How to make Steamed Chinese Buns

A friend of mine who once tried my Chinese steam buns and asked me to write a instruction of how to make it. I am trying here. I hope the instruction I put here would help. If you have any questions, please leave me a comment and I will try my best to answer it.

The step to make the Chinese steam buns like this:

Make a yeast dough ® make the stuffing ® make flat bread dough ® put the stuffing in the flat dough ® wait for water in steamer boiling ® put the buns into steamer ® close the steamer ® keep steamer on oven at high heating 30 minutes ® turn off the oven and open the steamer, buns are ready to serve!

1) To make yeast dough

• 
  Using a big salver (container) which can keep at least 1.5 gallon of water. Put 2 table spoon of yeast in the container

• Put about 500ml (or 1/8 gallon) of warm water (40 degree centigrade or as your hand can tolerate) in to the container
• Add 3-5 cups of all purpose flour in to the container and using a fork to stir the flour in to the water until they look like porridge ( thicker or thinner are all OK), we call it the beginner dough
• Let the container sits in someplace warm: not too cold, not too warm ( too keep the correct temperature to be able to wake the yeast up) for half hour or more
• Once you see the porridge like beginner dough have some bubbles raise, you may put more flour (4-5 cups or more) in to the container and start to make a dough
• The dough should be soft and the shape is easily changed by hands
• Put the dough in a warm place like before and let it sitting there for another hour or more
• Once the dough raises as twice as its original site, it is ready to use.

2) Use cooking spry on the steamer so it will not be sticky


3) To make the stuffing

• 
  Get one onion, one clove of garlic, one table spoon size of ginger and 2 jalepeno hot pepper as you desired and clean them up
• Get all above in to food processor and chop them to small pieces and put in a plat to be used
• Clean some vegetables (like one zucchini, couple carrots and 3 celery sticks) you like and ground them to small pieces and put aside to be used
• Fry 4-6 eggs or one box of tofu and then chop them as small pieces if you are vegetarian
• Ground half pound of meat as your choice if you like to eat meat

• Mix all the grounded mean or eggs or tofu with the vegetables and the grounded onion, garlic, ginger and poppers together, add 2tsp salt, 1tsp 5 specie powders and any other flavors you like, Add ¼ cup of soy sauce as you desired to make the stuffing smells good. Mix them well, add 1tsp sesame oil in to it, and stir them again.
• When the stuffing smells good, it is ready to be used.
  

4) To make the Buns

• Cut the yeast dough as small pieces like Ping-Pong balls

. Use roller to roll the Ping-Pong ball dough to a round flat bread

Pick up the flat bread and put 1 table spoon of the stuffing in to it

Close the flat bread with stuffing from edge to center and the bun is ready

Keep going and make as many as your dough can

5) Boil half pan of water for your steamer

6) Put the buns to the steamer

7) Put the steamer on the boiling water and keep the oven on high, let it steam for 30 minutes

8) Open the steamer and take the buns out and serve!

9) Enjoy!!

Chinese doctor in Zambia

The Chinese doctors started to help people in Zambia since 1970s. This year, one of my friend went to there and worked hard in Livingstone Genaral hospital as a gynecoligist. Here are couple of pictures she sent to me.

A lovely picture

Use amplitude of vibration method to calculate ECG Axis

Use amplitude of vibration method to calculate ECG Axis:

1) Calculate lead I and III’s QRS amplitude algebraic sum.
To measure R wave, 0.1mv = +1, 0.2mv=+2, and so on.
To measure q or s waves, 0.1=-1, 0.2= -2, and so on.
2) After got the algebraic sum, find the point on the lead axis I and III and make a perpendicularity line to Axis.
3) These two line will joint at some point “A”.
4) The “OA” line’s direction will be the Axis’s direction.
5) Measure the angle formed by line “OA” and Lead I, the degree is the mean Axis, clock-wise is positive and counter-clock wise is negative.

Using this rule, the above ECG example is:
I: +4
III: +9-1 = +8
Find the point +4 on lead I and the point +8 on Lead III, Make a perpendicularity line from the point to both of the leads.
The joint point of these two lines are the “A” point.
Make a line from “O” to “A”, that is the mean Axis.
Measure the angle formed by line “OA” and lead I. It is approximately +70o.

So in this example, the mean electrical axis is approximately +70o .

The mean electrical axis for the heart normally lies between -30 and +90o. (Some textbooks say the normal range is 0 to +90o.) Less than -30o (or less than 0o) is termed a left axis deviation and greater than +90o is termed a right axis deviation.







By Dreamer
Saturday, September 22, 2007

Pneumothorax

One day, I came on duty. That was an afternoon shift. There were rules that for shift exchange. For stable patients, the off going shift may only give oral and writing report, but for unstable patient who were in the pediatric intensive care room, there were always the needs to go to the bedside to give report to up coming shift.

The morning shift doctor was Dr. Li. She went to the pediatric intensive care room with me and introduced a little boy to me: “This 1 year old boy admitted with Pneumonia yesterday. He was in room 7 before transferred to the intensive care room. His heart had stopped beating for few times and every time he was brought back with CPR. I do not know why and what is happening to him. Therefore, I transferred him to this room so we can keep a closer eye on him.”

I started to exam the boy while listening her report: he was well nourished and on 1L oxygen delivered by nasal cannula, with moderated respiration distress. I listened to his lungs, there were dismissed breath sound in his left side of the lung, and then I performed palpation and percussion of the chest, there were decreased voice vibration and tympani noise on percussion at the left side.

“ Did we do any x-ray exam on his chest today?” I asked. “Yes. The X-ray film showed pneumonia. It was Dr. Wang in radiology gave the report.” “Is there any sign of Pneumothorax?” “Not I can tell.” Dr. Li replied. “OK. I want to borrow the film to take a look.” I said. “Why not we go together and take a look there?” Dr. Li suggested. “Sure.”

Dr. Li and I followed by four medical students, we went to the radiology department and found Dr. Wang, the chief radiologist in the hospital. Dr. Wang got the film out, put on the negatoscope, and explained to us: “Look, here, the white spots are the increases of density of the lungs showing us there is pneumonia on this film.” I look at the film; I saw the left side of chest showing a fine line around the lung, and between the line and the chest wall, there was a clear black area. I pointed the black area: “Dr. Wang, is this possible there is pneumothorax exist here?” Dr. Wang exam the film again and said: “Yes. You are right. It is a pneumothorax.” “Ok. Thank you. That is all I want to know.”

I went back to the unit, wrote an order for a thorax surgeon consolation, and later on we transferred the boy to their unit to get chest tube put in. The boy was recovered and discharged a week later.

In China, it is not required to be able to read X-ray film for every clinical practitioner even they do have classes in medical school for X-ray. There are radiologists who read the X-ray and give report. As a clinical doctor, we only read the report but the film itself. In addition, the radiologist sometimes lack of clinical experiences, and sometimes the clinician did not provide enough information of the patient’s history on the order of X-ray, it could be difficult for the radiologist to give the exactitude report. That really is the gap of clinical practice and accessory examination.

I can see the pneumothorax does not mean I was better then the radiologist. In fact, I was just learning. The only benefit I had was I did exam the patient, I did the basic physical examination as a doctor should do and I knew the patient‘s history better than the radiologist. Based on these, I already knew there were air in his chest. That was what I was looking for. That is why I got it right away.

It is the doctor’s preference to learn how to read X-ray film at that time. Doctors are very busy in China. They do not even have a personal life. Their house doors are opened to all patients. They even have prescription pad and lab order forms at home to serve the patients who may come and knock their doors. In addition, the pay was very little. My first years pay as a resident was 45 Chinese Yuan per month and after served the hospital for 15 years, my salary was 500 Yuan per months. They are very busy workers. There is very little time left after work. That is why many doctors decide not to learn more than they have to. Reading X-ray film is one of the knowledge that they do not have to learn.

I learned this when I was doing my graduate study in Tianjing Children’s hospital. There I spent a month to listen to the radiologist and read all different kind of children’s chest films. It really helped me a lot. I always appreciate the class they offered there. I appreciate the knowledge of reading X-ray films I got from there.

It is true that if I did not learn the skill, the baby boy would still get the correct treatment probably one or two days later. However, it certainly helpful having that skill so that I can help my patients to get less time suffering and cost less for curing.





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The first Lumbar puncture

Friday, August 17, 2007 10:29 AM

Suddenly, I am thinking about to write done my experiences as a pediatrician in China. It is true I worked as a pediatrician in China for 18 years even I did not have any work pictures and work dairy. But when I think back, there is lot of in memory and I want to write done it and share with others. I am not a very good English writer, but I certainly want to try. It also will be a good practice in writing for me anyway.

The first Lumbar puncture of my life


I stayed in the doctor’s break room and crying. I cried so hard that not only my tears but also my nose were running. “ The little boy has been through so much and we did so much work to get his permission to do the lumbar puncture, but I failed. I am so sorry and feel so guilty about it. I hate myself!” I was complaining of myself did not make my first lumbar puncture success.

It was in 1982, I first graduated from medical school in my hometown. I was sent to a pediatric department in the city’s hospital working as a resident. My attending doctor was Dr. Yang Xiu Mei.

As a resident, I basically act like a doctor independently for two years. But at the first three months, there was an attending doctor to work and watch me. I was still within the three months period.

Wang Dong was the patient. He was 5 years old with tuberculosis meningitis. We were using the intravenous and intrathecal anti-tuberculosis therapy to treat his disease. He was doing well. But before we discharge him, we need to do a last check of his cerebral spinal fluid to see if his meningitis was recovered.

As a 5 years old boy, he had been through lot. From the beginning of the therapy which require lumber puncture every other day for couple weeks and then once a week, and plus the use of steroids. His puncture area became thick and hard, it was very difficult to do the puncture. And the boy hate the puncture. Dr. Yong, me and the boy’s father, we work together to persuade the boy to agree of the last one and he finally nodded his head. It was my job to perform the operation.

The boy side lying on the operation table with the father and dr. Young’s help. I opened the sterile lumbar puncture kit and put on my sterile gloves, using a syringe get some lidocaine out of an ample. Put the sterile clothe around the puncture area. Applied local anesthesia and using the lumbar puncture needle to perform the puncture. It went well, but I could not get the CSF out. I checked the depth and the site, everything was correct but the cerebral spinal fluid did not come out. I had to give up …

Since the boy’s medications were weared down to oral and everything was normal except the CSF test was not done. He was discharged from the hospital and come visit as out patient. We performed the lumbar puncture again in put patient area at his first visit as an out patient. It was normal.

As for tuberculosis meningitis, the treatment plan at that time was after the CSF test was normal, it still was requiring additional two years anti-tuberculosis therapy and periodically check of the blood and CSF tests to be considered full recover. If there were any abnormal of the tests, the patient had to be hospitalized again to start the full treatment again. Dong went back to be hospitalized for few times since his first discharge due to incompliance of his medication. But finally at his 10 years old age, he was completely off of all medication and fully recovered.

With the time of my practice, I realized that not every attempt has to be successful since we are dealing with the deferent human bodies and deferent disease process. It requires practice, skills and the operator’s confidence. But I certainly appreciate the tears for my first lumbar puncture as newly graduated medical student. It stays in my memory forever and reminds me to improve my knowledge from time to time.

I still have problems with is site.

I am thinking about yo change this blog to my work experinces but I am not sure it will work well since I could not get in so long time. Well, I will try.

My Personal Philosophy of Nursing

My Personal Philosophy of Nursing

Dreamer

April 28, 2007, 3:06 PM

Today, on my birthday, I am sitting here thinking and writing my personal philosophy of nursing.

As my understanding, the essential roles of nursing, ADN nursing role is assist patients for their wellness in a professional manner. And health in the medical field, is commonly defined as an organism’s ability to efficiently respond to challenges (stressors) and effectively restore and sustain a "state of balance," known as homeostasis; and wellness is generally used to mean a healthy balance of the mind-body and spirit that results in an overall feeling of well-being.

Illness can be defined as a state of poor health.My beliefs concerning personal responsibility are being responsible to your decisions, actions and results of what you did and are still doing. And my beliefs concerning ethical decision making is whatever is good for others and not harm to self or good for self and no harm to others.

What is my philosophy of living? As one who grown up in China mainland, I believe human live to serve people and also be served by people. We serve each other. I also believe that as a server, I need to do the best service I can provide; and as a service receiver, I do not expect too much. Giving and receiving does not have to be equal. My philosophy of living is giving more and expecting less or no returning. Respect and be friendly with others. Never seek problems and never be aggressive to others. Avoid conflicts whenever possible and solve conflicts with a cooperative manner. I knew this probably is not applicable to American culture, but it is what I got from my education and experiences in China from elementary through college and my professional life as a healthcare provider.

In China, there is a famous three character primer which reflect Chinese philosophy of living. It taught us to respect teachers and parents; think others first instead ourselves and do not count what ourselves may loose. This over 2000 years old primer is still very popular in China and is used as a primary principle for teaching children how to live. It influences my life and beliefs. It becomes my personal philosophy of living. It also influence my aspects of professional life as a healthcare provider in China and as a nursing student in America.As a student nurses, I believe that humans are unique beings with biological, psychological, sociological, cultural and spiritual dimensions. These dimensions are in constant interaction and inseparable. I also believe that each human exists on a health-illness continuum that may move from high level wellness to severe illness and death. Humans are in a constant state of adjustment to internal and external environmental stressors as they strive to meet their needs. And our profession as a nurse ought to do what we can to help to meet their needs of wellness in healthcare system. We must use our minds and hearts, as well as our hands and senses to become successful professional nurses in today's challenging health care world.

In my practice, I certainly should aware the physiological and psychological limitations of myself and seek help whenever the conflicts of self limitation with patient’s need come to be a problem. I also will be awareness of my personal value may be different with patients, I would not let the difference effect my practice and remain nonjudgmental during my practice.

My philosophy as a professional nurse is:
1) For my customer: I will think patient’s physiologic and psychological needs and do my best to provide care to meet their needs. Provide patient centered care and assist patients to attain their maximal state of wellness on the health-illness continuum, including the support of a peaceful and dignified death.
2) For other professional providers: Respect others as human beings, healthcare professionals and friends. Be sincere and professional when communicate with them about the care and any problem it may raise. Avoid conflicts whenever possible and solve the conflicts with a cooperative manner when it arises. Help them in a caring and sincere manner whenever they need and be nonjudgmental for their personal beliefs. Trying to be socialized with them.
3) For my profession: I believe that nursing is an evidenced-based science that promotes, maintains and, when possible, restores health. As a professional nurse, timely update my knowledge is an important part of my life. In order to serve my customer the best, I will read and study the nurse researches to keep my knowledge updated.
4) For myself: I certainly apply my personal philosophy with my daily life. Be kind with people, do my best to help people and do not expect any from others. If there is any disagreement with others, try to solve it with a cooperative manner and avoid big conflict if it is not big deal. Make decisions based on not harm other’s benefits and awareness of self comfortable level. In one word: Always remember to provide my best to others.

I am back,I think or hope.

hello?

I am very upset

After Google asked me to change my blog using my Gmail to sign in, I could not get in my blog on my computer anymore. I am really not happy with it!!!!

Lion King Exercise / Erickson’s Stages of Development

Lion King Exercise / Erickson’s Stages of Development

1) What is the most important role of parents during their child’s First Year of Life? Do you think that Simba’s parents accomplished this task? Please explain.

During the first year of life, child develops trust vs. mistrust. They need maximum comfort with minimal uncertainty to trust himself, others, and the environment. Parents’ important role in this stage is to provide these needs to their child. I think Simba’s parents accomplished this task. They provided him a safe and comfortable living environment, Mom made sure there was someone wiser to go with him when he wanted to go out. His dad taught him how to make living and where he should not to go. The King dad also taught him the kingdom and promised him that he will always be there on the sky to guard him once he became a king.

2) When Simba believes it’s his fault for hid father’s death, he is most likely in what stage of development. Please explain.

He is in the preschooler development stage. In this stage, child begin to initiate, not imitate, activities, develops conscience and sexual identity. Simba went to someplace he should not be and got involved in a dangerous situation which indirectly caused his dad’s death. That is why he thought it is his fault for hid father’s death.

3) Simba makes friends with Timone and Pumba and adopts a life-style of “No Worries.” What development stage is he exhibiting?

He is in school-age child development stage. In this stage, child tries to develop a sense of self-worth by refining skills. Simba is learning from new friends and develop a new life style.

4) When do you think that the stage of Identity Vs Role Confusion is evidenced in the movie? Identify behaviors exhibits by Simba that convince you that he is in this stage?

When Simba and his new friends lying under the moon and Simba was talking about what his father once told me what the stars are. And when his girl friend came to find he is still alive and asked him to go back to his kingdom. These are the evidences in the movie of Simba’s development stage of Identity Vs Role Confusion. After Simba told his friends what the stars were and then said: “pretty dam. Isn’t it?” and when he refuses to go back to his kingdom, and said to his girl friend: “It does not matter anyone knows if I am alive. I am not the Simba before. I am not the king, Scar is the king.” These two parts convinced me that he was in this stage.

5) Describe a scene in the movie when Simba demonstrated behavior associated with the stage of Autonomy vs. Shame & Doubt.

After heard what uncle Scar talking about the world of the shadowy place and took his best friend to go there and investigate, he wanted to be brave and at the same time, he was not sure he was doing the right thing. He put himself and his best friend in danger. In this stage of life, child works to master physical environment while maintaining self-esteem. When dad gave him a speech about what he did, he expressed that he was just trying to be brave like dad. At this time, Simba was in the Toddler of development stage.

I cut my 4 years long hair today!

I have a dream, a dream to use my long hair to make a little girl happy, a little girl who lost her hair due to Chemo. Therapy. I was waiting and trying to find one. Couple weeks ago, my husband found a website which I can donate my hair to a cancer society. Here I am! I am cutting my hair today and donate it to them!

Here is some memories of my long hair:

Front look!



Back look:

Getting ready for cut!

The hair is no longer mine!

Weekly Journal Assignment

Week 10
My learning/personal growth of this term: time management

This term I have learned lots. But the very important thing I have learned is the time management, both in theory and clinical.

On clinical site, I still have two patients paperwork like last term, but started to care for my third patient. Paper work wise, I am more efficient, it took less time to finish all of them. I think the knowledge I have learned during the term helped for example the lab value and the pathophysiology, the reduction of the paper work this term is also helpful. Patient care wise, I am more efficient than last term. Sometimes when I got a difficult patient, I struggled with time but always can get things done. I think a timely plan for patient care is helpful, even most time it is a mental plan, and it can help me to manage my time of care more efficiently.

For theory, I take another 5 more credits this term. I felt lots more pressure by keep up on the 15 credits schedule. I am doing fine with it just because I am staying with a strict detailed time plan. I made a time table weekly by days for what to study and have another plan for when to finish which part of study. I am strictly following the plan and never let myself slip. That way even it is tight on time wise for study, I still can go step by step to finish what I have planed.

Next term, I think I am going to take one more cause besides the nursing once again. I will stay on strict planning for theory and time my patient care plan. Time management is the key to be success in nursing school and my future career for me I think. I love well planed life.

Evidence-Based Assignment

Epidemic obesity and type 2 diabetes in Asia

Who is the target audience?

As I read this, I think there are at least two target audiences: the public health department of the government and the regular population of Asia.

Does the article provide statistics from any of the original research?

Yes. This article is a review of 113 different articles. It provided some of the statistics of the original research. From these statistics, the author concluded that Asians have higher body fat then European origin as the same BMI level, and have higher prevalence of type 2 diabetes. People in Asia develop diabetes at a lower degree of obesity and at younger ages, suffer longer with chronic diabetic complications, and die sooner that those in developed countries. And Asians have a strong genetic susceptibility to type 2 diabetes, characterized by early B-cell failure and prominent central obesity.

How is the evidence relevant to your current level of practice?

Healthcare professionals in the US tend to use BMI to determine if the individual is overweight or obese. BMI is a good indictor to predict individual at risk of type 2 diabetes, hypertension, and coronary artery disease and so on. But as a group of Asians, the indicator has to be used differently. This article provided some evidence of BMI <>30kg/m2. So healthcare practice need to be individualized. This affects our health teaching to patient. As for Asians, even BMI<25kg/m2, there are still needs for better lifestyle and weight control and exercises.

Any indication the evidence is being utilized in your current or other clinical setting?

As so far, I did not see any practice utilizing this evidence in clinical setting I was involved. I am a Asian, my BMI is 23.4kg/m2 which considered normal by the WHO standard, and healthcare personals around me all were saying that my body’s size is perfect even I knew I need to keep exercises and watch my diet fat. I am glad I read this article so that I can use it on my future practice.

Reference:

Yoon, Kun-Ho, Lee, Jin-Hee, Kim, Ji-Won, Cho, Jae Hyoung, Choi, Yoon-Hee, Ko, Seung-Hyun, Zimmet, Paul, San & Ho-Young. (2006). Epidemic obesity and type 2 diabetes in Asia. Lancet 2006, 368, pp. 1681-1688.

Professional Communication

Week 9
Professional Communication

One day on Sunday, I went to work at 11:00 AM. I found a order which was timed for 04:00 AM. And there was another order for the same pt. And same test timed as 12:00 PM. I asked the morning shift tech what was going on. She told me that someone put the timed order together with the 12:00 Pm one on the top of the other one. Since 12:00 PM was far early to due, she did not check the order and went to do all the routine orders for the day. Once she finished the routine and had chance to check the timed orders, she found out the 04:00 AM one at 09:00 AM. She knew that was night shift’s responsibility to do the 04:00 AM test, and it was already far behind and the coming 12:00 PM one was almost due. She did not know what to do with the 04:00AM one and let it sit there.

Since it was already 11:00 AM, I took those two orders and went to the floor to talk to the nurse who cared of the pt. I want to know the rational for the timed orders and also want to know what the nurse want me to do since we already missed the correct timed one for 04:00. The nurse did not know the rational of the timed orders and did not want to find out. She told me “that is a incident report” and also told me that I could do the 12:00 one at 11:30 to cover these two orders. I end up to fill an incident report and did the 12:00 order as the nurse directed.

In this event, there couple of communication errors between healthcare professionals can be improved.

The first, since the error already be made by the night shift tech, the morning shift tech could check the timed order before going her routine. The timed order always is a priority, that is why you want to check it first so that you will not miss anything. That way, the error would be caught earlier at 06:30 and could be corrected earlier if there was a significant need for the timed order.

The second, the two mistakes already happened, when the morning tech found out the error at 09:00, she should directly go to the floor get the test done and talk to the nurse what happened and fill out a incident report. That still would be better than doing nothing.

The third, it is true that a missed test should be a incident report, but it is also important to know the rational for the timed test. Sometimes it is important because pt. was taking special medications which need to be monitored by ECG. But sometimes it was just the ward clerk’s mistake for putting the orders in that way. As a nurse, she should be able and have the responsibility to know the rational. But the nurse I communicated with indicated that she was “too busy” to help me to find out. And I am not suppose to look on pt. Chart as a tech. but following orders. That order was put in by different floor, and the pt. was moved to other floor after the order was put in. That was why I really want to know the rational, also, that was why the nurse did not know. But she could find it by checking the doctor’s original orders.

I am guessing no harm done of the event. But effective communication could make the situation better.

Prophylaxis of coronary artery disease

Week 8

Patient’s need for education

This week, I am lucky enough to get a chance to go to the Cath lab to observe the procedure. I am so amazed by the procedure, amazed how quickly a narrowing coronary artery can be fixed during the procedure. I really appreciate the opportunity I got.

One patient went to see his doctor for other reasons other than coronary artery disease. Just before he left the doctor’s office, he asked: “What is about the chest pain I am having now?” made him to be referred to a cardiologist. After few noninvasive diagnostic tests, he was diagnosed as coronary artery disease and scheduled for coronary angiogram and possible intervention. Under X-ray during agiogram, we saw a significant narrowing of his mid LAD, and the cardiologist decided to put a stent in it to treat the lesion. The procedure was successful and the patient can go home the same day.

There are still 3 places of his coronary artery a narrowed but insignificant and there is no need to put a stent in. It can be managed with medication. But the patient really needs to be taught to manage his blood cholesterol and change lifestyle which can reduce the factor of myocardial infarct. He also needs to be on Aspirin for at least a year to Prophylaxis of transient ischemic attacks and MI.

I would basically use the hand out the cath lab have abut the procedure and the hand out in PCU about CAD to do my patient teaching. I would also give him the information about internet and community services for him to get information in the future. The important thing need to be stressed is the cholesterol management and the life style changing. It can enhance pt’s well being and protect future damage of the coronary arteries. Stent fixed the existing problem, the potential problem need the pt. To be motivated to act and prevent.

5 stressors in my life

Weekly Journal Assignment

Week 7

5 stressors in my life and the intervention that would enhance my ability to cope with these stressors

1) School ---
As a nursing school, middle aged and English as second language student, school is a stressor of my life now. Sometimes I felt like I am reaching the point I want to quit or never going to school again. Yes, the intensive training of nursing can really stress students well. But I think to be able to see the future is a positive reinforcement of the students’ life. And also, it is the student’s decision to go to school. We have to remember it and respect it. For me, I just see the intensive training period is temporary, it is time limit. Once you graduate, life will be different. So laundry can wait, house doesn’t need to be super clean and food can be simple. It is all temporary, it will be over soon. For study, I put my mind on reading, trying to understand all the objects. Of curse, my back ground knowledge helps me too. So even with the second language, I cannot complain much.I think a positive attitude; an active learning plan can enhance my ability to cope with the stress.

2) Work ---
Work is wonderful! It gives us opportunity to be socialized, it gives us a source to live, and it gives us a reason to live too. But when you are stressed for school, plus there is not every day’s work is wonderful and peaceful, work can be stressful. When there is a work scheduled, I think it is a better idea to make the entire study and work plan together in detail so that when there is a work day, concentrate on work and forget about school. When there is the time to study, do not let anything else to interrupt you. So straight schedule and study plan is helping me to cope with this. And if you feel like it is too much to deal with, cut off some work hours. Take some student loans, live a simpler life. These all can help.

3) Children ---
Children occupy my mind all the time, even sometimes I cannot do anything. It really bothers me when they are not listening; they are not doing what they suppose to do. I used to be bothered a lot, but my brother’s talking put my on ease. He said: “everyone has their own orbit. Children have their own fates; you don’t have to be a slave of your children.” Since then, I am just talking to them and let them know what I am thinking and what I want them to do. If they listen or not, it is their choice. They are old enough to make decisions not matter good or bad; sometimes they have to learn the hard way.

4) Parents ---
As middle aged person, parents are getting old and need us to care of. One phone call from my parents can make me worry all day long. And when I am worried I cannot concentrate on my study. This can be stressful. My way to cope this stress is to ask my friends and brother close to my parents to call them and help them. And then write a dairy to talk to myself that they are already being taken cared of by my friends and nothing I can do here, so just do not worry. Writing to myself if another way I cope with stress and it works well for me so far.

5) Grades ---
I am a perfectionist. I always want to be the best of my life. This really is a big stressor for me. It pushes me keep going and sounds like there is no stopping. As a student now, I always want to get good grades; I mean “A”s. But with the 15 credits courses I am taking, it is hard to get all “A”s. It bothered me when I got my first “B”, I felt so sorry that I was so close to an “A”. So grades are a stressor for me and I am trying to let myself notice that “B” is a respectful grade too. I think I need to compare with people “C”s and be happy. Do not put on oneself too high expectation is a way to cope this stressor I think. I am doing better with it now. I think it enhanced my ability to cope with the unexpected grades.

Different way to study

Week 6

The care I provided to my patients this week is ordinary works: give IV, SQ and oral medications, assessments, educations etc. There is not something really can make me think that any interventions could be different. But I do have some thought about the way we study since our instructor mentioned about the two exams this term.
The formal way to study would be follow the objectives, do the required readings, attend classes and labs, attend clinical experiences. In fact, with the short amount time and the intensive training, the required reading sometimes can be difficult to be done. So there are module groups, people getting together and divided all the objectives and type them done and share with others. I think that is a great idea to do so and I totally support it!
But sometimes only studying the modules done by other students could narrow our sight of the course. It could be confusing sometimes because you are not the one actually did the module. And with the time limit, we cannot write done all the modules by ourselves.
There are alternated ways to study. One is useful for me. I do not write done any answers of the objectives, but I read the book against them. The difference is I read more then the objective asked for so that I can have a better understanding of the topics. I think I did even more than the required readings. And I don’t try to memorize everything, but really try to understand them. I guess my point here is trying to learn the topics lively.
I am a slow reader, especially English is my second language; I have to use my dictionary a lot when I am reading. But just read through against the module’s objectives but write done them spend less time. I write done some simple notes on my module and sometimes just the page of the book just incase I need to go back to read. I am not an “A” student, but I am getting fair grades. It works for me. I am sure there are other alternatives to learn too, one just needs to find a one to work for them.
For me, the goal of learning is to put the knowledge to practice. So when we think about this, we could feel a little ease when we are leaning. Not just for examination, not just for a good grades.

The clinical path and the disease process

Week 5
The clinical path and the disease process

This week, we only have one day clinical. It is nice that our instructor let us to come to the clinical site without prep. It reduced our paper work but challenged our time management skill and the ability to face the real patient care situation. We also discussed the clinical path and the disease process which made us realized the difference with theory and facts.

In theory, diseases have certain path to go, either better or worse, it is kink of black and white compared with the reality life with disease process. That is where the clinical path came from. It is other people’s experiences, other practitioner’s conclusion. Patients who have the same disease and treatment would most likely to go that way. But there always are some exceptions.

We discussed my patient this week which is a relatively young guy who went through a coronary bypass surgery. He was in post op day two, and already ambulating. His chest tubing drainage was only 40ml at my shift, which met the protocol to disconnect. He is pretty much following the clinical path. But on the other patient my classmate care of was a different story. He is much older in his 80s. I think he was post op of CABG week two and still there with lots of complications. As the ordinary clinical path, open heart patients should be discharged in a week. But this one was staying for another week at least. That is an example of exception.

Medicine is called “practice” because there are not always black and white answers. Same disease, same procedure with different patient can have different outcomes. It based on the individual’s health status, life style, and genetic variation and … as a student, it is very important for us to know there are differences, so we can be really careful with assessments, treatments and assistance. I appreciate our instructor leaded us for the discussion. Thanks.

Patient’s fall

Thursday, October 19, 2006

Weekly journal assignment

Week 4

Patient’s fall

This week, my assigned patient went to home when I arrived at the clinical day. The RN assigned me another one which is in the same bed. Without preparation, I started to take care of the patient. It went well. It also gives me some confidence for clinical patient care as real (without prep). This patient’s diagnose is not really clear yet. I have some thought about it.

The admission reason was “post fall”. Patient felled when he was walking his dog. He has an ICD in place, ER admitted him to PCU for evaluation of the ICD, and to find the reason of this fall.

Patient has history of CAD, A-fib, multiple stroke, hypertension, hyperlipidemia, diabetes and so on.

The reason for fall is “syncope” as the doctor’s H&P stated. But patient does not remember the event, did not feel dizziness and so force. There is no newly developed weakness, language difficulties and thought process disorders after the fall. Based on this, they basically ruled out stroke, and focused on “syncope”.

The cause for syncope has multiple reasons: it could be sudden onset arrhythmia, acute hypotension, hypertension crisis, hypoglycemia; they all can lead to temporary cerebral dysfunction and result to syncope and fall.

With a history of a-Fib and CAD, it is almost guaranteed that life threatening arrhythmia could happen. But with an ICD in place, the possibility became too little to be worried of, unless the ICD does not function well. Then, check the ICD is necessary.

The result is the ICD functioning perfectly. So this can rule out of cardiac syncope. And the blood sugar showed on the high side in ER.

But patient felled. And don’t remember the event. That is the key I think. I would like to order an EEG to see if there were any epilepsy event (with multiple stroke, there is very possible to have secondary epilepsy); I also would like to at least have a brain CT to see if there were any new changes if I were his doctor. Some mini stroke could make patient “pass out” without leaving marked signs and symptoms.

I am wondering why the doctor did not order these tests yet. Well, patient is in the hospital only one day, probably the doctor is going to order those tests later. This just are some my thoughts. I sure appreciate the opportunity I got to learn and think.

Thanks for being so patient to read my thought.