My medical skills add experience

Chapter 541 Advanced nutrition, mutual appreciation
It is naturally a good thing to have a super talent like Jiang Wei join.

I'm afraid I can't afford it.

Zhou Can currently has some wealth, but he is far from being a capital crocodile. He himself is incapable of supporting talents.At least not currently.

"Before I came to join you, I was mentally prepared. It doesn't matter if I suffer a little bit now, but I believe that life will definitely get better and better in the future. The personnel department asked me about my salary requirements yesterday. My minimum salary requirement is annual salary More than 30 yuan, sign an ordinary labor contract. If I am not satisfied with my work, I can leave at any time. If the hospital thinks that I am unqualified, it can also fire me at any time.”

Her salary requirements are really not high.

There are many nurses in Tuya Hospital whose monthly income is between [-] and [-].The monthly income of advanced nursing care is at least [-] or more, and it can reach [-].

However, the profession of nurses is basically at this salary level in China at present.

No matter how high it is, the hospital can't afford it.

Jiang Wei is a special talent, with an annual salary of 30 yuan and a monthly income of [-] yuan.

It is considered a high salary among nurses, but her education is there, and many hospitals are scrambling to get her at this price.

"If you want to keep you, it seems that you have to work hard to take on a big job in the future!"

Zhou Can showed a wry smile.

"Ah! This is a good idea! The only departments that can make great achievements are the Department of Cardiac Surgery, Shenwai, Shennei, Cardiac Surgery, and Orthopedics. Aren't you very capable in cardiothoracic surgery? Do more work in cardiothoracic surgery, Don’t talk about raising me a nurse, it’s okay to raise a few more.”

She stroked her smooth forehead and smiled back.

As expected of a person who has seen the world, his words are very incisive.

In the hospital, there are really only a few departments that can really make achievements.

Obstetrics has developed better and better in recent years, and it also has the potential to achieve results.

However, compared with old and powerful departments such as Heart and Outward, Shennei, Shenwai, and Orthopedics, Obstetrics is relatively weaker.

At this time, the two had arrived in the hospital ward.

The emergency department is actually not that big, no matter if you think about the operating room, inpatient ward, emergency room, ICU, basically it will not exceed 3 minutes away.

During the rounds, Zhou Can deliberately checked her level.

It happened that the first bed found was a very frail elderly patient.Because of acute intestinal perforation, Zhou Can performed debridement and intestinal repair on this old woman.He is currently recuperating in a hospital bed.

The recovery of the elderly is not very ideal. He is already 76 years old, and his body is thin, so the recovery is much more difficult than that of ordinary people.

According to Zhou Can's conservative assessment of the old man, it is not bad to be discharged from the hospital in seven days.

If an abdominal infection occurs, let alone being discharged in seven days, it is hard to say whether he can be discharged alive.

"Jiang Wei, you are a professional nursing student. Let's see if there is anything that can be improved in this patient's care?"

Postoperative care of patients is extremely important.

The current level of nursing in the emergency department is not very good, it can only be regarded as quite satisfactory.

"Ok!"

She agreed and began to understand the patient's situation in detail.

"From her current physical signs, appetite, gas, and urine output, it can be seen that the operation was successful, and there has been no postoperative infection, secondary intestinal perforation, or fluid leakage. Her postoperative care mainly focuses on anti-infection , I suggest that you can eat some liquid food appropriately, which can promote intestinal peristalsis and provide her with better nutritional support. In addition, in the liquid food, it is recommended to consume at least [-] grams of ground soybeans per day to increase the amount of gas , is more conducive to intestinal recovery.”

Zhou Can's eyes brightened slightly after listening.

This was his first formal exposure to the flexible application of nutrition in nursing.

Postoperative care also includes nutritional support in the Department of Critical Care Medicine, but it is only nutritional support to protect the life of the patient.And most of them use simple and crude nutrient solution input.

Jiang Wei's dietary advice at this moment is obviously a rank higher than that of ordinary nutritional support.

"As expected of a doctor studying abroad, this suggestion is very good. You tell the family members the detailed diet list, and let them watch and prepare." Zhou Can deliberately mentioned Jiang Wei's doctor studying abroad status.

This is to increase the family's trust in her.

In the clinical diagnosis and treatment of doctors and nurses, family members are more willing to listen to doctors, and will automatically ignore the existence of nurses.

So far, most patients and their families still have certain prejudices against nurses.

I think that nurses can only give injections and change dressings, and even a single injection will make mistakes. When encountering obese patients with invisible blood vessels, or children with very thin blood vessels, it often takes two or three injections to succeed.

These discriminations are very unfair to nurses and are also a reason for the high turnover rate of nurses.

"She is a doctor who came back from studying in the United States, and her level is very high. The suggestion just made is very good. Please remember, according to her suggestion, feed this grandma some liquid food, which can shorten her hospitalization time and save a lot of treatment expenses."

Zhou Can communicated with his family members very well.

If you say something else, family members often think you are farting.As long as it can reduce treatment costs, shorten hospital stays, and speed up recovery, it is guaranteed that families will immediately become particularly motivated.

"Okay, okay, please tell me, I will buy it as soon as I remember."

The patient's daughter should also be in her 50s. After hearing this, she took out her mobile phone and pressed the recording button on the spot.

Zhou Can couldn't help feeling nervous.

Every time he sees a patient or family member taking out a mobile phone recording or video recording, he feels nervous.I believe other medical staff are similar.

Because after these people videotaped and recorded, they were probably collecting evidence to prepare for future complaints and lawsuits.

However, this family member should be too old, and there is no paper and pen around him, so he had an idea and thought of using a mobile phone to record.

"Grind soybeans into powder, about [-] grams per day, and no more than [-] grams at most. Fish soup, especially the soup made by crucian carp and black fish, has good nutritional value and is more conducive to wound recovery..."

She gave some dietary advice.

Regarding the recording of the patient, Jiang Wei seemed very calm.

Zhou Can listened silently at the side, and the diet list she gave was very common.

But every food can be just right for the patient's condition or physical condition, showing that her nutritional level is very high.

Just like Zhou Can's incision level has reached level six, when encountering the need for dissection during surgery, he is often able to freely, accurately and quickly.Every time the tissue is cut or the lesion is removed, it can be just right.

Her dietary advice to patients has also reached this high level of just right.

Each food and consumption amount are specially formulated according to the physical condition of the patient.

In the following ward rounds, she could give some good suggestions from time to time in the key care or treatment of some patients.Even medication.

And she can target the target every time, which Zhou Can deeply agrees with.

Even Zhou Can benefited a lot from some medication suggestions, learned some new medication knowledge, or got some inspiration.

For example, when we checked the 27-bed patient just now, because this patient had undergone cardiac vascular stent surgery, he was hospitalized for pneumonia this time.She suggested that when patients are treated with inflammation, it is necessary to consider increasing the dose of anticoagulant drugs.

Some other medication adjustments also need to be made.

Because inflammatory response and coagulation activation are 'two-way street'.

An inflammatory response can lead to hypercoagulation.

This increases the risk of blood clots.

At the same time, hypercoagulation will lead to the combination of activated coagulation factors and PARs of various cells, which will promote the synthesis and release of more inflammatory mediators, and further aggravate the inflammatory response.

She suggested that the drug regimen should not only consider the risk of increased thrombus, but also decipher the "cross-talk" between inflammatory response and coagulation activation.

Even though it was just a small suggestion, it benefited Zhou Can a lot.

At the same time, it also revealed that the level of medical diagnosis and treatment in the emergency department was poor.

It can also be considered that her pharmacological level is very high, which highlights the poor level of emergency physicians.

After checking the house, Zhou Can was very happy.

This time it was indeed a treasure.

Having such a highly qualified nurse on his team is definitely a big help.It can instantly greatly improve the level of his team.

Take her into the operating room after changing clothes.

The first operation was an emergency trauma operation. During the morning run, the patient stepped on a banana peel thrown by a passer-by because the sky was dark and the street lights were not very bright. Unfortunately, he took a free flight.

In the end, he dropped a deep wound on the elbow of his right hand.

Zhou Can checked the wound on the patient's right arm, which was about 4cm long and could only be regarded as a small wound.At least in the eyes of a doctor like him, it was nothing.

The depth of the wound reached more than 2cm at its deepest point, and it could be seen that blood was still oozing out.

It appears to be a ruptured artery.

Because if it is a venous blood vessel, it can generally stop bleeding automatically, and the color of the fresh blood that emerges will be darker.

It seems to be just a minor injury, but the difficulty of the patient's surgery has increased a lot invisibly.

Because after inspection, Zhou Can found that the broken blood vessel was probably the ulnar recurrent artery.

Whether it is the anterior or posterior branch of the ulnar recurrent artery is very important.

In addition, the ulnar artery and the radial artery are the terminal branches of the brachial artery, which is the main blood supply to the end of the arm.

Simply ligate it to stop the bleeding, which will cause the patient's right arm to lose part of the blood function and cause many problems.Even dysfunction occurs, and some muscles and tissues are ischemic and necrotic.

In addition to debridement, surgery also needs to evaluate and repair damaged blood vessels.

As long as the patient does not go to grandma's house in time, there should be no need to consider blood vessel transplantation or artificial blood vessel replacement.

Occasionally, if the damaged vessel segment is long, an autologous venous vessel graft should be considered.

The doctor gives advice on how to treat it, and the patient and family members make their own choices.

Speaking of this, we must mention a principle of surgical signature.

If the patient is an adult and sane, the surgical plan requires the consent of the patient himself.Otherwise, even if the family members sign and the patient disagrees, the doctor must respect the patient's wishes and cannot force the operation.

There have been similar cases where the doctor was sued by the patient to court because he did not respect the wishes of the patient, and the hospital was eventually ordered to compensate the patient for the loss.

It's just that for patients, if they lose some important organs or functions, no matter how much compensation they pay, it doesn't make sense.

Just imagine, if a woman's breasts are cut off, or her uterus is cut off, what is the use of more money she gets?

"Jiang Wei, are you competent as an instrument nurse for this operation?"

Zhou Can asked directly.

Qiao Yu has already prepared equipment, medicines, sutures and other items.

Jiang Wei only needs to pass equipment, medicines and consumables to Zhou Can.

The equipment nurse in the surgical nurse also has a not-so-nice name, called the hand washing nurse.

If you understand it literally.

It is a nurse who specializes in helping doctors wash their hands. What technical content can this have?
In fact, the technical content of equipment nurses is not particularly high.As long as you are familiar with the operation process, you can basically do this job well.

During the operation, the surgeon will sometimes sound a reminder of what is needed.

Such as the number of scalpels, the number of sutures and so on.

Of course, a high-level nurse can prepare in advance without the need for a vocal reminder from the surgeon.

For example, like Qiao Yu, she was able to tacitly prepare all the instruments and consumables for Zhou Can in advance during the operation.When encountering rescue, it can be of great help, and even directly provide some rescue suggestions.

After working as a surgical nurse with Zhou Can for two years, Qiao Yu's actual combat ability is already very strong.

She has been teaching herself advanced nursing knowledge such as nutritional support and intensive care in preparation for studying abroad.

This time, a nurse who had studied abroad came here, which was also a good opportunity for Qiao Yu.

She can learn from Jiang Wei and learn about the preparations for studying nursing abroad.

"let me try!"

Jiang Wei calmly walked to the equipment nurse's position, while Qiao Yu walked aside, and said to her kindly, "Jiang Wei, don't be nervous, just operate normally. If you have any questions, you can ask me at any time."

"OK, thanks!"

Jiang Wei nodded at Qiao Yu and smiled gratefully.

The operation started, and Jiang Wei began to deliver or receive surgical instruments and consumables according to Zhou Can's needs.The whole assisting process is extremely easy and proficient, obviously with ease.

Qiao Yu, Ma Xiaolan, Pu Dingdong and others were all dumbfounded.

I thought it was just a novice who came, but who knew that a king-level master came.

The first operation was over soon, and Zhou Can found that Jiang Wei was replaced as his nurse, and there was no sense of disobedience.It's not even like a replacement.

The tacit surgical understanding between Qiao Yu and him, this Jiang Wei also has.

If Qiao Yu's ability to possess this ability is the crystallization of talent and hard work, then this Jiang Wei is definitely extraordinary.

"Jiang Wei, not bad! Your familiarity with instruments, various medicines, and sutures is definitely a seasoned surgical nurse."

Zhou Can did not hesitate to praise her.

"Hehe, thank you for your recognition! Your surgical skills are also the best among young doctors I have ever seen. Whether it is debridement, blood vessel repair, or cortical suture, every step is impeccable and perfect. .”

She has worked in at least two large hospitals, especially in the Central Plains Attached University, and must have seen many powerful surgical experts.

"And the speed of your operation is too shocking."

(End of this chapter)