Chapter 541 Advanced Nutrition, Appreciation of Each Other
Having a super talent like Jiang Wei join is naturally a blessing that we have been longing for.
I’m afraid I can’t afford it.
Zhou Can currently has some wealth, but he is far from being a capital tycoon, and he himself does not have the ability to support talents. At least not at the moment.
"I was mentally prepared before I came to you. It doesn't matter if it's a bit hard now, but I believe that life will get better and better in the future. The HR department asked about my salary requirements yesterday. My minimum salary requirement is an annual salary of more than 300,000 yuan, and I sign a general labor contract. If I am not satisfied with my work, I can leave at any time. If the hospital thinks I am not qualified, they can also fire me at any time."
Her salary requirement is really not high.
Many nurses in Tuya Hospital earn between 8,000 and 15,000 yuan a month. Senior nurses earn at least 12,000 yuan a month, and some can earn up to 28,000 yuan.
However, the salary level for nurses in the country is basically at this level at present.
If the price is any higher, the hospital can’t afford it.
Jiang Wei is a special talent, with an annual salary of 300,000 yuan and a monthly income of about 25,000 yuan.
It is considered a high salary among nurses, but given her academic qualifications, many hospitals are scrambling to hire her at this price.
"If I want to keep you, I'll have to work hard to get some big jobs in the future!"
Zhou Can gave a bitter smile.
"Oh! This is a good idea! The departments that can achieve results are only cardiac surgery, neurosurgery, neurosurgery, respiratory internal medicine, and orthopedics. Aren't you very good at cardiothoracic surgery? Take on more big jobs in cardiothoracic surgery. Not to mention supporting me as a nurse, even if you can hire a few more, it won't be a problem."
She stroked her smooth forehead and responded with a smile.
As expected of a man who has seen the world, his words are very insightful.
In the hospital, there are indeed only a few departments that can truly achieve results.
Obstetrics has been developing better and better in recent years and has the potential to achieve results.
However, compared with the old and powerful departments such as cardiac surgery, neurology and neurosurgery, and orthopedics, obstetrics is relatively weaker.
At this time, the two had already arrived at the inpatient ward.
The emergency department is actually not very large. Whether you are traveling to the operating room, inpatient ward, emergency room, or ICU, the journey is basically no more than three minutes.
During the ward rounds, Zhou Can wanted to see her level.
The first bed he found was a very frail elderly patient. This old lady had acute intestinal perforation, so Zhou Can performed debridement and intestinal repair surgery on her. She is currently recuperating in bed.
The old man's recovery was not very ideal. He was already 76 years old and was frail, so his recovery was much more difficult than that of an ordinary person.
Zhou Can gave a conservative assessment of the old man, saying that it would be good if he could be discharged from the hospital in seven days.
If an abdominal infection occurs, it is hard to say whether you can be discharged alive, let alone be discharged in seven days.
"Jiang Wei, you majored in nursing, can you see if there is any improvement in the care of this patient?"
Postoperative care of the patient is extremely important.
The current nursing level of the emergency department cannot be said to be very good, it can only be considered average.
"OK!"
She agreed and began to learn about the patient's condition in detail.
"From her current physical signs, appetite, flatulence, and urine output, we can see that the operation was very successful. There has been no postoperative infection, secondary intestinal perforation, or leakage. Her postoperative care is mainly focused on anti-infection. I suggest that she eat some liquid food appropriately to promote intestinal peristalsis and provide her with better nutritional support. In addition, it is recommended that she consume at least 50 grams of ground soybeans every day in the liquid food to increase the amount of flatulence, which is more conducive to intestinal recovery."
After listening to this, Zhou Can's eyes lit up slightly.
This was his first formal exposure to the flexible application of nutrition in nursing.
Postoperative care also includes nutritional support in the critical care department, but it is only for the purpose of protecting the patient's life. And most of them are simple and crude nutrition solution input.
The dietary therapy suggestions proposed by Jiang Wei at this moment are obviously a level higher than the ordinary nutritional support.
"As expected of a PhD student who studied abroad, the suggestion you made is very good. Tell the family members a detailed list of dietary therapy and let them prepare according to it." Zhou Can deliberately mentioned Jiang Wei's identity as a PhD student who studied abroad.
This is to increase the family's trust in her.
During clinical diagnosis and treatment, family members are more willing to listen to the doctors and will automatically ignore the presence of the nurses.
To this day, most patients and their families still have certain prejudices against nurses.
They believe that nurses only know how to give injections and change dressings, and that they can make mistakes even when giving an injection. When encountering obese patients with unclear blood vessels, or children with very thin blood vessels, it often takes two or three injections to be successful.
These discriminations are very unfair to nurses and are also one of the reasons for the high turnover rate of nurses.
"She is a PhD student who studied in the United States. She is very knowledgeable and the suggestion she just made is very good. Please remember to follow her suggestion and feed this grandmother some liquid food. This can shorten her hospital stay and save a lot of treatment costs."
Zhou Can has already become adept at communicating with family members.
If you mention anything else, the family members will often think you are talking nonsense. But as long as you mention that it can reduce treatment costs, shorten hospital stays, and speed up recovery, the family members will immediately become very positive.
"Okay, okay, please tell me. I'll make a note of it and buy it right away."
The patient's daughter was probably in her fifties. After hearing this, she took out her cell phone and pressed the recording button.
Zhou Can couldn't help but feel nervous.
He gets nervous every time he sees patients or their family members recording or videotaping with their mobile phones. He believes other medical staff feel the same way.
Because after recording videos and audios, these people are most likely collecting evidence in preparation for future complaints and lawsuits.
However, this family member must be relatively old and had no paper or pen with him, so he suddenly had an idea and thought of using his mobile phone to record the conversation.
"Grind soybeans into powder, about 50 grams a day, no more than 100 grams. Fish soup, especially crucian carp and black carp soup, has good nutritional value and is more conducive to wound recovery..."
She gave some dietary advice.
Jiang Wei seemed very calm about the patient's recording.
Zhou Can was listening quietly at the side. The dietary therapy lists she gave were all very common.
However, each food can be perfectly tailored to the patient's illness or physical condition, revealing her very high level of nutritional knowledge.
Just like Zhou Can, after reaching level 6 incision, he can perform dissections easily, accurately and quickly during surgery. Every time he cuts tissue or removes lesions, he does it just right.
The dietary advice she gives to her patients also reaches this just-right high level.
Each food and amount of food consumed is specially formulated according to the patient's physical condition.
In the following ward rounds, she was able to give some good suggestions from time to time in the key care or treatment of some patients, even including medication.
Moreover, she was always able to hit the target every time, which won Zhou Can's deep approval.
Even Zhou Can benefited greatly from some of the medication suggestions, and learned some new medication knowledge or gained some inspiration.
For example, when checking the patient in bed 27, because this patient had undergone a coronary stent surgery and was hospitalized for pneumonia, she suggested that when the patient's inflammation treatment medication is used, it is necessary to consider increasing the dose of anticoagulants.
Some other medication adjustments may also need to be made.
Because inflammatory response and coagulation activation are a 'two-way street'.
The inflammatory response can lead to hypercoagulation.
This increases the risk of blood clots.
At the same time, hypercoagulation can cause activated coagulation factors to bind to PARs of various cells, which will promote the synthesis and release of more inflammatory mediators, further exacerbating the inflammatory response.
She suggested that the medication regimen should not only consider the risk of increased thrombosis, but also resolve the "cross-dialogue" between inflammatory response and coagulation activation.
Although it was just a small suggestion, it benefited Zhou Can greatly.
At the same time, it also reveals that the level of internal medicine diagnosis and treatment in the emergency department is poor.
It can also be considered that her pharmacology level is very high, which highlights the poor level of emergency medicine physicians.
After checking the room, Zhou Can was very happy.
This time I really found a treasure.
Having such a highly skilled nurse join his team is definitely a great help. It can instantly improve the level of his team.
Take her to change clothes and go into the operating room.
The first operation was an emergency trauma surgery. The patient was jogging in the morning. Because it was dark and the street lights were not bright, he stepped on a banana peel thrown by a passerby and unfortunately took a free flight.
Eventually, a deep wound was left on the right elbow .
Zhou Can checked the wound on the patient's right arm. It was about 4cm long, which was only a small wound. At least in his eyes as a doctor, it was nothing.
The deepest part of the wound reached more than 2cm, and blood could be seen still oozing out.
It looks like an artery is ruptured.
Because if it is a vein, it can generally stop bleeding automatically, and the color of the blood that comes out will be darker.
Although it seems to be just a minor injury, the difficulty of the patient's surgery has been increased a lot .
After examination, Zhou Can found that the ruptured blood vessel was most likely the ulnar recurrent artery.
Both the anterior and posterior branches of the ulnar recurrent artery are important.
In addition, the ulnar artery and radial artery are terminal branches of the brachial artery, which is the main blood supply to the end of the arm.
Simply tying it to stop bleeding would cause the patient's right arm to lose some blood flow, causing many problems, and even dysfunction, ischemic necrosis of some muscles and tissues.
In addition to debridement, surgery also requires assessment and repair of damaged blood vessels.
As long as the patient does not die at his grandmother's house at an unlucky time, there should be no need to consider vascular transplantation or artificial blood vessel replacement.
Sometimes, if the damaged blood vessel segment is long, autologous venous grafting needs to be considered.
The doctor will give advice on specific treatment, and the patient and family will make their own choice.
Speaking of this, we must mention a principle of surgical signature.
If the patient is an adult and conscious, the surgery must be approved by the patient. Otherwise, even if the family members sign, if the patient disagrees, the doctor must respect the patient's wishes and cannot force the surgery.
There was a similar case where the doctor was sued by the patient because he did not respect the patient's wishes. The hospital was eventually ordered to compensate the patient for his losses.
But for patients, if they have lost some important organs or functions, no matter how much compensation they receive, it will be meaningless.
Just imagine, if one of a woman’s breasts is cut off, or her uterus is cut off, what is the use of all the money she gets?
"Jiang Wei, are you qualified to be the instrument nurse for this operation?"
Zhou Can asked directly.
Qiao Yu has already prepared instruments, medicines, sutures and other items.
Jiang Wei only needs to pass the equipment, medicines and consumables to Zhou Can.
The instrument nurses among surgical nurses have another not-so-nice name, called hand-washing nurses.
If you understand it literally.
She is just a nurse who helps doctors wash their hands. What technical content can this have?
In fact, the technical content of instrument nurses is not particularly high. As long as you are familiar with the surgical process, you can basically do this job well.
During the operation, the surgeon will sometimes give verbal reminders about what the surgeon needs.
For example, which size scalpel, which size suture, etc.
Of course, a skilled nurse can prepare in advance without the surgeon's reminder.
For example, Qiao Yu was able to prepare all the instruments and consumables for Zhou Can in advance during the operation. When it came to rescue, she could help a lot and even provide some rescue suggestions directly.
Having worked as a surgical nurse under Zhou Can for two years, Qiao Yu now has very strong practical skills.
She has been teaching herself advanced nursing knowledge such as nutritional support and critical care in preparation for studying abroad.
This time a nurse who had studied abroad came, which was also a good opportunity for Qiao Yu.
She can learn from Jiang Wei what preparations she needs to make to study nursing abroad.
“Let me try!”
Jiang Wei calmly walked to the position of the instrument nurse, while Qiao Yu walked aside and said to her in a friendly manner, "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 and smiled gratefully at Qiao Yu.
The operation began, and Jiang Wei began to pass or take back surgical instruments and consumables according to Zhou Can's needs. The whole assisting process was extremely relaxed and skillful, and it was obvious that she was at ease.
Qiao Yu, Ma Xiaolan, Pu Dingdong and others were all stunned.
I thought the person coming was just a newbie, but who knew that he turned out to be a king-level master.
The first operation was over quickly, and Zhou Can found that Jiang Wei had been replaced as his nurse, and there was no sense of disobedience. It was as if no one had changed.
Jiang Wei also possesses the same tacit understanding in surgery that Qiao Yu and he have.
If Qiao Yu's ability is the result of her talent and hard work, then Jiang Wei is definitely extremely capable.
"Jiang Wei, not bad! Your familiarity with instruments, various drugs, and sutures definitely shows that you are a battle-hardened surgical nurse ."
Zhou Can was generous in praising her.
"Haha, thank you for your recognition! Your surgical skills are the best among the young doctors I have ever seen. Whether it is debridement, vascular repair, or cortical suturing, every step is impeccable and perfect."
She has worked in at least two large hospitals, especially in Zhongyuan University Affiliated Hospital, and must have seen many great surgical experts.
"And the speed of your surgery is shocking."
