SN Janice Wong jobscope on Thursday 27/08/09

My hectic life as a nurse. Racing against time..

Woke up at 5am, felt a lil' sleepy still after 6 hours of sleep. Washed up
and had my breakfast before i make myself out of the house to take the 6am bus
to work.

Plugged in my ipod, Jay's music accompanied me through the journey.
Reached worked place at 6.45am. Bumped onto mich and faez in the staff locker's
room. Awww... i missed her so much.

Stepped into wd 75, donned our surgical mask, signed in our attendence.
Looked at the assignment for the day. "Onco I/C"... Eyes stared wide for a split
second. No senior to guide, me and mich will be left swimming i supposed.

Report taking at 7am. 20 minutes passed 7, report ended. I've got 3
patients...

• one patient running HD MTX
• another patient newly diagnosed ALL
• and the next is Neutropenic Patient

Very high nursing acuity patients!

7.30am - HD MTX patient is on hyper-hydration. The previous shift
staff didn't obtain the hydration for us! My current drip has another 1 hour to
go before it turned dry. I tried to obtain from pharmacy, their turn-over
time is 2 hours! We do not contain highly concentrated ampoules
now(due to JCI), someone suggested to just go next door to borrow ! Then,
we are utterly "suay"... blah blah blah.. the
sister mumbled... all i know is that, me and maricar were standing like a
fool, holding 2 pints of 5% DSM knodding our head away! Damn, why should i
listen to HER to go to next door for KCL. And its her fault in the first
place, she didn't obtained for us and caused us so much embarrassement. -.-

I tried all my ways to communicate with the pharmacy to supply us as
soon as possible. They agreed.

8am - mich and me made our way to check,countersign and hook
up IV MTX.(MethoTreXate - the drug name says it all. Its cyto-toxic.)

8.30am - another IV MTX to go. To run at 5mls/hr. Hooked up. Done. Patient
still asleep.

8.45am - Called up pharmacy, they've already prepared. Instead of waiting for
the porter, i ran down to basement to collect it myself.

8.55am - Rushed up, and dragged mich to check, countercheck and jabbed in the
KCL and NaHco3. Done. My hydration issued settled.

9am - My newly diagnosed ALL patient needs 3 hourly tumoulysis blood. Its due
now. Had a lil difficulty taking blood from the plug for this child. We cannot
do a lot of squeezing. The blood will lysed. Then i suggested to let the blood
just drip, because his platelet is only 60k. Done. 1.3 mls of blood
collected.

9.10am - Dr. T hurried to get the IT MTX confirmed and obtained. He
wants to get it done by 10am. -.-

9.15am - Went in to take consent for procedure, as well as to
apply emla cream at the IT site for the child.

9.25am - Consultant walked in. Seen the patients. Treatment changes to be
done. Lasix for newly diagnosed ALL, his cumulative balance was 800+. He was
edamatous! Stool for c/s and f/s added on.

9.35am - Neutropenic patient, plan continued as follows. Not much change. To
take blood during Line Change and await the ID team to be here.

9.45am - IT MTX prepared. Ready for collection. Dr. T hurried us to get
everything prepared. Mich and me praying that it will be one attempt for the
Lumbar Puncture. The previous time was a lil unsuccessful, this child has
got reflex. said mich.

9.55am - Carried in the child for procedure. Fretful. Sedation given.
positioning for the child was a lil difficult. Poor mich, arching for
whole 15 mins. CSF fluid dripping very slow. Managed to collect around
40-50 drops. IT MTX given. Procedure done.

10.15am - Carried the child back to the room. 15 minutes parameters for her.
Have not woken up from sedation,

10.20am - Senior for the shift kept pushing me and mich for break when i've
not completed my task. -.-

10.30am - Finally stepped out of the ward with mich for break. 45 mins of
break.

11.15am - Back to the hectic ward. Prepared to do line change and take blood
for my neutropenice patient. Shockingly, he has a spike of temperature. 38.2,
called my MO, she said to await the ID team to review the child. I was thinking,
hoping they dont add on blood culture. He had it done recently. His anti-biotics
is at the max now. Amphoterecin, Meropenum, Amikacin.

11.30am - Dr. KP. Lee walked with in with Head of ID. I start to panic.
But i assumed that his day was good. He's not making things difficult for me. He
asked the condition about this child and i told him what i knew. From his
reaction and his talking to me, i knew he must be in his good
mood. He was always nasty, however this is my first time seeing the
good - tempered side of him. LOL.

11.35am - Discussing where is the souce of infection now, i told them the
wound is slightly inflammed and they urged to open up the dressing to have a
look.
Janice, so can we see the wound now? I looked up with my voice,
trembling and answered "sure"! I hurried to prepare what-ever things that i can
think of for a dressing. Pushed the trolley in with them to the patient
bed-side.

11.40am - Did a wound swab at the erthymatous site. Plaster-ed back the
dressing again with gauze and hyperfix. He coaxed the child with his mandarin
and i'm impressed. He helped me with the trolley out. I'm again,
impressed.. since when is he so nice?

11.45am - Discussing the plans for the child, and i saw his tie,
"Burberry black label classic"..ohh nice*haha. =D
Then, Head of ID was nice as well, she
helped me with the labelling of forms for the wound c/s as well as
MRSA swab. How nice. She knew that i in need of sticky label, she
took it out for me. A big thank you i said. I was thinking to myself.
WOW, im just in luck today! KP.LEE read out the plans to me in a nice
way. Which i supposed he dont do it usually! Lucky me*

12.00pm - 3 hourly Tumourlysis blood due again. In the midst of
blood-taking, senior walked in and told me that she received a phone call, that
the CSF FEME that were despatched a while ago, SPILLED ! -.- OHmyFG****** But
they managed to get it done with the minimum CSF left. Im so shocked to hear
that. No way there will be another LP again if they cant do it. Who closed the
lid of the bottle? Am not pointing fingers...

12.05pm - Waste no time, gonna do the line change and take all the bloods so
as to catch in time for the ampho which is already due. Everything goes well.
Good backflow at the femoral site. Blood collected. MRSA swab done. Despatched
all the investigations at a go.

12.55pm - Lab called, the tumourlysis blood that was taken at 12pm was badly
lysed. Potassium level was 8... hahaaa.. Oooops. It must be the squeezing and
all. Anyway, repeated and sent down around 1.10pm.

Afternoon staff came for work. A.L was making so much noise! The messy
counter, blah blah blah.

Thank you Ms Gin for the help for the pre-meds that was given..

Passed over my report at 1400hr, everything more or less was done. Because i
do not like to pass over undone work.

Thank you michelle and maricar for the great help at work today!

What a hectic day at work.

Left the ward at 3.30pm

Met Faezah on the way, and we had a lot to chat on our way to Bugis MRT
station. Man, i missed her so much. She wont be coming back to wd75. Im really
damn sad. She's really a good and nice friend. Chatted with her alot.

I would rather she come back then the other person! She told me, that PERSON,
every single day go to ward and pester NM to let her be back. LOOK now what
happened? My poor faezah is always left behind. I felt so much for her.. Why is
she always so thick face?

Back home, bathed and all... finally meeting baby for movie.

Desert first.

Final destination 4.

Regretted to watch it.

Utterly grossed.

Back home, and i slept through out the night.

Entirely exhausted.

Woke up at 11am today. Malaise all over. I think i am falling sick.

Feeling so empty and upset that im going for my night shift later in the
night. Hated it*

Its FRIDAY NIGHT ! HELLO !!

In a daze now, started typing this entry around 1plus just now. Its a
lazy friday afternoon!

I miss Silly dumbdumb*

Wen