Metabolic Coma Coma – from the Greek word “koma” – deep sleep prolonged state of unconsciousness result of something that interferes with the functioning of the brain. Three Types : neurologic – (head injury, stroke) toxicologic – (drug overdose, alcohol intoxication) metabolic – (hepatic, renal, diabetic ketoacidosis) Metabolic Coma – condition that change the chemical environment of the brain thereby adversely affecting function. The basic nursing goals underlying the care of an unconscious patient are applicable to any unconscious patient regarding of the clinical course. establish and maintain an adequate airway assess the level of consciousness evaluate the progression of V/S maintain fluid and electrolyte balance maintain skin integrity Metabolic Coma Coma – from the Greek word “koma” – deep sleep prolonged state of unconsciousness result of something that interferes with the functioning of the brain. Three Types : neurologic – (head injury, stroke) toxicologic – (drug overdose, alcohol intoxication) metabolic – (hepatic, renal, diabetic ketoacidosis) Metabolic Coma – condition that change the chemical environment of the brain thereby adversely affecting function. The basic nursing goals underlying the care of an unconscious patient are applicable to any unconscious patient regarding of the clinical course. establish and maintain an adequate airway assess the level of consciousness evaluate the progression of V/S maintain fluid and electrolyte balance maintain skin integrity
Background: Uremia describes the final stage of progressive renal insufficiency and the resultant multiorgan failure. It results from accumulating metabolites of proteins and amino acids and concomitant failure of renal catabolic, metabolic, and endocrinologic processes. No single metabolite has been identified as the sole cause of uremia. Uremic encephalopathy (UE) is one of many manifestations of renal failure (RF). Physical: Physical findings are variable and depend on the severity of the encephalopathy. Neurologic findings range from normal to a comatose state. Cases of Wernicke syndrome associated with UE have been described in the literature, and Wernicke syndrome has been observed in patients with UE, dialysis dementia, or dialysis disequilibrium syndrome.
my PG friends
My life with PG and other friends through the years
PG Domingo, Ephraim Tiopianco, Ana Rosa Tortosa, Ron Carlo Uy, Pag-ibig Valdez, Liezel Valdez, Ma. Laarni Veloso, Elda Socorro Victorio, Maybelle Zapanta, Ma. Justina Zuñiga, Corazon Tingson, Cristine
I made this slideshow as a tribute to all my friends especially to the PG. First part are my duty days with them. The second part is a dedication to all of them. In no particular order ang apperance hah! Ano nga ba ibig sabihin ng PG? Well, Patay Gutom daw : ) Yun kasi ang biruan namin everytime we are eating, panu ba naman “ nothing goes to waste”..Pag hindi ko maubos, there’s always the others to the rescue. Kawawa nga ang aso at pusa pag kami ang kasama(wala na kasing lasa ang buto at tinik bago bitawan) ha!ha! We came from different generations : Amor and me; Ja, Set and May; Arni, Zhel, Eph, Tin , Ron and Elda, but got along very well (minsan….. : > ) PG also stands for Puro Ganda, Puro Gorgeous, Puro Guapo, Puro Great, Pretty Girls, Pure Genius, I can go on and on../../.// Pero for me PG stands for friendship that will stand the test of time,( thanks to technology : } ). I wanted to thank you all for coming into my life and making me feel “young, wanted and important” : ) I love yahhh all …..
“ I went to my garden, dear friend, best lover—breathed the sweet fragrance. I ate the fruit and honey. I drank the nectar and wine…Celebrate with me, friends…. To life! To love! “ ( song of Solomon 5 :1 ) “ The good life begins in the fear of God. Do that and you’ll know the blessing of God. His Hallelujah last forever! ( Psalm 111:10)
Jan 5-13 2006 Torres Bugallon Health Center, “ our very first duty together…di naman kami masyado excited, all smiles lang, : ) liban ata kay Tin,he!he!. We got along very well, kasi we have something in common .We love to EAT…
<ul><li>Oh, di ba? pansinin ang lamesa, kasama ng review materials ang tsitsa namin, nilayo lang yung iba para di kita sa picture, : ). </li></ul>
January 19-21, 2006 Fabella Hospital Hindi man lang namin nagawang magpiktyuran dito… Bukod sa natatakot kami kay sir Mejia, : ( pagdating pa lang namin blockbuster na ang dami ng pasyente.) Fresh na fresh kami ( kasi naka taxi ba naman eh) pagpasok sa duty…, sa uwian amoy mga ewan,ha!ha!.. Last day, nag SM San Lazaro … (did our favorite past time…. EATING>> )
February 9-11, 16-18 2006 Novaliches General Hosp. Hinati kami ni mam Leonardo sa 2 groups, 1 st group -no pics kasi sobrang busy : ) : )
H hypoglyc results ETIOLOGY body's glucose is used u Dreaming of dollars, yens and euros . . ZZzzzzzZZZZ This is the 2 nd group : ) Pansinin si amor..Nakangiti habang natutulog, ayyyyy nagtutulog tulugan pala!!
Time to relax muna..Bday ni Tin..all smiles kasi nakakain na.. Kasama sa pics mga gwaping ( daw sila..) na friends namin. Mag On na ba si Tin dito at Jose??? Hhhmmmm…basta ang alam ko may lovey-dovey dito , ha!ha!
One of my favorite picture ng group ( kaso wala si Eph dito ). This is when were doing a project for Human Behaviour.. award winning ang project namin na yun ( we got the highest grade ) … Best actress ang mga performances.. : >
Feb 23, 25 and March 2-4, 2006 Quezon City General Hospital Wala din pala kaming pictures dito ahh>> Super busy din kasi kami., Per partner ang case study under mam Molina… ( OB cases )
March 23-25 and April 6-8 Pagamutang Bayan ng Malabon Wala kaming pictures dito kasi : a. Graveyard shift ang duty namin b. Toxic sa dami ng pasyente lalu na sa ER !! c. Takot kaming may makasamang “mumu’ sa picture.. d. Ang mortuary nila nasa hallway lang..awwwuuuu e. All of the above
June 19-28, 2006 Fatima Hospital (med-surg ward ) Memorable kay Jaja ‘tong duty na to. Remember yung od, os, ou????? Kahit naman graveyard duty kami alam namin ang left and right eye, he!he! 1 st time ko din nagkapatient dito na q ° 15 ang BP , kasi naka BT. Ang ka-group namin dito ni May at Ja hindi mga PG, pero we got along fine liban kay Jaja at Radie nun una lang naman, ha!ha! (Radie, Weng, Lynel, sino pa ba? Memory gap na ko!! )
Aug 22-Sept 6, 2006 RHU Obando, We had our duty with other sections, Nagpedicab kami kahit sobrang lapit just to interview several families, panu kasi baha ang area… Pinuri kami ni mam for our discussion, sayang few lang nakarating sa ininvite namin. We enjoyed tiangge day dun (Wed).
Sept 11-13, 18-20,2006 Fabella 2 nd time namin dito , yung first OPD. Ngayon ward duty kami and close contact with the patient. No picture pa rin ( ewan ko lang kung meron sa ibang kagroup). I saw for the 1 st time dito kung gaano kalaki ang needle for mag sulfate IM.. Also, knew na super sakit yun kasi umiiyak yung patient. The same as our 1 st duty, pag uwi namin mga amoy “lochia” kami but had a great learning and life experience. Our CI was mam Ruby.
Sept 24-26, 2006 JRMMC Kagroup pa din namin si Radie, Lynel at Weng CI was asleep pag wala case …ZZzzzzzZZ kami nagre read, nagtsitsikahan o kumakain. : ) “ mam gising na, may case tayo “ : ) Had my first experience of OR. Memorable kay Weng to kasi mga gwaping ang surgeon nun siya nag assist, kinilig ang loka, he!he!
Nov 12-17, 2006 Balitukan District Hospital 1 st out of town duty ng group. Swerte ni Set kasi kahit di namin siya nakagroup same ang sched namin kaya naman “ ang saya, saya” (Parang excursion lang)
Yup, ganyan ang gawain namin pagka duty . Si May may laman ng bibig nyan, : ) Every day umaapaw ang basurahan namin samantalang yung kabila dorm matagal bago mapuno,he!he! Mga PG nga eh.
Our little bahay bahayan. Dito kami naging mas close sa isa’t isa. Kasi ba naman no dressing room, kanya kanyang diskarte pag bihis. Nagkasilipan ng tinatago pero okay lang!he!he!
Balitukan pa din to’ . With our two CI’s . Extremes nga sila kasi yung isa super bait, yung isa medyo terror!! (medyo lang daw oh ! : ) ) Parang grade schooler lang si elda dito sa pic. Luv you DA!
Nov 20-22, 27-29, 2006 Sapang Palay Bulacan We met 4 new friends here. Matthew, Carmie, Dennis and my “anak-anakan” Lander (kasi magkasurname kami) DR duty kami dito and by three’s ang grouping. “ ROCK ON “
Thanks to May’s uncle and aunt. Sa likod lang ng hospital (Sapang Palay) ang bahay nila kasi. We occupied one room dun. Hmmm, wala kaming picture dito na kumakain. We did our cooking dito kasi malapit lang din ang palengke ( at Jollibee )
Dec 4-5, 11-13, 2006 Santos Clinic Our group picture with Dr. Jun Santos . He’s so kind and pasensyoso, Super galing din niya mag-opera same as with his brother Dr. Gabriel Santos. In the picture also was Francis (nun lang namin siya nakaduty, I wonder where na ang loka?>>>..)
Dec 2006 PG Christmas Party – at my house ( obvious naman kasi kita sa picture si Jun, : ) Pot luck kami dito. Nag kris kringle din kami and my monita was elda. I made sure na Doraemon ang gift ko sa kanya.
That’s my gift kay elda. Nagets ko gift is from Set ( slippers) Memorable din tong party na to for someone. Nakasmile lang siya for the picture but hurting deep inside. : ( I’m glad everything turned out fine..
Di ko alam kung kelan to eh’ pero sinama ko na dito. This is at Hacienda Valdez San Ildefonso Bulacan : ) Kami lang ang natuloy, pero madaming nagplano ng trip . Super layo pala house ni Arni from “kabihasnan”, he!he! Naku ninang pa naman me daw sa December 2009.
Jan 2-4, 8-10, 2007 Rizal Medical Center Wala me picture dito with sir Laurence, pero I’m sure si Arni at Zhel meron. Favorite kasi sila ni sir dito (favorite asarin!) . ER duty kami dito, so we were able to see a lot of things and experience a lot of first. Also had the chance to assist minor operations gaya ng suturing. Ang layo ng RMC!!!. Sa pamasahe lang ubos na baon namin.
Jan 15-17 Sapang Palay , Bulacan 2 nd time din namin, nun una DR ngayon CD, so we were a bit cautious kasi nga “communicable disease no??!”” Lagi kami ready with alcohol and mask sa pocket. Also kasama namin here si Faith. (nasaan na din kaya siya???yung book ko din kaya?… )
Sharing an Oishi pagkalunch lang to hah! di kasi kami maka isip pag wala food.. Eph and Ron with Arnie, hmmm We’re all friends naman noon pa. Sana untill the end.. No pikunan : )
Jan 22, 2007 On our way to Mariveles Bataan for the 1st time. Super excited kasi medyo malayo ang duty. Sad lang : ( kasi hindi namin kasama si Roset. Pretty ng pic namin no?!! Parang sa other country(kasi naka long sleeve si amor eh! )
Pictures inside the dorm at Bataan I miss times like this… : ( Hu!hu!hu!
Jan22-27 our duty days here at Mariveles Mental Ward. With our CI sir Sandy. Had wonderful duty days there. Also learned a lot of things not only from our CI but also from our patients… Most of them bumigay dahil sa problema sa buhay…sad but true : ( All of us have problems in life, its just a matter of how we deal with it…. With the help of friends and family .
Last duty day, we did a dance presentation with our patients. Sayang bawal ang picture o video ( patient confidentiality ) sana napapanuod pa natin ang sayaw ni Eph.. : )
Swimming at Bataan beach Sayang mga poor kami, we would have gone to Corregidor sana kung may extra cash pa kami.. Maybe in the future makapunta kami…. I’ll wait for the day
Of course hindi mawawala ang food sa PG. Kahit medyo tight ang budget namin nabusog naman lahat. Thanks to sir Sandy for his mangoes. May take home pa nga ata kami eh.. For the love of Arni nga pala sumugod si Juancho sa Bataan..(how sweet!!)
Jan 29-31, 2007 V Luna Medical Center Guess where’s our CI sa picture?? Hindi halata no?? Parang classmate lang namin si mam Lyn.
February 26-28 and March 5-7, 2007 Rizal Medical Center ( Pedia duty) Ja and Me are the only two here, nahiwalay kami sa buo group kasi up to 8 persons lang yung other pedia duty nila. Our CI here was sir Nicolas. He was so kind to give us 88% sa grade ( pagod kasi kami sa duty, arruuuu parang totoo : } ) . Kaya nga one of our favorite si sir eh, he!he!
April 10-13,2007 PICU East Avenue Sobra liit ang room na pinagstayan namin dito. Si Arni ata di namin kaduty dito : (
April 16-20 2007 Kaunlaran Village Navotas Community Health Nursing duty. This picture was taken sa house nun kinakainan namin ng lunch. Ang nagseserve samin si “lola”.
Kaunlaran Village pa din otherwise known as Dagat-dagatan. Super dami ang patients dito especially immunization day.. Its summer kaya okay lang na nakacivilian kami. Super init nga eh..
Preparing for the exams. We did group study kasi talaga . Super focus kami here kahit magulo sa paligid (Trinoma ba naman magreview???ha!ha! Nag extra effort kami kasi computation ang management exam.
Some other pictures of the group I really miss times like this.. Food always brings us together. “ a friend is never a coincidence”
May 15-19, 2007 Mariveles Mental Ward Its our 2 nd time ( this time nagparequest duty talaga kami) The 1 st time wala si Set so this time we made sure na kasama siya. I was surprise kasi naalala pa ko nun patient ko dati. She called me by my name nun magkita kami ulit. Our duty for this time may OPD na, we got to see how the doctor assesess patients for admission. We got to see din how ECT is done and got to assist.
This was my only picture sa duty na yun, but I’m sure the rest have more pictures. With our CI sir Ronald. Medyo na high blood Siya sa iba namin kagroup, but all is well that ends well.
October 2007 Graduation Day “ Friendship is not about the friends who act true to your face, but those who remains true behind your back “
During our review for the board exams. Preggy pa si May dito : )
Enchanted Kingdom Trip December 2007 I treated the entire PG with Juancho and Eph’s brother. Birthday kasi ng anak ko. Everyone had a great time. (libre kasi eh, he!he! ) Kelan kaya mauulit ???...
Upon passing the quali ba o compre??/?? Anyway, basta happy me dito with friends Sam and Serman… Madali lang kasi makita kung pasado me o hindi eh Just see the last page.. “ It’s a nice feeling to share happiness with friends who honestly cares”
“ Put God on top of everything and let Him take charge of all your plans” “ In all things always give thanks” “ THANKS”
At the victory party for board passers. With sir Vasquez,sir Diño and sir Nicolas plus several friends
. Oath taking at SMX Mall of Asia “ God will make a way”
April 8-30, 2008 ECG Training at UP PGH We are only 5 na PG here. Had a great time with the staff (marami sila eh di ko na maalala lahat) Although mahirap intindihin ang ECG we passed the training. Pero ngayon tanungin mo ko,wala na me maalala kundi “flat line”…
September 11 to December 11, 2008 as a Volunteer Nurse at Sta Clara de Montefalco Hospital. Ja, Amor,Elda,Set n me
May 28, 2008 Lingayen, Pangasinan Julie’s Wedding Elda, Jaja, Set and Me. Overnight stay kami sa hotel courtesy of Julie. Super busog kaming apat palagi. Sarap ng JP bagoong : ) Sayang di kasama buong PG!! Met two new friends- Clarisse and Aileen from Baguio.
<ul><li>Dunkin Donut Morayta </li></ul><ul><li>Before umalis si Amor for Singapore, </li></ul><ul><li>We went to PRC to get our license </li></ul><ul><li>certificate. Parang padespidida </li></ul><ul><li>na din ni lola to” : ) </li></ul>
Pag-Ibig B. Uy We first met sa 5 th floor library. Introduced by a common friend na hindi ko na maalala, ha!ha! Then we ended up group mates nun naging magclassmate kasi nga magkalapit surname namin. Had our share of “iyakan” and “away” but eventually ended up as good friends. “ What does’nt breaks us, makes us stronger,so keep on praying my friend, everything will be fine, in His time“
Ma. Laarni Valdez My anak anakan sa group kasi magka age lang halos kami ng mama niya. We also played mother and daughter sa HB project. Ang “construction worker” sa group, grabe kung mag rice, saan kaya nilalagay?? Miss ko na mga kagagahan niya, walang “ dull” moment pag kasama ‘tong si Arni. Favorite niya asarin si Set, Ja and Amor. Minsan pati ako inookray ng loka. I pray my dear na sana till the end na kayo.. I remember what you said dati. “ Si Juancho na talaga sana” : ) “ Life is what you make it to be. Take care and God bless you all” : )
Cristine Tingson Si Tin ang unang nahiwalay sa group. After nun 1 st semester na magkaklase kami ,di na yata naulit. But we made sure that we got communication, (lalu na pag may quiz o exam, : ) ) I always knew she would be great in something. I was right kasi ngayon respected CI na siya. “ Future Chief Nurse”. Marami na rin akong nakita na luhang pumatak sa kanya. Maramina ding “red horse “ ang nabuksan nila..( coke o juice lang sakin eh! ) But eventually nalalam-pasan din niya. “ Whoever wants to embrace life and see the day fill up with good, say nothing evil or hurtful ( 1 Peter 3 : 10)”
Ma. Justina G.. Zapanta Si Ja medyo matagal na din kaming magkasama. We were always groupmate, ( obvious ba?/). Had a lot good and bad days together din. Although 10 years ang agwat namin ( di lang halata..) she is the one I can always rely on pagdating sa emotional side. Maybe because she has a strong faith and “ malakas siya sa taas”. The certified “sosi” ng group, pero kumakain ng “street foods” for the love of PG at sumasakay kahit hindi aircon na bus ( kasi no choice kesa maiwan!,he!he!) Goodluck my friend and God Bless You “ Always do right. That will gratify some of the people and astonish the rest” –Mark Twain
Ephraim Domingo Si pareng Eph ang group “clown”. Riot din pag kasama siya lalu na nun sa Bataan kasi nakakarelate siya,ha!ha! He is a good boy naman eh, he is just a bit confused minsan and needs ng mga ate to get him in the right track.. Hopefully now, you know na your prio- rities in life, my friend. Soon to be a dad, strive for the future of your family. “ Find a wife and you find a good thing. It shows that the Lord is good to you” (Proverbs 18:22)
Liezel Valdez This is my ever pretty friend. Kahit saan kami maduty may nagkakacrush sa kanya, doctor, nurse, pasyente pati mga bantay. : ) One of the “kikay” (the other being Arni and Elda). Hindi nagpapalampas ng tiangge pag may nadadaanan. Pag kasama sa divisoria, sasakit ang paa sa kakalibot(parang si May : ) ) Kung ang saddest bday niya ay 2006, I’m sure magiging happiest ang 2009!!. ( alam na ng PG kung bakit ) I’m happy for both of you. Ingat : ))) ““ Train up a child in a way he should go, and when he is old, he will not depart from it “ (bible verse)
Ana Rosa P. Tiopianco Si Set ang pinaka una kong naging friend sa PG. We go way back Anatomy days pa( 2004 pa yun ah!). Had a lot of days reviewing together sa library. Pag computation ang usapan si Set ang no.1, may calculator ata siya sa utak eh! : ) Very sweet kung friend mo na, pero sabi nga ni Ja “sungit” minsan, ha!ha! Of all the years na magkasama kami, we had one fight that we ended up “crying” pareho, : ( . Ang dahilan, isang patak ng “tubig”, ha!ha! Kidding aside, itong si Set medyo mahina lang ang loob but I know she would go places someday. Believe in yourself my friend.. “ The greatest thing in this world is not much where we are, but in what direction we are moving “ ( oliver holmes)
Elda Socorro V. Veloso The bunso of the group. She is very fragile kung titingnan but a “rockista” inside. I admire her perseverance and love for photography. Aakyat sa bundok, building o kahit saan basta makakuha ng magandang “angle” . I know she would have a name in the future. You go miss RN Photographer! Although minsan inaasar ka ng group, its just our way of “ lambing “ to you. : ) Good luck Miss MS ! You still have a lot of years before you. Continue to be religious, loving and creative. Love yahh!! “ There are two educations, one should teach us how to make a living and the other how to live” ( John Adams)
Maybelle O Victorio Si May ang akala mo hindi nagbibiro. Pero ingat kami lahat pag nagsalita na, ha!ha! Panu ba naman super galing mag gawa ng kwento nito : ). Minsan nga totoo na , di pa kami naniniwala. Yun nga lang di niya ko magawang “acomplish” kasi madali akong mahuli pag nag li lie.. : ) Ang house niya ang official “ seclusion” ng group. Kung meron may problema tyak nasa “ crying chair” sa kanila.( ilan na ba kaming nakaupo dun???..) Dun din kami nag ge get together kasi convenient sa lahat ang area. “ Worse than a quitter is a person who is afraid to begin” Believe me, Si May hindi siya quitter and hindi siya afraid to begin. I miss you and I love yahh my friend : )
Ronn Carlo Tortosa I’ve always been intrigued by Ron. One moment super sweet then the next nag eemote mag isa. But in fairness to him, he is reliable pag out of town ang duty namin. Magaling siya lalo na pag skills lab and ako ang nanghihinayang kung hindi siya magtuloy as a nurse. You can go places, if you put your heart and mind into it. I pray that you find the right person who stays with you and that you find the perfect place ( para hindi na palipat-lipat ng work. : ) ) “ Start the day with a joy in your heart and everything will be fine” Ingat and God bless you always. : )
“ It is in giving that we reach our highest potential. When we grow beyond ourselves and become channels of God’s love. “ “ Walk straight down the road God commands so that you’ll have a good life and live a long time in the land that you’re about to possess” ( Deuteronomy 5 : 33)