INFORMATION ABOUT YOUR CLIENT ON YOUR ACTIVITY SHEET.
SO YOU CAN WALK AROUND WITHOUT HAVING TO HAVE
THE CHART ATTACHED TO YOU AT ALL TIMES,
BECAUSE WE CAN'T, OTHER PEOPLE NEED IT.
SO YOU'VE GOT TO HAVE A MECHANISM OF GATHERING INFORMATION.
AND WHEN YOU GATHERED INFORMATION ABOUT MEDICATIONS,
YOU WENT TO THE MEDICATION ADMINISTRATION RECORD
TO SEE WHEN THOSE MEDICATIONS WERE DUE.
SO YOU HOPEFULLY, FOUND THEM IN THE MED BOOK.
YOU SAW THAT THESE PARTICULAR MEDS,
THE ROUTINE MEDS, WERE DUE AT EIGHT AND AT TWO.
WE'RE GOING TO BE GIVING THE EIGHT O'CLOCK MEDS FOR OUR ACTIVITY.
SO WHETHER YOU COME IN AT 10:30 OR 9:15, YOU'RE GIVING EIGHT O'CLOCK MEDS.
SO, DRAMA CLASS, IT'S EIGHT O'CLOCK WHEN YOU ARRIVE.
ALRIGHT. SO WE HAVE A PLAN. IT'S EIGHT O'CLOCK AND WE'RE GETTING READY.
RIGHT NOW I'M IN THE MED ROOM.
YOU ARE GOING TO BE IN YOUR LOWER PREP ROOM OVER HERE IN 182,
GETTING ALL OF YOUR SUPPLIES READY.
IN FACT, I'M NOT GOING TO CHECK YOU OFF ON GETTING READY.
YOU'RE GOING TO GET YOUR STUFF READY,
I'M GOING TO CHECK YOU OFF AS TO WHAT YOU HAVE.
AND THAT'S WHAT HAPPENS PRETTY MUCH IN THE NURSING FLOORS.
YOUR INSTRUCTORS WILL SAY, "GO GET YOUR MEDS, GO GET YOUR MAR."
AND THEN THEY CHECK IT WHEN YOU COME BACK WITH IT,
BECAUSE WE DON'T HAVE TIME TO WATCH EVERYBODY DO EVERY LITTLE THING.
ALRIGHT, WHEN YOU GET READY TO GIVE MEDS, WE WANT TO KEEP THREE THINGS IN MIND.
YOUR SIX RIGHTS, YOU ALREADY KNOW THEM.
SO WE'LL BE CHECKING OUR ORDER TO MAKE SURE THAT WE HAVE ALL THE INFORMATION,
AND WE'RE COMPLIANT WITH THE SIX RIGHTS.
BUT WE ALSO WANT TO DO ONE OTHER THING, AND THAT'S THE THREE CHECKS.
WE'RE GOING TO CHECK OUR MEDICATION THREE TIMES,
TO MAKE SURE WE'VE GOT THE RIGHT ONE.
OUR GOAL HERE IS TO HELP THE CLIENT,
AND NOT TO GIVE THEM ANYTHING WRONG, AND NOT TO MAKE ANY MEDICATION ERRORS.
SO WE GET A LITTLE ANAL-ATTENTIVE, IF YOU WILL, ON THIS.
BUT IT'S IMPORTANT SO THAT WE DON'T MAKE ERRORS.
AND THAT'S WHAT WE'RE GOING TO DO.
SO, WHEN YOU GET YOUR MEDICATION ADMINISTRATION RECORD, IT LOOKS JUST LIKE THIS.
THIS IS ST AGNES', BELIEVE.
YOU CAN TAKE IT OUT OF THE CHART.
JUST THE SHEET YOU NEED, DON'T TAKE A BUNCH OF EXTRA STUFF.
AND WHAT YOU WANT TO DO IS YOU WANT TO START
SYSTEMATICALLY LOOKING AT YOUR SHEET AND CHECKING IT.
ALWAYS START FROM THE TOP AND GO DOWN LOOKING AT THE TIMES
TO MAKE SURE THAT YOU'VE GOT ALL THE MEDS YOU THINK YOU WERE SUPPOSED TO HAVE.
THINGS COULD HAVE BEEN ADDED OR YOU MAY HAVE MISSED A TIME WHEN YOU DID YOUR LITTLE SHEET.
SO WE ALWAYS JUST CHECK FROM THE TOP TO THE BOTTOM.
PRETTY STRAIGHT FORWARD, WE ONLY HAVE TWO MEDS AND TWO ON HERE.
BUT I'M GOING TO START HERE AND REALIZE THAT I HAVE CONRAD CURRY.
DR. I AM SMART, I WANT TO NOTE THAT THIS CLIENT HAS ALLERGIES
BEFORE I EVER REALLY GET GOING TO MAKE SURE THAT ANYTHING I AM GIVING
IS OKAY WITH HIS ALLERGY SITUATION.
AND I'M KIND OF CAUTIONED STRAIGHTAWAY WHEN LOOK AT LASIX.
BECAUSE WE KNOW THAT LASIX HAS A CONTRAINDICATION RELATED TO --
- SULFA. - SULFONAMIDES.
SO IF THAT WERE THE CASE, THERE'S TWO THINGS I WANT TO DO.
FIRST IS, I WANT TO CHECK WITH MY CLIENT TO SEE WHAT HE THINKS AN ALLERGY IS.
THERE ARE SIDE EFFECTS AND THERE ARE ALLERGIES,
AND THEY ARE TWO DIFFERENT THINGS.
FOR EXAMPLE, I MIGHT SAY ON MY RECORD I'M ALLERGIC TO CODEINE.
I'M REALLY NOT.
IT MAKES ME THROW UP,
BUT I'M NOT ALLERGIC TO IT.
I JUST DON'T TAKE IT WELL.
THE SAME THING MAY BE FOR LASIX.
I NEED TO FIND OUT WHAT HAPPENS WHEN YOU TAKE IT.
OH, I GET A RASH, I HAVE SHORTNESS OF BREATH,
I GET THIS BUTTERFLY REDNESS ACROSS MY NOSE.
OH, THAT'S NOT GOOD. YOU'RE ALLERGIC TO IT.
SO YOU'RE LOOKING AT THINGS THAT ARE DISTINGUISHABLE
BETWEEN AN ALLERGIC REACTION AND JUST A SIDE EFFECT OF THE DRUG,
BECAUSE WE CAN GIVE SOMETHING FOR NAUSEA, IF THEY NEED THE DRUG.
BUT ALLERGY, THAT'S NOT A GOOD THING.
WE DON'T WANT TO MAKE IT WORSE, AND SOMETIMES, THE MORE MEDS YOU GIVE, THE WORSE IT CAN GET,
AND WE DON'T WANT ANY ANAPHYLAXIS HAPPENING, WHICH IS?
- STOP BREATHING. - STOP BREATHING. BAD SHAPE.
ALRIGHT, SO WE GO ASK HIM. ONCE WE'VE VERIFIED THAT IT IS AN ALLERGY
OR WE'RE PRETTY SURE WE'RE NOT COMFORTABLE GIVING IT,
THAT'S WHEN I WOULD CALL THE DOCTOR.
BUT YOU DON'T WANT TO -- EVEN WHEN YOU'RE TEST TAKING,
ALWAYS PICK THAT ANSWER THAT SAYS, "CALL THE DOCTOR."
YOU DO WHAT YOU COULD DO FIRST.
AND THEN YOU DECIDE WHEN THE DOCTOR NEEDS TO BE CALLED.
SO OUR FIRST THING IS TO MAKE AN ASSESSMENT,
WHAT HAPPENS WHEN YOU TAKE IT?
ALRIGHT, SO MY CLIENT SAYS, HE GETS NAUSEATED, AND WE'RE OKAY.
SO I'M LOOKING AT MY DRUGS HERE. I NEED TO GIVE LASIX AT EIGHT O'CLOCK.
MY DRUG ORDER IS COMPLETE. WHAT DO YOU NEED IN A DRUG ORDER?
A DRUG. SO WE NEED TO BE LOOKING TO SEE WE HAVE THE RIGHT DRUG.
WE NEED A DOSE, YOU CAN'T JUST MAKE IT UP.
YOU HAVE TO HAVE A ROUTE, AND WE WANT TO BE COMPLIANT WITH THE ROUTE,
AND WE HAVE TO HAVE A TIME.
AND THAT'S MINIMUM FROM WHAT THE DOCTOR HAS TO ORDER FOR US.
WE'RE GOING TO MAKE SURE THAT ALL THOSE THINGS HAPPEN RIGHTLY,
AS WELL AS IDENTIFYING OUR CLIENT WHEN WE GET IN THERE,
GIVING IT CORRECTLY AND THEN DOCUMENTING IT CORRECTLY WHEN WE'RE THERE.
SO MY ORDERS ARE COMPLETE. I'M PLEASED WITH THAT.
THE NEXT THING I WANT TO DO IS SIMPLY GO TO MY MEDICATION CART.
WE'RE GOING TO BE SIMULATING A UNIT DOSE SCENARIO
WHICH IS SIMILAR TO THE HOSPITALS.
AND THE TRICK ABOUT TEACHING MEDICATIONS IS,
I NEED TO TEACH YOU THEORY, BUT EVERY HOSPITAL DOES IT A DIFFERENT WAY.
FOR EXAMPLE, THOSE OF YOU THAT ARE AT THE V.A.,
THEY USE BARCODE SYSTEMS TO GET INTO THEIR DRUGS.
AND THEY HAVE A LITTLE WAND HERE ON THE MED CART.
AND THEY WAND THE DRAWER AND GET THEIR DRUGS OUT,
AND THEY WAND THE DRUGS, AND EVERYTHING READING THOSE BARCODES.
LIKE THEY HAVE IN THE SUPERMARKET THAT TELLS THEM THAT IT'S THE RIGHT DRUG.
AND IT ELECTRONICALLY DOCUMENTS IT,
AND THEN WHEN THEY GO IN TO THE CLIENT, THEY WAND THEIR NAME BAND
BECAUSE THEIR NAME BAND HAS A BARCODE, AND THEN THEY WAND THE DRUG.
AND WHEN IT ALL MATCHES, YOU GET TO GIVE THE MED.
WE'RE DOING THE SAME THING MANUALLY.
MOST OF THE SYSTEMS IN THE HOSPITALS HAVE A PICSYS SYSTEM
WHICH IS AN ELECTRONIC SYSTEM, BUT IT'S STILL A HARD COPY PAPER SYSTEM.
SO YOU STILL HAVE TO GET IN, AND IT'S A UNIT DOSE SYSTEM INTO DRAWERS.
BUT IT'S ELECTRONICALLY CALCULATED, IF YOU WILL.
AND THE DRAWERS ARE ELECTRONICALLY MANAGED.
SO WHATEVER THEIR SYSTEM IS, THEY'RE STILL DOING THE SAME THINGS.
THEY HAVE TO HAVE COMPLETE ORDERS, AND YOU HAVE TO CHECK IT THREE TIMES,
EVEN ELECTRONICALLY TO GIVE THE RIGHT MEDS.
SO, WE'RE GOING TO JUST DO IT MANUALLY, BECAUSE I DON'T HAVE ALL THOSE SYSTEMS.
BUT YOU'LL SEE THAT IT ALL PLAYS OUT THE SAME, WHEREVER YOU'RE WORKING.
ALRIGHT, THE FIRST THING I WANT TO DO, I WANT TO EXPLAIN THE MED DRAWERS HERE.
WHEN YOU SEE CARTS LIKE THIS,
JOINT COMMISSION REQUIRES THAT WE KEEP THE MED CARTS LOCKED.
THEY CAN'T JUST BE SITTING OUT IN THE HOSPITAL, IN THE HALLWAY LIKE THIS.
- THERE'S SOMETHING ON IT. - UH-HUH. AND THEY'RE NOT SUPPOSED TO BE IN IT.
IF OSHA CAME THROUGH, AND IF THE JOINT COMMISSION AND THE REGULATING BODIES COME THROUGH,
THEY GET FINED OR THEY GET CITED, BECAUSE IT'S NOT SAFE PRACTICE.
ANYONE COULD GRAB INTO A DRAWER AND CAN GET WHATEVER THEY WANTED.
I MEAN, MOST PEOPLE DON'T, BUT YOU KNOW WHAT I'M SAYING.
AND SO FROM A SAFETY POINT OF VIEW, THESE NEED TO BE LOCKED.
SO THIS ONE IS LOCKED BY A KEY ON THE SIDE.
AND THEN MY NARCOTICS CABINET, I REALLY DO HAVE LOCKED.
OKAY, AND WE'RE GOING TO GET TO NARCOTICS LATER.
BUT RIGHT NOW, THIS IS OUR MED DRAWER AND I'M NOT GOING TO KEEP IT LOCKED,
FOR ONE, IT'S JUST THE KEYS GET ALL DISCOMBOBULATED AROUND HERE.
SO THIS NEEDS TO BE LOCKED BETWEEN MED ADMINISTRATIONS,
AND IT NEEDS TO BE LOCKED IN THE ROOMS.
NOW IF THE NURSE IS GIVING MEDS, AND SHE'S GIVING A WHOLE BUNCH OF THEM,
SHE USUALLY DOESN'T LOCK IT BETWEEN EVERY SINGLE ONE,
BUT AFTER MED ADMINISTRATION, THEN SHE LOCKS IT.
ALRIGHT, I NEED TO GET CONRAD CURRY'S CARD OR DRUG DRAWER.
YOU CAN SEE THAT WE HAVE THREE FOR EVERY CLIENT.
I HAVE SALLY SMITH, BETTY JONES, ALAN SMITH AND SO FORTH.
SO, JUST GET A DRAWER THAT YOU NEED. WE JUST MAKE DUPLICATES COS WE GOT LOTS OF YOU.
AND THERE YOU HAVE IT.
ALRIGHT, ONCE I HAVE MY --
MY LITTLE DRAWER, I CAN MOVE THIS STUFF ASIDE FOR NOW.
AND WHAT I WANT TO DO IS GET MYSELF A TRAY.
AND I WANT TO GET MYSELF A CUP SO THAT I CAN BEGIN TO HUNT FOR MY MEDS,
AND PUT MY MEDS INTO A MEDICATION CUP.
SO, THAT'S WHAT WE'RE GOING TO DO, NOT TOO DIFFICULT.
I'M DIGGING THROUGH MY DRAWER, I'M LOOKING FOR LASIX 40 MILLIGRAMS,
I HAVE LASIX 40 MILLIGRAMS, THIS IS MY FIRST CHECK.
LASIX 40, LASIX 40 PO, IT'S A PILL. I PUT IT IN MY CUP.
ALRIGHT, THE NEXT THING I NEED, I'M GOING TO GO ON DOWN MY LIST
IS POTASSIUM 10%, 40 MIL EQUIVALENTS PO.
SO I DIG AND I DIG AND I DIG, AND THERE'S NO PILLS.
SO NOW MAYBE I SHOULD LOOK AT THESE BOTTLES.
OH, I HAVE IT IN A LIQUID FORM.
OKAY, YOU DIDN'T KNOW THAT WHEN YOU WERE GETTING YOUR DRUG CARTS READY.
SO YOU'RE GOING TO HAVE A LITTLE BIT MORE TO ADD TO YOUR DRUG CARTS
BUT YOU KNOW ENOUGH ABOUT POTASSIUM
THAT WE'LL BE ABLE TO DISCUSS A LITTLE FURTHER HERE.
ALRIGHT, IT SAYS I NEED POTASSIUM 10%, 40 MIL EQUIVALENTS PO BID.
THIS SAYS, I HAVE POTASSIUM 10 MIL EQUIVALENTS 10%,
10 MIL EQUIVALENTS PER 5 MILLILITERS.
HOW MUCH DO I NEED?
I NEED TO GET 40 MIL EQUIVALENTS AND I HAVE 10 PER 5.
- 20 MILLILITERS. - 20 MILLILITERS, OKAY.
NO TRICKS, BUT YOU GUYS NEED TO GET INTO YOUR DRAWERS AND MAKE SURE
THAT YOU'VE ALREADY PRE-CALCULATED WHAT YOU NEED TO GIVE THE RIGHT DOSE.
ALRIGHT, I'M GOING TO GO AHEAD AND LOOK AT MY BOTTLE
AND MAKE SURE THAT THIS HASN'T EXPIRED YET.
AND SO MY EXPIRATION DATE IS GOOD, EVERYTHING LOOKS FINE ABOUT THIS.
NOW I NEED A MEASURING CUP.
THESE MEASURING CUPS ARE ONLY GOOD TO THE 5 CENTIMETERS.
CENTIMETERS, NO. 5 MILLILITERS OR CUBIC CENTIMETERS. THEY'RE THE SAME.
SO IF I HAD A DRUG THAT WAS SEVEN OR EIGHT OR TWELVE MILLILITERS,
THEN I'D HAVE TO GET A SYRINGE TO DRAW IT UP AND THEN I COULD SQUIRT IT INTO THE CUP.
BUT I'M OKAY WITH 20.
SO WHAT I WANT TO DO IS POUR IT TO THE 20 MILLILITER LINE ONCE I FIND IT.
WHEN YOU DO A LIQUID MED, YOU WANT TO TAKE THE CUP OR THE JAR,
AND YOU WANT TO HOLD IT WITH THE LABEL IN YOUR HAND
SO THAT WHEN YOU POUR, IF IT DRIBBLES DOWN,
IT DRIBBLES TO THE BACK OF THE JAR AND IT DOESN'T OBSCURE THE LABEL.
THEN YOU ALSO WANT TO GET DOWN HERE AND BE AT EYE LEVEL WITH THE 20 MILLILITERS.
ALRIGHT, AND THEN YOU JUST POUR IT IN TO THE 20 MILLILITER LINE.
ONE OTHER LITTLE THING IS HAPPENING WHILE I'M POURING,
AND THAT IS, I'M CREATING A LITTLE BIT OF A MENISCUS. WHAT'S A MENISCUS?
- BASICALLY THAT... - OTHER WAY.
THE LITTLE -- THE LITTLE DIP THAT GOES THIS WAY IN YOUR LIQUIDS.
IT'S HOW IT HOLDS ON TO THE CONTAINERS.
AND SO WHEN YOU'RE MEASURING THAT DIP THAT HAPPENS,
YOU WANT TO MEASURE YOUR DRUG TO THE BOTTOM OF THE DIP NOT TO THE SIDES OF THE EDGES.
BUT IT'S NOT MUCH, IT'S NOT VERY PRONOUNCED IN THERE
ESPECIALLY WITH THIS PARTICULAR VOLUME.
BUT SOMETIMES YOU CAN SEE IT A LITTLE MORE PRONOUNCED WITH CERTAIN VISCOSITIES OF DRUGS,
AND SO YOU WANT TO MEASURE RIGHT TO THE BASE OF THAT.
ALRIGHT, WELL, THERE WE HAVE IT.
I HAVE SOME LASIX AND I HAVE SOME POTASSIUM, I BELIEVE.
SO NOW I WANT TO MAKE MY SECOND CHECK.
NOW THAT THEY'RE OUT OF THE DRAWER AND READY AND I WANT TO LOOK AT THEM,
AND I'M GOING TO BE MAKING MY SECOND CHECK.
AND I'M GOING TO BE THINKING IS THIS DOSE SAFE, 40 MILLIGRAMS?
YES, IT IS LASIX AND IT DOES MEET THE PARAMETERS OF ADMINISTRATION FOR LASIX.
I'M HAPPY ABOUT THAT. THIS IS POTASSIUM.
AND NO ONE WOULD KNOW IT'S POTASSIUM, EXCEPT IF I TOLD THEM, RIGHT?
BECAUSE IT'S IN AN UNLABELED CONTAINER.
SO I THINK I BETTER DO SOMETHING ABOUT THIS.
SO I HAVE A LITTLE PAPER TAPE HERE.
AND I'M GOING TO TAKE A LITTLE PIECE OF PAPER TAPE AND MY PEN.
AND I'M JUST GOING TO WRITE THAT I HAVE KCL 10% 40 MIL EQUIVALENTS.
I'M NOT GOING TO WRITE 20 MILLILITERS COS I CAN READ THAT ON THERE.
BUT AT LEAST IT TELLS ME WHAT I'VE GOT GOING IN THIS PARTICULAR JAR OR LITTLE CUP.
ALRIGHT, I'M GOING TO DOUBLE CHECK AGAINST MY LABEL THAT THIS IS INDEED
POTASSIUM CHLORIDE 10% 40 MIL EQUIVALENTS IS WHAT I NEED.
10 MIL EQUIVALENTS IS PER 5, I MIGHT REDO MY MATH
AND MOST OF THE TIME PHARMACY WRITES ON THERE,
AND YOU NEED 20 MILLILITERS, THEY'RE NICE TO US.
BUT I WANT TO DOUBLE CHECK EVERYTHING. AND THEN I'M HAPPY.
ALRIGHT, I WANT TO BE THINKING ABOUT MY DOSE ON THIS ONE.
WHAT DO YOU THINK ABOUT THIS 40 MIL EQUIVALENT DOSE,
ACCORDING TO YOUR READING, AND YOUR DRUG CARTS?
A LITTLE HEFTY, RIGHT?
WHAT DID THEY SAY THAT YOU SHOULD GIVE FOR A SINGLE DOSE? NO MORE THAN 20 MIL EQUIVALENTS.
YOU COULD GIVE UP TO 100 MIL EQUIVALENTS PER DAY RELATED TO DEPLETION,
BUT 20 MIL EQUIVALENTS IS WHAT'S RECOMMENDED PER DOSE.
SO WHAT WOULD YOU DO AT THIS POINT?
- BRING IT TO THE PHYSICIAN'S ATTENTION.
- NOT FIRST. I DO A LOT OF THINGS BEFORE I CALL A DOCTOR.
I'VE BEEN YELLED AT ENOUGH IN MY LIFE. I'VE LOOKED STUPID, I'VE FELT STUPID.
SO THAT I DO A LOT OF OTHER THINGS FIRST. SO, ALWAYS ENTERTAIN.
IS THERE ANYONE ELSE YOU COULD CALL BEFORE YOU CALL A PHYSICIAN?
- THE PHARMACY. - CALL THE PHARMACY?
THEY'RE NICER, I DON'T KNOW WHY.
BUT CALL THE PHARMACIST AND SAY, "I SENSE A LITTLE DISCREPANCY HERE.
MY BOOK SAYS THAT YOU SHOULD ONLY GIVE 20 MIL EQUIVALENTS AND THE DOCTOR'S ORDERED 40.
THE CLIENT COMPLAINS OF STOMACH BEING UPSET. AND WHAT DO YOU KNOW ABOUT THIS?"
AND THEY'LL SAY, "WELL, THE BOOK RECOMMENDS THAT YOU ACTUALLY CAN GIVE UP TO 40
ACCORDING TO MY LITERATURE, AND MY STUDY.
YOU MIGHT WANT TO CALL THE DOCTOR AND ASK HIM
IF HE'D LOWER IT TO 20 AND GIVE IT WITH FOOD BECAUSE OF THE GI DISTRESS."
OKAY, NOW I'VE GOT SUPPORT AND I'VE GOT A LITTLE MORE INFORMATION AND MY BOOK.
WHAT YOU WANT TO DO AT THAT POINT IS, IN YOUR NURSE'S NOTES SAY,
"CONTACTED DR. SMITH, PHARMACIST AND DISCUSSED KCL DOSE.
RECOMMENDS LOWER DOSE FOR CLIENT RELATED TO GI DISTRESS AND RECOMMENDED DOSING."
THEN DR. I AM SMART WAS CALLED.
SO DO SOMETHING FIRST IF YOU CAN, THEN CALL THE PHYSICIAN.
SO NOW, YOU ARE INFORMED AND YOU DON'T FEEL SO DULL.
BECAUSE IT'S JUST EMBARRASSING TO GET BEAT UP ABOUT STUFF LIKE THAT ALL THE TIME.
ALRIGHT, SO, WE'RE GOING TO GO AHEAD AND GIVE IT AS ORDERED,
JUST BECAUSE THAT'S THE DRILL AND WE POURED IT, BUT PROCESS THROUGH.
THROUGHOUT ALL OF MY MED ADMINISTRATIONS,
I FREQUENTLY MIX IN SOME DRUGS THAT ARE OFF.
SO DON'T JUST ACCEPT THAT BECAUSE IT WAS WRITTEN, IT IS RIGHT.
IT'S NOT THAT WAY OUT IN THE FIELD, AND IT'S NOT THAT WAY IN HERE.
SO BE DISCERNING NURSES AND COMPARE AND HAVE SOME LITERATURE
TO SUPPORT THE DECISION THAT YOU'RE GOING TO MAKE.
WE'LL DISCUSS IT AT THE BEDSIDE AND GO, "YOU KNOW, I'D PREFER TO GIVE 20 MIL EQUIVALENTS."
I'LL CALL THE PHARMACIST, I'LL CALL THE PHYSICIAN, AND I'LL GO, "GOOD, GIVE IT."
YOU KNOW, BECAUSE WE WANT TO GO THROUGH THE OTHER STEPS AT THE END.
ALRIGHT, AFTER -- UH-HUH? - WHAT DO YOU DO IF YOU POUR TOO MUCH OF IT?
- IF YOU POUR TOO MUCH, YOU'RE NOT SUPPOSED TO POUR IT BACK INTO THE BOTTLE.
YOU'RE SUPPOSED TO JUST POUR IT OUT. SO THAT CAN GET A LITTLE MESSY.
SO IT'S BETTER TO POUR LESS IF YOU CAN AND THEN UP -- AND THEN WORK IT UP,
AND THEN IF YOU NEED TO POUR OUT, POUR OUT IN THE SINK.
OKAY, I HAVE THE TWO DRUGS I NEED. I THINK I'M READY TO GO.
I'M GOING TO PUT THIS BACK HERE.
AND THIS IS WHAT YOU NEED TO DO AS YOU DO THIS.
AS A NURSE, I WOULD GO GET IT -- I'M GOING TO DO MY THIRD CHECK AT THE BEDSIDE.
BUT AS A NURSE, YOU WANT TO HAVE YOUR INSTRUCTOR CHECK IT AND THEY HAVE TO GO WITH YOU.
SO, YOU'RE GOING TO GET YOUR MEDS READY IN YOUR --
IN THE THE LITTLE STUDENT ROOM. THERE'S STILL A COUPLE OF THINGS, I NEED TO DO.
AND THEN YOU'RE GOING TO COME LET US AND CHECK IT FOR A THIRD CHECK.
SO BEFORE YOU COME TO ME, THERE'S A COUPLE OF THINGS YOU MIGHT WANT TO DO FOR YOURSELF.
AND THAT IS, I KNOW THAT BECAUSE I'VE DONE ALL MY READING ON THESE DRUGS,
THERE ARE SOME THINGS I WANT TO CHECK ABOUT MY CLIENT, BEFORE I GIVE THE DRUG, RIGHT?
THERE ARE SOME THINGS YOU WANT TO KNOW ABOUT YOUR CLIENT BEFORE YOU GIVE LASIX.
WHAT WERE THOSE THINGS?
WE CHECKED FOR SULFA ALLERGY.
- ELECTROLYTE. - ELECTROLYTES.
SO, YOU MIGHT CHECK THAT WITH THE CHART. WHAT ELSE?
- HYDRATION. - HYDRATION, HYPOTENSION.
- HYPO-BULIMIA. - THAT'S LAB STILL, SO WE CAN CHECK THE LABS.
THE CLIENT, WE WANT PULSE AND BLOOD PRESSURE BEFORE WE GIVE THIS DRUG.
HOW LONG DOES IT TAKE THIS DRUG TO WORK?
ABOUT 45 MINUTES, THAT'S WHAT IT'S --
LOOK IN YOUR BOOK FOR THE ONSET PEAK AND DURATION OF YOUR DRUGS.
I DIDN'T HAVE YOU DO THAT QUITE YET
AND YOU'RE GOING TO REALLY HONE IN ON THAT A LITTLE MORE IN PHARMACOLOGY,
BUT IT TAKES ABOUT 45 MINUTES FOR A PO MED TO START WORKING TO UP TO AN HOUR.
SO, WE HAVE A LITTLE TIME.
BUT WE WANT TO GET VITAL SIGNS BEFORE AND THEN TELL OUR CLIENT WHAT TO EXPECT FROM THIS DRUG.
SO ONE OF THE THINGS I'VE DISCOVERED, WHEN I GO INTO A CLIENT'S ROOM
IS THAT THEY JUST ARE READY FOR A NURSE TO COME IN.
AND AS SOON AS YOU GET THERE, THEY HAVE A MILLION QUESTIONS.
"GET ME THE TV, HELP ME TO THE BATHROOM, CAN YOU GET ME A BLANKET, I'D LIKE SOME JUICE."
AND THEN THEY JUST START HITTING ME WITH ALL THESE QUESTIONS.
AND IT'S VERY EASY TO GET DISTRACTED WHEN YOU'RE IN THE ROOM.
SO IF YOU GIVE YOURSELF SOME CUES ON YOUR LITTLE CUP, IT WILL REMIND YOU
THAT I NEED TO GET A PULSE AND I NEED TO GET A BP BEFORE I GIVE THIS DRUG.
SO GIVE YOURSELVES SOME CUES SO THAT YOU DON'T GET DISTRACTED.
WITH POTASSIUM, IS THERE ANYTHING I WANT TO DO REALLY BEFORE?
WHY AM I GIVING POTASSIUM ANYWAYS?
- COMPENSATING FOR THE LIQUID WE'VE LOST FROM [INDISTINCT].
- YES. IS THERE ANYTHING I NEED TO CHECK IN PARTICULAR WITH THE CLIENT?
I MEAN, I'M GOING TO CHECK LAB WORK.
NOT REALLY. BUT WHAT DO YOU THINK ABOUT GIVING THESE MEDS?
DID YOU NOTICE THAT WHEN YOU GIVE THEM, THAT THERE'S CRITERIA FOR HOW TO GIVE THEM.
DO YOU GIVE THIS ON AN EMPTY STOMACH OR WITH FOOD?
- WITH FOOD. - THIS ONE WAS WITH FOOD.
YOU DIDN'T HAVE MUCH CRITERIA FOR YOUR POTASSIUM, YOU DIDN'T KNOW IT WAS LIQUID.
HOW DO YOU GIVE A LIQUID? DO YOU JUST TAKE IT STRAIGHT?
DO YOU DILUTE IT? WITH FOOD OR WITHOUT?
- MIX IT AND PUT IT IN SOME KIND OF JUICE.
- YES, PUT IT IN JUICE. THIS STUFF IS JUST NOT TASTY.
IT'S PRETTY STRONG AND SO WE'RE GOING TO WANT TO DILUTE IT.
SO, I'VE SET MYSELF A LITTLE CUP HERE. I THOUGHT I DID.
A CUP. AND BEFORE I GO TO THE CLIENT'S ROOM,
I MIGHT ASK THEM OR I'LL GO IN AND ASK THEM" WHAT KIND OF JUICE DO YOU WANT ME TO PUT THIS IN?"
A LOT OF THEM LIKE CRANBERRY JUICE COS THIS IS A LITTLE BITTER
AND SO IF YOU PUT IT IN BITTER DOESN'T SEEM SO BAD.
A LOT LIKE APPLE JUICE BECAUSE THEN IT'S A LITTLE SWEETER COS THAT'S SOUR.
SO WHATEVER, DOESN'T MATTER. ORANGE JUICE, FINE, WHATEVER.
AS LONG AS IT COMPLIES WITH THEIR DIET.
ALRIGHT, WHAT WAS OUR DIET? THE CLIENT'S DIET?
- LOW SODIUM. - REGULAR, LOW SODIUM.
SO THEN YOU NEED TO BE CAREFUL ABOUT SOME OF YOUR JUICES LIKE TOMATO JUICE.
THAT'S TOO SALTY, BUT PICK SOMETHING APPROPRIATE.
AND THEN WE'LL BE READY TO POUR IT IN.
ALRIGHT, I BELIEVE FINALLY, I'M READY TO GO.
SO, I SHOULD HAVE MENTIONED -- DARN, JUST TAKE A POINT OFF --
THAT I WASHED MY HANDS PRIOR TO GETTING MY MEDS READY.
YOU WOULDN'T WANT TO DO THIS WITH DIRTY HANDS.
AND THEN I'LL DO MY HIGH FIVE WHEN I GET INTO THE ROOM.
THEN NEXT THING YOU WANT TO DO IS CHECK WITH YOUR INSTRUCTOR.
SO YOU GOT ALL YOUR MEDS READY, YOU HAVE EVERYTHING READY TO COME CHECK WITH YOUR INSTRUCTOR.
AND THIS IS WHAT YOUR TRAY SHOULD LOOK LIKE.
YOU HAVE A CUP THAT'S GOT YOUR PARAMETERS MARKED ON IT.
YOU HAVE YOUR DRUG, DON'T UNWRAP IT.
WHY WOULD YOU NOT UNWRAP IT?
- BECAUSE, YOU MIGHT FORGET WHAT IT IS.
- YOU MIGHT FORGET WHAT IT IS.
- SOMEONE ELSE MIGHT NOT KNOW. - SOMEONE ELSE MIGHT NOT KNOW.
- IF YOU HAVE MORE THAN ONE --
- HE MIGHT REFUSE IT, THEN WHAT DO YOU DO WITH THE DRUG?
AND THIS IS MY FAVORITE, I MIGHT HAVE A SPAZ AND LOSE IT.
AND YOU JUST BE SURPRISED WHERE A SPAZ - IT FALLS IN.
I WAS WALKING DOWN THE HALL ONE DAY, I HAD ALL MY STUFF.
AND THIS DOCTOR CAME OUT OF THIS DOOR THAT THEY WERE NOT SUPPOSED TO COME OUT.
AND I RAN SMACK INTO THE DOOR, AND HE LOOKED AT ME AND GOES, "I'M REALLY SORRY."
ME TOO, WHOA! I FELT LIKE I WAS IN A CARTOON.
YOU NEVER KNOW WHAT'S GOING TO HAPPEN. SO, KEEP EVERYTHING IN ITS CONTAINER.
AND FINALLY, HOW DO YOU DO YOUR THIRD CHECK AT THE BEDSIDE IF YOU DON'T KNOW WHAT IT IS.
SO, YOU KEEP EVERYTHING WRAPPED UP AND YOU OPEN IT AT THE BEDSIDE.
ALRIGHT, SO I GOT MY MEDS. THEN YOU'RE GOING TO COME TO ME WITH YOUR DRUGS.
AND I'M GOING TO TAKE YOUR MAR AND I'M GOING TO TAKE THE DRUGS, AND I'M GOING TO GO,
"OKAY, YOU HAVE LASIX 40, LASIX 40 AND POTASSIUM."
I HAVE TO SEE THIS TO KNOW THAT THIS IS OKAY.
SO DON'T JUST BRING ME A CUP OF KOOL-AID HERE.
OKAY, IT'S GOT TO MATCH UP. SO, I'LL COMPARE THESE AND GO, "OKAY. OKAY."
AND THEN I WILL LOOK AT YOU AND I'LL HAND YOU THIS.
AND YOU'LL HAVE YOUR MED CARDS, AND YOUR ACTIVITY SHEET AND I'LL GO,
"SO WHY IS YOUR CLIENT GETTING LASIX?"
AND YOU'LL GO, "BECAUSE HE'S GOT CHF." "WHAT DOES IT DO?"
"WELL, IT HELPS THEM NOT ABSORB THE SODIUM ANYMORE,
RETAIN IT AND SO THEY -- IT'S A DIURETIC, AND THEY LOSE WATER."
"GOOD. ARE YOU GIVING A SAFE DOSE?"
"YES, 40 TO 80 MILLIGRAMS IS RECOMMENDED FOR THIS CONDITION, UP TO 600 MILLIGRAMS.
AND I'M GIVING A 40 MILLIGRAM DOSE AND IT'S ONLY TWICE A DAY.
"SO I NEVER GO ABOVE THE 80 MILLIGRAMS."
"GOOD . WHAT NURSING THINGS ARE YOU GOING TO DO?"
"WELL, I'M GOING TO GO IN. I'VE CHECKED THEIR LAB WORK TO CHECK THE ELECTROLYTES.
THE DAILY WEIGHT WAS ORDERED
AND I'M GOING TO GO IN AND CHECK THE VITAL SIGNS BEFORE I GIVE THE MED,
SO THAT I KNOW HOW THEY'RE DOING. AND THEN I'LL BE TEACHING THE CLIENT
ABOUT CHANGING POSITIONS SLOWLY IN ORTHOSTATIC CHANGES."
AND I'LL GO, "GOOD. GO GIVE THE MEDS."
SO THOSE ARE THE QUESTIONS WE'RE GOING TO ASK YOU EVER SINGLE TIME FOR EVERY SINGLE DRUG.
AND I HOPE YOUR CLINICAL INSTRUCTORS ARE DOING THE SAME WHEN YOU GO TO GIVE A MED.
WHAT'S IT FOR? WHY ARE YOU GIVING IT?
WE HAVE TO HAVE A CONNECTION BETWEEN DRUG AND DIAGNOSIS.
DO YOU HAVE A SAFE DOSE? WHAT NURSING THINGS ARE YOU GOING TO DO?
OKAY, ALRIGHT, SAME THING FOR POTASSIUM.
WE'VE DISCUSSED IT A LITTLE BIT. WHAT'S IT FOR?
IT'S THE SUPPLEMENT BECAUSE WE'RE GIVING A LOOP DIURETIC.
AND BECAUSE THEY'RE DIURESING, AND LOSING A LOT OF FLUID,
WE'RE GOING TO SUPPLEMENT THEIR POTASSIUM. IS IT A SAFE DOSE? NO.
I WOULD CALL THE PHARMACIST, AND THEN I'D CALL THE PHYSICIAN.
HOW ARE YOU GOING TO GIVE THE DRUG?
WELL, I'M GOING TO ASK THEM WHAT KIND OF JUICE TO GIVE IT IN.
I'M GOING TO BE KEEPING TRACK OF THEIR ELECTROLYTES AND SO FORTH,
AND SO, THAT'S WHAT WE WANT TO KNOW. DO YOU HAVE TO HAVE IT ALL MEMORIZED?
NO, THAT'S WHY I MADE A MED CARD. THAT'S WHY I WANT YOU TO KNOW
EXACTLY WHAT YOU'RE GOING TO SAY ON THE MED CARD,
AND I DIDN'T WANT YOU WRITING THE WHOLE BOOK,
I JUST WANT YOU TO WRITE WHAT'S PERTINENT FOR YOUR CLIENT
SO THAT YOU'RE ABLE TO RESPOND TO THOSE QUESTIONS.
AND THAT'S WHAT YOU SHOULD KNOW FOR EVERY CLIENT, FOR EVERY MED YOU EVER GIVE.
OKAY. NOT TO MENTION, WHAT SIDE EFFECTS WOULD YOU BE LOOKING FOR, RELATED TO THIS DRUG.
ALRIGHT, ONCE YOU'VE BEEN BLESSED BY YOUR INSTRUCTOR, THEN YOU CAN GO AHEAD AND GIVE IT.
AND THAT'S WHAT WE'RE GOING TO DO.
I DO WANT TO MENTION BEFORE THE THOUGHT LEAVES MY MIND,
THESE DRUGS WERE ORDERED AT EIGHT O'CLOCK.
IF YOU HAVE SIX CLIENTS AND THEY ALL HAVE SIX, EIGHT O'CLOCK MEDS,
WHAT'S THE LIKELIHOOD OF GETTING TO ALL SIX PLACES AT EIGHT O'CLOCK?
- NOT VERY MUCH. - SLIM AND NONE.
SO WHAT ARE YOUR PARAMETERS FOR SAFE ADMINISTRATION?
- 30 MINUTES BEFORE AND AFTER.
- 30 MINUTES BEFORE THE ASSIGNED TIME AND 30 MINUTES AFTER.
SO IF I HAVE A SLUG OF EIGHT O'CLOCKS TO GIVE,
YOU BETTER BELIEVE, I'M GETTING READY AROUND 7:15.
AND I'M STARTING TO PASS THEM AROUND 7:30, 7:40
SO THAT I HAVE PLENTY OF TIME TO GET THEM IN.
NOW IF I GOT -- LASIX WAS ORDERED TWICE A DAY
AND LET'S SAY, I DON'T KNOW, LIFE HAPPENED, AND I DIDN'T GET IN THERE UNTIL NINE O'CLOCK.
WHAT DO I DO? WHAT HAPPENS?
- YOU WAIT UNTIL THE NEXT DOSE. - YES.
OFFSET YOUR NEXT ONE.
- OKAY, THOSE ARE SOME VERY GOOD RESPONSES.
YOU OFFSET YOUR NEXT ONE, YOU GO TO THE NEXT DOSE, SOMEONE SAID.
AND THERE WAS ANOTHER THING, JUST DOCUMENT WHEN YOU GAVE IT.
OKAY, I WANT TO EXPLAIN A LITTLE BIT ABOUT HOW THE DRUGS ARE ORDERED.
IF THE DRUG IS ORDERED ONCE A DAY,
DOES IT MATTER WHEN IN THE DAY YOU GIVE IT?
- DEPENDS ON THE DRUG.
- DEPENDS ON THE DRUG AND IT DEPENDS IF IT WAS SPECIFIED. IF THE DOCTOR SAYS,
"GIVE IT AT EIGHT O'CLOCK OR BEFORE BREAKFAST." THEN YOU'RE -- YOU'RE HELD TO THAT TIME.
BUT SOME DRUGS DON'T MATTER VERY MUCH, LIKE A LAXATIVE, FOR EXAMPLE.
IF YOU WERE TO GIVE A LAXATIVE ONCE A DAY
AND YOU'RE AN HOUR OR TWO LATE OR AHEAD, DOES IT REALLY MATTER?
NO, IT MET THE ONCE A DAY CRITERIA. BE CAREFUL ABOUT THAT.
WHAT HAPPENS IN THE HOSPITALS IS, WHEN WE HAVE A DRUG ORDERED ONCE A DAY,
IT GETS AN ASSIGNED TIME, I THINK I MENTIONED THIS A LITTLE LAST WEEK.
IT GETS AN ASSIGNED TIME BY THE HOSPITAL JUST SO THAT WE STAY ORGANIZED.
AND SO, WE GIVE MOST OF OUR ONCE A DAYS AT EIGHT O'CLOCK.
BUT WHAT IF THE CLIENT'S AN EARLY RISER AND THEY WANT THEIR LASIX AT 6:00?
- GIVE IT TO HIM AT 6:00.
- GIVE IT AT 6:00. YOU STILL MEET THE CRITERIA.
IT'S NOT AN INCIDENT REPORT, IT'S NOT AN ERROR, IT'S A NURSING JUDGMENT.
YOU CAN DECIDE WHEN TO GIVE A MED AS LONG AS IT'S WITHIN THE SAFE PARAMETERS.
IF THE SECOND DOSE WAS ORDERED AT 2:00
BECAUSE OUR LASIX TIMES ARE NORMALLY 8:00 AND 2:00, BUT OUR CLIENT GETS UP AT 6:00.
THEN WHY NOT GIVE IT AT NOON WITH HIS LUNCH
COS ALL OF THIS STUFF'S SUPPOSED TO BE WITH FOOD.
AND YOU CAN CHANGE THE TIMES THAT ARE SET.
HOWEVER, IF A DOCTOR ORDERS A DRUG TO BE GIVEN EVERY SIX HOURS,
WE DON'T HAVE ANY CHOICE, BUT WHEN WE GIVE IT.
AND WE HAVE TO STAY WITHIN THOSE HALF HOUR PARAMETERS.
IF YOU GET OUTSIDE OF THE PARAMETERS, FOR EXAMPLE YOU HAVE AN ANTIBIOTIC.
AND WE WANT TO KEEP THE SAME BLOOD LEVEL GOING ALL DAY LONG,
AND YOU WERE SUPPOSED TO GIVE THE DRUG AT 6:00,
IT'S USUALLY LIKE 12:00, 6:00, 12.00 AND 6:00,
AND FOR WHATEVER REASON, YOU COULDN'T GET THE DRUG IN TILL 7:00.
THEN YOU CHANGE ALL THE TIMES. YOU GIVE IT AT 7:00,
AND THEN YOU MOVE EVERYTHING AROUND AN HOUR.
AND YOU JUST CHANGE THE TIMES ON THE MAR.
SO NOW IT'S 7:00, 1:00, 7:00 1:00, SO THAT THEY KEEP THAT BLOOD LEVEL GOING. OKAY?
- FOR HALF AN HOUR, YOU ALREADY HAVE A HALF AN HOUR DELAY.
- YOU CAN. YOU COULD, IF YOU WANTED TO GET IT BACK ON.
YOU COULD BUMP IT UP THAT HALF,
AND THEN BUMP IT UP FINALLY TO THE RIGHT TIME IN THE NEXT HALF
AND THEN GET IT BACK ON. ESPECIALLY WHEN IT'S JUST ONE HOUR.
BUT WHEN IT STARTS GETTING TO BE TWO OR THREE COS THEY WERE OUT AT A TEST OR PROCEDURE,
AND WE MISSED AND SO FORTH. YOU USUALLY JUST GET THEM GOING,
GET THEM ON TO ANOTHER TIME-FRAME OR YOU SKIP THE DOSE,
AND GO TO THE NEXT ONE, DEPENDING ON WHAT THE DRUG IS.
- AND THEN WE CHANGE IT ON THE MEDICAL, MAR.
- YES, UH-HUH I WOULD JUST CROSS IT OUT, I CAN SHOW YOU,
I WOULD JUST CROSS IT OUT, AND WRITE IN NEW TIMES.
- DO WE NEED TO INITIAL THAT OR --
- NO, AND THEN YOU CAN JUST SAY AND REPORT WHY IT HAPPENED
AND THEN I'D JUST GO BY THE NEXT SHEET.
I SEE THE TIME IT WAS GIVEN AND I MAKE MY DECISION FOR THE NEXT DRUG
BASED ON WHEN THE LAST DOSE WAS GIVEN.
SO THAT'S WHY WE HAVE THE WHOLE SHEET TO WORK ON.
OKAY, WE'RE READY TO GO.
I'VE OBVIOUSLY CHECKED MY DOCTOR'S ORDERS,
I'VE OBVIOUSLY GATHERED ALL MY EQUIPMENT, I'VE WASHED MY HANDS AGAIN.
AND I NEED MY TABLE TO GO NEXT TO THE CLIENT.
I AM GOING TO IDENTIFY MY CLIENT AND PROVIDE PRIVACY,
BUT WE HAVE A NEW WAY TO IDENTIFY OUR CLIENTS.
NOW THIS IS SERIOUS BUSINESS OF IDENTIFYING AT THIS POINT.
GOOD MORNING, MR. CURRY,
I'M DIANE, I AM YOUR NURSE TODAY.
AND I HAVE YOUR MORNING MEDICATIONS FOR YOU.
COULD YOU TELL ME YOUR WHOLE NAME?
I KNOW I CALLED YOU MR. CURRY, BUT TELL ME YOUR WHOLE NAME.
CONRAD CURRY. ALRIGHT.
I JUST WANT TO CHECK YOUR NAME BAND HERE.
AND THIS IS WHAT IT SAYS ON YOUR SHEET.
AND I WILL NOT GIVE YOU POINTS IF YOU DO NOT DO THIS.
YOUR MAR MUST GO TO THE NAME BAND AND YOU'RE COMPARING MAR TO NAME BAND.
YOU DON'T JUST SAY, "AND I CHECKED MY DOCTOR'S ORDERS, IDENTIFIED MY CLIENT,
AND I COMPARED MAR TO THE NAME BAND AND I'LL...TRY TO PASS --"
AND I'LL GO, "MAR IS NOT MOVING."
GOT TO GO DOWN HERE.
SO THIS IS WHAT I WANT TO HEAR, CONRAD CURRY.
AND I WANT TO HEAR THEIR IDENTIFICATION NUMBER.
333770000, WE HAVE A MATCH.
AND IT SAYS HERE THAT YOU'RE ALLERGIC TO SULFA.
WHAT HAPPENS WHEN YOU TAKE SULFA?
IT UPSETS YOUR STOMACH?
HAVE YOU EVER HAD ANY TROUBLE WITH RASH, DIARRHEA, ANY DIFFICULTY BREATHING?
HAVE YOU TAKEN LASIX BEFORE, THE WATER PILL?
IT HAS A LITTLE BIT OF SULFA IN IT.
YOU HAVE? YOU'VE BEEN TAKING IT FOR FIVE YEARS.
ALRIGHT. PURSUE A LITTLE BIT WHAT'S GOING ON.
OKAY.
SO ASK THEM THEIR NAME, AND CHECK THEIR NAME BAND.
PROBLEM, NURSING HOMES, NO NAME BANDS.
WHAT DO YOU DO?
HAVE THEY TALKED TO YOU ABOUT THINGS TO DO IN THE NURSING HOMES?
ONE OF THE NURSING HOMES IN THE AREA HAS A PICTURE BOOK
AND IN THE NOTEBOOK, THEY HAVE TAKEN ALL OF THE RESIDENTS' PICTURES,
THEIR NAME AND IDENTITY IS ON THE BOOK,
AND YOU TAKE THE BOOK, YOU MATCH UP THE PICTURE,
ASK THEM THEIR NAME AND THEN YOU MATCH IT THAT WAY,
SO THAT YOU KNOW YOU HAVE THE RIGHT CLIENT.
ALWAYS ASK THEM THEIR NAME,
AND THEY SHOULD HAVE AT LEAST PUT A NAME BAND ON THE BED OR SOMETHING.
BUT THE PEOPLE CAN MOVE, YOU KNOW, THEY'RE A MOVING GROUP.
SO FIND OUT WHAT THEIR CRITERIA IS FOR CHECKING BANDS,
BECAUSE YOU HAVE TO IDENTIFY THE CLIENT, ESPECIALLY IF, YOU KNOW,
YOU'RE IN AN ALZHEIMER'S UNIT OR SOMETHING,
BOY, YOU GOT TO KNOW WHO YOU'VE GOT FOR YOUR CLIENT.
SO PICTURE BOOKS WORK, ASK TO STATE THEIR NAME, AND GET THE RIGHT CLIENT.
OKAY, I HAVE TWO PILLS FOR YOU.
I HAVE YOUR LASIX, WHICH IS A WATER PILL.
IT'S TO HELP GET THE WATER OUT OF YOUR SYSTEM BECAUSE OF YOUR CONGESTIVE HEART FAILURE.
IT MAKES YOU GO TO THE BATHROOM, YOU KNOW THAT
BECAUSE YOU'VE BEEN TAKING IT FOR SO LONG.
DO YOU HAVE ANY TROUBLE GETTING TO THE BATHROOM? GOOD.
THE OTHER THING IS THAT IT CAN CAUSE SOME ORTHOSTATIC CHANGES.
AND WHAT THAT MEANS IS THAT WHEN YOU'RE LAYING DOWN AND THEN YOU GO TO SITTING UP OR STANDING,
IT MAKES YOUR HEAD A LITTLE DIZZY.
HAVE YOU EXPERIENCED ANY OF THAT?
OH, YOU HAVE? IN FACT, YOU'RE DIZZY RIGHT NOW.
I MEAN, TALK TO THEM ABOUT IT A LITTLE ABOUT BIT AND SAY,
"I WANT TO JUST TELL YOU THAT IT'S REAL IMPORTANT THAT YOU CHANGE POSITIONS SLOWLY.
MAYBE DANGLE AT THE EDGE OF THE BED FOR A FEW SECONDS
AND MAKE SURE THAT YOU ARE NOT TOO DIZZY, SAME WITH STANDING.
DON'T JUST JUMP OUT OF BED AND START WALKING REAL FAST.
MAKE SURE THAT YOU HAVE YOUR BEARINGS THERE WITH THE WATER PILL.
WE'RE ALSO GOING TO KEEP TRACK OF I&O,
WHILE YOU'RE ON THIS, TO SEE THAT WHAT'S COMING --
GOING IN IS COMING OUT, AND HOPEFULLY, MORE IS COMING OUT RIGHT NOW.
AND THEN WE'LL BE GETTING YOUR WEIGHTS EVERY MORNING.
YOU'VE LOST A COUPLE OF POUNDS THIS MORNING, THAT'S GREAT. OKAY, SO, THIRD CHECK.
I AM NOW GOING TO TAKE THIS AND GO,
"OH! BLOOD PRESSURE, PULSE. YOU KNOW WHAT, BEFORE I DO THIS,
I NEED TO GET YOUR VITAL SIGNS."
SEE WHAT A GOOD CUEING SYSTEM THAT IS FOR YOU
BECAUSE YOU JUST KEPT TALKING ABOUT STUFF, YOU DISTRACT YOURSELF, I DO.
SO I GET MY VITAL SIGNS, AND NOW I'M GOING TO DO MY THIRD CHECK.
AND I HAVE LASIX 40 MILLIGRAMS, LASIX 40 MILLIGRAMS, GREAT, OPEN IT, AND PUT IT IN HERE.
AND THEN MY POTASSIUM, I'LL GET GOING HERE IN A SECOND.
SO, THIS IS MY DUPLICATE CUP HERE.
I HAVE YOUR LASIX FOR YOU, IF YOU WANT TO WANT TO GO AHEAD AND TAKE THAT
GIVE IT TO THE CLIENT, AND HE CAN TAKE IT HIMSELF.
ALRIGHT, THEN YOU WANT TO JUST WATCH, AND MAKE SURE THAT THEY SWALLOWED THE PILL.
THE SECOND THING IS I HAVE YOUR POTASSIUM.
IT SEEMS LIKE THEY WROTE ON YOUR CHART
THAT YOU LIKE APPLE JUICE WITH YOUR POTASSIUM. IS THAT OKAY? IT'S WHAT I BROUGHT.
THAT'S OKAY.
SO, PUT THIS IN HERE.
THE POTASSIUM IS TO GO ALONG WITH THE LASIX.
YOU KNOW, ANY TIME YOU TAKE A LOOP DIURETIC, WHICH IS WHAT THIS IS.
YOU NEED TO SUPPLEMENT YOUR DIET OR SUPPLEMENT WITH MEDICINE
FOR YOUR POTASSIUM BECAUSE IT PULLS OFF, POTASSIUM.
ALRIGHT, THERE YOU GO.
IT'S IN ABOUT SIX OUNCES OF FLUID,
AND HE TAKES THAT, AND WE'RE GOOD TO GO.
ALRIGHT, ANYTHING ELSE I CAN GET FOR YOU?
YOU SWALLOWED BOTH OF THOSE, YOU GOT IT DOWN OKAY? GOOD.
AND LOOK, SOMETIMES THAT FEELS A LITTLE INSULTING.
BUT I HAVE TO TELL YOU, I'VE GIVEN MANY A BED BATCH
AND I'VE FOUND MANY A GREEN PILL AT THE BOTTOM OF THE BED.
YOU'VE GOT TO LOOK ON SOME OF THESE CLIENTS
AND MAKE SURE IT REALLY WENT DOWN,
AND THAT EVERYTHING IS OKAY WITH THAT.
ALRIGHT, WELL, I HAVE SOME MEDS TO GIVE YOU LATER,
SO IF YOU NEED ANYTHING, GIVE ME A HOLLER,
YOUR CALL LIGHT'S WITHIN REACH, AND I AM OFF THE ROOM.
OKAY. ALL OF THIS STUFF THEN WILL GO BACK IN THE DRAWER.
PUT IT IN THE DRAWER WHERE IT CAME FROM.
WE HAVE PLENTY OF DRUGS IN ALL THE DRAWERS,
SO DON'T JUST TOSS THEM IN ANY DRAWER, PUT THEM IN THE DRAWER THAT YOU GOT THEM FROM.
- IS THERE ANY REASON WHY HE COULDN'T SWALLOW THE LASIX WITH THE POTASSIUM IN THE JUICE?
- NO, HE COULDN'T -- HE FELT SO LUCKY.
DON'T TAKE THIS, AND POUR IT BACK INTO THE BOTTLE.
WHAT A MESS, IT GETS OUR LABELS ALL YUCKY.
IT'S JUST FOOD COLORING IN WATER.
SO JUST TOSS IT IN THE SINK AND THEN THROW THE STUFF AWAY, OKAY, FOR YOUR CUPS.
ALRIGHT. FINALLY, YOU'RE STILL NOT DONE,
WHEN THE MED HAS BEEN GIVEN, WE DOCUMENT.
OKAY, SO I NEED TO GO OVER DOCUMENTATION, AND I'LL DO IT FROM HERE.
THEN I WASHED MY HANDS, DID I SAY THAT?
I DON'T KNOW WHICH WAY. THEY ALREADY PICKED UP ON NOT WASHING AGAIN.
I'M AS BAD AS YOU. I GO HOME, DREAM ABOUT MY CHECKUPS.
OKAY.
A COUPLE OF THINGS ON THE MAR.
THIS -- THIS COLOR RIGHT HERE, WE ACTUALLY CHECKED IT LAST WEEK,
BUT WHERE IT SAYS THE LASIX ARE IN CHECK.
MY INITIALS IN HERE MEAN THAT I CHECKED
THIS MAR TO THE DOCTOR'S ORDER,
AND I KNOW THAT IT WAS WRITTEN CORRECTLY.
LASIX 40 MILLIGRAM BID, POTASSIUM BID.
AND THAT'S ALL IT MEANS, THAT THIS IS A CHART CHECK.
THIS DOES NOT MEAN YOU GAVE THE DRUG.
IT MEANS THAT SOMEBODY CHECKED THIS SHEET
WITH THE DOCTOR'S ORDER, AND EVERYTHING'S RIGHT ON IT.
WHAT WE NEED TO DO IS DOCUMENT WITHIN OUR SHIFT,
SORRY. THAT WE GAVE THE DRUG.
SO THIS IS A 7:00 TO 3:00 SHIFT,
AND WE GAVE AN EIGHT O'CLOCK DRUG.
SO WE'RE GOING TO COME OVER HERE
AND WRITE EIGHT O'CLOCK, 0800 AND OUR INITIALS.
0800, YOUR FIRST AND LAST INITIAL.
THAT'S ALL THERE IS TO THAT.
AT THE BOTTOM, WHEN YOU SIGN YOUR NAME,
WHENEVER YOU SIGN INITIALS, YOU HAVE TO SIGN WHAT THOSE INITIALS STAND FOR.
SO YOU NEED TO PUT YOUR INITIALS ON THERE,
AND THEN SIGN YOUR COMPLETE FULL NAME,
AND LAST NAME, AND YOUR CREDENTIALS.
AND YOUR CREDENTIALS, RIGHT NOW ARE STUDENT NURSE, SN CSUF.
AND THAT MUST BE AT THE END OF YOUR NAME EVERY SINGLE TIME.
THERE'S A LOT OF STUDENT NURSES OUT THERE,
STUDENT NURSES FROM MADERA, STUDENT NURSES FROM CITY COLLEGE,
STUDENT NURSES FROM HERE, SO WE HAVE TO HAVE
THE CREDENTIALS OF OUR SCHOOL BY OUR NAME.
WE WANT THEM TO KNOW HOW WONDERFUL WE ARE
BECAUSE, YOU KNOW, IF THERE'S PROBLEMS,
THEY ALWAYS BLAME IT ON THE STUDENTS.
AND SO WE'RE GOING TO BE THE GOOD ONES OUT THERE.
SN CSUF. AND THAT'S IT.
ALRIGHT, YOU SHOULD ALWAYS DOCUMENT AFTER YOU GIVE THE MED, NOT BEFORE.
THINGS HAPPEN. YOU MIGHT HAVE GONE IN TO GIVE YOUR MED --
LET'S SAY YOU WENT IN TO GIVE LASIX AND WHEN YOU TOOK THE BLOOD PRESSURE,
IT WAS 80 OVER 40. WHAT ARE YOU GOING TO DO?
- CALL THE DOCTOR. - HOLD THE LASIX.
CALL THE DOCTOR. IT'S TOO LOW.
YOU'RE NOT GOING TO GIVE LASIX WITH A BLOOD PRESSURE LIKE THAT.
SO YOU'RE GOING TO HOLD IT. THEN WHAT DO YOU DO?
IF YOU DON'T GIVE A MED THAT'S BEEN ORDERED, HOW DO YOU DOCUMENT THAT?
WELL, ON THIS SHEET, YOU'RE GOING TO CIRCLE THE EIGHT O'CLOCK,
AND THAT MEANS NOT GIVEN,
AND IF I DIDN'T GIVE THE LASIX, WELL, I'M NOT GOING TO GIVE THE POTASSIUM EITHER.
SO I'M GOING TO HOLD THEM BOTH,
I'M GOING TO CALL THE PHYSICIAN, AND IN MY NURSE'S NOTES, I'M GOING TO SAY,
BLOOD PRESSURE AT 0800, 80 OVER 60,
CLIENT COMPLAINING OF DIZZINESS, VERTIGO, ON AMBULATION,
MEDICATION HELD, DR. SMITH NOTIFIED.
AND DR. SMITH COMING IN TO EXAM LATER, OR WHATEVER.
HE MAY NEED TO SEE THE DRUG, HE MAY, WHATEVER YOU DO.
THAT'S -- YOU HAVE TO DOCUMENT THAT YOU MADE AN ATTEMPT.
ANY TIME YOU DON'T GIVE A DRUG, THEN YOU HOLD IT, YOU CIRCLE IT.
SO THAT MEANS YOU KNEW IT WAS TO BE GIVEN, BUT YOU JUST DIDN'T GIVE IT.
YOU COULD EVEN, IF YOU WANTED TO, WRITE THE BLOOD PRESSURE IN THERE.
IN THAT SQUARE. SO ALRIGHT, THAT'S IT.
OKAY AT THIS POINT, THE NURSING CALL LIGHT GOES OFF.
"YES, MR. CURRY, WHAT'S GOING ON, HOW CAN I HELP YOU?"
"MY KNEE IS HURTING SO BAD, CAN I HAVE MY PAIN PILL?"
"WELL, SURE, YOU DIDN'T HAVE ONE LAST NIGHT, DID YOU?
SO IT'S BEEN A WHILE SINCE YOU'VE HAD IT.
DO YOU WANT TO TAKE ONE PILL OR TWO?"
"WELL, I DON'T KNOW WHAT DO YOU THINK?"
"WELL, HOW BAD IS YOUR PAIN ON A SCALE OF ONE TO TEN?"
"WELL, IT'S A FIVE."
"WELL, HAVE YOU TAKEN DARVOCET BEFORE?"
"NO." "YOU WANT TO TRY ONE, AND SEE HOW IT WORKS?"
"OKAY, YOU WANT TO TRY TWO, AND SEE HOW IT WORKS?"
IT'S TOTALLY UP TO YOU, AND THE CLIENT.
IT DOESN'T MATTER REALLY, IF THEY GET THE ONE OR THE TWO.
SO...
..SAY, "I'LL BRING IT RIGHT IN."
OKAY, SO YOU'RE GOING TO RUN TWO SEPARATE DRILLS.
YOU'RE GOING TO GIVE YOUR NARCOTIC AT ONE TIME
AND YOU'RE GOING TO GIVE YOUR ROUTINE MED AT ANOTHER,
SO THAT YOU CAN GO THROUGH THE CHECKS AND ALL THAT KIND OF STUFF.
ALRIGHT, SO HERE'S OUR ORDER. I GO TO THE NURSING, THE MAR,
AND I LOOK AT MY DARVOCET ORDER,
AND IT SAYS THAT THEY COULD HAVE ONE DARVOCET OR TWO.
HOW COME IT'S ON SEPARATE LINES? DID YOU NOTICE THAT?
- IT'S ONE INTO ONE AND ONE INTO TWO.
- UH-HUH, SO HOW WOULD I KNOW IF YOU GAVE ONE OR TWO
IF YOU DIDN'T SEPARATE THEM?
SO I HAVE TO HAVE THE ONE, ON ONE LINE OR THE TWO, ON ONE LINE.
SO THAT I KNOW WHICH THE NURSE GAVE.
IT'S JUST, THE WAY ABOUT HERE. SO WHAT WE NEED TO DO BEFORE WE GIVE DARVOCET,
ONE, IS TO FIGURE OUT WHEN THE LAST DOSE WAS GIVEN,
BECAUSE WE CAN'T GIVE A DOSE ANY SOONER THAN WHAT IT WAS PRESCRIBED.
AND IT SAYS THEY CAN HAVE IT EVERY SIX HOURS AS NEEDED.
SO IF IT'S AT EIGHT O'CLOCK, THEY COULDN'T HAVE HAD A DARVOCET
AT ANY TIME AFTER TWO O'CLOCK.
SO IT APPEARS THEY DIDN'T HAVE ANYTHING, I'D HAVE TO CHECK YESTERDAY'S SHEET,
THIS SHEET OBVIOUSLY HAS NOTHING ON IT, TO FIND THE LAST DOSE.
AND THEN ONCE I'M OKAY THAT THERE'S NO ALLERGIES OR ANYTHING,
THEN I CAN GO AND GET MY MED. SO, I THINK I'M OKAY.
- CAN I ASK YOU A QUESTION? - UH-HUH.
- I KNOW THIS SEEMS REALLY SILLY.
IF THEY'RE ALLOWED TO HAVE ONE OR TWO EVERY SIX HOURS AND THEY HAVE ONE.
AND DECIDE THEY STILL HURT -- - WE'RE GOING TO TALK ABOUT THAT LATER.
- YEAH, WE'LL TALK ABOUT THAT AT THE END OF THIS
BECAUSE THERE ARE THINGS WE CAN DO AND CAN'T DO RELATED TO THIS.
WE'RE GOING TO GO WITH ONE, FOR NOW, AND THAT WILL HELP REMIND ME OF THAT SCENARIO.
OKAY, WHEN YOU COME TO YOUR TEST,
DON'T BRING ALL OF YOUR SHEETS, AND GO, "WHICH ONE ARE YOU?"
ONLY TAKE THE ONE THAT YOU NEED AT THE TIME YOU'RE DOING THE DRUG.
ALRIGHT, SO WE NOW HAVE OUR PRN SHEET WHICH IS A DIFFERENT COLOR.
AND WE HAVE OUR DARVOCET AND OUR CLIENT HERE,
SULFA ALLERGIES, AND MY HANDS ARE WASHED.
I AM GOING TO GO TO THE MED CART,
THIS IS A WHOLE SEPARATE SHEET, ON CHECKING OUT A NARCOTIC.
ON YOUR MEDICATION CHART, YOU WANT TO GET YOUR MAR,
AND YOU WANT TO GO TO THE NARCOTICS CABINET.
OUR NARCOTICS CABINET IS -- WE HAVE A DRAWER IN THE LAB THAT WE'LL OPEN UP FOR TESTING
BUT WE ALSO HAVE THIS DRAWER FOR PRACTICE.
AND THEY'RE ALL LOCKED.
WHAT WE WANT TO DO IS WE WANT TO GO GET THE DRUG.
WE KNOW THE TIME-FRAME IS OKAY.
WE KNOW THE ALLERGIES ARE NO PROBLEM,
WE JUST NEED TO GET THE DRUG.
SO WHAT YOU WANT TO DO IS YOU WANT TO COME
TO YOUR NARCOTICS CABINET AND GET THE NARCOTIC LOG.
AND THEY ALWAYS KEEP TRACK OF NARCOTICS, THEY'RE LOCKED UP.
AND WE HAVE TO MAKE SURE THAT WHEN WE TAKE A DRUG OUT
THAT THE RIGHT NUMBER OF PILLS WERE IN THERE. AND THAT WHEN WE SIGNED IT OUT,
WE LEFT THEM WITH THE RIGHT NUMBER OF PILLS.
SO I WANT TO COME TO THIS NARCOTIC LOG,
AND I WANT TO COME ACROSS HERE AND I WANT TO FIND DARVOCET,
AND IT SAYS, DARVOCET-N 100,
THERE ARE 36 TABS THAT ARE SUPPOSED TO BE IN THIS DRAWER. ALRIGHT?
SO I'M GOING TO GET THE KEY, UNLOCK THE DRAWER...
..AND COME INTO THE NARCOTICS CABINET.
I'M GOING TO LOOK THROUGH ALL OF THIS STUFF HERE,
CHECK IN MY LITTLE SHEET, AND FIND THE DARVOCET,
IT'S NOT IN ANY OF THIS STUFF, WHICH IS ALL FAKE,
I GOT TYLENOL NUMBER THREE, IT'S ALL A BUNCH OF FAKE STUFF.
AND THEN FINALLY, I HAVE DARVOCET, AND WE'VE PUT THEM IN AN EMESIS BASIN,
BECAUSE WE'VE RIPPED THEM APART SO MANY TIMES THAT THEY HAVE LOST ALL SENSE OF ORDER.
NORMALLY, YOUR NARCOTICS COME IN SHEETS LIKE THIS.
AND THEY COME IN A ROLL, IN A BOX AND THEY'RE NUMBERED.
SO IF THERE ARE 30 IN A BOX, THIS WOULD BE 30,
THIS WOULD BE 29, THIS WOULD BE 28.
AND SO AS YOU RIP THEM OFF, THE NUMBER IS ON THERE.
WELL, WE'VE LOST ALL SOPHISTICATION,
AND WE JUST HAVE THIS HEAPING PILE OF DRUGS THAT YOU'RE GOING TO HAVE TO COUNT.
OKAY, AND I HAVE ALREADY REALLY PRE-COUNTED AND THERE'S 36, AND I DID COUNT EVERY ONE.
SO THOSE OF YOU TUESDAY MORNING AT EIGHT O'CLOCK WILL HAVE A SLUG TO COUNT,
AND THOSE OF YOU TUESDAY AT 11:15 WILL HAVE VERY FEW TO COUNT.
ALL RIGHT, YOU WANT TO MAKE YOUR COUNT,
MAKE SURE IT MATCHES, 36, 36.
AND THEN I NEED TO SIGN OUT THAT I HAVE TAKEN A PILL.
YOU SIGN THESE OUT BEFORE YOU GIVE THEM,
BECAUSE ONCE THEY'RE OUT OF THE DRAWER, THEY'RE GONE, THEY'RE TAKEN.
SO I COME OVER TO MY NARCOTICS LOG AND I SAY, 0800.
MY PATIENT IS CONRAD CURRY.
NOT MUCH ROOM HERE. ROOM NUMBER, BED NUMBER FIVE,
AND MY NURSE SIGNATURE, IS HERE THAT I TOOK IT.
AND I'M GOING TO COME ACROSS HERE TO THE NEXT LINE,
AND SAY DARVOCET-N 100, THERE ARE NOW 35 IN THE DRAWER
BECAUSE I TOOK ONE.
NOW ONCE I FILLED OUT HOW MANY ARE LEFT IN THE DRAWER, WHO'S TAKEN IT,
THIS IS WHEN YOU, AS A STUDENT, SAY TO THE RN
WHO HAS BEEN WATCHING YOU TAKE THIS OUT OF THE DRAWER,
YOU SAY, "WILL YOU CO-SIGN FOR ME?"
YOU HAVE TO HAVE A CO-SIGNATURE AS A STUDENT TO TAKE OUT A NARCOTIC.
YOU DON'T, AS AN RN, BUT YOU DO, AS A STUDENT.
SO I'LL SAY, "SURE." AND THEN I'LL CO-SIGN FOR YOU.
WHAT I WON'T DO IS I WON'T SIGN A BLANK CHECK.
IF YOU HAVEN'T PUT THE NUMBER IN HERE AND YOU ASK ME TO CO-SIGN FOR MR. CURRY.
I WON'T. OH, I FORGOT TO DO ONE OTHER THING.
I KNEW SOMETHING WAS MISSING HERE.
WHERE IT SAYS DOSE, YOU HAVE TO WRITE THE DOSE,
AND MY DOSE IS ONE PILL. AND THAT'S ALL THERE IS TO IT.
SOMETIMES IT'S MILLIGRAMS, BUT THIS IS A PILL.
- ARE THOSE COMING IN TWO -- ARE THERE TWO PILLS TO ONE PACKET.
- NO, THERE'S ONE PER PACKET. - ALRIGHT.
- SO IF THE DOSE WAS TWO, THEN YOU WOULD COME OVER HERE
- AND GO TO PAGE TWO AND THEN --
- UH-HUH. AND THEN MY COUNT WOULD GO FROM 36 TO 34.
ON THIS PARTICULAR LOG SHEET, YOU DON'T HAVE TO SIGN OUT FOR EVERY LINE.
SOMETIMES THEY HAVE A SHEET PER DRUG,
AND THEN YOU HAVE TO SIGN OUT FOR EVERY LINE,
BECAUSE EVERY LINE IS THE NUMBER OF THE DRUG.
SO WHEN IN ROME DO WHAT THEY WANT YOU TO DO.
BUT NEVERTHELESS YOU'RE STILL ACCOUNTING FOR EVERY PILL.
OKAY, ONCE EVERYTHING'S SET, I HAVE MY PILL, I WANT TO DO A CHECK,
DARVOCET-N 100, DARVOCET-N 100, I'M GOING TO PUT IT IN A CUP.
I'M GOING TO SHUT MY DRAWER AND LOCK IT.
AND GIVE THE KEY BACK TO THE NURSE.
YOU DON'T JUST LEAVE THE KEY HANGING AROUND OUR POCKETS,
LIKE WE DO FOR PRACTICE. BUT IT'S KEPT BACK.
ALRIGHT, DARVOCET N100, I DID MY CHECKOUT OF THE DRAWER, MY CHECK HERE,
I WANT TO DO ONE MORE CHECK.
IT'S GOT ACETAMINOPHEN, 650 MILLIGRAMS
AND PROPOXYPHENE NAPSYLATE, 100 MILLIGRAMS.
IT'S GOOD TO GO HERE.
ALRIGHT, I HAVE MY DRUG, IT'S CHECKED OUT.
AND THAT'S REALLY ALL THERE IS TO THAT, OKAY.
- IF THERE WAS A POSSIBILITY, THERE ARE LESS THAN REALLY THERE ARE --
- I'LL START HUNTING THEM DOWN.
THIS IS A LITTLE TRICKY, I MADE SITE VISITS AT THE HOSPITALS RECENTLY,
AND BECAUSE OF ALL THESE DIFFERENT ELECTRONIC SYSTEMS,
THEY'RE NOT CONSISTENT IN THEIR CHECKING OF THE NARCOTICS DRAWERS
BECAUSE THE NARCOTICS DRAWERS, FOR EXAMPLE, IF THE VA SPIT OUT THE DRUG ONE AT A TIME,
YOU JUST DIAL IN WHAT YOU NEED, AND IT GIVES IT TO YOU. AND IT'S KEEPING AN ELECTRONIC COUNT.
SO THEY'RE ONLY CHECKING THEIR NARCOTICS, LIKE, ONCE A WEEK, WHICH I DON'T THINK IS ENOUGH.
I'VE BEEN DOING SOME READING ABOUT IT AND THEY REALLY SAY, AT LEAST ONCE A DAY.
THAT YOU SHOULD MAKE SURE EVERYTHING IS RIGHT IN YOUR MACHINES.
BUT MOST OF THEM, WHEN YOU'RE DOING A MANUAL TECHNIQUE, LIKE THIS,
EACH SHIFT HAS TO COUNT.
SO IF I'M THE DAY SHIFT, AND YOU'RE THE NIGHT SHIFT,
YOU COME ON WITH ME -- YOU COME HERE AND YOU READ THE BOOK,
AND I, AS THE DAY SHIFT COUNT, AND WE MAKE SURE THE NUMBERS ARE ALRIGHT.
SO, IF LATER ON IN THE SHIFT, YOU SEE THAT THERE IS NOT A DRUG WRITTEN DOWN THERE
AND THE COUNT IS OFF, YOU START HUNTING YOUR PEERS DOWN AND GO,
"OKAY, WHO GAVE DARVOCET? THE COUNT IS OFF."
AND I CAN'T SIGN UNTIL I KNOW WHERE IT IS.
YOU GOT TO FIND THEM. SO I'LL SIGN UP MINE AND I'LL GIVE IT,
BUT I START HUNTING FOR IT. I CAN'T HELP THAT THE COUNT IS OFF,
I'LL CIRCLE IT UNTIL I CAN FIND OUT WHAT'S GOING ON.
SO MY PATIENT'S NOT WAITING FOR OUR PROBLEMS, BUT WE GOT TO HUNT IT DOWN,
AND WHAT USUALLY HAPPENS IS THEY DON'T LET ANYONE GO HOME
ON THE NEXT SHIFT UNTIL THEY FIND THE ERROR, SO.
- DOES THAT HAPPEN OFTEN? - NO, THANK HEAVENS.
BUT WHEN IT DOES HAPPEN A LITTLE MORE OFTEN,
IS WHEN YOU GOT A LOT OF PEOPLE IN THE DRAWER.
SO WHEN YOU GOT STUDENTS AND STAFF AND STUFF AND A LOT OF COMMOTION GOING ON,
THEN SOMETIMES THE NURSE WILL GRAB IT AND NOT SIGN IT UP.
THE STUDENTS TEND TO NOT DO IT, BECAUSE WE'RE SO,
YOU KNOW,"OH, OH! SIGN FOR ME, I DON'T WANT TO GET IN TROUBLE."
AND FACULTY, AND STAFF ARE WATCHING YOU.
SO THEY USUALLY DO GET SIGNED OUT.
SO IT JUST DEPENDS ON HOW PEOPLE ARE GETTING HOLD OF THE KEYS AND STUFF.
SO NO, NOT VERY OFTEN, BUT IT DOES.
IF THERE IS A RUSH AND SOMEONE'S RUSHED INTO SURGERY,
AND YOU NEEDED SOMETHING QUICK OR WHATEVER,
YOU MIGHT GRAB YOUR MED BEFORE YOU SIGN. SO, YEAH.
ALRIGHT, IT'S TIME TO GIVE OUR MED.
WE'VE CHECKED TWICE, WE HAVE THE RIGHT MED,
WE HAVE NO ALLERGY PROBLEMS WITH THIS.
I THINK WE'RE OKAY TO GO.
I DO WANT TO DISCUSS ONE THING THAT YOU DISCOVERED ON YOUR DRUGS.
WHAT DO YOU THINK ABOUT THE DOSE THAT THE DOCTOR ORDERED?
- IS IT A POSSIBILITY... - IT SHOULD BE EIGHT HOURS.
- IT SHOULD BE EVERY EIGHT HOURS AND NOT EVERY SIX HOURS.
AND WHAT IS OUR PRIMARY PROBLEM?
- TOO MUCH, ON THE TWO PILLS.
- UH-HUH. WITH TWO PILLS, WHAT'S THE MAXIMUM PROPOXYPHENE
WHICH IS THE NARCOTIC PIECE OF THE DRUG, WHAT'S THE MAX THAT YOU COULD HAVE?
- 600. - 600 MILLIGRAMS.
SO IF WE'RE GIVING IT FOUR TIMES A DAY AND WE GAVE TWO PILLS,
WE COULD THEORETICALLY BE UP TO 800 MILLIGRAMS WHICH IS TOO MUCH.
WHAT ABOUT THE TYLENOL COMPONENT?
WHAT IF YOU GIVE TWO PILLS A DAY, I MEAN, TWO PILLS AT A TIME?
HOW MANY MILLIGRAMS IS THAT OF TYLENOL?
THAT'S 1,300 MILLIGRAMS A DOSE, AND THEN IF YOU GIVE THAT FOUR TIMES, WHAT HAPPENS?
WE GO OVER 5 GRAMS.
WHAT WAS THE RECOMMENDED MAXIMUM FOR TYLENOL IN A DAY?
- 4 GRAMS. - 4 GRAMS.
YOU HAVE TO BE VERY CAREFUL WITH SOME OF THESE COMBINATION PRODUCTS,
LIKE DARVON, DARVOCET, PERCODAN, PERCOCET
BECAUSE THEY'VE GOT AN ASPIRIN OR TYLENOL COMPONENT IN THEM.
YOUR CLIENT HAS A FEVER,
CAN YOU BE GIVING HIM TYLENOL, AND DARVOCET FOR PAIN?
NO. YOU WOULD BE LOADING THEM UP.
SO BE AWARE OF WHAT YOU'VE GOT GOING IN YOUR PRODUCT.
YOU WOULD, HOPEFULLY, THINK THAT THE PHARMACISTS WOULD GO,
THIS IS TOO OFF, AND THEN CALL THE DOCTOR.
BUT WE TOO WOULD CALL, AND SAY, THIS IS TOO MUCH.
NOW IF YOUR CLIENT DOESN'T TAKE IT MORE THAN THREE TIMES A DAY IT NEVER BECOMES AN ISSUE,
BUT IT DOES IF THEY WANT IT EVERY SIX.
AND THEY WANT TWO PILLS. SO, PROBLEM. ALRIGHT, THE OTHER THING,
THAT'S NOTEWORTHY AND YOU'LL GET MORE ABOUT IT IN PHARMACOLOGY IS WITH THE TWO PRODUCTS.
WHY HAVE TWO PRODUCTS IN ONE DRUG?
WHY NOT JUST GIVE THEM ONE OF EACH OR ONE WHEN THEY NEED IT?
THEY FOUND IN PHARMACOLOGY AND IN PAIN MANAGEMENT THAT IF YOU GIVE A NARCOTIC,
IT WORKS ON A CERTAIN KIND OF PAIN, THE DEEP VISCERAL PAIN.
AND THEY FOUND OUT THAT NON-NARCOTIC MEDICATIONS, WORK ON MORE PERIPHERAL PAIN.
SO IF THEY PUT THE TWO TOGETHER AND NOT EVEN AS HIGH A DOSE, YOU GOT BETTER PAIN RELIEF
BECAUSE THEY WERE ACTING ON TWO DIFFERENT NEURAL SYSTEMS,
AND THE MORE PERIPHERAL PAIN
AND THEY GOT BETTER PAIN MANAGEMENT. THEY WERE HAPPIER PEOPLE.
SO THEY STARTED MARKETING A PRODUCT THAT GAVE A COMBINATION
TO ACT ON THOSE TWO TYPES OF PAIN.
AND THAT'S WHAT WE'VE GOT HERE. SO, IT'S NOT REALLY A STRONG DRUG,
BUT IT IS A GOOD ONE.
ALRIGHT, WE'RE GOING TO GO INTO OUR CLIENT'S ROOM.
GOOD MORNING, MR. CURRY, I HAVE YOUR PAIN MED FOR YOU.
WHERE DID YOU SAY YOU WERE HURTING? IN YOUR KNEE.
AND WHAT IS IT ON A SCALE OF ONE TO TEN. FIVE, ALRIGHT.
WELL, IT TAKES ABOUT AN HOUR FOR THIS PAIN MEDICATION TO WORK.
SO, LET ME KNOW HOW IT'S DOING AND I'LL CHECK BACK WITH YOU.
BUT ONCE A PILL GETS IN YOUR SYSTEM, IT LASTS A GOOD WHILE.
SO IT SHOULD LAST YOU WELL FOR ABOUT SIX TO EIGHT HOURS.
SO WE'LL KIND OF KEEP TRACK OF THAT AND DON'T LET YOUR PAIN GET MUCH OVER FIVE,
BECAUSE IT'S HARDER TO CATCH UP WITH.
YOU GET LIKE UP TO AN EIGHT OR NINE IN THE PAIN THRESHOLD,
AND IT'S A LITTLE HARD TO MANAGE AT THAT POINT.
SO GIVE ME A CALL, I'M HAPPY TO GET THAT PAIN MED FOR YOU.
CAN YOU TELL ME YOUR NAME?
I KNOW I JUST ASKED YOU, BUT I NEED TO ASK YOU AGAIN
SO I GIVE THE RIGHT MEDS TO EVERYONE. YOU DON'T WANT ME MIXING UP.
I KNOW YOU DON'T WANT MRS. JONES' STUFF.
NOW THEY'LL SAY THAT TO YOU, WHY DO YOU KEEP ASKING ME?
AND THIS IS MY FAVORITE LINE OF ALL, THE OTHER NURSES DON'T DO THIS.
WELL, I DO. THAT'S THE WAY I KEEP MY MEDS STRAIGHT.
SO, I DON'T BE NURSE BASHING. IT'S THE WAY I DO IT AND IT'S THE BEST WAY TO DO IT.
AND THAT'S ALL THERE IS TO IT, AND THIS IS HOW I MAKE NO MED ERRORS.
ALRIGHT SO, CONRAD CURRY, CONRAD CURRY.
DR. I AM SMART, 333770000. YOU'RE STILL ALLERGIC TO SULFA.
AND THAT SHOULDN'T BE A PROBLEM WITH DARVOCET. HAVE YOU EVER TAKEN DARVOCET BEFORE?
ALRIGHT, IT'S GOT A LITTLE BIT OF A NARCOTIC IN IT,
AND IT'S GOT A LITTLE TYLENOL IN IT.
AND THAT'S HOW IT WORKS TO MANAGE THE PAIN.
IT MIGHT MAKE YOU A LITTLE NAUSEATED,
SO IF YOU WANT SOMETHING TO EAT WITH IT, THAT WOULD BE GOOD.
AND THE OTHER THING ABOUT NARCOTICS THAT YOU MIGHT WANT TO KNOW IS
THAT IF YOU TAKE THEM FOR A WHILE IT CAN MAKE YOU A LITTLE CONSTIPATED.
SO YOU WANT TO KEEP TRACK OF THAT. WHEN WAS YOUR LAST BOWEL MOVEMENT, BY THE WAY?
ASK EVERYBODY EVERYDAY. "HI, HOW ARE YOU, WHEN WAS YOUR LAST BOWEL MOVEMENT?"
AND SO TRY TO GET OVER SOME OF THOSE PERSONAL ISSUES STRAIGHTAWAY.
ALRIGHT, MY HANDS ARE WASHED, I'VE PROVIDED PRIVACY, I HAVE IDENTIFIED MY CLIENT,
I THINK I HAVE JUST DONE ALL THERE IS TO DO.
YOU WANT TO GET SOME GOOD VITAL SIGNS BEFORE. AND IN PARTICULAR, WHEN YOU GIVE A NARCOTIC,
WHAT'S THE VITAL SIGN YOU'RE MOST CONCERNED ABOUT?
- BLOOD PRESSURE. -NO.
- PULSE. - NO.
- RATE OF RESPIRATION. - RESPIRATION.
IF I KNEW I'D GET THERE, THERE'S ONLY FOUR. I'D LOVE TO HANG IN THERE, RIGHT?
RESPIRATION. WITH NARCOTICS, THEY SUPPRESS THE RESPIRATORY SYSTEM.
SO WE'RE ALWAYS WATCHING RESPIRATIONS RELATED TO NARCOTICS.
SO FILE THAT LITTLE TIDBIT INFORMATION AWAY.
AND SO, WE'LL KEEP AN EYE ON HIM.
THIS IS A LOW DOSE AND IT'S NOT VERY LIKELY, UNLESS HE HAD SOME KIND OF ALLERGIC RESPONSE,
BUT NEVERTHELESS THAT'S THE VITAL SIGNS. I'VE GOT GOOD VITAL SIGNS.
I'VE CHECKED HIS PAIN, I HAVE CHECKED EVERYTHING.
I AM NOW GOING TO DO MY THIRD AND FINAL CHECK, MAYBE FOURTH OR FIFTH BY NOW.
DARVOCET-N 100 1 PO, YOU ARE CONRAD CURRY,
THE KEY IS THAT WE CHECK THIS SHEET TO HIM,
AND THIS IS THE DRUG FOR HIM AND THIS IS WHY WE NEED TO MAKE OUR FINAL CHECK.
THIS IS HIM, THIS IS OUR OFFICIAL DOCUMENT.
ALRIGHT, SO I'M GOING TO PUT IT IN THE CUP, GIVE IT TO HIM,
GIVE HIM HIS GLASS OF WATER, HE'S GOING TO SWIG IT DOWN.
DID YOU GET THAT DOWN? GOOD.
AND THAT'S ALL THERE IS TO THAT.
ALRIGHT, ANYTHING ELSE I CAN GET FOR YOU? YOU HAVE YOUR CALL LIGHT, GREAT.
I'LL COME BACK AND CHECK ON YOU IN ABOUT AN HOUR, AND SEE HOW THAT PILL WORKED FOR YOU.
AND SEE YOU IN A BIT.
- DO WE NEED TO TELL THEM -- - WASH YOUR HANDS.
- DO WE NEED TO TELL THEM TO LIFT THEIR TONGUE AND --
DEPENDS ON THE CLIENT, I'VE HAD SOME SWEET LITTLE CONFUSED PEOPLE OUT THERE
THAT I SAY, "OPEN YOUR MOUTH. YOU NEED TO LOOK IN THERE."
YOU KNOW, BECAUSE I'VE SEEN THE GREEN PILL ON THE WHITE PILLOW ON THE BASE OF THE BED.
BUT I MEAN, HONESTLY, IF YOU GAVE ME A PILL, ARE YOU GOING TO GIVE ME THE WHOLE MOUTH CHECK?
NO, RIGHT. YOU KNOW, BASED ON ALERTNESS, AND SO FORTH.
JUST ASK THEM IF THEY GOT IT DOWN OKAY.
YOU NEVER KNOW, MIGHT POCKET IT AND SAY SOMETHING, RIGHT.
OKAY, SO WE NEED TO DOCUMENT. SO LET'S GO DOCUMENT.
DID NOTICE THE DOCUMENTATION IS ASTERISKED?
EVERY TIME, BECAUSE IT'S CRITICAL, RIGHT.
IT'S OUR FIFTH RIGHT, OUR SIXTH RIGHT. SO, WE GOT TO MAKE SURE THE DOCUMENTATION IS RIGHT.
AND SO, AFTER WE GIVE THE PILL, I DID CHECK THAT TO THE DOCTOR'S ORDER.
I GAVE THIS, IT COULD BE EIGHT O'CLOCK, I DON'T CARE WHAT TIME IT IS.
AT EIGHT O'CLOCK, I GAVE THE DARVOCET.
AND MY NAME IS...
THIS PEN IS KIND OF CRUMMY, TURNING INTO A BIG BLUR.
I'LL TRY AND GET THIS THERE SN CSUF.
AND THAT'S WHAT WE DO.
ANY TIME YOU GIVE A NARCOTIC OR ANY PRN MED,
YOU HAVE TO FOLLOW UP ON THE EFFECTIVENESS OF THAT MED
AND DOCUMENT ABOUT THAT IN YOUR NURSE'S NOTES.
SO THAT'S WHY I SAID, "I'LL BE BACK IN AN HOUR, TO SEE HOW IT IS -- HOW IT'S WORKING FOR YOU."
AND THEN IN MY NURSE'S NOTES I WILL SAY,
PAIN THREE AFTER ONE HOUR OR ONE HOUR POST DARVOCET.
SO THAT I -- IT WORKED FOR HIM,
HE'S MORE COMFORTABLE OR IT DIDN'T WORK, PAIN STILL FIVE.
OKAY, LET'S TALK ABOUT PAIN STILL FIVE,
CLIENT NOT COMFORTABLE, AND HE ONLY TOOK ONE PILL.
WHAT CAN YOU DO?
GIVE HIM ANOTHER ONE.
OKAY, NOW HERE'S THE TRICK.
THE ORDER IS ONE PILL OR TWO PILLS.
SO, IF YOU GAVE THE FIRST PILL, AND HIS PAIN WASN'T RELIEVED,
AND YOU CHECKED WITH HIM IN TWO HOURS OR THREE HOURS AND IT HASN'T WORKED,
YOU CAN GIVE HIM THE NEXT ONE PILL.
SO NOW HE'S GOT TWO PILLS ON BOARD, BUT YOU NEED TO EXPLAIN THIS.
I CAN'T GIVE YOU ONE PILL ALTERNATING EVERY THREE HOURS,
THAT WASN'T WHAT THE DOCTOR ORDERED.
THE DOCTOR SAID YOU CAN HAVE ONE PILL OR TWO PILLS.
SO IF I GIVE YOU THIS SECOND PILL,
IT WILL BE A FULL SIX HOURS BEFORE YOU CAN TAKE TWO PILLS.
OR YOU CAN WAIT FIVE AND A HALF HOURS AND YOU CAN TAKE TWO PILLS.
YOU SEE WHAT I'M SAYING?
SO, ONE PILL, NOT WORKING, YOU CAN GIVE A SECOND ONE PILL IN THREE HOURS.
BUT THE SECOND PILL OR TWO PILLS CAN'T HAPPEN FOR SIX HOURS.
AND THEN YOU FALL INTO A ONE OR TWO PILL SCENARIO.
SO YOU COULD ONLY ONE TIME DO THE DOUBLE BACKING THING.
DOES THAT MAKE SENSE? SO, EXPLAIN TO THEM, WHICH WOULD YOU RATHER DO?
WOULD YOU RATHER WAIT A COUPLE MORE HOURS, AND TAKE TWO PILLS OR DO YOU WANT TO TAKE ONE NOW
AND THEN YOU HAVE A FULL SIX HOURS BEFORE YOU CAN TAKE THE TWO,
BECAUSE THAT ISN'T THE ORDER. ALTERNATE EVERY THREE AND THAT'S WHAT YOU DO.
OKAY, ANY QUESTIONS ABOUT PILLS AND DRUGS AND THINGS?
ALRIGHT, THAT'S ALL YOU HAVE TO DO.
AMAZINGLY, IT TOOK AN HOUR TO GIVE THREE PILLS.
ISN'T THAT JUST ASTOUNDING?
IT WON'T TAKE YOU AS LONG.
WHAT YOU NEED TO DO IS COME INTO THE ROOM, GET YOUR TWO PILLS READY,
OR YOUR LASIX AND YOUR POTASSIUM. HAVE THEM --
HAVE YOUR CUPS LABELED, AND ALL YOUR STUFF TOGETHER. YOU'LL COME IN AND CHECK HIM.
AND WE'LL EITHER HAVE YOU GO TO THE NARCOTICS STATION, DOESN'T MATTER WHICH ONE YOU GET FIRST.
WE MAY SAY SET YOUR PILLS DOWN, AND GET YOUR NARCOTIC FIRST.
SO WE'LL SEND YOU TO GET YOUR NARCOTIC.
AND YOU GO GET YOUR NARCOTIC, SO WE CAN ALTERNATE A LITTLE ON THE BEDS.
DEPENDS ON HOW MANY STAFF I HAVE.
AND SO FORTH. SO, EVERYONE OKAY WITH THAT?
ALRIGHT, I WANT TO EXPLAIN ONE OTHER LITTLE THING.
YOU'VE MADE THIS ACTIVITY SHEET, AND SO WHAT IS THE POINT OF IT?
WELL, IT TOLD US TO GO GET MEDS AT EIGHT O'CLOCK AND I DID.
SO WHAT DO I DO WITH MY SHEET?
AFTER I GIVE MY EIGHT O'CLOCK MED, I PUT A LINE THROUGH IT.
AFTER I DOCUMENT MY EIGHT O'CLOCK MED, I PUT A SECOND LINE THROUGH IT. I'M DONE.
IT HELPS ME KEEP IN MY MIND, KEEP STRAIGHT THAT MY TASK HAS BEEN COMPLETED.
GIVING THE MED IS ONE PART OF THE TASK, DOCUMENTING IT IS THE SECOND PART OF THE TASK
AND I NEED TO KEEP MYSELF TOGETHER BECAUSE YOU GET SO BUSY
THAT SOMETIMES YOU DON'T GET TO ONE PIECE OF THE PUZZLE, UNTIL LATER.
NOW THE DARVOCET, WHAT I LIKE TO KEEP TRACK OF OVER HERE IS NOTICE I WROTE, LAST DOSE.
WHEN I GOT REPORT, THEY TOLD ME THAT THE LAST TIME THE CLIENT TOOK DARVOCET
WAS AT TEN O'CLOCK AT NIGHT. SO I KNOW THAT MY CLIENT IS OKAY TO HAVE MORE DARVOCET.
AFTER I GET MY DARVOCET, I'M GOING TO SAY, 08 O'CLOCK."
SO THAT IF THE CLIENT CALLS ME AT 1:30 AND SAYS,
"YOU KNOW, MY KNEE IS STILL HURTING, AM I STILL DUE FOR MY PAIN MED?"
AND I LOOK AND GO, "YOU HAD IT AT 8:00, IT'S 1:30,
THAT'S FIVE AND A HALF HOURS. YEAH, THAT WOULD BE GREAT.
DOESN'T SEEM TO LAST YOU VERY LONG. YOU WANT TO TRY TWO THIS TIME?
YOU'RE UP AND ALONE, WE'RE ACTIVE THIS AFTERNOON WITH YOUR FAMILY, YOUR PT'S COMING.
WHY DON'T WE TRY TWO PILLS THIS AFTERNOON?"
YOU KNOW, JUST NEGOTIATE WHAT WOULD WORK BEST FOR YOUR CLIENT.
BUT THAT'S HOW I KEEP TRACK OF IT ON MY LITTLE SHEET,
AND THEN ONCE I GIVE IT AND ONCE I DOCUMENT, I MARK THROUGH.
I DO THE SAME THING AS I GATHER INFORMATION THROUGHOUT THE DAY.
I'M WRITING DOWN VITAL SIGNS, AND I'S AND O'S.
AND THEN WHEN I CHART, I EXIT OUT. AND THAT MEANS, IT'S IN THE CHART. I'VE DONE IT, I'M DONE.
THE HAPPIEST SIGHT AT THE END OF MY DAY IS EXITS.
I DO EVERYTHING AND THEN I CHART IT, I PUT A LINE THROUGH THE WHOLE DEAL, DONE. DONE, DONE.
OKAY, SO, BRING YOUR ACTIVITY SHEET,
YOU'LL HAVE TO GATHER UP YOUR MARS AND YOUR MEDS AND YOU'LL BE SET.
OKAY, LET'S TALK ABOUT MED MATH A LITTLE BIT,
IF THERE'S NO MORE QUESTIONS ABOUT MED ADMINISTRATION.
SO WE CAN GET READY FOR THAT
BECAUSE THERE'S A BIG MED MATH TEST THIS NEXT WEEK.
SO, OH, PLEASE STUDY THIS WEEK. THIS IS NO TIME TO NOT STUDY AND THINK YOU GOT IT.
EVERYDAY, DRILL YOURSELVES ON THOSE CONVERSIONS.
YOU JUST GOT TO KNOW THEM, IT'S BY MEMORY.
AND PEOPLE FEEL SO BAD WHEN THEY GO, "I JUST COULDN'T REMEMBER WHAT A TABLESPOON WAS."
OH, IT'S SAD TO HAVE TO TAKE A TEST OVER BECAUSE OF THE TABLESPOON.
SO I WANT TO REVIEW WHAT THOSE CONVERSIONS ARE
AND THEN I WANT TO GO THROUGH ONE MORE PRACTICE TEST WITH YOU.
AND I WANT YOU TO APPRECIATE THAT IN YOUR SYLLABUS, I GAVE YOU A MED MATH PACKET.
IF YOU HAVEN'T SEEN IT YET, THERE'S A BUNCH OF PROBLEMS FINALLY TO JUST DO AGAIN.
YOU REVIEWED IT, YOU'VE DONE ALL OF THESE PRACTICE TESTS, NOW GET IN HERE AND DO THAT.
I'VE ALSO GIVEN YOU PAGE ASSIGNMENTS WITH EXACT PROBLEMS IN YOUR MATH BOOK.
IF YOU'LL DO THOSE, YOU GUYS WILL BE IN GREAT SHAPE.
IF YOU DON'T AND YOU'RE JUST DOING IT, OH, IT'S GOING TO BE SAD.
- IN YOUR SYLLABUS, YOU HAVE THESE LITTLE GRADES LIKE ROMAN NUMERALS,
THAT'S JUST FOR OUR PRACTICE TO MAKE SURE WE GOT IT.
- UH-HUH. ON EVERY TEST, THERE IS A ROMAN NUMERAL, EVERY SINGLE TEST.
SO YOU'RE NOT GOING TO BY LUCK GET IT.
EVERY TEST HAS A HOUSEHOLD MEASURE.
WHICH ONE IT IS, I DON'T KNOW. THERE'S A BUNCH OF TESTS.
AND SO I JUST PULL TWO OR THREE FOR EACH SECTION AND SO IT'S JUST WHATEVER I PULL.
I ROTATE THEM FROM SEMESTER TO SEMESTER AND SO FORTH.
- THERE'S 25 QUESTIONS ON THEM. - NO, 10. 10, IT'S NOT THAT BAD.
THIS IS WHAT THE TEST LOOKS LIKE.
ACTUALLY, THERE'S 20 AND THIS IS -- ACTUALLY, 19.
THE FIRST 10 QUESTIONS ARE MATCHING,
AND THEY ARE WORTH ONE POINT EACH.
BUT ACTUALLY, THE FIRST FIVE ARE MULTIPLE CHOICE.
AND SO IT SAYS, LIKE, ON A DOCTOR'S ORDER,
LASIX PO BID, AND WHATEVER IS IN BOLD FACE,
YOU HAVE TO PICK THE MULTIPLE CHOICE OF WHAT IT IS. SO, BID IS?
- TWICE A DAY.
- IT'LL DAY, ONCE A DAY, TWICE A DAY, THREE TIMES A DAY, FOUR TIMES A DAY
AND YOU PICK THE MULTIPLE CHOICE.
AND SO IT'S TO DO YOUR ABBREVIATIONS ON THOSE FIRST 10.
FIVE ARE MULTIPLE CHOICE, AND FIVE ARE MATCHING.
SO, GO OVER YOUR ABBREVIATIONS LIKE WE'VE DONE.
WHAT'S OU? - BOTH EYES.
- BOTH EYES. OS? - LEFT.
- LEFT EYE. PC? - PUPILS?
- UH-UH. AFTER, AFTER. P IS AFTER A. P IS AFTER A.
A IS BEFORE. P IS AFTER A. SO A IS BEFORE, P IS AFTER, AC?
- AIR-CONDITIONING.
- THE FOUR MEALS -- I THINK WE COULD USE SOME IN THIS WONDERFUL SPRING WEATHER.
I WAS TALKING TO A FACULTY NOT EVEN FROM OUR DEPARTMENT, HE SAID,
"I HAVE SPRING FEVER SO BAD, I GOT TO GET OUT OF HERE."
I SAID, "I KNOW, AND EASTER BREAK IS NOT FOR A WHILE."
SO, WE GOT TO GET TO WORK.
LET'S SEE, WHAT ELSE IS THERE? Q?
- HOURLY.
- QH? - EVERY HOUR.
- HS? - HOURS OF SLEEP.
- PRN? - AS NEEDED.
- STAT? - RIGHT AWAY.
- OKAY, JUST REVIEW THOSE AND MAKE SURE YOU'RE FEELING PRETTY GOOD ABOUT THOSE ABBREVIATIONS.
THAT'S THE FIRST 10. THOSE ARE MY GIFT TO YOU, ONE POINT EACH.
OKAY, SO THAT'S 10 OUT OF 90. THEN YOU HAVE NINE QUESTIONS.
EIGHT OF THEM ARE STRAIGHTFORWARD CONVERSIONS.
THE DOCTOR ORDERED THIS, YOU HAVE THAT.
NO, LET ME TAKE THAT BACK.
SIX OF THEM ARE THAT.
THEN ONE OF THEM IS THAT KIND THAT SAYS, YOU'RE THE CAMP NURSE,
AND YOU HAVE A PINT OF PEPTO BISMOL AND A DOSE IS A TABLESPOON.
OR YOU HAVE EIGHT OUNCES OF KAOPECTATE AND ONE TEASPOON IS THE DOSE.
HOW MANY DOSES PER CONTAINER?
OKAY. PUT EVERYTHING INTO MILLILITERS AND DIVIDE YOUR PART INTO YOUR WHOLE.
WE'RE GOING TO DO ONE MORE HERE TODAY, OKAY?
AND THEN FINALLY, YOU HAVE A QUESTION
THAT IS THE POUNDS, KILOGRAMS KIND OF CONVERSION DEAL.
AND THAT'S IT. NO SURPRISES, NO TRICKS, STRAIGHTFORWARD.
BUT IN THOSE, YOU'LL HAVE A GRAIN, YOU'LL HAVE A MILLIGRAM,
YOU'LL HAVE A ROMAN NUMERAL AND YOU'LL HAVE A HOUSEHOLD MEASURE. IN EACH ONE. ALRIGHT.