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Art Of Nursing-Prepared Hairis-Registered Nurse from India-HarrisjoseKNMC39630NUIDKL663517

I am a Cis Gender Male, I believe, I am a 'Che' but before discussing about equality for all in terms of truth of inner beauty and acting, showing strength with inner values in truth avoiding lifeless actions and before talking about how Christianity is no a religion but a free benefit for all people in the Universe; I have to discuss about my favorite job articles in poetry form of Art of Nursing prepared by Registered Nurse in India Harris Jose Hairis with Kerala Nurse and Midwives Council KNMC Registration Number 39630 with Nurse Unique Identifier Card Number KL663517 provided by NRTS Nurses Tracking System within Indian Nursing Council, Indian Country. "Her-Aval-Wisdom-Personified-Bible", 'Shaswathamaaya Paara; Firm/Stern Rock Of Salvation", "Pen, Pen, Pen, If I am strong, I am capable."

Poetry Introduction About Work Of A Registered Nurse mainly seen working in busy, heavy scheduled night, evening and day work shifts in ‘Intensive Care Units ICUs’ with more than 4 to 7 clients or in patients all together as an ‘Art’ of Nursing Work Fields.

Whether it is for accident MLC Medico Legal Case clients, hanging clients or poisoning clients; mind to provide with aseptic precautions utmost care making them reach with Cervical Collars, right bowel wash with suctioning of extra poisoned secretions with stomach wash or lavage with Normal Saline, Betadine solutions with Metrogyl inner wash and extracting those washes with cleaning and suctioning, discarding the inner huge waste bin amounts collected by your own precious hands to tackle out, restore and reassure the life of your valuable client on time who have faith in you than others. Be sure you do proper Urinary Catheterisation with catheters and feeding tubes for relieving Urinary Retentions heavily felt in ICUs and Casualties. Be careful while taking care of clients with unconsciousness due to above causes together with heart failures with respiratory distresses like Strokes. Be sure you will stop the 30:2 or 15:2 Cardiopulmonary Resuscitation CPR 100 width cycles if the Electrocardiogram ECG lines show a straight value lifeline. Mind to check the carotid pulse, tapping the client’s shoulders, check for response, shout or call for help in alarming blue codes even if it is an ‘several times fist back bumps tried’ unrelieved choking case that you handle with care. Mind the ‘dog barking’ mouth position of clients while securing with E-C clamps while inserting, securing tongue depressor with torch i.e The Laryngoscopes with head tilt chin lift positions while securing ryle’s tubes with suctioning tubes with sterile precautions with Endotracheal tubes, oro pharyngeal or Guedel Airways or even if it is a surgical Tracheostomy incision with suctioning and routine changing of ties. Be mindful, alert and lively while adhering with Intubation Trolley set up, recording each procedure timings, handovering valuables, ornaments with relative consents, while taking ICU consent signatures after explaining the ICU disease management scene, orienting to visiting times after explaining the risks of management of procedures to relatives and neighbors of the critical clients in life threatening situations. Be maintaining patient relations free of cost or if they want another doctor referral to another low cost disease managing hospitals or to go with signed Leave or Discharge against Medical Advice i.e LAMA or DAMA. Be attentive while Intravenous IV Cannulating both hands of clients with surgical IV 18G or 20 Gauge Cannulas rather than simple 22G IV Cannula Catheters. Do all routine palpation, percussions as said by emergency physicians together with checking, monitoring all vital signs i.e Respiratory rates, Blood Pressure, Body Temperature, Pulse Rates, ECG lifeline, GRBS, RBS, Arterial Blood Gas Pressure Values after giving pressure under wrist i.e deep artery blood collections for routine sampling and monitoring. For Stroke affected clients, be attentive to send immediate EDT blood vacutainer samples within red, purple, gray, yellow vacutainers with Cannulation, ABG Routine samples checking and immediate CT and MRI (Computerised Tomographic and Magnetic Resonance imaging or scanning) after handovering all ornaments to client relation parties with all shifting done with Emergency drugs kit together with an emergency technician, Emergency Nurse, General Duty Assistant (GDA staffs) and physician. Be attentive with Non Rebreathing Masks and Non Invasive Masks (NRBMs and NIVs) while connecting Ventilators whether it is BIPAP, CPAP, IPAP modes while conducting Continous Controlled Positive Airway Pressures or Intrinsic Positive Airway Pressure with adjusting PEEP volumes; O2 concentration, tidal volumes. Check with emergency ICU Physicians, always. Be alert, confidential, attentive and lively no matter whatever time it is. Client’s life is in your precious hands. Be Very careful while administering slow 10 mins injections like 20 ml Sodium Bicarbonate or Calcium Gluconate injections or Calcium Bicarbonate or Potassium Chloride (Potklor) injections; manage timings to rescue clients in your hands preventing them in going desaturation. Sedation Protocols is a very must carefully done procedures for clients for get relieved soon with their soft diet or fluid diet management administered through their feeding Ryle’s tubes inserted through their nostrils (i.e after measuring tube from ear pinnae to nostrils till tip of Xiphi Sternum). Be attentive that Urinary Foley’s catheters should be taken care while in the groin/inguinal region or area to prevent infection by routinely washing and sterilizing it with betadine or soap solutions while doing bed care and bed bath in routine manner whether the unconscious, critical client is admitted for 4 days or for 2 weeks. Mind to change every Foley’s catheters after 14 days of insertion. Mark to attend with Urine output while maintaining Intake/Output Charts as it can initiate fast progress in client’s condition if reported and noted by concerned physicians in a timely manner. Mind to remove or change every IV Cannula in three to four days of insertion as it is protocol in every hospital. Every Blood pressure increasing/managing injections with sedation highly alert narcotic drugs should be given in dilution preferably with sterile/distilled water rather than with Normal Saline as it is protocol in every hospital nowadays as it can balance Na+ level in body fluids for highly critical clients spending on hospitals. High alert drugs mentioned here like Inj. Noradrenaline (NORAD), Inj. adrenaline, Inj. atropine sulfate, Inj. ketamine, Inj. midazolam, Inj. propofol, Inj. vecuronium bromide, Inj. Rocuronium, Inj. fentanyl. Mark that Inj. Morphine, even if it is kept in a double locked narcotic cupboard; it is not used by clients in hospitals as it is highly addictive/seductive for pain and diseases for clients. So, always cross check with Nurse Incharge, with whom double lock key is always kept with; while replacing empty narcotic ampules for pharmacy reimbursement. For exemplary: Inj. Fentanyl is diluted with 2 ampules i.e 8 mcg in 46 ml distilled sterile water in 50 ml infusion syringe pumps at 12.5 ml rate/hour. Like that, follow cross check, repeat back, take written orders on medicine prescription charts; on ‘on call’ reaction reporting, medicine change reporting with physicians. For example: after 3 days Urine culture or blood culture reports, if a more suitable antibiotic is better for treating the particular disease conditions (exemplary: Piperacillin for Taxim or For Cefuporaxime for Sulbactam). Also, for Insulin-electrolyte KCL correction, its 40 ml Potklor injection is diluted with 10 units of refrigerated Huminsulin or Human Actrapid or Glargine insulin together with taking oral tablets like Vildagliptin 500mg, Glimepiride, Metformin Hydrochloride tablets. 

An Advertisement in between usually for health advice for all of us: Take care of your Liver more than your Heart for preventing all types of other diseases; as Liver is the most vital organ together with our powerful Heart with all organs are connected, even if its situated in a side, it's the most vital organ. Even if you take medicines for other diseases like Thyroid management it is just symptom management after blood checkups, but take care of your Liver, which should remain healthy till our deaths even after age 100 together with all types of exercises. Do diet management from your birth if you have sense and meaning for your life, my life advice. So, if you want to be healthy always, be alert, be lively, attentive, sturdy and don't sit idle always.

Check the hourly GRBS and inform the physician whoever it is in ICUs and, according to normalizing Random Blood Sugar, lower the Insulin administration rate with electrolyte corrections adhering with physician orders.

Care of Dialysis clients is a must in ICUs together with routine blood cross matching, reaction managing, Fresh frozen plasma, Red Blood bag transfusion Administration, routine monitoring, routine Haemoglobin, K+ and Creatinine level checking and management, in blue, red, gray, yellow violet vacutainers; cross checking with concerned physicians, warming the blood bag while administering to avoid chills after bought refrigerated. Check for normalizing client’s conditions. Assist the dialysis technicians in ICUs.

Maintain assistance and rapport with bedside portable X-Rays routinely checking technicians.

Particularly, handovering the clients to next duty staff should be in detail maintaining confidentiality and continuous rapport with clients, relatives and staff.

I have to discuss two important articles together which are connected with modern nursing work fields in today’s world. 

(Article: 1)

While I got affected by positive 2 mild Corona Viral Pneumonia SARS Covid 19 Virus on July 28, 2021 from busy job schedules, after free RT-PCR/CB-NAT Covid-19 nose/throat deep swab centrifuge tube laboratory checking on that day. I got free Corona treatment with all job benefits like all other health professionals got by then including nurses, doctors and other health senior workers by then. Within, 7 days of admission and isolation, I got relieved on August 2, 2021 on my birthday from all Corona symptoms like Loss of job concentration, confusions, chest pain/congestion, breathlessness, nauseated vomiting feeling, no fever/no hyperthermia/no elevated body temperature at all, unproductive coughing, unable to do daily works, unable to stand properly due to diarrhoeal watery stool symptoms after three weeks of occurence with continuous stomach bumps which are too painful to stand with.

Free treatment followed with my lately found out Pre Diabetes/Diabetes with HbA1c 6.4 to 7.2 with Fasting Blood Sugar 140 mg/dl and PPBS/RBS (Post Prandial Blood Sugar or Random Blood Sugar) which reach from 390 mg/dl till 490 mg/dl which show sudden occurence of Diabetes with tiny infiltration of traces of fatty covered liver. Chest X-Ray CORADS was zero to 1 and not like other people’s severe lung infections found out were ruled out.

So, the free treatment allowed for me were all out of cost of salaried amount:

1). Tab. Vildagliptin (Metformin Glimepiride Hydrochloride 50mg/500 mg orally taken tablets 0-0-1 A/F), Diet Education.

2). Triphala churna kashayam for drinking with ayurvedic tablets for clearing all fatty forms caused due to daily food, work-life stress from birth, but all over I am healthy, slim, beautiful, normal and diet free with good looking plus activities, talkative as I do like aerobics, my life, singing high, pleasantly, flew out smiles, dancing a lot of forms yet not accomplished all with so much of actings, but 2021 Corona beated me for 7 days till my birthday from July 28, 2021.

3).A lot of raw lemon skins/inner parts, haldi, garlic mixed boiled water lukewarm ingestion all day from Corona started from March 2020, here in India, after our family baptism in 2019 till November 2021.

4). Cap. Doxycycline 100mg 1-01 for 5 days.

5).Tab. Limcee, Vit.C oral chewing tangy flavored tablets 500 mg 1-01- for 14 days.

6).Cap. Zinc 50 mg 1-0-1 for 10 days.

7).Tab. Ecosprin-AtorVastatin 75/10 mg to relieve chest pain/congestion symptoms 0-1-0 for 10 days.

8).Tab. Pantoprazole P/O 40 mg to relieve gastric symptoms 1-0-0 B/F for 5 days.

9).Tab. Vit-D 60K once in a week for 6 weeks.

10).MDI Foracort Via Spacer Puffs Inhaler 2-0-2 200/6 mcg for 2 weeks (gargle after use)

11).Tab Montair 10mg 0-0-1 for 1 week A/F

12).Tab.Relent P/O 5/60mg 1-0-1 for 3 days.

13).Syrup. expectorant Ascoril plain for unproductive cough 2 tsp 3 times a day for one week.

14).Tab.Ciplox for relieving stomach painful bumps symptoms (started after 2 and a half weeks)

Planned for Endoscopy and Colonoscopy but after drinking 3 huge bottles of Colon Prep Solutions, my stomach cleared fully.

Other free of cost lab routine blood, urine and doppler findings were:

1). Calcium Oxalate crystals seen in Urine sampling.

2).Epithelial cells seen 1-2/hpf L in urine sampling.

3).KUB, ECG, USG were totally normal findings.

4).Vitals were normal.

5).Hb level % was up to 15.6 g/dl but now its only 12.7 g/dl after I got dengue fever after working in Rajasthan’s sweaty heated up climates with no air conditioning in restrooms with lots of stagnant water mosquitoes, rats, poisonous rattling snakes in our living room during July-August 2023. I will talk about Dengue NS1 Antigen fever, after consulting with a physician in Thrissur, and after having prescribed medicines all symptoms were devoid of symptoms within two and a half days. Thank You to the physician. Anyways, life and work in Rajasthan was too good, our skin will glow whilst so much and while taking too much bath accordingly in their salty heated up/sometimes cool water. I enjoyed Rajasthan alot. Rajasthan food and people were too good and hospitable.

6).SGOT/SGPT in Liver Function Tests were a little bit elevated 45/41 U/L respectively which should be below 38-40 u/l from bit 5 u/l.

7).Phosphorus 4.8 H mg/dl

8).CRP C Reactive Protein 6.800 H mg/dl.

9).Monocytes 11.2 H %

10).Eosinophils 3.8 H %

Anyways, after 14 days of home isolation at Mangalore, I continued my job from August 11th, 2021 till September 21st, 2021; on August 15th and August, 30th 2021, the Covid SARS report was found negative for COVID Pneumonia Viral Fever, but the stomach painful bumps continued with unable to concentrate on job, unable to stand with properly with nauseating symptoms together with watery stools discharges, but it became fully okay by doing all works in life properly now for growing up reasons stage by stage. A lesson to be taught. Be fruitful for everyone, be fruitful in truth, right wisdom in strength in inner values day by day for all adhering to our humbleness in Living God our loving Creator whose presence is everywhere.

For Dengue fever my prescribed treatment from physician was for symptoms like hyperthermia 105 degree F, anorexia, loss of good taste of food, loss of sleep(Insomnia), nauseated coughing, diarrhoeal stomach symptoms, breathlessness, painful calf, joint, body muscles which continued for past one week which were relieved within two and a half days after having prescribed medicines were:

1).Tab. Levores M 0-0-1

2).Tab. Bipacef 500 mg Cefuroxime 1-0-1

3).Tab. Vamol 650 mg 1-1-1.

4).Tab. Deriphylin Retard 150 mg 1-0-1.

5). Syrup. Zeez Ex. 2 tsp 1-1-1

6).Tab. Surbex XT Multivitamin purposes 1-0-0 all for < 6 days, but all symptoms relieved within 2 days, though I continued the prescribed medication for next three and a half days, such a clean, diligent, lovely physician I got referred by my family.

7). Lots of Raw Papaya leaves chewing and swallowing which is good for Dengue elimination.

(Article 2:)

That means, I don't smoke, nor drink alcohol, nor chew distasteful tobacco/gutka which are so weakly harmful to our life and body so I adhere by avoiding it fully from my life right from my birth till now. I don't like such activities and I'm never interested in doing such health deteriorating activities, that means useless foolish weak activities. Good food and good fresh drinks, I prefer. Term food and drinks as ‘Amritha’, enjoy but don't have it in more amounts, lest you will have vomiting nauseated sensations. Happy to live lively and healthy without including weak activities inside life but for upliftment of others in an inner strong way in Living God’s pure, free love, humble valued strength and in right wisdom in sacrificial truth. Love for all. Proof: My family, life and my living connections.

From english usage in foreign nurse works, I understood that Stipend is different from Salary:

I.e Stipend is just daily, weekly wages or calculated monthly given an incurred amount for freshers, part time student job learners for their daily travel expenses, food, life expenses, mainly seen in European countries and in Great Britain; whilst Salary is a huge amount given to experienced employees from employer with minimally included service taxes, liabilities, provident funds, calculated annually to give to a lifetime worker for 3 to 12 to 30 years for settling for long years seen mainly for example in family life leading Indian countries.

I understood the difference between saying,” See you later”, and “Catch you later”

I.e “See you later” ,we use parting times particularly at nights as an informal way and usage.

“Catch you later” means ‘now we have parted but soon we have to see sometime to finish some unfinished business to talk about later when we both get free time.’

“Have a tight night” means have a nice sleep or to say ‘have a goodnight sleep’.

Additional Points:

For pre and post delivery/ pregnant women and ladies I know this much about it, also for newborn care:

Do Prenatal health checkups, doppler fetal heart sounds, Ultrasonography, do immediate blood collection investigation as ordered by Paediatrician under Gynaecologist/ Obstetrician, if immediate delivery for preparing in Lithotomy position, do sudden IV Cannulation with 18G or 20G, administer Paracetamol Injection drips diluted with Inj Dynapar, Inj. Syncopa, Inj. Syndopa, Inj. Oxytocin for pain removal, acting as muscle relaxants, syncope relieving, if healthy newborn delivered start Immunization/Vaccination doses of first round Bacillus Calmette Guerin BCG S/C I/M Vaccin; Diphtheria-Pertussis-Tetanus DPT Vaccine and Oral dose of Polio Vaccine with initiation of Birth Certificate after entering Aadhaar Card Identification details of both parents, entering initial vitals, body weight of mother and child in Immunization health check up card. Keep newborn in phototherapy/Warmer after examining, cry, removing vernix caseosa from skin, extra greenish meconium, tapping on back to remove inner secretions. Post delivery injections for mothers like Ampicillin, Roscillin, Rifampicin, Cefazolin in 500 mgs in 2ml syringe dilutions. Assisting and managing hurdles/cry from 2 year old child to 10 year old child for securing 24G light yellow IV cannula if to manage any mild fever/vomiting disease conditions while needed to give half pediatric dose of antiemetic syrups, cough syrups or half doses of 1.5 or 2.5 ml of  5 ml diluted syringe medicinal volumes. After that, home visits and community health check ups are free, routine purposes for all lactating mothers at home to provide family population number and health management with follow up education.

Do patient registration, collect morbidity/immunization/disease status, data flow, assessment, history collection, investigations, referrals,  re-assessment, Identification bands, with admission dates, age, follow ups, treatment, background, symptoms with utmost correctness and accuracy to avoid mismanagement; preferably do nursing notes recordings and assessments according to ISBAR protocols as done in every hospitals in here nowadays particularly while administering medicines with all care given and while sending separate lab investigations with different patient identity.

For ICU care for critical patients, provide mouth care, tooth care with gargling pink coloured chlorhexidine mouthwash, bed bath, hair care, inguinal care for all prolonged treatment clients critically admitted. Tepid Sponging is applicable. Provide daily dry bed sheets with clean pillow covers on a daily basis. Clean the Endotracheal tube secretions coming out with closed and open lumen suctioning upto a cms insertion cleaning/suctioning also during tracheostomy care with proper catheter mount and thermoheppa changing/cleansing with fixing new dry sling gauze ties. After, extubation is done for normal 3 days admitted critical clients, give head end elevations intermittently before getting shifted to normal wards from ICUs, provide back rolling and tapping to remove extra inner secretions. Continuous nebulisation with respules- Asthalin, Normal Saline, Salbutamol, Imipramine, Levolin, Duolin, Budecort could be done all together with partial oxygen/ strong steam inhalation for clients to come in normal condition for betterment of treated condition from relieved endotracheally intubated post artificial ventilator conditions.

Always assist Dialysis technicians for dialysis tube leveling, measure surgical drains, pleural/chest/intercostal drains as for measuring in Intake/Output Chart for better patient condition outcome. Always do morning routine blood investigation collection and check ups as ordered by ICU concerned physicians. Dilute antibiotics in sterile distilled water or in preferably 100ml Normal Saline after 30 minutes; followed by 26 needle intradermal test dose AST with given time on it checking for any color change or adverse reaction for it, as for not to give antihistamines like Inj Avil 2ml nor Inj Cort-S hydrocortisone 100mg direct IV. Follow position changing every 2 hourly for bedridden ICU clients to prevent bed sore coming from wrinkling of bed sheets due to prolonged bed rest, give gentle body massage with talcum, oils with kneading, tapotement and tapping of back muscles and joints. Do daily bed making in every work shift. Semi fowlers, side lying, supine/prone, head elevated, tredelenburg’s positions are applicable. There are disease condition where every hour routine vital sign check up is necessary also in another simple, mild disease conditions, only 4 hourly vital signs monitoring is only needed, applicable for example for orthopedic clients where wet Plaster of Paris POP with cotton bandage rolls, slings, traction, with pins limb rests are given where many nurses assists the orthopedic physicians for doing those procedures. Adhere to the prescribed treatment by concerned physicians.

More Additional Points;

In case of children or young adults bitten by rabid dogs or do happened to be in exposure to rabies, First cleanse the injury/wound/bleeding/scratch site thoroughly with soap/water/debridement ointments/betadine/hydrogen peroxide/normal saline with washing thoroughly for 10-15 minutes to flush out all infected saliva from stray dogs for prevention in extra amounts which cause mixing of infected saliva of bitten dogs with blood of aged adult/ human child; then Rabipur mixed dose vials with intramuscular/intradermal injections are applicable, coming for next 6 days of balance dose administration while visiting the nearest health center. 

Next, for snake bites in a mild way, Anti snake venom ASV10 ml 2-8 degree celsius cooled; not allowed to freeze- refrigerated injections administered intravenously at 2 ml per minute rate; while under ICU observation, extract/draw blood samples from affected client, do observe for blood clotting/disseminating vials in time as ordered by physicians, if blood clotting/coagulation time/levels is in between 2/4-10 minutes which becomes in normal in mixture, get discharge the client from hospital after cross checking with concerned ICU physicians.

There are two Amikacin vials with different color coded cappings one with 500mg, 250 mg=750 mg; sometimes physicians might say to give two in mixed proportions or at different times in different dosage criterias. So, be careful while administering Amikacin injection IV after only checking with physician prescription orders twice.

And, always be mindful of explaining in detail about risky procedures to critical client’s relatives and relations while admitted in ICUs and take respective witness signatures from them and the staff. For exemplary: Risky procedures in ICUs like blood transfusion/cross-matching procedure, dialysis procedure, invasive catheter procedures, valuable/ornament handovering procedures, ct scan/mri scan/x ray/usg procedures, stroke procedures/ sedation administering procedures, ICD Drain/Pleural effusion procedures, critical surgery procedures, last sacramental/peaceful death with ongoing medicines only procedures. It's the duty of both nurses and doctors in ICUs.

Be in ‘Kanivu’ , clement, show clemency in palliative care for pain suppression and agony elimination as in carcinoma malignancy handling therapeutics; through tender-heartedness, politely answered, compassionately touched with warm benevolence. Be patient centered, provide client centered care  in comprehensiveness permitting clients, for them to make their own choices/preferences/needs .

More Information:

In the case of suctioning, do use multiple new, sterile suction tubes to get fitted inside suction apparatus by routine emptying of suction bottles also to prevent outside infection to get inside already inside infection; to prevent new nosocomial, second degree hospital acquired infections. Always have a double extra suction tube kept ready inside the Intubation trolley,also in multiple casualties to keep the client rescuing timing intact. Discard the used/soiled onesTrain the staff about this important criteria.

Daily work shifts checking for all nursing staffs; are Defibrillator checking, Medicine cupboard extra checking, Intubation Trolley checking, Laryngoscopes/Battery working checking, Inventory checking, Emergency trolley checking, Stroke kit checking, Ventilators checking, Room Temperature, Humidity/ Fridge Temperature checking; Bio-Waste discarding Management checking, Suction apparatus functioning checking, Oxygen cylinder functioning checking, Dressing Trolley checking/ Mark-fill the daily checklists.

Regarding Bio waste discarding management: 1)Yellow bins/covers for solid soiled cotton body wastes/blood fluid wastes.

2) Blue bins/covers for big glass vials/ampoules discarding.

3)Red bins/covers for plastic waste/plastic drip bottles discarding.

4)White sturdy small bins for sharp pins/blades, used needles, cut glass ampules, sharp instruments discarding.

5)Black bins/covers for stationery/paper/paper glasses/tea bags-wastes discarding.

Electrolytes Dripssets Composition include in Health Care Systems and in Hospitals:

1) 100 ml Denis Distilled Water with 3% Normal Saline Sodium Chloride.

2) 500 ml Distilled Sterile Water with 0.45% concentrated Sodium Chloride electrolyte Normal Saline.

3)500 ml or 1000 ml Ringer Lactate 0.9% in sterile water with Sodium lactate, sodium Chloride, Calcium chloride electrolytes in tonicity in it; Given for low blood volume, low blood pressure patients.

4)500 ml or 1000 ml 0.9% Normal Saline in Sterile distilled Water Tonicity.

5)GDW 5% Dextrose 0.9% Normal Saline DNS with other electrolytes tonicity.

6)DNS 500 ml with 0.9% Normal Saline electrolytes tonicity in Sterile distilled Water.

7)DNS 1000 ml with 0.9% Normal Saline electrolytes tonicity in Sterile distilled Water. 

All drips and drugs to be stored below 30 C room temperature, expiry should be checked daily or monthly.

Tetanus Toxoid Intramuscular Injection for infection/injury prevention stored in fridge temperature, but not to freeze them, with Enoxaparin Sodium Clexane( both 40mg-0.4ml and 60mg-0.6ml Inj.)Subcutaneous Injection for preventing DVT Deep vein Thrombosis, thromboembolism, blood clots due to Ibuprofen ingesting stagnant lifestyle which increases side effects like blood vomiting, internal bleeding, i.e haematemesis (which occurs as mass haematemesis also for tongue/lung cancer patients)

Inj. Tranexamic Acid drips in the form of Inj. Traneei for internal bleeding diminishing due to internal Hemorrhage caused due to severe road accidents, internal organ cancerous situations.

Inj. Heparin flushing in syringes 2ml before Arterial Blood Gas drawing diminishes blood clotting in waiting storage ABG machine results.

Remind you always to flush the Intravenous rubber neck/cap site with Sterile distilled water/Normal Saline and keep it tact with sterile dressings/pads, also during ABG blood pressure monitoring routine time while with critical clients in ICUs. Always be known to wind the cap of Canula extensions in proper shut/open forms in passage, after flushing, using sterile precautions and sterile trays.

Check for admissions, manage it even if it is for four to seven critical clients.

Even if you are a team leader, Nurse In Charge, do the ordering for juniors, give assignments for juniors; as such there are no juniors nowadays, be lively, attentive and alert, don't invite diseases for yourselves by sitting always idle doing only diary or book assignment or on screen table works. Reach to the clients and critical patients before juniors reach them, load injections, cannulate, catheterize, administer injections, medicines after asking for physicians prescription. Be a model to our juniors, let them study from our team leaders, Nurse Incharges for present and in their future. Let our juniors fear they might themselves lose their jobs while sitting in their own closets; if team leaders and Nurse In Charges do all sort of faithful work that they as juniors should do. Maintain continuity in learning and training, as for all above faithful procedures; train and take classes in routine manner for all staff explaining all new health protocols used in modern hospitals and in health care fields.

For example:

Like Nun Elsy Sister, a Thrissurite (SABS) from Angamaly studied from Germany that I have seen in my previous working experience areas, also witnessed by our colleagues, who is The Matron but who is enthusiastic to do every faithful works like juniors do, even if she is more senior and aged than all of us.

Thank you.

To be continued in between, I will make it too precise that it will be available equivalent to all as a gift from all from living God in humbleness, humility and sacrifice for all and all free for all for living God's good will to be accomplished in own Universe. Wish for good days ahead in doing good, strong works in strength of truth in living God but by avoiding lifeless actions. Give importance to living God to know and acknowledge our loving living Creator whose presence all over felt but cannot be seen with our naked eyes. "Spread the radiance of strong smile; full of life, in the truth of living God; our living Creator; adhered to Yahovah's Sena." We all are people of our living God even if how much tired we are in daily activities. Be living, strong in truth, so we will not fall in ignorance of war and in lifeless greediness, materialism, arrogance and in useless foolishness. Try to know and understand the true wisdom in our living God in humbleness and true strength.

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