Story Time About the Dog and His Owner.

"You must give everything to make your life as beautiful as the dreams that dance in your imagination"-Roman Payne.
My handsome big dog dedicated to his owner.Runs errand for the owner.
The dog is asked to go into the house and bring kola nut(this could be anything for

It is a bedtime story about a dog and his owner.The owner surprisingly had visitors that they were not expecting .So the owner started a song like this.

My handsome big dog go into the house in the living room and get me some kola nut, so that we can give to these uninvited visitors.I did not invite them and I am sure that you did not invite them.So come on big boy go into the house and get me some kola nut so that we can give to these strangers.Hopefully the kola nut will force them to tell us why they are here.

So the dog went into the house and got the kola nut.The uninvited strangers ate the kola nut.After eating the Kola nut (coca cola) they confessed that they are interested in buying the piece of land in their backyard so that they could be their neighbor.Sometimes a kind gesture can lead to meeting pretty nice people.The dog owner told them that she owns the land but the land is not for sale.So they left back to where they came from.The big dog and his owner live happily there after .The End.


My Honor As A Nurse.

On my honor as a Registered Nurse.

I will provide compassionate excellent Nursing care.

I will do my best now and tomorrow.
Be a good leader,not a follower.
I must Move Nursing Agenda Forward.
I must do my Best all the time.
I promise to update and obtain required CE every two years.
Advance my knowledge,education,and experiences.
I will be Knowledgeable not Knowledge Deficit.
Team player,work effectively with my colleagues and other ancillary.
Clock or sign in on time.
Clock or Sign out on time. Have all my equipment such as Stethoscope,Pen and Pencils.
I must Reason,and be Reasonable.
Perform my assigned role effectively and efficiently. Follow Hospital policies and Regulations.
Comply with JCAHO Standards of Care and Regulations.
Carry out Doctors Orders on Time.
Troubleshoot and be Supportive of my Colleagues. Know and Understand Patient Bill of Rights.
Respect Patient and Families. “The very First Requirements in a Hospital is that, it should do the sick no harm “Florence Nightingale .
Give medications by mouth and intravenously as ordered. Advocate for my Patients.
And provide TLC.
Must not Abuse Patients Physically, Emotionally or Sexually.
Promote Health and Prevent Diseases.
“I attribute my Success to this -I never gave or took any excuse”- Florence Nightingale .
Nursing Assessment.


To measure your wounds you need measuring Tapes,Gloves, Cotton Swab,digital camera,and clock.

Have all your supplies ready because you do not want to be going back and forth for supplies.

Provide privacy.

Wash your hands and wear your glove.

Get the measuring tools ready.(Write patient initial ,date,time and your name and title).

Patient initial and room number is good enough for this situation,because we are trying

to protect the patient as much as we can.Please follow your Facility policies and procedures .

Position your patient properly for the camera.

Remember do not take a picture of your patient face or his/her tattoos.

Position the measuring tape correctly and take your picture.

Use the tape to measure length and width ,and the cotton swab to measure the

depth by sticking it into the wound to find the depth,undermining and tunneling.

Place the cotton swab on the measuring tape to get and document the depth of the wound.

L x W x D =Length x Width x Depth

If the wound is round find the diameter.

Is there a tunneling.

Check for undermining?

What did you see?

Do not alter what you saw.And do not use personal phone to take pictures.

Remember that the head is always 12oclock and the tail 6oclock.

Discard the measuring tapes with patient initial in patient’s room ,inside the trash can,

after tearing it.

Wash your hands before leaving patient room.

cotton swab

Measuring tape

Print the pictures ,write a brief description and place it in patient chart.

Thanks ,you have done well.


We Do have the other types of wounds that are not related to

pressure ulcer, bedsores or debicutes ulcer.You do not Need to be bedridden or wheelchair bound to have this wound.

Anyone can have this wound anytime in their life.

The most important thing is taking proper care of it.

*Remember that wound is not part of your body,so it Must heal and go away.*

Educate your patients to take care of their wound (s):

To prevent infection. (Signs of infection can be fever,increase drainge,swelling(edema) ,pus,smell,change in color of the surrounding tissues.)

To follow doctors orders.

And should not allow their wound to adhiscence.

(That is the seperation of the skin from tissue layers).

Wound can adhiscence few days after surgery.(3-11days).

I am talking about the following wounds below.

Surgical wounds/Surgical incision.

Vascular Ulcer.

Diabetic Ulcers.

Wounds due to Trauma for example bruises and contusions.

Cancer related wounds.



Skin tear due to adhesive tapes.



These Other wounds can be Classified as:

Closed wound.


Partial thickness.

Full Thickness.

The wound is bumpy red granulation,scar formation.

Fat known as adipose.

Muscles,tendon,or bone are exposed.

Rolled edges.(Epibole )

The skin is maroon or purple.

Firm to touch and non blanchable such as bruises .

Wounds due to trauma such as car accidents.

Blood filled blisters.

There could be slough,yellow ,tan or eschar.

Whereas Pressure Ulcer can be Classified as:


Pre stage 1 : This is known as blanchable.

Stage 1 :Non blanchable erythema (redness)

Stage 11.partial thickness of the loss of the dermis showing wound without slough.

Stage 111. This is the fullness tissue loss in which the subcutaneous fat may be exposed

but not the bones,tendon or muscles.Slough ,undermining and tunneling may be present.

But you can still see and able to measure the wound.The staging of stage 111

depends on the location of the wound.Please read more on that.

Stage IV. This is full thickness skin loss in which you can see the bones,

tendon and muscles.

DTPI: Deep Tissue pressure Injury. Area will be boggy,firm,painful,warm or

cooler than the adjacent skin.It is marooned or purple localized discolored

intact skin.You do not know what is in the injury,it is warm,painful,different

but the skin is intact.

Unstageable.It is named unstageable because we do not know the depth.

It is a full thickness skin loss in which the wound base is covered

with yellow slough,tan,black or eschar.We do not know the dept.

The only way we could know the depth of the wound is if all the

soughs are removed.Which might involve Sharp debridement or any other

types of debridement.

The doctor or trained physical Therapist can do Sharp debridement.

Again please follow doctors orders, and your hospital protocols,

policies and procedures.

PRESSURE ULCER.WHAT IS IT?(In my understanding as a Registered Nurse)

Pressure ulcer in a simple term is known as bedsores or decubitous ulcers.

They are localized damages to the skin.They are very expensive to treat,

so the best thing is not to develop pressure ulcer.The hallmark sign of pressure

ulcer is that they usually develop over Bony Prominence due to unrelieved pressure

such as the back of the head,sacrum,coccyx,hips,ankles,elbows, occipital,shoulder,

ischium,ilac crest,medial malleolus,lateral malleolus etc.Development of pressure

ulcer around the ears is due to equipment.

Pressure ulcer could be a combination of pressure and friction.

If you are alert and oriented x4,walking,able to comprehend,not incontinent.

Will you develop pressure ulcer?The answer is “NO”.

So if you are compromised,you stayed in bed for too long or in one position

for too long.And you are not able to repostion yourself because

you are bed ridden or wheelchair bound.Then pressure ulcer will develop.

due to unrelieved pressure.

When there is a limitation in the flow of blood in the area where there is pressure

bedsore will develop. Pressure ulcer or bedsore is categorized in stages.

You cannot talk about pressure ulcer without understanding the BRADEN SCALES.

Please look up on Braden scales.It is a scale for predicting pressure ulcer risks.

Braden Scales is great predicting indicator for developing Pressure Ulcer.

And understanding who are at risk for developing pressure ulcer.

The Braden Scales for Pressure ulcer is as follows:

Lowest risk 15-18

Moderate risk 13-14.

High risk 10-12

Highest risk 9.9 and below.

When you think about Braden Scales think about the following.

Is the patient able to respond to pressure?.

To what degree is the skin expose to moisture?

Is the patient active?

What about their nutritional intake?

Can patient reposition self in bed or can patient ambulate(That is walk).

How to prevent Pressure Ulcer:

To prevent pressure ulcer is to understand the skin,nutritional intake, the Braden scales,

immobility,various types of wound including their origin, wound care.

These are very important as an healthcare professional.

The right equipment should be in place for bariatric patients.

According to the National Center for Health Statistics report shows that 30% of

American adults are obese-over six million Americans.

Reposition patient every two hours while in bed,and evry one hour while in the wheelchair.

(PT/OT ) Physical and Occupation therapists should be ordered for all patients.

Physical therapist should evaluate who need therapy and who need treatment.

Physical and occupational theraist clearance sould be done before discharge

home or SNF or REHAB transfer.Each patient situation is different.

Nurses should encourage and assist in early ambulation and other activities

of their patients.

Nurses are to medicate patients for pain thirty minutes prior to physical activities.

Unnecessary immobility should be discouraged by the nurses.

The GOLD STANDARD will be getting the patient ready for physical activities as

long as it is NOT against doctor orders.

Is there an OVERHEAD TRAPEZE for the patient to turn and

reposition self while in bed?

Avoid Electrical blanket under an immobilized patient with very low Braden Scales.
During repositioning ,watch out for bony prominent areas.Protect bony prominent areas.


Nutrition Assessment.

Can the patient eat independently?

Does patient have adequate nutrtion.

Is there a recent weight loss >5% in 30days.

What is the prealbumin level?

WNL > 16 mg/dl

What is Albumin level?

WNL >3.5g/dl

But if the patient is trauma patient,inflammation or has infection.Plasm prealbumin level can be false result since the prealbumin level has been affected due to trauma,or infection or inflammation.Then the C-reactive protein test can be use instead.It is the doctor decision if he/she wants to do that.

The importance of adequate nutrition cannot be overemphasized.

Evaluate PO intake that is can the patient tolerate food by mouth very well ?.

Eating 80-100%. Is patient getting enough nutrient?

If NO can the patient swallow?

Does patient need swallow evaluation?can your patient chew?

If NO Speech therapist and nutrition consult will be ordered by the doctor.

Speech therapist will evaluate for swallow and make recommendation.

Registered Nutritionist will make recommendation on type of feeding.

Tube feeding type for example Glucerna.1.0,1.5, jevity 1.0 or 1.5,Suplena

based on patient disease process and notify the doctor

on their recommendations.

And the doctor will write the orders.

Does the patient need Tube feeding,TPNor PPN ?

If your patient is not getting adequate nutrion,notify your doctor so that

he or she can order Nutrition Consult.

And the Nurse will execute the orders.

Next concern do the hospital beds have moisture control assistive device?

Is redistribution of pressure and comfort provided for patient?.

Are the patient feet off -loading from the mattress?.

Understanding of the wound that you are dealing with is very important because

successful treatment involves not just the wound but a complete knowledge of the

patient with the wound.

For example who is this patient?

Does the patient have diabetes,vascular disorder,anemia,hypothyroidism,

obese,COPD,or CHF?.

Is he/she a cigarette smoker?

In order words, good assessment of the comorbidities

are very important for adequate wound healing.


Assess location of wound,type of tissues,etiology of the wound,wound

suroundings, amount of exudate,odor,pain, signs and symptoms of infection.

Is the wound viable?

What are the factors affecting the wound?.

(A) Maintain moist environment for the wound to heal.

(B)Keep the wound surrounding clean.

(C)Avoid early closure of the wound that is not ready to be closed.

Why? Because it will be back to SQUARE ONE.

When it becomes clear that the drainage from the wound is winding

down,then the wound is getting ready to be closed.

(D)Excess exudate should be removed.

(E) Understand skin condition,products,products adherence

, and absorption and quality of products when making selection.

(F) Understand various ulcers such venous,arterial ulcer,lymphatic ulcer

and diabetic wounds and the types of dressings.

When do you use a negative pressure wound therapy or

any other type of wound therapy?.What are the indication and special

reasons or rational for using Hyperbaric Oxygen Therapy?.

One simple thing that I will say to you is please assess your

patient,his/her lab values and check the blood sugar.

If the blood sugar is low take action.Follow doctor’s order.




(1 )Bedridden patient position should be repositioned.While in bed—————————and

while in wheelchair—–———————————–

(2) Partial thickness wound can be classify as:

(a) Stage IV

(b) Stage 111

(c) Stage 11

(d) Stage 1

(3) Full thickness wound without exposed bony areas ,tendonor

slough should be classified as.:

(a) Stage 11

(b) Unstageable.

(c) Stage IV

(D) Stage III

Answers 1.Every two hours and every one hour.
2. C.

3. D.



A comprehensive Guide for the Wound Care Clinician.

2ND EDITION Pages 13 -123.

Black J,Clark M,Dealey C,et al.Dressings as an adjunct to pressure Ulcer prevention:

consensus panel recommendations.Intwoundj.2015;12(4)480 -485.

Washington,DC: National Pressure ulcerAdvisory Panel,2009.

Lippincott William&Wilkins: Wound care Incredibly Visual. 2nd Edition. Pages 3-26.

Diane L. Krasner,PhD,RN,FAAN . Chronic Wound Care.A Clinical Source Book for

Healthcare Professionals. Pages 1-20.


Where are you my love? You stood like you evolved. You are my sweet dove. If you are sweet candy.
Then I crave for  sweet candy.
I am ready to eat up the candy.
And worry about tooth
decay later.
We giggle with each other. Holding hands on the street. You rebuilt and organized me. We jump up together. Happy and sad together. You lifted me up. And now I can fly. We play with each other. Dive into the Ocean with each other. Peaceful and divine. Our eyes spark at each other. “The world can stop turning, the Sun can stop burning, Who can tell me that love is not worth going through?. If it falls apart,I will understand deep down in my heart ,the only dream that meant a lot to me, has come true. In this life,I was loved by you”Bette Midler. You held my hands. And I held your hands. When I see you I behave. I have lots of curves. I feel like a new me. “What the heart gives cannot go away,it is kept in the hearts of others”Robin St. John. Now I am alive . I am your beloved. And you are my beloved. “I have learned not to worry about love,but to honor , its coming with all my heart”. -Alice Walker. Love me in the light and in darkness. I promise to do the same.



Electroconvulsive Therapy (ECT) is an effective treatment for major depression with an eficacy rate of 80% or more,which is equal to or better than response rates to ANTIDEPRESSANT medications in some patients.
It is particularly useful for people who cannot tolerate or fail to respond to the use of medication treatment.

There  are various Reseaches from MAYO CLINIC ,JOHN HOPKIN’S University,and others but they did not allow to download for your references.You  can reference them .Also talk to your doctor or healthcare provider for educated information.


Provide educational support to patient and family.

Assess pretreatment protocols to ensure that it was according to hospital procedures.

Assess the patient behavior ,memory and functioning ability before the ECT.

Patient should remove prothesis before treatment to prevent damages or loss.

The Nurse should prepare and monitor patient during the actual ECT procedure.

Patient should use the bathroom before procedure to prevent incontinent.





4. Severe psychosis with acute onset,life threatening psychiatric conditions.

Rigidity of parkinsonism or the neuroleptic

malignant syndrome.


1.Education on procedure and expected effects to patient and family.

2. Encourage expression of feelings by patient and family.

3. Reinforce teaching after treatment.

4. Check emergency equipment before treatment/procedure.

5. Maintain NPO(Nothing by mouth) Status for 4-8hours

before treatment.

6. Remove harmful objects such as denture,jewlry before treatment.

7. Check vital signs ,maintain airway,assist to ambulate,

offer analgesia or antiemetic as needed.

8.Remain with patient before and during treatment.

9. provide support.Your focus should be on that patient only during treatment.Do not combine with other assignment.

10.Reorient patient and assist family members after procdure.



Informed means educated, provide knowledge,schooled, discussed.

Consent means approved, agreed, accepted the information given, given permission for the procedure to be perform.

Informed consent can be defined as the permission given by a patient to the doctor for treatment with the full knowledge of understanding of the benefits and possible risk.

The patient have learned and discussed the benefits and risk involved.

The Medical or surgery procedures must be clearly written and there should be no abbreviation.

The name or names of the doctor (s) and associates well written.

The consent will be signed by a mentally capable adult patient,alert and oriented ×4.If patient is a child a designated adult who has the legal authority will sign.

If a patient cannot sign and the family cannot come to the hospital consent can be signed over the phone with two Registered Nurses.

Please read up on the process of obtaining consent if patient cannot sign. Every facility has their policy and procedures.

So please comply with your hospital policy and procedures.

The Nurse will withness the consent and it will be dated and signed.

Blood transfusion form is usually part of the surgical consent form in case you will need blood.

Since you have agreed to the surgery ,pre operative teaching will begin, this include that you should remove jewelry, remove your dentures, denture cup will be given, no prosthesis.Do not wear anything except the hospital gown,you will be given a special bath (CHG bath) to make sure that you are clean and no contamination before surgery.You will be taught on how to use incentive Spirometer,and also how to do deep breathing because you will need to do deep breath after surgery and use incentive Spirometer 10×1hour, while you are wide awake.(Ten times every hour while awake)Please my dear patient make sure that you use it,because you need to expand your lungs after surgery.This will prevent you from developing pneumonia.

The Nurse will get the preop checklists ready,your chart ready and the ticket to ride ready.Your vital signs taken before going to surgery and after you returned to your unit.

And you the patient will relax,smell good,feel good and ready to put the surgery behind you.

When I hard my surgery(Myomectomy) in June 2nd 2001,I just looked forward to the end of my pain and my misery.

And since then the pain was gone and no more bleeding.

Thank you Doctor Thomas Lee and thank God.And also thank you Doctor Charles Ho that introduced me to doctor Lee.

I am sure that you have all retired by now.God bless you all.


Blood transfusion is the procedure in which you receive blood through

intravenous iv line.Blood transfusion is usually safe but there some risk ,

which are clearly explained below.But why do we need blood?


You might need blood due to the following reasons:

  1. Lost of blood during surgery
  2. Serious injuries such as accidents,stab wound.
  3. Fibriod.
  4. Cancer.
  5. Lost of blood during child birth.
  6. Low hemoglobin due to GI bleed.
  7. Other factors such as unknown etiology.

Determine if the patient need blood based on his H/H

What is the Hospital policy on blood transfusion.

Find out if patient knows the reason for transfusion.

Ask patient if he/she has transfusion reaction in the past.

Check for signed informed consent form.

Did your doctor talk to you about getting blood transfusion today?

Explain procedures to the patient.

Check iv site,you need preferable 18guage or 20guage due to

the viscosity of blood.I will not encourage 22guage.

Ask your patient to report chills,rashes or unusual symptoms.

Wash your hands and put on clean gloves.

Use at least two identifier whenever you are giving

blood/blood products.

Hang 0.9ns(Normal Saline)preferable 250ml bag with

blood administration set to initiate iv infusion and

follow administration of blood .



Obtain blood from the BLOOD BANK according to your hospital policy

when you are ready.Do not keep blood in patients or Nurses fridgerator.

Need another Nurse for verifications.

Check For:

Name Identification.Is this the patient’s name?

Does it match?

Blood product and type.

(The ABO group and RH are the same)

Check for expiration date.

Inspect blood for CLOTS.

Take vital signs before beginning transfusion.

Start infusion of the blood product slowly.

Prime in line filter with blood after priming with 0.9NS.

Start adminstration slowly 2-4ml/minute for the first 15minutes.

Check vital sign Q5minutes for the first 15minutes,

just to make sure that your patient is tolerating transfusion well.

Observe patient/client for:

Flushing,dyspnea,itching,hives or rash.

Maintain the prescribed flow rate as ordered by the doctor.

Assess infusion frequently, if you observe reaction.

Stop transfusion immediately and notify the doctor and the blood bank.

When transfuion is complete infuse 0.9normal saline.

Record adminstration of blood and patient reaction as ordered and

by hospital policy.

Return blood tranfusion bag to blood bank according to your agency policy.

Or discard in the RED Container per your agency policy.

It is very important to comply with your Agency policy.


Electronic infusion devices may be used to maintain prescribed

rate but must be spcifically designed for use with Blood Transfusion.


It is very important to know the eight rights of medication administration.

When administrating medications to your patient.The number one rule

is to use two patient identifiers.It should NOT be the patient room number.

Rather use patient ID,his date of birth and medical record number.

Before giving medications you should know the eight rights

of medications the abbreviations and its meaning.

1.Right Medication: Is this the right medications?

2. Right Patient.: Is this the right patient

3. Right Dose: Is this the correct dose that the doctor ordered.

4. The Route.: What route? Is it by mouth,sub Q ,intravenous,

or intramuscular.

5. Right Time: What time is he suppose to get the medication

9am,12noon 1700?

6. Right Reason: What is the reason or the rational for giving this medication?

7. Right Education : Have I educated my patient on the side effects of the medications?

8.Right Document: Have I documented that I gave this medication?













Take actions to prevent medication errors by identifying the LOOK ALIKE,and SOUND ALIKE medications.It is very important to label medications,syringes,medication bottles,and cups in ICU,Medical/Surgical,Med telemetry ,Operating rooms , Emergency Rooms

and all the departments that administer medications.

Medications should be reconciled across the the continuum of care without exception.

A list of patient medications should be communicated to the next next nurse.
To be a Nurse is to know colace.
Have you met colace?
Have you met mr Lovenox?
Have you met mr Norvasc?
What about warfarin
To be a Nurse is to know them.
To be a Nurse is to deliver compassionate care.
To be a Nurse is to know the eight Rights of Medication administration.
To be a Nurse is to know
patients Rights.
To be a Nurse is to understand medication safety.
To be a Nurse is to be friendly.
To be a Nurse is to have sense of humor.
To be a Nurse is to be blessed. .
To be a Nurse is to be happy.
To be a Nurse is to show nobility.
To be a Nurse is to show gratitude.
To be a Nurse is to be kind,assertive but loving.
To be a Nurse is to have pen,stethoscope and pencils.
To be a Nurse is to understand rules,protocols, and Regulations.
To be a Nurse is to have job security.