Wednesday of Hope

I went to Silang first and had my first look in the area it was a bit easy because the center of the town is full of medical clinics where most of my doctors are residing. Fortunately I was able to cover the last one at exactly 1pm hoping that he will be the one to order my product as soon as possible ...Then I went to Tagaytay City I really love the perfect scenery of the Taal Lake it was really amazing how i wish I am residing in Tagaytay I love the weather ...Veru conducive for living ...But one thing that i noticed is the costs of transportation it was so expensive but it's ok ...the Way up is not that traffic like in Dasma ...Then 2nd to my last stop is Mendez where i gain nothing from my doctors lol ...I went back to DLSUMC to get the OR of my ID unfortunately it was the only day were in we are not allowed to cover so disappointing ...

Tuesday Escapade

I woke up early in the morning ... one thing i hate is to carry all the promats because it's heavy. I went first to Gen Trias but again the Doctor in the Health Center is not around for the second time hate it...I decided to move to my next destination City of Dasmarinas where DLSUMC is located the hospital is a tertiary level facility and a training ground for all of the students of DLSU Allied Health Courses... I applied for the ID it costs 500 php...But no one of my doctors are around so i decided to move to the center of the City where i met some of my Doctors. I got a good feedback from them hoping that they will order soon lol...I think this is it this is the most critical time of my life as a medical representative ... How i wish to have my first order soon

MANIC Monday!!!

i woke up almost 6 in the morning and started my day right ... i thougt it will be a bumper to bumper traffic but it's not ... i went to th office and got my healthcard ... i went first to Molino where I encountered this terrible doctor asking for a lot of requirement that is not yet available in my hand... but still i got to talk with her for almost 30mins ...after that i went to Imus but not a potential place for my product ... plus a very bad lunch @ Mang Inasal Lotus Mall branch ... Hate that store a lot!!! i even got the chance to talk to the manager and told her that it this the way u prepare ur food with a plastic inside ...it was a total disaster that I never want to happen anymore...After the day of stress I went back to office and got my uniform for I Love it!!!I am ecstatic to wear them ...All in all i still thank God for this wonderful day...

My First Post For 2010 ( The Blessings of 2009)

New year start of a new chapter in my life...I am very thankful for all the blessings that GOD has given me during the entire 2009...First was when i graduate in the Nursing School and took the Nursing Board Exam, luckily I passed it and had my oath taking in SMX Mall of Asia...After that was the most difficult part of my life (my bum days)...Many of my friends would ask me were are u now? What are u doing? Where do you work? What is your work etc...Maybe the latter question is the most difficult to answer. Why? Because they expect me to answer them that I am working with a certain hospital or institution since i am already a license nurse...But things went really surprising,I got a call from a certain pharmaceutical company telling me that I passed their standards and qualifications for the training of a certain product by one of the leading multinational pharmaceutical company, of course I was shocked about it but at the same time thankful to GOD for giving me the opportunity as a Professional Health Specialist Representative or in short a Medical Representative. As the training goes by I was very ecstatic and optimistic on its result because we were under the Expansion project of our Company...We even had our Revalida and we are required to pass that final examination inorder to be hired and start working in the field ...Here comes the result after all the hardworks i passed the Revalida knowing that it is very difficult and complex ...I started my work in the field December 1,2009 at last I belong to the work force and as of now I am very excited this January because this will be a very challenging work for us. May the Lord Almighty help us with our target...

Sex in Pregnancy: Is it safe to have sex during pregnancy, and if so, what is the best sexual position?

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Geriatric Cardiac Function

Afterload increases in the geriatric patient. This is largely due to increased vascular tone and decreased vascular elasticity. Vascular tone increases secondary to stimulation of the renin-angiotensin system in an attempt to maintain perfusion of aging kidneys. Stimulation of the renin-angiotensin system results in vasoconstriction, which increases vascular tone and blood pressure. Vascular elasticity decreases over time as a result of the atherosclerotic process. These effects cause a decrease in arterial vascular elasticity (compliance).

In the elderly patient, cardiac output decreases due to atherosclerosis and decreased perfusion of the heart. Previous cardiac insults, such as unstable angina and myocardial infarction, add to the dysfunction. The sympathetic nervous system is one of the compensatory mechanisms that maintain blood pressure in different body positions. The sensors that stimulate the sympathetic nervous system become blunted in the elderly patient, leading to orthostatic hypotension.

Keep these changes in mind when assessing your elderly patient: decreased cardiac output will result in decreased systolic pressure, unless compensatory mechanisms take over and cause vasoconstriction. Decreased arterial compliance and increased arterial pressure causes additional stress on the elderly heart leading to heart failure over time. Lastly, watch carefully for orthostatic hypotension which can cause the elderly patient to fall and become injured.

From: Magauran, B, Kahn, J, & Olkshaker, J. (2006). Geriatric Emergency Medicine, An Issue of Emergency Medicine Clinics. St. Louis: Saunders.

"Cardinal sign” of SIADH

The syndrome of inappropriate antidiuretic hormone release (SIADH) results in too much antidiuretic hormone being released. The patient inappropriately "hangs on" to fluid which dilutes the serum sodium resulting in hyponatremia.

The increased release of ADH usually occurs as a result of a central nervous system insult, such as a stroke. Ischemia or injury to the brain causes the pituitary gland to malfunction and release an inappropriate amount of ADH into the bloodstream. Antidiuretic hormone causes the patient to conserve water which dilutes the serum sodium and results in hyponatremia.

You can find SIADH quickly in your patients by assessing the urine and the serum sodium. In SIADH the urine will be concentrated (which looks like the patient is dehydrated). If the patient were dehydrated then the serum sodium would be increased. In the patient with SIADH the urine is concentrated and the serum sodium is decreased.

Treatment for SIADH includes fluid restriction, hypertonic saline, corticosteroids, and thiazide diuretics.