Busy day

My team started with 11 patients this morning, including 2 that were just admitted with interventions to follow-up. There were 2 discharges. Then there was another admission by mid-morning. At around 12pm, 1 patient upgraded to a double-room and was moved to the other team, while I continued to manage his medication. Then, there was another admission which discharged at-own-risk subsequently.

The ward manager (NO) was in-charge. SSN Y and I were taking the teams near and far from the nursing station respectively. Initially SSN F from the adjoining ward helped as runner. She helped to empty a colostomy bag on my side. Then SSN Y got her help with her team's medications while SSN Y cover as in-charge, because the NO was busy in her office. After that, SSN F was re-deployed to the adjoining ward, which was opened to accommodate new admissions because my ward was full. On my side, the runner was HCA K was great with the HCA duties, but cannot help with EN level work and does not do admissions. On SSN Y's side, the runner was SEN S who is still not quite familiar with my ward.

Needless to say, I had a busy day. 2 morning medications leftover from the night shift (excluding the new admissions), 7 IV medications (including 2 discharges which needed IV antibiotics and removal of IV drip before discharge), 1 IV helplock, 4 patient education on medications, 1 new admission done by me, 2 IV cannulations. This is on top of following the doctors' rounds, pharmacy orders for top-ups and non-ward-stock items, answering call bells, assisting patients, 3 cases with nebulization, and medications for all. Would not have been so bad, if not marred at the end by the AOR discharge. In the end, I completed all my paperwork and billings, and left at 5pm! Thankfully, I managed to have a 15 minutes lunch break in-between.

Who's in pain?

As a paediatric nurse, I find myself learning about parenting do's-and-don'ts through observing real life cases along the way. One such interesting example is the mother of a recent GE case.

The mother was very agitated and fretful over her 3 years-old son. She rang the call-bell almost every 5 minutes for assistance and to highlight repeatedly that her child complained of pain. The mother varied her indicated location of the child's pain -- abdomen, IV drip site on the left hand, anus, generalized pain or some non-specific location. Here's my observation during one of those call bells.

I saw the child watching TV and the mother talking to the child.

“有沒有痛？有沒有痛？”, the mother kept pestering her child repeatedly, raising her voice and tone in agitation with each repetition of her question. ["Is there any pain? Is there any pain?"]

Her child was watching TV calmly. When the mother started raising her voice, he looked worried and confused at his mother. Finally, he lowered his eyes.

“是不是手？是不是手？” the mother continued in her agitated tone. ["Is it the hand? Is it the hand?"]

Then the child looked at his left hand with the IV drip in-situ. He seemed somewhat confused.

At this point, the mother then concluded, “Nurse 啊！Nurse 啊！我的兒子一直講他的手很痛，leh！” ["Nurse! Nurse! My son kept saying that his hand is very painful leh!"]

I walked over. Meanwhile, the mother walked away to the toilet. I asked to the boy calmly. “你那里痛？跟姐姐講。” ["Where do you feel pain? Please tell me."]

The boy looked at me calmly and then continued to watch his TV. No sign or complaint of pain whatsoever!

Reducing your child's fear

Had a good day today. SN L was in-charge, SEN L and I taking teams near and far from the nursing station respectively. SEN IV the runner for both teams. My team started with 5 patients, including a new admission done by the morning staff with the investigations, medications and IV cannulation outstanding. Admitted 1 more case later in the afternoon. Thus, I ended with a total of 6 cases. With some help from my runner SEN IV (who did the 2nd admission) and the in-charge SN L, I had time for dinner and toilet breaks, completed all work items and taped my hand-over report. I even wrote out some pharmacy "please supply" slips for the next morning's staff, so that she will know which items need re-supply. At the end of our shift, SN L, SEN IV and I left on-time and walked to our bus-stops together.

Fortunately for me, both new admissions today were not fearful of hospitalization. Neither the 3 years-old boy nor the 7 years-old girl cried during IV cannulations. Emla cream takes away the pain but not the fear. [Some of the children cry, mainly due to fear.] Both took their medications in their stride, even the yucky Klacid syrup antibiotics. My colleague SN L remarked that the parents of both children are rather calm about their hospitalization, and somehow that influenced their children. I agreed.

This reminds me of a GE case we had recently.

Code Blue Drill

We had a code blue drill yesterday.

I have re-certified my BCLS, Basic Cardiac Life Support, recently. I have yet to attend the LSCN, Life Support Course for Nurses, although we were taught the required skills in school. For my ward's code blue drill, I was designated as the second nurse-to-arrive, i.e. responsible for the chest compression.

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To prepare for the drill, my ward manager (NO), held code blue rehearsals on the day before and the morning before the code blue drill. At our first rehearsal, NO was role-playing the first nurse-to-arrive. When the code blue alarm sounded, I rushed into the room with the emergency trolley. Then the NO painted the scenario to me, "You see me trying to resuscitate the patient, what do you say?"

Thanks to my BCLS training, I automatically replied "I know CPR, can I help?"

"Of course you know CPR, you're a trained nurse!"

Ha ha. This became a joke that greeted us at work the next morning.

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JCI visitors paid a surprise visit to the ward just before our code blue drill. We, the staff nurses, prayed very hard that they would leave before our code blue drill started. Thankfully, our prayers were answered.

The code blue drill proceeded as rehearsed. I was focusing on the chest compression. There was a visiting admin staff who was trained on BCLS. She took over my compression after the "switch" count. Then all of us stood clear for the defibrillation. After the defibrillation, I continued with the chest compression. I continued to pump away until I felt a gentle slap on my buttocks.

Apparently the doctor had declared sinus bradycardia rhythm. I was so focused on the chest compression that I was still pumping away on a "patient that had recovered". My colleague SSN R, playing the role of the defibrillation nurse, gave me the discreet slap on the butt to signal for me to stop.

Good days and GE cases

Had a series of good days at work. We had a surge of GE (gastro-enteritis) cases for the past 2 weeks. GE cases are rather simple in their oral medications since most cannot take much orally. The main focus is to ensure their hydration e.g. with IV drips (with or without KCl added), monitoring their intake and output (vomiting, diarrhoea and any blood in stools). IV medications, if any, are usually antibiotics and the optional anti-emetics. The odd cases include bowel wash-out, daily weighing (for infants). Some have combination of diagnosis that include respiratory tract infection.

Learnt something from a consultant last week. He had a reputation for being a strict doctor and would monitor his patients' pulse and respiration himself when he reviews them, a full-minute for each vital sign. He happened to have a 8 month old infant with GE. He instructed the parents to keep a soiled diaper sample for his review. Upon looking at the soft greenish stool with light blood stains, he explained that the stool is typical of Salmonella infection.

For the past 2 days, the same staff were on duty with me. SSN Y was in-charge, SN L was the other team leader and SEN IV was the runner. The other runner was either SSN F (from the adjoining ward) or HCA K. Glad to have SSN Y and SN L around. They are really very supportive to colleagues. I am very lucky to be assigned SSN Y for preceptor-ship. SEN IV and SSN F were also very helpful as runners. HCA K is very experienced and effective at her work. Thus, I had a good time for the past 2 days.