Hey Hey Are You Okay? Part 1

Its been a while since I last posted here, that's because I had a task to accomplish and that is to look after my angkong(grandpa) during his confinement in the hospital. He was confined there related to infected wound below his right first metatarsal bone. The slow healing process can be brought about by his DM and the condition worsen because of self-medication and for late consultation to a physician. Even we didn't expect that to happened

So there I was, looking after my angkong during his stay in one of the most prestigious hospitals in the Philippines (take note: it has an joint accreditation from US). He was confined in a private room in a CVU (cardiovascular) unit so we expected that nurses there are competent enough because it is in fact a CVU unit.

1st day:July 4, 2006 (according to my tito and be ko ma - grandpa's youngest sister)

My angkong was confined at the unit at around 7pm and Co-Amoxiclav/ IV was ordered STAT by his physician. Because it was an antibiotic, skin testing should be done prior to adminstration. 9pm na na-skin test! ang dami pang reason. So, after a negative skin test, the antibiotic was already administered 10pm by Nurse X.

COMMENT: e hello? STAT order nga, 2 hours before makapag-skin test! ang tagal ha! major delay! kaya nga STAT - ASAP!

2nd day: July 5, 2006 (1st day of duty)

It was just an ordinary day, nothing special happended compared to the previous day. During night shift, my angkong was asking me the regarding his IV. That why is it not consumed yet well in fact it should be consumed in 24 hours. The regulation was KVO so I assumed that it was 10gtts/min as always during our duty at school. So when I tried computing it, it should be already consumed within 24 hours. SO I asked the nurse Y.

Me: Nurse, tinatanong ng lolo ko kung bakit hindi pa nauubos yung IV?

Nurse Y: Ah kasi po ung regulation ay KVO, so that's 10ml/hr. So aound 240ml/day po ang maco-consume. E 1 L po ung IV so mga 4 days po un.

Me: Ah, thank you.

I really thought that his answer was wrong so I texted some classmated regarding it. Almost all of them answer 10gtts/min. So I wondered why it was different. Then Chinny texted me. Her answer was the same with mine but she also referred the book as reference. Then she found out that it was really 10ml/hr - the answer of Nurse Y. We were corrected. All along we thought that it was 10gtts/min. At least the wrong info was corrected.

3rd day: July 6, 2006 (2nd day of duty)

Around past 5 in the afternoon, a resident fellow visited my angkong to check the condition of his foot, whether the drug is helping in combating the infected, to check the site for improvement... we also talked about angkong's CBG monitoring, so we agreed upon that CBG monitoring would be done BID, pre-breakfast, and 2 hrs after dinner. After some time when the fellow left, the Nurse X who did the skin test enetered...

Nurse: Excuse me sir, kukuhanan ko po kayo ng CBG bago kayo kumain ng dinner... anung oras po kayong huling kumain?

Me: Nurse, mamaya pa siya i-CBG.

Nurse: In-order ng fellow na TID ang CBG monitoring niya.

Me: E kakaka-usap ko lang so fellow kanina lang and we decided that CBG monitoring would be done BID, pre-breakfast, and 2 hrs after dinner. I-check mu.

Nurse: Sige po pero ang in-order po talaga TID, before meals. Sige po babalik na lang po ako mamaya.

(after few minutes...)

Nurse: Ay ma'am, tama po pala kayo... Pasensya na kayo... babalik na lang po ako mamaya.

COMMENT: Nurse, dba it is a must to establish rapport first when making interaction with the patient? And are you reading your patient's chart before entering the room?! Why is it that you are not familiar with the procedures that would be done to your patient?! Don't you know that on what you're doing, your misleading the patient, adding an unnecessary expense to their hospital bill and that you may be held liable when you do a dependent nursing function which is not ordered?! Gosh...

At around 730 pm, the sisters of my angkong who happened to be nurses and my tito visited him. We were discussing the incident regarding the late admisnistration of the anitibiotic and the CBG when Nurse X came and said:

Nurse: Excuse me sir, what time po kayong huling kumain?

Me: Around 7pm.

Nurse: Ah oki po. Starting 8pm, NPO na siya, dahil i-MRI po siya mamayang 12mn. (then she exits the room.)

COMMENT: She used the term NPO? Hindi ba that's a technical term and that it's a NO NO during health teaching dahil baka hindi ma-understand ng patient? Panu kung hindi kami nurses? E d hindi naman maintindihan ang mga pinagsasasabi nya jan... NPO for MRI? Is that possible? E wala namang sinabing may iaadminister na dye or something. She even didn't explain the reason for putting the client in NPO.

The nurse came at 830pm to check the IV.

Xa Ko Ma (3rd sister of angkong): Nurse, bakit kelangang i-NPO ang patient? E ako nga, na-MRI sa head, hindi naman ni-require ng fasting?

Nurse: Ah BAKA po kasi may iinject na dye e. Sige po. (Then she left the room.)

At around 10pm, rounds, a new set of staff nurse was assigned to my angkong...

4 Nurses: Hi Sir! Good Evening po... What time po kayo huling kumain?

Angkong: 7pm.

Nurse: Ah oki po. mamayang 12mn po kayo i-MRI, susunduin na lang po kayo mamaya.

Me: Bakit po kelangang i-NPO? May contrast medium po ba?

Nurse: Ah, hospital policy during MRI na NPO for 3 hours prior to procedure.

Me: Ah oki.

COMMENT: It seems ngayon lang ako nakarinig ng NPO as a hospital policy during MRI, e wala namang sinabing may contrast media. It seems that they are making my angkong do unnecessary fasting which is kawawa naman on the patient's part.

The night duty nurse came, Nurse Y, the nurse I asked regarding the KVO thingy.

Nurse: Hi Sir, Kamusta po kayo? Ako si ___. Kamista na po kayo? Tingnan ko lang po yung paa niyo (which was the affected part).

Me: Wala po bang contrast media ung MRI nya kasi sabi kanina nung nurse (the 8pm nurse) na BKA meron daw.

Nurse: Wala pong naka-order basta po hospital policy sa MRI yun.

COMMENT: He was the 1st nurse during the whole day who came to the room not to check the IV nor the drug but to assess the affected area. Yung iba, chinecheck lang ang IV at hindi ung affected area. Dba dapat, ur frequently assessing the affected part for improvement to chart it? e anong i-chachart mo kung you'll not gonna inspect it?! Chaka why is it that hindi mag-jive ang information na binibigay ng nurses regarding the reason for NPO during MRI? Hindi ba dapat alam nila yun so that they could tell the patient?

1230 am came, my angkong was fetch to be brought in the MRI. I went with him to see for myself and also took this opportunity to clarify things regarding reasons of putting him to NPO, whether a dye would be injected or not because I am really confused on the things the nurses are telling me.

Nurse in MRI did his interview regarding presence of metal plates etc. You know, the usual things to be asked before proceeding with the procedure. Then I asked him...

Me: Excuse po, Bakit po kelangan i-NPO prior to MRI?

Nurse: AH kasi, may dye tayong iinject later and kelangan naka-fast so that the dye would be concetrated enough.

Me: E bakit po may dye?

Nurse: Ah kasi, it was ordered by the doctor. Maybe they want to visualize something to rule out possible complications. Maybe the blood vessels, to rule out dead blood vessels like that.

Me: Ah oki.

Nurse: A non hypo-allergenic dye would be injected mamaya, and after the procedure, please watch out for itching of the body, and redness, some possible bad side-effect ng dye that needs to be reported immediately.

COMMENT: So, may dye pala, and it was in fact ordered by the doctor, I saw it written on the POS. Why is it the nurses in the ward, didn't know know about that - the dye and the reason for NPO? Well in fact they should know it beause it is written in the chart. And why is it that they didn't do explanation regarding the procedure?