My Journey at HUSM
Salam mahabbah buat sahabat-sahabat sekalian..
Di sini,saya attachkan sedikit pengalaman saya ketika melakukan ‘attachment’ di HUSM,Kubang Kerian,Kelantan..
“sharing is caring”….moga semua dapat manfaat..(maaf for broken English)
Alhamdulillah..permohonan untuk mengadakan ‘attachment’ di HUSM Kubang Kerian telah diluluskan .saya bersama rakan saya,kak irhaam daripada Fakulti Perubatan,Universiti Mansurah akan memulakan ‘tugas’ bermula
14 sept-25 sept 2008 di jabatan yang telah ditetapkan oleh pihak HUSM sendiri.antaranya Jabatan Hemodialisis,Jabatan Perubatan(medical),Jabatan mata(ophthalmology),Jabatan kecemasan(A&E) dan Jabatan perbidanan dan sakit puan(O&G).kursus saya bermula pada jam 8 pagi setiap hari dan usai lewat jam 4 petang.
Saya memulakan tugas saya di ward ini pada jam 9am dan berakhir pada jam 2 petang.jumlah pesakit seramai lebih kurang 12 orang sahaja.saya diperkenalkan oleh sister di sini mengenai mesin dializer,perawatan kaedah CAPD(continuous ambulatory peritoneal dialysis) dan ubat-ubatan yang dibekalkan kepada pesakit.
Saya sempat beramah mesra dengan seorang pesakit buah pinggang(chronic renal failure) yang dihidapinya sejak 8 tahun yang lalu.beliau juga menghidap penyakit kencing manis,strok di bahagian kiri badan dan jantung.kebanyakan pesakit yang membuat rawatan di sini merupakan pesakit tetap dan rata-ratanya berupaya untuk memasang sendiri alat dan tiub ke mesin dializer.bagi pesakit buah pinggang,tiub akan dipasang pada fistula(arteriovenous fistula) di antecubital fossa(bahagian lipatan lengan ).tiub juga boleh dipasang pada femoral vein dipanggil femoral vein catheter(FVC) dan internal jugular catheter(IJC)
sedikit fakta mengenai arteriovenous fistula…
An arteriovenous fistula is a disruption of the normal blood flow pattern. Normally, oxygenated blood flows to the tissue through arteries and capillaries. Following the release of oxygen in the tissues, the blood returns to the heart in veins. An arteriovenous fistula is an abnormal connection of an artery and a vein. The blood bypasses the capillaries and tissues, and returns to the heart. Arterial blood has a higher blood pressure than veins and causes swelling of veins involved in a fistula. Although both the artery and the vein retain their normal connections, the new opening between the two will cause some arterial blood to shunt into the vein because of the blood pressure difference.
Untuk peakit CRF,terdapat 3 kaedah perawatan yang digunakan seperti hemodialisis,CAPD dan transplant.
What is Peritoneal dialysis?
peritoneal dialysis is a method for removing waste such as urea and potassium from the blood, as well as excess fluid, when the kidneys are incapable of this (i.e. in renal failure). It is a form of renal dialysis, and is thus a renal replacement therapy.
Peritoneal dialysis works on the principle that the peritoneal membrane that surrounds the intestine, can act as a natural semipermeable membrane (see dialysis), and that if a specially formulated dialysis fluid is instilled around the membrane then dialysis can occur, by diffusion. Excess fluid can also be removed by osmosis, by altering the concentration of glucose in the fluid.
There are three types of peritoneal dialysis.
• Continuous ambulatory peritoneal dialysis (CAPD), the most common type, needs no machine and can be done at home. Exchanges of fluid are done throughout the day, usually four exchanges a day.
• Continuous cyclic peritoneal dialysis (CCPD) uses a machine and is usually performed at night when the person is sleeping.
• Intermittent peritoneal dialysis (IPD) uses the same type of machine as CCPD – if done overnight is called Nocturnal intermittent peritoneal dialysis (NIPD).
Alhamdulillah,first of all,I would like to express the thankfulness to Almighty because we were giving the opportunity to proceed our attachment here..on this day without having much complication throughout the day.
Kak Mashitah was willing to help us very much.we were assigned to do the attachment at medical ward(7 utara).with lots of confidence and hope,we’re stepped there and we were introduced to sister who was in charge of us in this ward.
Our first job was tagging a patient to ICL (invasive cardiovascular laboratory).this patient named was Semah Salleh,41 years old.she’s got asthma and diabetes mellitus.her case was referred from Hospital Raja Perempuan Zainab II with conditions-nausea,vomit,lethargic,chest pain and pedal edema.apart from her case,the doctor agree to do an angiogram for her.
What is an angiogram?
An angiogram is an imaging test that uses x-rays to view our body’s blood vessels. Physicians often use this test to study narrow, blocked, enlarged, or malformed arteries or veins in many parts of our body, including brain, heart, abdomen, and legs. When the arteries are studied, the test is also called an arteriogram. If the veins are studied, it is called a venogram.
To create the x-ray images, the physician will inject a liquid, sometimes called “dye”, through a thin, flexible tube, called a catheter. He or she threads the catheter into the desired artery or vein from an access point. The access point is usually in our groin but it can also be in the arm or, less commonly, a blood vessel in another location. This “dye, ” properly called contrast, makes the blood flowing inside the blood vessels visible on an x-ray. The contrast is later eliminated from the body through kidneys and urine. The physician may recommend an angiogram to diagnose a variety of vascular conditions, including:
• Blockages of the arteries outside of heart, called peripheral artery disease (PAD)
• Enlargements of the arteries, called aneurysms
• Kidney artery conditions, called renovascular conditions
• Problems in the arteries that branch off the aorta, called aortic arch conditions
• Malformed arteries, called vascular malformations
• Problems with veins, such as deep venous thrombosis (DVT) or blood clots in the lungs called pulmonary emboli
Sometimes physicians can also treat a problem during an angiogram. For instance, the physician may be able to dissolve a clot that he or she discovers during the test. A physician may also perform an angioplasty and stenting procedure to clear blocked arteries during an angiogram, depending on the location and extent of the blockage. An angiogram can also help the physician plan operations to repair the arteries for more extensive problems.
After that,we went back to 7 utara to proceed our ‘adventure’ there. By helping from the other nurses,we were taught on how to insert a catheter into female’s vagina.this process was called urinary catheterization. Urinary catheterization is the insertion of a catheter into a patient’s bladder. The catheter is used as a conduit to drain urine from the bladder into an attached bag or container.this procedure is mainly to maintain urine output in patients who are undergoing surgery, or who are confined to the bed and physically unable to use a bedpan. Critically ill patients who require strict monitoring of urinary output are also frequently catheterized.
Intermittent insertion of a urinary catheter is a treatment option for patients with certain types of urinary incontinence. Intermittent catheterization is performed a minimum of four times a day by the patient or a care giver. The genital area near the urethral opening is wiped with an antiseptic agent, such as iodine. A lubricant may be used to facilitate the entry of the catheter into the urethra, and a topical local anesthetic may be applied to numb the urethral opening during the procedure. One end of the catheter is placed in a container, and the other end is inserted into and guided up the urethra until urine flow begins. When urine flow stops, the catheter may be moved or rotated, or the patient may change positions to ensure that all urine has emptied from the bladder. The catheter is then withdrawn, cleaned, and sterilized for the next use. Recommended cleaning practices vary, from the use of soap and water to submersion in boiling water or a disinfectant solution. Some patients prefer to use a new catheter with each insertion.
We’ve embarked our journey here started from 8 am until 4pm.so,throughout these times,we’ve learned so many things such as urinary catheterization,clerking case of the patient,drawing blood from the patient and so on.
This ward actually was divided into 4 blocks according to the level of risk of the diseases.patient who has the critical diseases such as infection and transmitted diseases were separated from the others and were put near the nurses caunter for more observation on them.patients mostly have some diseases such as thyrotoxicosis,dengue fever,bronchial asthma,infection for CAPD patient and tuberculosis(TB).
Day 5- obstetric and gynaecology(O&G)
Today is the last day for us at HUSM..so today after having a little introduction by Kak Mashitah,we were brought to the ward 2 Akik,2 baiduri,2 Topaz..these are obstetric ward.or we called it ‘miracle of life begins’..we were so astonished when we first entered the ward..there was so nice..as we know,HUSM is well-known with its motto “hospital rakan bayi’.the theme for breastfeed program here is “mother support:going on the gold”..so,a newborn are not allowed to drink milk from a bottle instead of they have to breastfeed.this is very important for the babies body system and life and also for the mothers too..the mutualism between both of neonates and mothers are very important to achieve healthy life and happy family.
We were orientated by Sister .she said that this ward are divided into antenatal ward and postnatal ward.at antenatal ward,we have seen a doctor doing VE(vaginal examination) to the mother.Vaginal examinations are done when a pregnant woman has:
• Uterine contractions that may have changed her cervix and may be preterm labour. The cervix may open and thin without strong or painful contractions.
• Unusual pelvic pressure or back pain.
• Vaginal bleeding.
Preterm labour is diagnosed when a woman who is 20 to 37 weeks pregnant has uterine contractions and her cervix has changed, as seen with a vaginal examination.
Preterm labour is not diagnosed if contractions are occurring but the cervix is not becoming thinner or more dilated.
After that,we went to postnatal ward and met with Dr Faisal,a doctor from Maldives who is doing his master on paeds here..we went to one bed to another and check for the newborns.Dr Faisal explain to us in detail about the process of giving birth.truly,this is the miracle of life..
At 2pm,we went to 1 Utara-gynaecology ward.with guidance from Sister ,we are told specifically about the ward and the diseases that might occurred to the patient such as fallopian cancer,ovarian cancer and so on.we also met our senior who is now doing his practice here,Dr Zuhdi.he taught us about the procedure on drawing blood from the patient and cannulation.we were given a chance to do it practically.