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Monday, October 25, 2010

A week in Recovery Area

Last week I was assigned to be in Recovery Area or previously known as Post Anaestatic Care Unit (PACU). For the first three days, I could only help the basic things while my mind were struggling to remember the flow and the job-to-do there. Yeah, by right, I need to catch up myself whatever happens in the area (huhuu, newly joined person kan =(..hukhuk). But, the next few days, I felt so grateful for people in OT started to accept and help me mastering the area (really hope that I am accepted..*optimist..optimist..). Know what, I only have 6 days to catch up all those thing, by the way, it should be enough right..You will know whether it is suffiicient or not after this yaa..Happy reading!!

What to do..

Here is the to-do-list for nurses incharge of recovery area at my place ya..It might be useful for you or it might not, so, take good things and do leave the bad ones ya..

Preparing Setting

 Since currently I am working according to office hour, my official time starts at 0830 and ends at 1700 (24hour style). For last week, I was placed in Recovery Room (RR), so basically, RR begins to have patient after the operations are done. Thus, there is no cases commonly early in the morning except emergency cases but still rare. Therefore, nurse's job for morning time is to prepare the RR, clean and clear the places, top up anything related (such as face mask, green gauze, yankuer sucker and etc.), change the collecting tube, and arrange nicely the setting. If we have some extra time, do help the general worker (we usually call them attendant in GOV hospital) preparing trolleys to receive patients.

Do lend your hand and a little energy for small works as I believe there might be hidden barakah among them that we conciously dont know, and it might help us back when we need people's assistance one day. Let us not be a selfish person ya. For a new beginner like me, all those thing help me lots, allowing me to slowly catch up the whole setting, knowing what do OT have in it and where are places of things (this would be helpful for us in the future when we seek for something ya), and most important thing, we can do lots of things by ourselves without depending so much on the other people when they are not around. This is so-called indirectly self-ward orientation as we cant expect people to tell and orientate us all the time, and it surely benefits you much.

Receiving the patient.

Once an operation is done, patient will be wheeled out by the circulating nurse assisted by general worker (GW) or runner of the operation. First thing to do is 10 seconds assesment on the patient by a glance. What to see is the condition of the patient by sight. Is patient concious, is patient put under general anaesthasia (GA) or local anaesthasia (LA) or regional block (RB). From that, we straightly can arrange in our mind what to do next and next.

Patient under GA

Initial thing to do is to maintain patient's airway because normally they are sent out before they gain  their fully consciousness, that the main job for RR (to keep eye on till patient conscious and send them back safely). Patient under GA commonly needs assistance to breath post-operatively as we know GA decreases respiratory function (we'll talk on this later ya). We will commonly see patient with Guedel airway to help them breath.

Guedel Airway
Compulsorily, giving oxygen is the first thing to be done for under GA patient. Next is the SpO2 monitoring, then blood pressure taking. Continuing drips is also a must if any.

Patient under Local Anaesthasia or Regional Block

Usually, they normally breath and what we need to do is to monitor the SpO2 and the blood pressure. Comforting the patient is always a must like covering up patient with blanket or switching on a warmer. We must be alert about LA areas or RB type (wether it is spinal or epidural) because sometimes it will affect patients' movement and might need some assistance from us.

Pain Management

Frequently, painkillers are administered in the OT while and after the procedure. However, anaesthetist will also order those drugs in the RR such as Dynastat 20mg or 40 mg intravenously and Morphine via Patient Controlled Analgesic (PCA).

To prepare the PCA, we just need real guide to show us because different types of PCA need different step to run them. So, alwas be prepare to learn ya..!!

Sending Patient Back

After close observation for almost 30 mins without any complications, severe pain, and good respiration, patient will be sent back to ward or day ward to be discharged or further intervened. We commonly call nurse in charge form ward right after 10 mins of observation, giving them time to come and also to help patient to reduce their bill by not staying longer in RR.

During pass over, patient will transfer from bed to bed with or without assistance, depend on the condition. This will benefits patient so much, as an early ambulatory is proven beneficial in healing period, physically and spiritually. We'll report to the nurse in charge, the type of surgery done, surgeon and anaesthetist, specimens if any, induction drugs used, dressing if any.

That is all for RR week.... To reach the competency, 1 week is never enough and as I always believe, skill can be gained by time and repetitions but not knowledge and rationales, as they need up-high passion and keen desire to get them. Not to say that we have to study all the times, but what I insist is DO ALWAYS USE YOUR BRAIN TO THINK, TO ANTICIPATE, TO ANALYZE, and  TO SET ACTONS. Later, you will find out that you can still manage to competently do steps of procedure, because the strong memory and tough thoughtful mind will guide you then.

fiey ahmad
so much thing to learn, 
that makes life so beautiful

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