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.


Keeping your nose clean.

I mean doing the right thing.

Don’t do the wrong thing.

On your first day at work

All eyes are on you.

Keep your nose clean.

Be transparent at work.

When you take narcotics to give.

Have a witness,and keep your nose clean.

Make sure that you document the

Medication given to the patient.

If it is not documented,it is not given.

If your facility use scanners.

Then scan the medications.

Keep your nose clean.

Because if you are accused of medication.

Error, it will take time to debunk it.

Even when you did debunk it,some will still not

Believe you. So how do you debunk it.

It might cause you your job.

Or cause you your license.

Who will help to to debunk it.

Follow the hospital policy and procedures.

Return narcotic keys where it belongs.

Don’t put it in your pocket.

So that you will not forget.

Don’t take narcotic keys home.

Don’t take hospital phone home.

Keep your nose clean.

Document,date and sign medications given.

Be effective, honest nurse by

Keeping your nose clean.

Remember not documented.

Not given. So keep your nose clean.


I promise to do patient teaching.

Request patient demonstration.

And return demonstration.

To make sure that it

is effective teaching.

Without return demonstration

How are you sure about the teaching.

That it is delivered and well received.

For example when you are teaching.

How to give self insulin.

You want patient to show that he or she

Can give self insulin because you.

Don’t want patient to return to emergency room.

Because of ineffective teaching.

Always remember to do what.

Any competent nurse will do.

Do you understand the teaching?.

Do you have any question?.

I am glad that the teaching.

Is effective and you understand it.

So take control of your health.

Here is our phone number 000-000-0000

to call in case you have questions.


Is Pharaoh a stubborn wound with

a lingering smell and pain.

Emotionally draining

With mental exhaustion.

Pharaoh was very stubborn (Exodus 7:13 – 14)

He refused to obey the word of God

or listen to the advice of his people.

He was defiance.

Stubborn in Hebrew means to turn away.

( Deuteronomy 9:13,ESV)

Deuteronomy 21: 21 Stubborn and defiance of God and His ordained authority is a serious offense, one that can spread in the family and community like poison. (Mark 3: 1 to 6).

You stiff neck people your hearts and ears are still uncircumcised””. (Roman 2:5)

“Because of your stubbornness

and your unrepentant heart

are storming up wrath against

yourself for the day of God’s wrath”.

Self opinionated and stubborn

Self willed and stubbornness.

Stiff neck.

Unbending and defiance.

With your stiff neck.

Uncompromising and stubbornness.

Obdurate and defiance.

Who will fix it.

Refusing to change nasty attitude.


Hard headed and defiance.

Headstrong and unrepentant heart.

Dogged devotion to stubbornness.

Immovable that is been defiance.

Inflexible ,not flexible, and stubbornness.

Bullheaded that means stubbornness.

Adamant is also stubbornness.

Stubborn and refused to change.

Pharaoh refused to change.

He was adamant ,yes defiance.

God got frustrated and send the plagues to Egypt and so many people died

because of his stubbornness.

Stubbornness is a determination

not to change behavior.

Unreasonably obstinate is the

ugly side of perseverance.


Be nice and do the right thing.

Don’t poison yourself and others.

Don’t be a stubborn wound with a

lingering smell and perpetual pain.

Everyday is yours.

One day everything will come to an end.

Wickedness, and defiance will

Come to a permanent holt.


Do you know that the skin is the largest organ of the body?.Yes the skin provide protection, fluid balance, sensation.It facilitate communication and how you see yourself as an individual.A wound is a disruption of a normal state of the body. Wound heal faster in healthy people with good nutrition,physical status with intentional. (surgical wound)Wound will heal by primary, secondary and tertiary intention.The inflammatory and stress response will influence wound healing from the beginning of trauma through formation of scar.

Factors that can influence wound healing are?

Age of the patient.

Tissue circulation .

Wound condition.

Wound oxygenation.

The wellbeing of patient.

What will make wound to become complicated?.


Evisceration and dehiscence.


The most common psychological problems about wound are


Body image disturbance.

Fear of the unknown about the wound.

Anxiety about the wound,the smell and people reaction about the wound.

Before you start the dressing change, gather all the supplies that you will need for the dressing change. Don’t let your patient wait for a long time because it can be emotionally draining.

(1)The patient abdominal wound has area with a broken skin.This can be identifies as ?.

(A ) Surgical wound.

(B )Closed wound.

(C) Infected wound.

(D) Open wound.

Correct answer D.

Rationale: Correct answer is D because in an open wound the skin is broken. It may or may not be intentional. If a wound is closed it will not have open area of the skin.There may be tissue damage inside but there is no broken skin.Surgical wound can be closed or open depending on the type of wound.Infected wound has different signs and symptoms to be noted the appearance, smell, odor and exudate.

(2) The doctor orders patient discharge after surgical incision of his right ankle. In teaching the patient with wound about symptoms of infection. The nurse ask patient to call and report?.

(A)Decrease in size of wound.

(B) Temperature of 102.7°F.

(C) nausea/Vomiting.

(D) Wound granulation.

Correct answer B.

Rationale: Temperature of 102.7 is sign of infection. An elevated temperature is a systemic body response to the presence of infection. A,C, and D all wrong. Decrease in wound size wound granulation are normal signs of a healing wound.Nausea and vomiting is irrelevant to the answers.

3.What indication will show that patient understands the teaching?.

(A )Those heat or cold therapy don’t work.

(B) Why is my leg so swollen.

(C )I feel so floated.

(D )I feel relieved my pain is gone.

Correct answer D.

Rationale: One of the desired outcome is pain relief after cold or heat application. A,B,C are all wrong.

(4 )The doctor removed skin cancer from Mrs Theresa right upper arm. The wound healed very fast with minimal scar.So the wound healed by which process?.

(A) Secondary intention.

(B )Unintentional process.

(C )tertiary intention.

(D)Primary intention.

Correct answer D.

Rationale: Surgical incisions heal by primary intention.The wound healed quickly without any delay. Secondary intention also known as secondary healing that occurs when a wound is left open to heal by granulation, contraction and epitheliazation.It goes through four phase Hemostasis(closing by clotting),

Inflammation(Controls bleeding and prevent infection),

Proliferation ( Rebuilding with new tissues made of collagen and extracellular, forming new blood network)and

Remodeling (Known as a maturation phase).It begins about 21days after injury). Tertiary intention in the wound healing is the intentional delay in the closing of the wound because the wound is infected. So the wound are left open covered with a sterile dressing to allow the infection or inflammation to decrease or completely subside. Once the wound is closed with sutures or staples. The wound healing will be quick with minimal scarring.

NB: If wound doesn’t do well during these stages it becomes chronic.


What is Pneumonia?.

It is infection that inflames air sac in one or both lungs, which may be filled with fluid or pus.It can be life threatening to anyone. But especially in older adults, infants, young children and people over 65years old. Follow the CDC guidelines.


The most common causes of pneumonia are bacteria, viruses and fungi. The bacteria called Streptococcus pneumoniae is the most common form of pneumonia. (The pneumococcal pneumonia) Do you know that pneumonia can cause infection in the brain and blood?.


Symptoms are

cough with phlegm

or pus,



difficulty or trouble breathing.

How does it spread?.

By airborne, respiratory droplets. (Cough or Sneezes)Flu vaccine should be received every year. But the Pneumonia vaccine should be received every five years. Please follow your doctor orders. Even if you already had Pneumonia, you can still receive pneumonia vaccine.

The CDC recommends that every adults 65years and older to get Pneumonia vaccine.

Find out what CDC recommends for children under 2years old and people with chronic health conditions or those with weak immune system. There are many strains of pneumonia.

Talk to your healthcare provider about pneumonia vaccine. Pneumonia vaccine is not only for 65years old and older.People 65years old and older are more likely to get pneumococcal pneumonia. WWW.urmu.rochester.edu/encyclopedia/content.


I know that you wanna be cool.

Smoking is not good for diabetes.

Smoking will make your sugar higher.

Bad idea for diabetes.

Not good for your legs and feet.

Smoking not good for the nerves.

So if you wanna be cool do something else.

Not good for your vision.

I know that you wanna be cool.

I am sure that it is not good for your libido.

Check out with your doctor.

Reach your A1C target and maintain it.

But how cool are you when you.

Worsen kidney disease.

Medication that helps with kidney failure.

I know that it is not easy to do.

But it will be difficult if we don’t try.

Might not work for smoker.

Develop plantar ulcers.

Yes plantar ulcers.

How cool are you when you can’t socialize.

With all your friends and families.

How cool are you when everyone

Have deserted you because your wound stink.

Who will change your wound?.

That is under your feet.

I mean the non-healing wound.

You cannot do it by yourself.

What is the TCP02 level of

your lower extremities.

Please don’t remind me.

I don’t want another amputation of my toes.

Some nurses tell patients smoking is bad for you.

But are smokers themselves.

Some go through the complications too.

And later stop smoking if they choose.

As a smoker you don’t want

health care professionals.

Seeing you as a noncompliant with your health.

All they need is to ask basic questions.

Some of their questions do you smoke?.

How many packs a day?.

Do you drink?.

What type of alcohol?.(wine,beer,whiskey)

How many bottles a day?.

How cool are you when stroke or

heart attack visit?.

Ten times more likely if you smoke.

We will die of something don’t make it faster.

Smoking reduces your body

ability to use insulin.

1800- NO – BUTTS.

I am told that they can help.

It is a California smokers helpline.

From me to you.


I got your letter.

We want to reassure you that

If you take care of you.

We will take care of you.

So stop lamenting.

Here are some phone numbers

1-800-858-8072. For supplies.


1 800- Diabetes.


The phone number is the America Diabetes

Association Free hotline.


Other numbers are 833- 808-1234

323- 361- 2311.

Emergency after hours 323-361-2311.

Please don’t be afraid of me your diabetes.

We are in this together.

Check your blood sugar as instructed .

by your diabetes educator.

Take your diabetes medication or insulin.

As orders by your doctor.

Monitor your blood sugar.

Monitor your feet, eyes,and skin.

Do not run out of diabetes supplies.

Remember that you are doing it for you.

Love yourself for you.

Please maintain normal blood sugar.(60 to 100)

Protect your heart and body.

Thanks for contacting us.

We are here for you.


My dear diabetes mellitus.

I know that you affect every part of

the body including my lovely skin.

I know that you can cause skin disorders.

I promise to keep my skin clean and good.

I promise to continue to love my skin.

You promise to stay away from my skin.

I promise to keep my sugar within normal range.

Because is not your skin but my skin.

I will use a powder in areas

where my skin touches each other.

And to avoid hot showers.

No lotions between my toes.

Because they are my toes.

I promise to use fine lotion for my body.

I will and must prevent dry skin.

Scratching itchy skin can open it up.

Because it is not your skin but my skin.

Cover minor cuts with sterile

gauze after washing it.

I will not use any harsh chemicals on my skin.

Keep my home humid during cold weather.

Keep my feet clean and dry.

See a dermatologist for skin care.

I will see my doctor if I get major burns or cut.

Manage my skin well.

I promise to take care of my own skin.

I will pay attention and

catch any skin disorder early.

Maintain my weight and my sugar.

This is my promise.

Sincerely yours,

Keeping my diabetes together.

Wound Care Dressing Changes.( NURSING)

Check the doctor orders for dressing change. What did the order say?.Follow doctor orders.Gather your supplies,and wash your hands. Explain the procedure to patient. Close the door to provide privacy. Place waterproof plastic under the patient. Place patient in a comfortable position. Open plastic red bag that can be easily reached by you. ( Working area)Open dressing carefully. Remove old dressing, if hard and adhered to surface wet the dressing for easy removal. Drop old dressing in a red bag.Assess the wound, odor,appearance and drainage amount. Remove old used gloves and place in the red plastic bag. Using aseptic techniques open sterile dressing and supplies. Open solutions and pour it over the gauze sponge in the plastic bag. Then wear your gloves. Maintaining aseptic techniques. Clean wound or surgical incision from the center to outward in a circular motion. Or you can clean from top to the bottom. You can use the forceps if you want.Use the 4×4 gauze for the wipe.Clean wound well,use each gauze once and discard into the red trash bag.Dry the wound using same circular motion. Apply ointment if ordered. Apply dressing on wound as ordered, cover with abdominal dressing and tape. Remove your gloves and discard it to the red trash bag, wash your hands. Make patient comfortable. Remove all supplies away from patient and keep the area clean. Documentation, documentation. As a nurse you are responsible for caring for the patient wound and documenting your findings.Abdominal incision to the right lower abdomen 6×4 incision cleaned with 0.9normal saline. The staples are intact, wound edges well approximated.Tiny crust along incision sites removed and cleaned.Skin around incision intact but edematous. Hemovac present in the lower side of the incision with serosanguineous drainage. Dressing change Every Shift.Medicated patient for pain as ordered and per patient request. Every facility is different. Some facilities have WOUND CARE team.Follow your hospital policy and procedures. As the frequency of dressing change cannot be emphatically stated since it depends on doctor choices or preferences, wound type,dressing types, wound drainage and location of the wound.Must not over pack wound because it will impede blood flow and prevent wounds from healing. When Do you Remove Staples and Sutures?.It is removed when the wound tensile strength has developed and be able to hold the wound edges together. Every patient is different and it also depends on nutritional values, location of wound,and age.Collagen formation and remodeling will often take 21days.TYPES OF WOUND DRESSING FOR CHRONIC WOUND. Hydrogel Dressings: For wounds not deep.And are oxygen permeable, maintain moisture and nonadhesive.Transparent Adhesive Dressing: For minimal drainage wounds. Allowing exchange of oxygen in the wound and surrounding environment maintains moisture in the wound. Keep the wound bed moist and prevent contamination. ABSORBENT DRESSING:Absorbent dressing provides effective exudate control, and skin contact gently. Examples of absorptive dressings are karaya powder, polymer starch. Maintain moist surface by formation of gelatinous mass.They are for heavy exudate and deep wounds.Minimize maceration of wounds and keep exudate at the middle of the wound.

Abdominal dressing.
169- b- knd1801-6715- kendall-675Kerlix roll 4×4.
Would-be dressing- nurse- prepare- tray- material. Absorbent dressing.

HEAT VERSUS COLD APPLICATION. It is done to create therapeutic effects on the affected areas of the body. Our body temperature is regulated by the cells in the hypothalamus in response from the heat or cold receptors which are located close under the surface of the skin. When these receptors are stimulated, it will signal cells of the anterior hypothalamus to spread heat to the body by vasodilation and sweating.Or to the cells of posterior hypothalamus to conserve heat leading to vasoconstriction and shivering. Pain receptors are also activated if temperature are to cold or too hot.HEAT BENEFITS . Will raise body temperature and promote healing. Reduce the need for anti inflammatory medications. Reduce infection. Decrease pain.Increase circulation. Relieve painful menstruation involving abdominal cramps. COLD BENEFITS. It reduces swelling and prevent edema. Relaxes the muscle on affected areas. Decreases Circulation. Decreases pain to the affected areas. Acts as anesthetic to the affected area. It decreases metabolism and oxygenation to the affected areas. Heat and Cold therapy have systemic and localized effects. They are both used as a therapeutic methods for the treatment of traumatic body injuries. Before the application of cold or heat patient should be assessed on the physical and mental status of patient and the influence of the therapy on the individual .Questions The nurse is changing dressing on the flank side of the abdominal wound and she note the drainage to be light pink and thin.The nurse will document this drainage as?.A Serosanguineous drainage. B Purulent drainage. C Serous drainage. D Sanguineous drainage. Correct answer A.Rationale: Serosanguinous drainage is a mixture of blood and serum and very common in surgical wounds. Purulent drainage is thick and discolored, infection. Serous drainage is clear and watery. While Sanguineous drainage is mainly blood.(2) Your husband has sprained his right ankle and asks you how long should he leave the ice bag on his right ankle. Your response will be?.(A )Keep it there until you start to shiver. (B) 3hours on and 4hours off.(C )2hours on and 1hour off.(D) For 30minutes and you will leave it off for 1 hour.Correct answer D.Rationale: An ice bag should be applied for 30minutes and removed for 1hour.Because it will help to prevent the effects of prolonged cold.A,B,and C are all wrong. Caruso, C.C Hadley, B.J.,Shukla,R.,Frame,P.,&Khoury,J.Cooling effects and comfort of four cooling blanket temperatures in humans with fever.Nursing Research 41(2) 69 to 71.


What to ask in your next doctor visit.

What is your major health concern?.

Doctor visit why ?.


What do you need from your doctor?.

If you are like me.

You might want to write your questions down.

Before your next visit.

Do you have a record of your blood sugar?.

Come home to complain what the doc didn’t do.

Because I assume that they should know.

They are not psychic solution,

so they don’t know.

Yes don’t know, so you have to ask questions.

Have a record self check of your blood sugar.

Ask how often do you check your blood sugar.

Ask health care provider about.

Your A1C.

Your cholesterol level.

Your blood pressure.

What goal would they want you to achieve?.

What you need to do to maintain normal A1C.

Ask for diabetes educator for some guidance.

Tell the doctor the symptoms

that you are having.

Ask questions on nutrition

Because you are what you eat.

Find out if Medicare will pay for healthcare

professional to help you manage your

diabetes and your nutrition.

Don’t just go to doctor office.

Without proper communication of your needs.

Remember that each visit insurance is billed.

Plus your co- payment.

Moreover it is life.

Live your life.

Don’t go to doctor’s office and

be quiet like a ghost.

When I go to the doctor I sit like a ghost.

So I take my husband to help me out.

Make your needs known.

Are you ready for your next doctor visit?.

Same here, I am ready for my doctor visit.

Do it, you got this?.