Day 1 and 2 in Psychiatric Ward

Year 3的第二個practicum--精神科!!
我一早就好想出架啦!!!><
果然好開心,零壓力.
一開始其實有D驚架，因為好多patient都好似好惡
但原來好多patient都好nice~
姑娘又好人，好照顧我地。
Ward無咩做，主要同patient傾計




第一日只係幫手take BP,
勁開心囉！係叫咪叫病人出黎排隊度架！好輕鬆！
但我又先記得如果pulse低，要用手摸一分鐘confirm.




第二日幫手沖涼，要向病人講下野
confirm patient唔會沖沖下自殺


呢個ward著格仔衫既patient係SO(suicidal observation)的


探病時間要睇下patient有無食野，
social skill如何，emotion，有無危險物品(藥物，玻璃，水樽.....)
Mental Patient唔可以簽任何文件！要醫生話得先可以

Day 6-9 in paediatric ward

因為呢個星期都好灰，所以都無打blog了。
事緣有個姑娘覺得我地表現好差，
話會肥我地，
所以好大壓力.
其實我都只係chart錯格，計錯數，做野比較慢
不過我都覺得自己可以做好d既,
而家好好彩pass左，應該要好好溫下書啦！




Admit Patient from Home Leave
首先要度返d vital signs,
戴返個baby tag,
patient可能會係屋企有記低temp & IO
temp就要用虛線寫返落temp chart,寫埋back from HL at 0930
IO就寫返refer to HL I&O chart.


見到patient唔飲水就要encourage small and frequent diet.

Day 5 in paediatric ward

今日兇惡的姑娘唔係度，好開心！
學左新野：
FEV1(forced expiratory volume in 1 second)
FEV1 is by far the most frequently used index for assessing airway obstruction, bronchoconstriction or bronchodilatation; FEV1 expressed as a percentage of the VC is the standard index for assessing and quantifying airflow limitation.
用spirometer就會出E個value
叫patient吸一口氣,之後用力吹一下
用View mode 會show理其他value
FEV1/predicted FEV1 x 100%
吹都有分pre med & post med
吹完記得要抹返部機，
同埋patient自己有自已個吹咀。




FiO2=O2 saturation given, RA is 21%


My little patient:
Kawasaki disease (KD), also known as Kawasaki syndrome, lymph node syndrome andMucocutaneous lymph node syndrome,^[1] is an autoimmune disease that manifests as a systemic necrotizing medium-sized vessel vasculitis and is largely seen in children under 5 years of age.
There is often a pre-existing viral infection that may play a role in its pathogenesis.


Treatment:

Intravenous immunoglobulin (IVIG) is a blood product administered intravenously. It contains the pooled IgG (immunoglobulin (antibody) G) extracted from the plasma of over one thousand blood donors. IVIG's effects last between 2 weeks and 3 months. It is mainly used as treatment in three major categories:

• Immune deficiencies such as X-linked agammaglobulinemia, hypogammaglobulinemia (primary immune deficiencies), and acquired compromised immunity conditions (secondary immune deficiencies) featuring low antibody levels.
• Inflammatory and autoimmune diseases.
• Acute infections.

-Salicylate therapy
-Corticosteroids

Day 4 in paediatric ward

返完P又返A真係幾累
但routine快在好多=]




今日第一日埋大I&O,姐係將一日的I&O加起晒，
之後開新紙
所以原來所有liquid intake都要用ml做單位，唔可以寫1/2杯水


教左睇urine SG,
用syringe抽小小尿落mic睇,
normal: 1.010- 1.025




俾姑娘大鬧左一餐,
姑娘叫我換左patient部Oximeter
我無睇清楚拎左部cardic mon ><
之後我才找插座找好耐
我再去問清楚她係咪淨係換機唔換線,
佢就過黎鬧我慢，又唔睇下部機個牌子拎錯線
係我錯，但我覺得佢唔應該咁大聲向病人面前鬧我囉
i'm so upset!!


panadol PR
2 dose: 125mg 250mg
要check下有無stat同other route俾左。
panadol dosage: 10-15mg/kg
left lateral




用three way要fill with watch先博落HB
要turn好，唔好block左條line




接OT要帶ambulatory bag
推車時要企係patient頭

Day 3 in paediatric ward

第一次返P shift,
一返去就聽交間
之後做routine.




Erect Suspine  BP
叫patient半訓五分鐘，
訓係度度一次BP.
之後patient起身再度一次，
如果兩個systolic 差20就要report


SaO2低
睇下個senser有無問題、
Check RR
睇有無dizzy，pale......


Abnormal BP
BP高,pulse低= increase ICP
BP低,pulse高=shock


倒尿後要寫BE(bag Empty)
唔係就=換左袋


Otraven
decongestant
最多俾3-5日
 Besides hypertension, common side effects include sleeplessness, anxiety, dizziness, excitability, and nervousness.
Decongestants are normally paired with antihistamines to lessen this effect, but the combination of both classes of drugs do not necessarily cancel the side effects of each other.
Topical nasal or ophthalmic decongestants quickly develop tachyphylaxis (a rapid decrease in the response to a drug after repeated doses over a short period of time). Long-term use is not recommended since these agents lose effectiveness after a few days.




OT返左patient要度BP，幫patient著衫,第一次小便要report.

day 2 in paediatric ward

今日的routine順左d，不過仍然係慢，




Ventoline administration
小朋友會用spacer噴ventolin,
用之前要搖下先,
個spacer有塊valve，可以睇到小朋友吸氣
10 breath 1 puff,
puff and puff之間又俾小朋友吸1分鐘新鮮空氣。


Apply Urine bag
記住唔可以掂urine bag入面！
驗完multistix就吸一個for multistix既印落Kardex,
之後寫返D readings,
記得要chart I&O 1次urine


 remove HB
如果小朋友勁喊的話就要快快心撕爛micropore去remove splint,唔好慢慢"meet"
用gauzes cover住就"蚊"出黎,
俾塊膠布媽咪


Drip to HB 
remove connection of the line,
用針咀cover返條IV line
(docu: I&O W/H IVFxX-ray)




感想：今日其實都做多在野,學左check儀器，師姐好好人，好俾心機同耐性教我地，好開心。

Day 1 in paediatric ward

今日第一日出兒科，呢間醫院我15分鐘就去得到，係唯一值得開心既事。
更衣室很怪，像一個空置的泳池放滿locker，大家一齊換衫=.=


Key Point today!
1.兒科最重要的是I&O!
2.IV是用pump機落的，每小時read一次水(read水是指要check right IV fluid, right rate,一個鐘落左幾多ml水,patient手仔有無腫！<<小朋友手腫好大件事，要切手!)
3.I&O點都要填D野，無都要填No intake, NPU, refuse meal
4.collect urine要先抹乾淨，之後放綿花入urine bag.(docu: urine bag applied after swabbing)
5.OT時用的providine係antiseptic solution,not swab!
6. 1安士=30ml
7.fever advice remove clothing, bathing, drink more water但唔俾ice pack.
8.Breast feeding chart I&O: BF 6 min
9. 3 months below 度temp度腋下
10.驗尿("九味"試紙) ,如有nitrate, leukocyte, RBC的話, indicate UTI,要留小便for mic
11.條line有bubble的話可以自己彈散
















Routine
A shift
簽到
7A 11A take vital signs
read IV Q1H
check CSSD,水車,儀器
走之前數人


P shift
簽到
聽交間
3P 6P take vital signs
收症
order CSSD

check CSSD,水車,儀器

走之前數人

ops: Temp, RR, apical rate( <5 yr), pulse(>5yr), I&O ,好少要BP

收症：TPR, BP,度height,weight,head circumference

感想:今日我地take ops超慢，因為要數AR & RR，又要問I&O,paed既野我地唔識，成日似問我地到底year幾.........哎！好灰囉，同wardmate都有唔想再做nurse的感覺............