na kung saan inassign sa akin.

Back to the first topic that I had, my patient had a Glascow Coma Scale of 11 (Eye Opening: Spontaneous =4, Verbal Response: None = 1, since he had tracheostomy, Motor response: obeys commands = 6). He can lift both upper and lower extremities, but when I asked my patient if “kaya niya i-lift yung buttocks niya” sabi niya.. hindi niya kaya. Upon my assessment, mukhang wala naman siyang lesion sa Medulla kasi wala naman weakness yung both upper and lower extremities. Pero yung nag-complain is yung wife ng patient. Sinabihan niya ako na mag bedbath ng one ng madaling araw. Akala ko aalis na siya.. Pero bumalik siya ng one sakto ng madaling araw. Pero may rules sa unit na bawal bumisita ang relatives at a certain hours at night, pero siya inallow na pumasok. Pero pasalamat na din ako na dumating siya, kasi hindi ako komportable paliguan ang gising na pasyente lalo na kung lalaki, tapos kaming dalawa lang sa loob.

Alam nio ba guys, sa hospital na yun, kawawa ang mga nurses. Ang wish ko lang, sana magkusa din tumulong yung mga nursing aids kahit na mas matataas sweldo nila sa nurses dun dahil sa tenure nila sa trabaho.

Nga pala, siguro meron din fault ang nurses, dahil siguro dapat sabihan nila ng maayos yung nursing aids ng plano nila for the day, at hindi ora orada na sabihan agad na gawin ang pinagagawa, dahil oo nga naman, tao din sila.. kung nursing aid din siguro ako.. ayoko rin na gawin ang isang bagay lalo na kung hindi ako handa. Dapat may plano, sa ganitong oras kailangan na magbedbath or kailangan magchange ng linens.

Alam nio ba, nung college ako.. sobrang decisive ko. Like, I can decide agad agad sa mga gagawin.. pero nung naging nurse na ako… in actual experience, mahirap pala. Lalo na yung delegation of tasks.

Anyway, gusto ko mabasa yung complaint ng patient ko sakin. Sabi ng tita ko sa Netherlands, it’s a normal thing na magcomplaint sa nurses or even doctors sa culture nila.. for the improvement of services. Kaya, do not be disappointed when someone files a complaint against you, kasi.. para sa ikakaimprove yun ng services.

I am actually not afraid to face the complaint. Kaya ako absent ng ilang araw since Nov. 3, 2020, kasi hindi pa dumadating yung license ko. Hindi ako komportable na magduty na wala ang license. Proteksyon ko yun eh. Kaya kung aalisin nila ako sa trabaho.. okay lang. Mag-aapply na lang ako sa ibang hospital. Gusto ko talaga makatapos ng contract sa work, kasi laging hindi natutupad. Pero sobrang thankful ko kasi nareach ko ang one year plus ilang months sa work sahospital na yun.

Kanina, kumain pala ako ng rice sa niluto ko at noodles, at nung gabi.. kumain ako sa yellowcab.. kumain ako ng pepperoni pizza and chicken na bones.. nakalimutan ko na pangalan sa order. Haha basta four pieces. Masarap with Mountain Dew. Pero mas gusto ko sana water, pero hindi available. Mahal yung tubig sa yellowcab, pero buti may outlet sila ng saksakan para sa Tablet notebook ko.

Yun lang… Nga pala.. Naisip ko mag-aral ng MAN sa UP Open University din, kaso four years yun.. sana matanggap ako. Pangarap ko talaga mag-aral sa UP nung college. Pero hindi ako nag-UPCAT para sa college, kasi ang gusto ng mama ko mag-aral ako sa RTRMS – MMC kasi dun din siya graduate ng Nursing Batch 88 ata if I am not mistaken.

Yun lang. Try ko na matulog, after ko uminom ng gamot ko. Hahaha.