Reverse Barrier Nursing

First of all, been trying to search for our MPK (Manual Procedure Kerja) for this issue, and I even searched it in our Nursing Procedure Manual, its either, I was too tired sampai nda ternampak or memang inda ada tia kali.

Anyhoo, talking (blogging) from experience (honestly aku ani baru jua setahun jagung *grins*).

What? and Who?

Say, a patient's FBC was found to have LOW WBC (White Blood Cell Count), the normal count will be 4000 to 11,000 cells per microlitre, this patient, should be imediately put in an isolation room. This patient will be having increases the risk of serious infection. (http://www.mayoclinic.com/health/low-white-blood-cell-count/AN00726)

Why?

Because .. White blood cells, or leukocytes, are cells of the immune system defending the body against both infectious disease and foreign materials (http://en.wikipedia.org/wiki/White_blood_cell).

How?

This is our Reverse Barrier Nursing notice sign, which we usually put up in our ward.

Additional:

If you are having flu, cold or fever, please do not enter the room. High risk of infection, that is.
Any outside food, are not advisable.
The patient should be advised to practice a healthy and hygienic environment.
Gargle, frequently.. not too frequent lah hehe

Where?

The patient should be isolated in a clean room, where, if it's possible, it shouldn't be just a room, but a room with his private bathroom and toilet.

I will elaborate more on these, when I have ample of information on these. Any comments or suggestion are almost welcome.

What We Have Been Doing... After Duties .. *grins*

Fizah and Uma at our February Picnic...

C Mas... Dengan makanannya (Pot Luck we had)

The future generations... TARIIkkk~

The Mom and Mommies to be... Yang sorang tu bila lagi? hehe

Iklan Minyak?

Boxing Day Outing

Bakat Terpendam *grins*

BBQ at SN Hjh Rahmah's place

The Nightingalessssssss????

Manager atu manager tah jua ehehehe

Ngaga Open Houses.. Tee Hee.. Mamam...

Not forgetting our spouses pun inda ketinggalan

Outing, cuci mata...

Mamam again... andang acivity sepanjang tahun ni, lepak makan.. Hi Tea.. Sungkai.. Busday party hehehehe

Lapas makan liat football match *winks*

Ulcers?

What's that white thingy? Any idea?

He was admitted few days ago, with history of swelling at both legs and having big "wound" at both legs, and not healing. He is bedridden and non-communicate. According to the relatives he used to crawl with his both legs and his butt support his movement, honestly I don't know how to explain (my English can be very bad sometimes.. teehee), and according to his daughter, he has not been eating for the past few days. That white thingy is actually his tendon, at the back of one of his right knee

Anyhoo the ulcer/sore which I uploaded above, is not actually build up from our care. He was admitted along with these! Guys... anything to comment? Please do.

Our usual nursing care for these is usually, turning, as in, you know, turning them to different position in every few hours (usually 2 hours). But how frequent are we doing it? Despite of the jobs pending that need to be attended, and also the shortage of staffs issues (no comment!). But at least we can do this in between our other jobs or as it should be called, nursing procedures. *grins*

Until then, I left this for you to think and discuss or even argue (I know one of these days, this issue will come up)

(The swelling actually had reduced, you can see from this picture :) )

p/s: Any social updates and activities are almost welcome :)

Losec Infused Intravenously around the clock??

Well, maybe some of you, might encounter and had done this before. But as for some of us, and as far as we know, Losec (Omeprazole) usually given intravenously, in bolus form.

Okay, here's the scenario:

A patient admitted with abdominal pain and malaena stool, who's actually a known case of Acute Duodenal Ulcer. On admission his had a low HB count, which I can't remember heeeheee, and for sure he had 2 pints of packed cell and emergency OGD.

He was then prescribed, IV Losec 80mg over 24 hours, and to our understanding, it means, around the clock. And so the nurses, started the infusion, diluting it with 100mls of Normal Saline and infused it continously.

The day after, one of the nurse manager realised, that the solution (diluted in the Burrette) had changed its color. Well go to basic pharmacology and the 5R's.. when it changes it's colour, you should've start to query, isn't it?

For over 24 hours, the solvent changed its colour, and according to the delegated pharmacist, it wasn't usually administered that way i.e. around the clock.

And so, the nurse manager started to query out with the doctors and pharmacists on duty. Then our pharmacist on duty give us a leaflet for referring :

Recommended Method of reconstitution and preparation

1. With a syringe, draw 10mL of solvent from ampoule.
2. Slowly add approximately 5mL of solvent into the vial with the freeze-dried Omeprazole.
3. Withdraw as much as air as possible from the vial back into the syringe in order to reduce positive pressure. This will make it easier to add the remaining solvent.
4. Add the remaining solvent into the vial & ensure adequate mixing of the content.
5. Please note that upon reconstitution and preparation of infusion mix. The solution shall be kept below 25 degrees Celcius and to be use within 4 hours.
6. Thus infusion mix needs to be changed every 4 hours and dose to be adjusted.
7. Infusion bag should be protected from light after preparation and during infusion period.
8. Example of Rx: 8mg/hr for 72 hours. Therefore total dose in 4 hours = 32mg. Withdraw 32mg out of the reconstituted vial and add in 100mL - 250mL (depending on fluid requirement/restriction) of Glucose 5% or Sodium Chloride 0.9%

The Nightingales

Nursing profession basically was founded as the modern profession by Florence Nightingale (1820 - 1910), who was well-known as "The Lady with the Lamp". There is where I had the idea to put this blog title after her name. Although, I had Rufaidah binti Sa'ad in my mind, but please don't argue why I didn't put her name. No Comment. Ahaks.

Anyhoo, this blog is especially dedicated to Internal Medicine (Ward 21 and 22) of RIPAS Hospital, Brunei Darussalam.

Any updates, or CNE stuffs, will be uploaded here.

We Care - Kami Memeduli

We Are :) .. Are You?

Been trying to post something months ago, but non came out hehe.. Mental block I guess. Anyhoo there will be more updates soon. Especially for the Nightingales.

Cheers