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The NCP that made a hospital owner BOW to a nursing student... almost!

Ito ang NCP na hinding hindi ko makakalimutan. When our group stayed in SANTOS GENERAL HOSPITAL in malolos for a duty, we are required to present a case study based on our patient at the last day of our duty. Ang patient ko noon ay isang matandang na stroke. Ako ang naka duty sa ICU noon. So as usual, ang mga ginagawa ko ay V/S , NGT Feeding, nililinis ko si tatay, pinapakain, dinadamitan at nag pupulse oximetry.

Ang nurse naman na naka duty noon eh wala lang, parang invisible. Nag chachart lang sha with matching patanong tanong to test our knowledge. Kasama ko sa duty noon ay ang aking ate na classmate ko rin.

So dumating na ang last day, at natapos ko na ang aking NCP. Ako ang tipo ng studyante na 3 days bago makatapos ng isang NCP kasi talagang ginagandahan ko para walang makitang butas, although kaya ko rin naman gumawa ng ncp sa loob ng 5 minutes kasi usually sa exam required na gumawa ng NCP sa ganoong kabilis na time.

So natapos ko ang NCP, you can download it here : NCPBudekSantosGen.doc

So as usual, i didiscuss namin yung NCP at ako yata ang isa sa huling tinawag. So chika chika lang habang dinidiscuss ko ang NCP humirit si Dr. Santos , yung owner ng hospital.

Dr. Santos : How can you assess the placement of the NGT Tube? Wag ka mashadong malikot bat paikot ikot ka. [Coz nilalaro ko yung chair dahil umiikot sha sarap mag pa ikot ikot] Wag kang kabahan.

Budek : Ay! [Sabay ngiti, pati mga groupmate ko tawanan] Well, we have 3 different ways to assess the placement of an NG Tube sir. One is via aspiration of the fluid and testing it with the litmus paper. If the return is acidic, definitely it is from the stomach. The paper will then turn to Red. We should then return what we aspirated as not to disturbed the fluid and electrolyte balance of the patient.

Second, We can introduce air via the asepto syringe and auscultate for the bubbling sound in the mid epigastric area. If we heard a gugrling sound in the epigastrium, Then the NGT Must be in the stomach, although we cannot certainly assure it, that is why we have the 3rd step which is the Confirmatory test to determine the NGT placement, which is Chest X-ray which is not usually done in the philippines kasi nga its not that cost effective.

Dr. Santos : Wow ha, kumpleto. What is it in the NGT tube that made it visible sa X-ray?

Budek : [Honestly di ko alam, so birit nalang at nanghula] Well, The manufucturer really intended to made the tube opaque as to not allow light to pass during X-ray making it visible in the film.

Dr. Santos : Wow talaga! ang ganda ng ncp mo talagang practical. Matalino ba talaga to? [Tanong nya sa mga classmate ko]

Mga groupmates : Sir opo, future topnotcher po namin yan sa board exam! [ mga loko loko talaga]

Budek : Hindi naman [hiyang hiya]

Dr. Santos : O sige last question nalang, pag nasagot mo ito BAW ako sayo. [Aba talagang nang dadare] What is the normal caloric requirement for an adult individual?

Budek : [ Diyos ko day, eh nababasa ko yan sa likod ng mga chichirya at noodles na kinakain ko no ] Sir, the average daily requirement for an adult individual is 2,000 to 2,500 calories per day.

Dr. Santos : [Na nangiti parang feeling nya mahirap yung tanong nya at ang galing galing ko talaga] Wow talaga, grabe ang galing mo naman, basa ka siguro ng basa?

Mga groupmates : Wow naman debu galing galing mo!

Budek : hindi naman over naman tong mga to.

Dr. Santos : O last na tanong na, pag nasagot mo talaga ito talagang BAW na ako sa iyo.[Teka kala ko ba tapos na yang tanong mo at BAW ka na sakin?] Kung ako ang patient mo, Paano mo i didistribute yung 2,000 calorie na yan?

Budek : Sir diba mas marami dapat carbo then protein at fats ?

Dr. Santos : Hindi nga, yung exactong number gusto kong makuha. Ilang calorie bawat isa?

Budek : Sir anong patient ba? diabetic or mga nagpapagaling? kasi diba depende eh.

Dr. Santos : Hindi mo alam no?

Budek : Ahmmmm... hindi ko alam sir eh. [Nag give up na ako hindi ko alam ano gusto nyang sabihin eh]

Dr. Santos : O, risearch mo yan ha then tell me tomorrow ha.

Then after the presentation, kinamayan nya ako and sabi nya wag ko raw shang kakalimutan pag nag top ako [As if naman] at pinakilala nya ako at pinagmayabang sa mga doctors at nurses sa hospital dahil lahat daw ng tanong nya nasagot ko.

Ohhhh what a feeeeeling ! After the event nagtatago na ako nahihiya kasi ako hindi ako sanay sa spotlight. Then i researched on the answer, that he meant pala is paano ko i divide yung 2,000 calorie between protein,carbo and fats which is 4 , 4, 9.

Pero it was really complicated , kailangan ng calculator. computing the caloric breakdown for a 2,000 calorie diet we need to divide 2,000 by .5 .3 and .2 to measure the calories between carbo, fats and protein.

2,000 x .5 = 1,000 from carbohydrates
2,000 x .3 = 600 from fats
2,000 x .2 = 400 from protein

So we had an intake of about 250 grams of carbohydrates. 67 grams of fats and 100 grams of protein. Balance? Balanced!

250 grams x 4 = 1,000 calories from carbohydrates
67 grams x 9 = 600 calories from fats
100 grams x 4 = 400 calories from protein

Sayang, kung nasagot ko sana! pero ang hirap talaga hindi ko alam yan during that time medyo nalimutan ko na yung nutrition ko :) dont forget that ha baka matanong ka rin diyan.

i downloaded and read your 'NCP that almost made a hospital owner BOW to a nursing student' and i must say im really disappointed.

this is not to burst your bubble but whatever happened to NCP's being patient-centered having SMART (specific, measurable, attainable, and time-bound) goals/patient outcomes?

your NCP was merely copied from NCP books which should ONLY serve as guides.

don't take this personally, i am not putting you down.

perhaps the hospital owner who almost 'BOWED' to your 'NCP' didn't have any idea about how NURSING CARE PLANS should be written.

Hello, its alright ... I can accept that and I want to thank you for that. Bill cosby said that the key to failure is trying to please everybody.

Thanks :)

With all due respect Budek, nothing special in the NCP. It was practically copied from the book. It is pretty obvious the hosp owner knows shit about NCPs & Nursing, because your paper was basically that, SHIT copied and claimed as your own.

sister / brother, there is such a thing a intellectual honesty.

Sa Q&A sya almost napa-bow sayo. hindi ata sa NCP. iba pati ata prioritization mo for your NCP. i would suggest unahin mo ang impaired immobility since matanda na rin sya at sabi mo kakagaling lang nya sa stroke. ok din siguro ang nutritional aspect kasi he's on NGT. don't forget the basics. ABC and Maslows's. dapat pati hiniwa-hiwalay mo ang independent, dependent and collaborative nursing interventions mo po. and kung may short term and long term goals ka indicate mo din. di naman kasi masyado pinagbabasehan ang mga theories when doing the NCP. dapat aggregate ng mga theories. that's why yung iba NANDA ang ginagamit na reference when doing NCP's. anywy, iba siguro turo sa inyo. just sharing some info po

hi. um, i think what you do for other nursing students and nurses are terrific. but this ncp is not one i would commend.
tama yung isang comment na dapat client-centered and dapat SMART. basing on your NCP, parang very technical and hindi gawa ng nurse with a big heart. looks like the work of one with big brains lang.
tsaka i could have come up with the same kind if were to copy entirely from a book. i know the work it takes to come up with an ncp, weaving all the parts together and all. but you say ginawa mo yun in days? more like you copied it from an NCP book in minutes lang.
but saludo ako sa pagpresent mo ng case ng patient mo and how excellently you answered the doctor. nurses should be more like that. =)

hey Budek.. i think that your NCP is very realistic.And I believe your effort definitely deserves an appraisal..

i really think that you are a good student and you'll have a very bright future ahead of you..

keep on studying and don't forget to pray always..

In my reading this morning talks about how David in the Bible accepted criticism and regarded it as constructive...

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