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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
entertainment)

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.

Featured

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.

WHAT MAKES ME HAPPY,COST ME A LOT?.

Alcohol makes me 🍸happy cost me a lot.

Smoking makes me happy cost me a lot.

Fentanyl makes happy

cost me a lot.

Amphetamine makes me happy.

Can cost me a lot.

My vision is blurry even with glasses.

Is this my cataract or alcohol?.

Cataract done on both 👀eyes already.

My girlfriend left.

Complain of lack of intimacy.

Due to alcohol and drugs.

I hit the 🌳tree due to alcohol.

1800 no Butt.

I called AAA.

But are mine ready to quit.

Quit what alcohol 🍸or drugs?.

Smoking or sniffing?.

I got DUI ×2.

Driver license suspended.

Who cares.

Mom and dad are crying.

I promised to change.

Stay with prescription drugs only.

Love son,love my parents.

But alcohol 🍸make very good.

BAC is greater than 0.08%

The drugs make me forget my problems.

A1C greater than 7.

Erectile dysfunction.

Me erectile dysfunction how?.

I fired my doctor.

Get me a really good doctor.

Support groups where are you?.

Enablers where are you?.

We recommend good nutrition, Counseling, support groups and Rehabilitation Center for return to normalcy.

511 CASE SCENARIO. DECUBITUS ULCER LEFT HEEL.

KINGDOM OF GOD HOSPITAL LOS ANGELES CALIFORNIA 900000.INTERDISCIPLINARY KARDEX.

Age/Sex 79years old female.

Account number: Q004634313.

MR #Q00066867541.

Admission date 11/10/2021.

Status: Inpatient admit.

Location: General Surgery.

Room 62115.

Attending doctor: Tommy Holbib.

Patient name: Littlelove Holdme.

Resuscitation Status:Full Code.

Allergy NKDA.

Weight 135lbs.

Height 5feet 3inches.

Alert and oriented ×3.

Primary Diagnosis: Decubitus Ulcer left heel with eschar.

Secondary Diagnosis:Bilateral mastectomy, HTN,DM,Chronic Anemia.

Is patient at risk for fall: Yes.

Suicidal risk: Yes.

Language barrier: No.

Family Support: Daughter at her bedside 24/7.

Do you have an advance Directive: No.

Copy of advance Directive on the chart.

Diet Carb Controlled cardiac diet.

Doctor orders:

Turn and reposition Q2hours and prn.

0.9NS @ 75ml/hour.

Accucheck Qac and Qhs.

Humalog insulin (lispro insulin)per sliding scale: Bs =70 to 200 Zero coverage. 201 to 250 give 2units SubQ. 251 to 300 give 3units.301 to 350 give 4unit .350 to 400 call the doctor. ( Please follow the doctor orders and your hospital policy and procedures)

Vancomycin 1gm IV Q12hours.

Zosyn 3.375gm IV Q8hours.

Myperlex dressing to Buttocks discoloration.

Norco 5/325mg po Q4hours prn pain.

Tylenol 500mg po Q6hours prn fever. ( Patient can swallow a whole pill.Does not want her pills crushed)

Risk for skin breakdown. Keep left heel elevated on the pillows.

Laboratory tests :

CBC with differential and Chem 7 in am.

Continue to monitor vital signs Q4hours. Call MD for temperature 🌡>100.5.

Plan:

Discharge to SNF with Zosyn 3.375gm IV Q8hours.

510 CASE SCENARIO. ARTERIAL OCCLUSION RIGHT LOWER EXTREMITY/CHF.

KINGDOM OF GOD HOSPITAL LOS ANGELES CALIFORNIA 900000.INTERDISCIPLINARY KARDEX.

Age/Sex: 53years.

Account number :Q005634333.

MR # : Q00098867543.

Admission date: 04/17/2021.

Status : Inpatient.

Attending doctor : Tommy Holbib.

Patient name :Isaac Apple.

Location : MedTelemetry.

Room # : 42114.

Resuscitation status: Full Code.

Weight :152lb.

Height: 5feet 6inches.

Primary diagnosis:Arterial Occlusion right lower Extremity.

Secondary diagnosis: Tabacco abuse, cocaine abuse, alcohol abuse,Hypertension,DM, high cholesterol,left foot ischemic due to embolic Occlusion.

Isolation Status: Standard Precautions.

Is patient at risk for falls: No.

Suicidal risk: Yes.Impaired skin intergrity:Yes.

Do patient have Copy of advance Directive?. No.

Copy of Advance Directive on the chart.

Diet: Carb Controlled cardiac health diet. Accucheck Qac/Qhs.

Transportation method: Bed.

02 at 4liters NC .

Suicidal risk: No.

Doctor orders: IR for Arteriogram infusion of TPA and Heparin per doctor orders during procedure. Possible amputation of toes .TPCO2?. Patient is alert and oriented x4,moves all extremities. Right lower Extremity elevated on pillows,SCD left lower Extremity. Hx of partial amputation of 2nd and 3rd right toes.

Plan:

discharge to SNF after normal WBC result.

Laboratory tests:

WBC : 14.8.

H/H: 13.6/43.0.

K: 4.3.

NA :140.

WHERE IS MY BABYLON?.

Where is my Babylon?.

In between two rivers.

I looked it is well secured.

My mother told me that,

it is a temple of God.

No questions asked.

It is sacred and guided.

It must remain secured.

The temple of God.

River flows out.

But cannot flow in.

The temple of God.

My Babylon.

No invasion of you.

Unless authorized.

My sweet Babylon.

Look and see nothing.

Look and feel better.

No registration.

No payment or recurring payments.

It is secured and hassle free.

My beautiful Babylon.

509 CASE SCENARIO. ABDOMINAL PAIN/ ETOH WITHDRAWAL.

KINGDOM OF GOD HOSPITAL LOS ANGELES ,CALIFORNIA 900000.

INTERDISCIPLINARY KARDEX.

Age/Sex : 65years old man.

Account number : Q004215328.

MR # Q00099593422.

Admitted : 09/03/2021.

Status: Inpatient admit.

Attending doctor : Tommy Holbib.

Patient name : Bulley Bathurste.

Location: General Surgery.

Room : 62114.

Resuscitation status: Full Code.

Weight: 198lbs.

Height: 5feet 9inches.

Allergy: NKDA.

Primary diagnosis: Abdominal pain/ Etoh withdrawal.

Secondary diagnosis: Hypertension, high cholesterol, Etoh.

Isolation Status:

Standard Precautions.

Is patient at risk for fall: Yes.

Do you have an advance Directive: No.

Copy of advance Directive on the chart.

Diet: Cadiac Heart health diet.

Transportation: Bed.

Skin intergrity impaired: Yes.

02 2liter NC.

Suicidal risk :No.

Family support. Jenny Moody( mother)

Alert and Oriented ×2.

Noncompliance with plan of care.

Doctor Orders:

CT scan of abdomen ( showed Fatty liver)

CIWA PROTOCOL.

Ativan 1mg iv Q8hours prn agitation.

Ativan 2mg IV Q6hour withdrawal.

Ativan 1mg po Q8hours prn agitation.

Dilaudid0.5mg IVQ3hoursprn pain.

Phenergan 12.5mg IM Q6hours prn Nausea and Vomiting.

Zofran 4mg IV Q4hours prn nausea/Vomiting. Metoprolol 10mg po daily.

Hctz 12.5mg po daily.

Norco 5/325mg 2tablets po Q6hours prn pain. Norco 1tablet po Q4hours prn pain.

BOLUS ×1.0.9NS at 75ml/hour rt forearm. Laboratory tests:

CBC with differential, Chem 7,LFT in am.

Urinal at bedside.

Incontinent of bowel and bladder.

Laboratory results:

K=3.8,WBC=4.8,H/H =14.6/43.5.NA= 138

WHAT IS GREAT ABOUT MY TEAM?.

What is great about my team?.

Hmmmmmm?.

Competent and knowledgeable.

Prudent Healthcare professionals.

Patients advocate with great service delivery. Exceptional patients education upon admission, discharge and after discharges.

Understand the importance of electrolytes and replacement when deficient.

Reporting critical values to doctors on time.

Readback and verified.

Great team players.

90% of Registered Nurse can insert saline lock.

100% can insert foley catheter.

Great team leaders.

Great Charge nurses.

Honest and direct support group.

No backstabbers.

Admission and discharges done on time.

Great customers services.

JCAHO ready 100% 24/7.

So what is great about my team?.

Read and tell me.

MY 🍎🍏🍎🍏APPLE.

This is my apple.

I take good care of it.

Well put it in the basket.

This is my clean apple.

It is perfect and delicious.

Well put it in the basket.

Here is my rotten apple.

Well put it in the same basket 🧺

All apples are made alike.

It will mess up the other apples.

Put all of them together.

My apple is an exceptional apple.

Exceptional apples?.

Well put it in a separate basket 🧺

We watch ,watch, and watch.

As for the good apples keep them with rotten apples.

Okay the exceptional apples seem different.

rotten apples never mix with oranges.

Never mix with 🍍pineapples.

For the good and perfect apples,

do they have defendants?.

Otherwise leave them with rotten apples.

Close their stories for they’ve none.

508 CASE SCENARIO. SMALL BOWEL OBSTRUCTION/ ALCOHOL ABUSE.🍸

KINGDOM OF GOD HOSPITAL LOS ANGELES CALIFORNIA 900000.INTERDISCIPLINARY KARDEX. Age/Sex 53years old Female.

Account number Q006634322.

MR # Q00063593429.

Admitted :01/05/2021.

Status : Inpatient admission.

Attending doctor : Tommy Holbib.

Patient name: Berlin Australia.

Location :MedTelemetry.

Room : 42114.

Resuscitation status: Full Code.

Weight:160lbs.

Height: 5feet 6inches.

Allergy: NKDA( No known allergy).

Primary diagnosis:Small Bowel Obstruction/ Etoh intoxication. (BAC level: 0.08%)

( Shaking with alcohol in her breath, could not spell her name)

Secondary diagnosis : Diabetes type 2,Anxiety disorder, depression, history of domestic violence,divorced three years ago.

Isolation Status: Standard Precautions.

Is patient at risk for fall: yes.

Fall prevention protocol in place.

Suicidal risk : No.

Transportation method : Bed.

02 at 2liter NC.

Do patient have advance Directive: No.

Copy of advance Directive on the chart.

Diet: NPO x ice chips.

Skin intergrity impairment risk : Yes.

Language barrier: No.

Doctor Orders:

Ngt to Low intermittent Suction.

Morphine sulfate 2mg IV Q3hours prn pain.Reglan 4mg IV Q8hours.

Dilaudid 0.5mg IV Q4hours prn pain.

Zofran 4mg IV Q4hours prn nausea/ Vomiting. Accucheck Qac/ Qhs.

Ativan 2mg Q8hours.

CIWA Protocol.

Encourage ambulation.

CBC with differential, Comprehensive Metabolic panel, magnesium level in am.Abdominal xray 1V PORT.

WHAT ARE SOME SOLUTIONS FOR GOOD NUTRITION IN RURAL AREAS IN WEST AFRICA ( Example Nigeria)?.

  1. Good nutrition for everybody.Farming is a quick solution that could send hunger away with immediate alacrity. In your backyard plant vegetables ,plant yams,cassava, banana and 🪴plantains. Extend it to your other piece of land.You will not regret this.Farming does not prevent schooling or having a business. You can spend an hour or two in the farm before going to school 🏫. It is doable. Do not let hunger become a major crisis in your community.
  2. Good health and healthy diet. Livestock: Raise some chicken 🐔, ducks and demonsticated 🐐 animals such as goats to sell for extra cash .Be self sufficient and self reliant.
  3. Government support: Government can support by providing incentives if you are farming on a larger scale such as 🚜, equipments and some loans that will need to be repaid back or can be forgiven. Open up a fish bonds.
  4. Don’t milk dry your families abroad just because they want to help out.If only you know what they are going through. Ask not for what your country can do for you but what you can do for your country. So appreciate whatever that they can provide so that they can be happy to offer more assistance.
  5. Are you an able body man or woman?.Don’t let hunger dictate Terms and Conditions for you. If you are very busy hire some people to do the farming for you and you pay them for their labor.

ADULT PAIN ASSESSMENT/DOCUMENTATION/REASSESSMENT/ DOCUMENTATION.

Assessment for PHYSICAL pain,SURGICAL pain ,and NONSURGICAL pain.

Assessment for pain Q4hours prn pain or more frequent .For po medications such as percocet,norco,lortab,oxycodone,hydrocodone & acetaminophen, tramadol, advil,Ibuprofen,assess before giving medication and document, reassess after one hour (1hour)of giving the medication and document immediately.

The intravenous medications given such as morphine sulfate, dilaudid (hydomorphine ),Toradol, assessment before giving medication, reassess 30minutes after giving the medication and document. Documentation is very important. If you did not document the assumption is that it was not given.

There are verbal Standard Pain Scale in which the person can rate their pain level on a scale of 0 to 10.

1 to 3 is mild pain.

4 to 6 is moderate pain.

7 to 9 is really bad pain,very severe.

And 10 is the worst pain ever.

And there are the “Pain Faces Scale”.0 means no hurt and 10 means hurts a lot.

Assess your patient constantly for pain or discomfort. Remember that your patients and family members are your customers, and pain is SUBJECTIVE. Your assessment is OBJECTIVES FINDING such grimace, crying ,moaning. But if your patient said that his pain is 10 it is 10.Choose the appropriate medication to give to your patient.Medicate on time and encourage your patient to call for help, to use incentive Spirometry if indicated and to take a deep breath. Encourage ambulation if not contrainicated.Empower your patient to take charge of their own health. Show that you care.

SOME CHEAT SHEET THAT CAN HELP WHEN IT COMES TO PAIN MEDICATION.

1.Assess every patient under your care for pain,new admissions, current patients and document your findings.Gather information which is data collection. Planning:

What do you plan to do about your patient pain?.

What is your intervention?.

For example intervention with po medication or iv medication?.Call the doctor if medications are not working properly. Evaluation of plan and documentation.

2. Educate patient on pain medications. Ask patients to call you at the initial stage of their pain and do not wait for the pain to get worst. 3.Document, reassess, document, reassess and document. Is the pain medication effective?.If it is not effective what is the next action to take?.Did you notify the doctor?.

Which doctor should you call?.

The primary care physician or the physician on call?.

What is the intervention?.

What is the next plan of action?.

What is implemented?.

Is the intervention working for your patient?.

What are the side effects of Narcotics?.

1. Overdose of medications. Narcan ( naloxone is the drug use for opioid overdose)

2.Constipation.( Stool softener such as Colace or doculax can help)

3.Upset stomach.

4.Nausea and Vomiting.(Phenergan 12.5mg, Zofran 4mg IV,Compazine, Reglan, Anzemet)

5. Sedation can result from too much medication. Decrease the amount of medication given. Call and notify the doctor. Space out the interval ,Q6hours prn instead of Q4hours prn pain per doctor order .

6.Itching.Medications such as dilaudid,tramadol or morphine can make your patient itch.(Benadryl 25mg or 50mg po or IV)

7.Hallucination.Some patients after taking morphine can be fighting elephants 🐘 or beating up tigers 🐅Assess your patient systematically,monitor and document.

Do not forget to use two patient identifiers to identify patient before giving medication. This is one of the National Patient Safety Goals on medication administration.