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Monday, October 19, 2009
I am updating bcos someone is reading..
Learned abt roles of uro-nephro nurse:
to teach / share ur knowledge with ur junior staffs
act as an advocator (speak on behalf of pt)
act as a counsellor, resourcer
clinical nurse
leading and managerical roles
advanced practise nurse
almost wad i am doing now.. so role as a nurse it's still e same as before
1st speaker : Dr Tan seng hoe - gleneagles
covered on complication of UTI
dun look down at simple diagnosis like UTI
when u have a male pt, having a UTI, it is a serious matter and has to be investigated further.
as male pt's anatomical structure unlikely to cause UTI (long urethra)
collection of mid-stream urine:
should wash perineal area
ask ur pt to pass first bit of urine (do not collect)
pt continue to pass, nurse then collect the urine.
this is e correct way of getting specimen
not to ask pt to pass abit then hold (this is not a mid stream urine)
when DR look at FEME result EC (+) means the sample taken isnot from midstream
this is when DR starts to ask to repeat FEME and write in treatment order (midstream, clean catch)
gram stain test is done by putting dye into the sample and look at the type of bacteria growth.
can be gram (+) and gram (-)
however while waiting for result to come back, one shld start with an antibiotic tt covers pseudomonas bacteria as well. (as pseudomonas bacteria complicates UTI)
he is good, but his voice is too soft.
2nd speaker: Dr Ng Tsun Gun
covered on Acute renal failure in adults and elderly
divided into 3 phases:
pre renal
interstitial renal
post renal
we need to pick up and correct at early stage , otherwise pt will collapse (fatal)
once pt is dehydrated, shld start aggressive fld challenge and put pt on at least 2-3L of drip
once pt is dehydrated, shld start aggressive fld challenge and put pt on at least 2-3L of drip
monitor output at the same time.
if u r giving 4L drip and pt is passing 4L of urine, we shld increase further fluids (+ another 500-800mls, to compensate for water lost)
need to check daily u/e/cr to look at Cr level and K+.
biopsy when need to identify exact cause of ARF
when Dr asked to add test for mg, PO4, Ca is to look for metabolic acidosis, hypercalcemia, hyperphosphatemia..
we will dialyse pt if pt doesnt respond to resonium, calcium+insulin (for hyperK+)
NDAIDs like ponstan, synflex, etc causes ARF (we need to closely monitor pt esp elderly who are on NSAIDs, they r more fragile)
learnt a lot from him. best speaker. very clear and loud enough.
3rd speaker - Prof. Chan from NUH
covered on diabetes nephropathy
he is supposed to talk more abt diabetes, instead he keep emphasizing on treating hypt.
treating hypt improves the pt's mortality rate by almost 50%
dialysis pt still can conceive, however, to take into consideration tt pt will lose certain kidney's function, baby maybe premature, etc
anyone ever thought abt those on CAPD getting pregnant?
on top of carrying baby, u are carrying fluids at the same time..
i tink the 3rd speaker not touching the topic well.. but he is the HOD of renal meds dept in NUH
it was a long day..
pre-course test was quite difficult. anyway, it's not considered as ICA marks.
missing the rest vy much..
happy to receive jiayou msg from Zihui, Caiji and Rita.
i got to love the kidney anatomy..
life is unpredictable, pls cherish every moment
5:54 AM
