4, 5, WHATEVER.

6 -- YOU ARE REALLY
INTO DRAMA.

NOW.

ON THESE MEDS, ARE ANY OF THEM,
THE VITAL SIGNS A BIG DEAL?

A COUPLE OF THEM,
THEY ARE.

SO, WHAT YOU CAN DO. FOR
EXAMPLE, THE NITRODERM PATCH.

IF I'M CONCERNED ABOUT THE
PULSE AND THE BLOOD PRESSURE,

I MIGHT WRITE A P72
AND THE BP 110/80.

SO THAT THERE'S A REFERENCE
POINT AND PEOPLE KNOW

THAT I DID SOMETHING
WITH THIS DRUG.

NOW, THAT FILLS UP
THE WHOLE SQUARE

AND IF THEY'RE TAKING THIS
DRUG TWO OR THREE TIMES DURING
THIS TIME FRAME,

THE PEOPLE THAT YOU'RE SHARING
THAT SQUARE WITH AREN'T GOING
TO BE VERY HAPPY WITH YOU.

SO YOU CAN WRITE YOUR OTHER
INFORMATION IN YOUR NURSES
NOTES THAT YOU TOOK THAT.

ALL THE OTHERS ARE OKAY.

I MIGHT SAY RESPIRATION'S 24,
SOMETHING. I DON'T KNOW.

YOU KNOW? "OH, THEY REALLY
NEEDED IT," KIND OF A THING.

BUT YOU CAN WRITE A NOTE.

I WANTED TO MENTION JUST
A COUPLE OTHER THINGS
YOU NEED TO KNOW

ABOUT THESE MEDICATION
ADMINISTRATION RECORDS.

WHAT HAPPENS IF THE DOCTOR
COMES IN AND DISCONTINUES --

I FORGOT MY MARKERS HERE --

DISCONTINUES BECLOVENT

AND STARTS THEM ON ALUPENT.

IF THAT'S THE CASE,
THEN WHAT YOU NEED TO DO

IS YOU NEED TO COME OVER HERE
AND HIGHLIGHT THROUGH
ALL THIS MED

OR WHATEVER THEIR POLICY IS,

AND SAY,
"DC

3/24/04,

12 O'CLOCK." OKAY?

SO I KNOW THAT
DRUG'S BEEN DC'ED.

THEN THE NEW DRUG

GETS WRITTEN DOWN HERE
IN HANDWRITING FOR THE DAY.

ALUPENT:
2 PUFFS,

Q6 HOURS.

OKAY. THEN WE START
DOCUMENTING HERE.

WHAT HAPPENS THEN TOMORROW
IS WHEN THE NEW SHEETS
COME OUT FROM PHARMACY,

PHARMACY PRINTS THEM ALL OUT
BECAUSE THE ORDER --

THIS HAD BEEN WRITTEN
ON AN ORDER.

DOCTOR WOULD COME OVER HERE
AND DOWN HERE AT THE BOTTOM

AND SAY, "DC BECLOVENT.
ALUPENT, 2 PUFFS.

Q6 HOURS." OKAY?

SO SOME -- WE HAVE TO GET IT
GOING ON OUR SHIFT.

BUT A COPY OF THIS ORDER
GETS SENT TO PHARMACY

AND THEN THEY GENERATE A
COMPUTER COPY FOR THE NEXT
DAY.

THESE ONE-A-DAY SHEETS.

SO ON THE NEXT DAY, YOU'RE
GOING TO GET THE NEW ORDER

AND YOU'RE GOING TO MAKE SURE
EVERYTHING GOT PUT ON THERE.

YOU'RE GOING TO MAKE SURE
THAT BECLOVENT GOT DC'ED
AND ALUPENT GOT PUT ON

AND THEN YOU'RE GOING TO PUT
YOUR NAME IN ALL OF THESE
LITTLE BOXES.

AND SO THAT'S WHAT THE BOX
MEANS, THAT WE'VE CHECKED
AND THAT EVERYTHING IS CURRENT.

THAT WHAT WE WERE DOING
YESTERDAY, WE'RE STILL
DOING TODAY,

AND THE OLD SHEET DIDN'T
COME THROUGH BY MISTAKE.

SO ARE YOU STARTING TO GRASP THE
POINT OF THIS LITTLE CHECK ROW?

AND DAILY SHEETS,
EACH DAY.

IF YOU WANTED TO KNOW WHAT
THEY WERE DOING YESTERDAY WHEN

YOU LOOKED AT TODAY'S SHEET,
YOU GOT TO GO PULL THAT SHEET.

BECAUSE THE NEW ONES COME EACH
DAY AND THEN THEY JUST PILE UP
UNDER THEIR ROOM NUMBER DIVIDER.

SO WE'RE JUST WORKING WITH ONE
DAY, BECAUSE IT'S ALL WE GOT.

ALRIGHT.
THAT IS IT.

YOU CAN SEE IT'S NOT
TOO TIME CONSUMING,

SO WE'LL BE RIGHT ON SCHEDULE
FOR GIVING YOUR MEDS.

YOU GET THEM READY.
YOU GET ALL YOUR SUPPLIES.

WHEN YOU COME TO EACH STATION,
WE'RE GOING TO ASK YOU,

"WHAT'S YOUR DRUG FOR --
WHY IS YOUR CLIENT GETTING IT?

WHAT DOES IT DO?
ARE YOU GIVING A SAFE DOSE?"

AND THEN WE'RE GOING TO SAY, "DO
YOUR TEACHING AT THE BEDSIDE."

SO TEACH 'EM HOW TO TAKE THE
DRUG CORRECTLY AND TEACH THEM
ABOUT THEIR SIDE EFFECTS.

KIND OF LIKE I WAS DOING
AS I TALKED ALONG.

I AS SAYING, "THIS WILL
AFFECT YOUR BLOOD PRESSURE.

THIS WILL MAKE YOU DIZZY.
THIS MAY BURN.

YOU NEED TO TAKE THIS
OFF AT NIGHT." YOU KNOW?
THAT KIND OF STUFF.

- NOW, DO YOU NEED TO PREPARE
MED CARDS FOR THIS?

- YES.
MED CARDS FOR ALL OF THESE.

YES, ALWAYS.

WHENEVER THERE'S A MED
THAT YOU GIVE IN HERE,

WHENEVER THERE'S MED THAT
YOU GIVE IN THE CLINICAL AREA,

YOU MUST HAVE A CARD.
YOU MUST KNOW YOUR DRUG.

SO, THAT'S PART OF
HOW YOU'LL KNOW.

YOU WON'T HAVE TO DO IT
ALL BY MEMORY.

YOU'LL HAVE YOUR CARD TO DO
YOUR TEACHING WITH YOUR CLIENT.

- IF WE BOUGHT THE PACKET
OF ALL THE CARDS BECAUSE WE JUST
CAN'T DISTRIBUTE --

- UH-UH, BECAUSE THERE'S TOO
MUCH INFORMATION AND I DON'T
WANT ALL THAT INFORMATION,

I WANT YOU TO GLEAN OUT OF THAT
INFORMATION WHAT'S PERTINENT FOR
YOUR CLIENT WITH YOUR DIAGNOSIS.

BECAUSE THAT'S THE WHOLE POINT
OF GETTING INTO THE BOOK

IS THAT YOU KNOW WHAT IS --

WHAT'S IMPORTANT FOR YOUR
CLIENT AND YOUR TEACHING.

OKAY?

ANY OTHER QUESTIONS ON THAT?

ALRIGHT, I'M GOING TO
GIVE YOU NINE MINUTES.

WE'LL START PROMPTLY AT
11 O'CLOCK, THE MATH TEST.

I NEED YOU TO PUT ALL YOUR
STUFF UNDER YOUR CHAIRS.
TURN YOUR CHAIRS.

WE NEED TO DO A COUPLE
OF BUSINESS THINGS FIRST.

CESAR CHAVEZ IS NEXT WEEK

AND IT WOULD BE, LIKE, WEDNESDAY
THAT WE GET THE DAY OFF.

THIS IS A PROBLEM. THIS IS A
BIG, HUGE PROBLEM FOR US.

I HAVE NEVER HAD A WEDNESDAY
OFF IN MY WHOLE EIGHT YEARS
WORKING HERE,

SO I'M LIKE,
"WHAT IS THIS?"

SO HERE IS OUR PLAN.

FIRST, EVERYONE CAN COME TO
THE FRIDAY LECTURE IF YOU WANT
TO, SO YOU CAN SEE IT LIVE.

I SEE YOUR FACES' PAINS.

SO, DID ANYBODY TRY TO GET THE
VIDEO ON BLACKBOARD THIS WEEK?

- I GOT IT.
- DID IT WORK?

- YES.
- NO.

- OKAY. WELL, I'M SAD FOR
THOSE THAT IT DOESN'T WORK

BECAUSE WHAT WE'RE GOING TO DO
IS WE'RE GOING TO PUT

LAST SEMESTER'S VIDEO ON
BLACKBOARD FOR YOU THIS WEEK.

SO YOU'LL HAVE A -- THIS CLASS
WILL HAVE A VIDEO AVAILABLE.

TOM HAS -- THIS IS PART OF HIS
MASTER'S PROJECT THAT HE'S
WORKING OUT FOR US,

AND SO YOU SHOULD JUST
HUG HIM AND THANK HIM

THAT HE'S DOING ALL
THIS WORK FOR YOU GUYS
AS A FELLOW STUDENT.

HE WANTED ALL THIS,
SO HE'S CREATING IT FOR YOU.

HE'S MAKING CD-ROMS
AND WE MAY BE ABLE

TO CHECK OUT A COUPLE
IF YOU'RE JUST DESPERATE,

BUT WE'LL ALSO BE ABLE TO WATCH
'EM ON THE COMPUTER IN HERE

AND THEN WE'LL HAVE VIDEOS
IN THE MEDIA LAB.

SO HOPEFULLY, YOU'LL HAVE
ENOUGH RESOURCE THAT YOU'LL
BE ABLE TO GET TO IT.

THE THING ABOUT THIS IS
IT'S SHOTS NEXT WEEK.

SO IT'S A BIG, HUGE MODULE
AS WELL AS MISSING.

AND WHAT CAN I DO.
I MEAN...

- YOU CAN POSTPONE THIS ONE.

- SO, WE CAN'T GET A DAY
OR SECOND BEHIND AT LAB.

WE'VE GOT LIKE EIGHT
MILLION THINGS TO DO.

AND YOU GUYS NEED TO GIVE
INSULIN AS SOON AS YOU CAN
WHEN AVAILABLE.

SO, ANYWAYS, THAT'S THE DEAL.

SO, WE'LL PUT IT ON BLACKBOARD.

YOU'RE WELCOME TO
THE FRIDAY LECTURE

AND THERE WILL JUST
BE MORE RESOURCES.

OKAY, QUESTION?

- WHAT TIME IS FRIDAY'S LECTURE?
- TEN. SAME O'CLOCK.

- I KNOW THAT IN THE LIBRARY
ON THE THIRD FLOOR,

THEY HAVE SOMEWHERE
WE CAN GO TO VIEW...

- IN THE MUSIC?
UH-HUH.

- DO YOU KNOW IF YOU GUYS
WILL BE DOING THAT --

- WE USED TO, BUT IT WAS
A PROBLEM BECAUSE IT
WAS A PROBLEM.

I PROBABLY COULD PUT SOMETHING
UP THERE JUST FOR THE -

BECAUSE OF THE HOLIDAY, BUT I
THINK THEY'LL BE CLOSED AS WELL.

SO IT WON'T HELP YOU
AS FAR AS THE EXTRA DAY.

- I WASN'T TALKING ABOUT
JUST NEXT WEEK, I WAS
TALKING ABOUT --

- IN GENERAL.
YEAH, IT'S BEEN A PROBLEM

TO ACCESS ALL OF THIS STUFF.
AND THEN WE WERE USING IT
FOR CHECKOUT.

SO THAT IS WHY WE CREATED
OUR OWN MEDIA LAB,

WHICH HAS ITS OWN SET
OF PROBLEMS, I REALIZE.

THEY'LL UP AND CLOSE IT ONE DAY
BECAUSE SOMEONE DIDN'T SHOW UP.
THAT'S A PROBLEM.

SO, WE'RE TRYING TO MAKE SURE
THAT WE GET SOME CD-ROMS.

THAT'S WHY WE'RE CREATING THESE,
SO YOU HAVE THEM IN HERE

AND YOU CAN WATCH THEM ON A
COMPUTER BECAUSE WE NEVER CLOSE.

- WELL..
- EXCEPT FOR WEDNESDAY.

- HUH? YEAH.
- EXCEPT FOR WEDNESDAY.

- SO, YEAH.
THE WHOLE UNIVERSITY.

- OVER SPRING BREAK IS
THE RESOURCE CENTER GOING
TO BE OPEN?

- OH, YEAH. OH, YEAH, BABY.
I'M LOOKING FORWARD TO IT.

[LAUGHTER]

- BUT THEN HOW WILL WE VIEW THE
VIDEOS IF THE MEDIA LAB AND THE
RESOURCE CENTRE IS CLOSED.

- BLACKBOARD OR IF WE'RE ABLE
TO GET SOME FOR CHECKOUT
SO YOU COULD TAKE A CD-ROM HOME.

I KNOW, TOM. WE TRIED IT THIS
WEEK AND WE MADE 3 CD-ROMS

TO HAVE AVAILABLE
TO WATCH ON COMPUTERS.

SO, WE'LL SEE WHAT WE WORK UP.

ONCE WE HAVE THEM CREATED,
THEY'RE A LITTLE FASTER
TO BURN, BUT --

- DO YOU THINK THAT THEY'LL HAVE
A VIDEO AVAILABLE FOR US ON
TUESDAY AFTER WE DO OUR

- UH-HUH. OH, YEAH.
- RIGHT THERE IN THAT ROOM?

- IT'S AVAILABLE TODAY.
- OKAY.

- BECAUSE IT'S LAST SEMESTERS'.

SEE WHAT MY HAIR LOOKED LIKE. I
DON'T THINK I LEFT ANYTHING OUT.

BUT, SO, YEAH.

WE HAVE EVERYTHING NOW,
IT'S JUST OLD.

SO, YEAH.
IT'S ALL THERE NOW.

ALRIGHT.
I THINK THAT'S IT.

I HOPE YOU LISTENED
TO ME A LITTLE BIT.

I KNOW YOU'RE
WORRIED ABOUT MATH,

BUT MATH WILL COME AND MATH
WILL GO AND IT'LL BE FINE.

BUT WE GOT TO GIVE THESE MEDS.

SO WE'RE IN THE SECOND
WEEK OF OUR MODULE.

AND THIS WEEK,
THE EMPHASES IS TOPICAL MEDS.

AND SO THESE ARE MEDS THAT ARE
GOING TO GO IN EYES, EARS, NOSE.

YOU'VE PROBABLY REVIEWED THAT,
BUT YOU HAD TO PASS YOUR
BLACKBOARD EXAM FOR THIS WEEK.

SO THAT'S WHAT WE'RE
GOING TO DO.

THIS TIME, I WANT YOU TO
BE CAREFUL WHEN YOU'RE
LOOKING AT YOUR DOSING

BECAUSE THEY'LL BE A LITTLE
DIFFERENT FOR THE DIFFERENT BEDS

AND I'LL EXPLAIN
WHEN I GET THERE.

BUT NOT EVERYBODY IS
EXACTLY THE SAME THIS WEEK.

ALRIGHT. TOM HATES IT
WHEN I START MOVING,

BUT HERE I GO.

ALRIGHT.
YOU HAVE YOUR ORDER

AND NOW WE'RE GOING TO GO
TO THE SECOND WEEK MEDS.

SO WHEN YOU'RE LOOKING
AT YOUR ORDER THIS WEEK,

CONRAD CURREY OR WHOEVER
YOUR CLIENT IS NEEDS
BECLOVENT INHALER.

NEEDS NEOMYCIN OTIC SOLUTION,
2 DROPS, RIGHT EAR.

NEEDS PILOCARPINE, 2%.
OPHTHALMIC SOLUTION, ONE DROP.

OKAY?

LEFT EYE. JUST CHECKING IF YOU
GOT A TEST COMING UP HERE.

OKAY. AND NITRODERM PATCH,
0.2ML EVERYDAY.

OKAY.

I NEED TO GO TO MY MAR

AND MAKE SURE THAT THOSE
ORDERS WERE TRANSCRIBED
CORRECTLY.

SO THAT WHOEVER COPIED THEM,

COPIED THEM FROM THE DOCTOR'S
ORDERS TO THE MAR RIGHT.

IF I'M THE ONE
WHO'S CHECKING THAT,

THEN I WILL INITIAL
THAT THEY'RE CORRECT.

AND THAT'S ALL THAT THIS MEANS
DOWN THIS COLUMN.

AND PEOPLE THAT CAME TO MY
STATION, WHO HAD DONE THAT,

I'D SAY, "OH, THAT'S WONDERFUL.

YOU HAVE YOUR LITTLE VB IN
THERE. YOU'VE CHECKED YOUR
ORDERS TO YOUR CHART."

BUT I WOULDN'T SEE THEIR
SIGNATURE AT THE BOTTOM.

THERE WAS SOME CONFUSION
AND, "OH, CAN I SIGN THIS
BEFORE I GIVE IT?"

OH, YES, YOU CAN SIGN ANYTHING.

THAT JUST MEANS THAT DB
STANDS FOR DIANE BENEFIEL.

AND THAT'S ALL IT MEANS.

THAT YOU CAN EVEN SIGN --
THAT YOUR CHARTS --

YOU CAN SIGN YOUR MAR'S
WITHOUT EVER EVEN GIVING A MED.

KIND OF A WASTE OF TIME.

BUT ANYTIME THAT YOU
PUT INITIALS DOWN,

YOU HAVE TO TELL THEM
WHAT INITIALS MEAN.

SO THAT'S STRAIGHTAWAY.

WE JUST DON'T SIGN OUT A MED
WE HAVEN'T GIVEN YET.

ALRIGHT. SO WE KNOW THAT
THIS ALL MATCHES

AND WE'RE IN GOOD SHAPE AND
WERE' GOING TO GIVE OUR MEDS.

I WANT YOU IN DRAMA
CLASS THIS WEEK

TO PRETEND IT'S 6 O'CLOCK
IN THE MORNING, OKAY?

SO WHATEVER TIME YOU COME,
IT'S 6 O'CLOCK.

SO TODAY WE'RE GIVING
ALL 6 O'CLOCK MEDS

AND THAT'S PART OF
THE PLAN OF ACTION.

SO WHEN I FILLED OUT
MY LITTLE ACTIVITY SHEET,

WHICH YOU'RE GOING TO GO BACK TO
BECAUSE IT'S THE SAME CLIENT

WITH THE SAME ACTIVITIES,
DIAGNOSES, LAB AND SO FORTH.

NOW WE'RE FOCUSING ON
6 O'CLOCK MEDS.

SO YOU DON'T HAVE TO RE-WRITE
YOUR ACTIVITY SHEET,

YOU'RE JUST GOING TO CHANGE
YOUR MED GROUPINGS.

SO THAT THAT'S YOUR CUE SHEET
TO GIVE FOUR MEDS AT 6 O'CLOCK.

SO YOU'VE GOT A LOT TO DO
AND A LOT TO GET READY,

SO YOU WANT TO GET GOING.

SO, WE HEAD TO THE MED ROOM.

AND ONCE AGAIN, YOU'RE
GOING TO GO TO THE MED ROOM,

IN THAT ROOM, GET ALL
OF YOUR SUPPLIES TOGETHER

AND THEN YOU'LL COME TO
THE STATIONS AND WE'LL
CHECK YOUR MEDS.

SO I WASH MY HANDS
TO PREPARE MY MEDICATIONS.

6 O'CLOCK OR HOW MUCH EARLIER

COULD I GIVE MY MEDICATION
THAN ORDERED?

- 5:30.
- 30 MINUTES.

SO IT COULD BE 5:30
OR IT COULD BE 6:15, EITHER WAY.

I'M OKAY AS LONG AS
I STAY WITHIN THAT

HALF HOUR BEFORE-AFTER CRITERIA.

ALRIGHT.

WE LEARNED LAST WEEK, OF COURSE,
WHEN YOU WERE DOING YOUR SHEETS

THAT IT'S BEST TO GO
FROM TOP TO BOTTOM

WHEN YOU'RE PULLING
YOUR MEDS TO MAKE SURE
THAT YOU HAVE EVERYTHING.

SO I JUST WANE TO START
HERE AT 6 O'CLOCK
AND GET MYSELF TOGETHER.

I'M LOOKING - I'VE NOTED THAT
MY CLIENT HAS A SULFA ALLERGY

AND I'LL BE KEEPING THAT IN MIND
AS I AM PULLING THE MEDICATION.

THE FIRST MED THAT I SEE
ON MY LIST IS BECLOVENT.

A BECLOVENT INHALER,
2 PUFFS, PO, QID.

MY ORDER'S COMPLETE.
I HAVE A DRUG,

I HAVE A DOSE, I HAVE A ROUTE
AND I HAVE A FREQUENCY.

I'VE ALREADY LOOKED UP MY MEDS

BECAUSE I'M PREPARED
WITH MY MEDICATIONS

AND I KNOW THAT THIS DOSE
IS WITHIN NORMAL LIMITS.

SO IT'S AN ACCEPTABLE RANGE.

BECAUSE WHEN YOU COME TO MY
STATION AGAIN, I'M GOING TO SAY,

"OKAY, WHAT ARE YOU GIVING?
WHY IS YOUR CLIENT GETTING IT?"

AND "IS THE DOSE SAFE?"

I KNOW IT'S SAFE.

I KNOW MY CLIENT HAS
SOME ASTHMA, I DO BELIEVE.

AND THAT'S WHY HE'S GETTING IT
AND THIS ALL LOOKS ACCEPTABLE.

SO, I WENT AHEAD TO MY DRAWER,
PULLED MY DRAWER

AND I PULLED OUT BECLOVENT.

THIS IS A BECLOVENT INHALER.

I CHECKED THE EXPIRATION DATE
AND IT HAPPENS TO BE EXPIRED.

WHAT DO YOU DO?
- CALL PHARMACY.

- CALL PHARMACY. GET ANOTHER
ONE. THIS IS NO GOOD.

SO NOTE YOUR DATES.
CONNIE AND I LAUGHED.

HOW TIME FLIES. WE THOUGHT
THESE WOULD LAST US FOREVER,

BUT WE FINALLY EXPIRED OURSELVES

SO I'LL PUT SOME 2012
OR SOMETHING ON THERE.

ALRIGHT. SO I HAVE
MY BECLOVENT INHALER.

I HAVE A CANISTER AND
THERE'S A LITTLE IN THERE,

AND I HAVE A SPACER.

AND THAT'S ALL I WANT
FOR THIS PARTICULAR DRILL.

WE'LL TALK ABOUT THAT LATER.

OKAY. NEOMYCIN OTIC SOLUTION.

WELL, I KNOW WHAT --
OTIC IS A WHAT?

- EAR.
- EAR.

SO I'M LOOKING FOR SOMETHING
THAT GOES IN THE EAR.

AND THIS WOULD SEEM
THE MOST LIKELY.

SO, MY NEOMYCIN OTIC SOLUTION,
2 DROPS, RIGHT EAR,
EVERY 12 HOURS.

I KNOW FROM USING THE DRUG BOOKS

THAT YOU'RE NOT GOING TO
BE ABLE TO FIND THIS DRUG
IN THE DRUG BOOKS.

SO I GAVE YOU A DRUG INSERT
AND THAT'S EXACTLY WHAT YOU DO

WHEN YOU CAN'T FIND
YOUR INFORMATION.

YOU CALL THE PHARMACY AND GO,
"CAN I HAVE A DRUG INSERT
FOR THIS DRUG?"

YOU KNOW, WHEN YOU BUY
YOUR PACKAGES OF DRUGS
AND YOU GET THEM,

THERE'S ALWAYS WHAT COMES
IN THE PACKAGE.

THAT'S EXACTLY WHAT'S PRINTED
IN THE PDR, PHYSICIAN'S
DESK REFERENCE.

THAT'S THE MANUFACTURER'S
INFORMATION ABOUT THE DRUG.

SO THAT'S WHAT I HAVE GIVEN
YOU SO THAT YOU CAN HAVE
A REFERENCE TO THIS.

I HAPPEN TO KNOW THAT THIS
ISN'T A VERY GOOD ORDER.

I'LL LET YOU FIGURE OUT
WHAT'S WRONG WITH IT.

I CALLED PHARMACY
TO DOUBLE-CHECK IT,

THEN I FOLLOW UP
WITH MY PHYSICIAN

BECAUSE I'M NOT SATISFIED
WITH THE ORDER FOR THIS DRUG.

ALRIGHT? AND WE'LL
LEAVE IT AT THAT.

YOU CAN RESEARCH IT
AND SEE WHAT I MEAN.

OKAY, SO I HAVE MY EARDROP.

I KNOW THAT I'M PROBABLY GOING
TO NEED TO CLEAN THE EAR.

MY CLIENT HAS A
LITTLE OTITIS MEDIA.

THAT MEANS THEY COULD --
THEY HAVE AN INFECTION GOING ON.

MAYBE THERE'S SOME DRAINAGE,
I MIGHT NEED TO CLEAN THAT OFF.

SO I'M GOING TO
HAVE A WASHCLOTH.

AND I'M ALSO GOING TO PUT A
LITTLE COTTON WICK IN THE EAR

SO THAT IT DOESN'T DRAIN
ALL OUT AND DOWN HIS NECK.

SO I HAVE MY SUPPLIES FOR THAT.

ALSO, EARDROPS SHOULD BE ROOM
TEMPERATURE, BODY TEMPERATURE.

SO I MIGHT WANT TO WARM 'EM.

SO I MIGHT THROW 'EM
INTO MY POCKET

AND GET A LITTLE
BODY HEAT TO 'EM.

NEVER GIVE EAR DROPS STRAIGHT
OUT OF THE REFRIGERATOR.

WHOA! GIVE THEM A LITTLE
RING IN THE EAR.

SO THEY'LL BE WARMED
A LITTLE BIT.

YOU CAN CHOOSE HOW
YOU WANT TO DO THAT.

OKAY. NEOMYCIN --

AND LET ME JUST CHECK
MY EXPIRATION DATE HERE.

IT EXPIRES 2006
AND SO I'M OKAY ON THAT.

AND IT IS THE RIGHT DRUG.

OKAY, MOVING ALONG.
6 O'CLOCK, I HAVE A PILOCARPINE.

PILOCARPINE IS FOR
GLAUCOMA AND --

LET ME LOOK HERE
IF I HAVE THE RIGHT THING.

2% EYE DROP.
I'M GOING TO GIVE

ONE DROP IN THE...LEFT EYE.

AND I DO BELIEVE
THAT'S A NORMAL DOSE

AND SO I'M HAPPY WITH THIS ONE,

BUT DOUBLE-CHECK
JUST TO BE SURE.

PILOCARPINE'S A LITTLE TRICKY
WHEN YOU LOOK IT UP IN
YOUR DRUG BOOK.

THERE'S ORAL PILOCARPINE,
PILOCARP AND THERE'S OPHTHALMIC.

WHEN YOU LOOK UP THE OPHTHALMIC,

YOU NEED TO GET INTO THE
CHOLINERGIC MEDS IN THE BACK.

IT'S A GRAPH IN
THE BACK OF THE BOOK

AND IT'S JUST LISTED
IN A BUNCH OF CHOLERGERNIC --

CHOLINERGIC MEDS. I'LL TALK
ABOUT THAT IN A MINUTE.

BUT THAT'LL HELP YOU GET
THE INFORMATION THAT YOU NEED.

ALRIGHT, I KNOW THAT
WHEN I PUT THIS IN THE EYE,

I'M GOING TO HOLD THE
CONJUNCTIVA DOWN A LITTLE BIT

AND IT'S A LITTLE
SLIPPERY WITH GLOVES.

SO I'M GOING TO GET MYSELF
A 2 BY 2 TO HOLD THE
CONJUNCTIVA DOWN

AND TO PUT IN THE
CORNER OF THEIR EYE.

I'LL EXPLAIN LATER.
OKAY.

SO I HAVE MY 2 BY 2.
I'M GOOD.

AND FINALLY, NITRODERM PATCH,

0.2MG PER HOUR.

I'M GOING TO PUT ON ONE EVERY
DAY, REMOVE IT AT NIGHT

AND REAPPLY AT SIX
IN THE MORNING.

OKAY. SO I HAVE
MY NITRODERM PATCH.

NITRODERM IS OFTEN USED
IN CONJUNCTION FOR CHF.

IT'S SIDE EFFECT IS THAT
IT CAN LOWER BLOOD PRESSURE

SO THAT'S WHY MY CLIENT
IS GETTING IT.

EITHER FOR A CHF.

PROBABLY NOT THE BEST DRUG
OF CHOICE FOR MANAGING
BLOOD PRESSURE, BUT IT DOES --

IT'S SIDE EFFECT IS BLOOD
PRESSURE AND WHO KNOWS WHY
THEY HAVE HYPERTENSION.

BUT THAT'S WHERE IT
WOULD FALL IN.

THE DOSE IS NORMAL

WHICH IS LIKELY TO BE WHEN YOU
GET A PRE-MANUFACTURED PRODUCT.

BUT THE INTERESTING THING IS

ARE YOU WONDERING WHY
I'M PUTTING IT ON

AND TAKING IT OFF
AT THIS INTERVAL.

READ ABOUT THAT A LITTLE BIT
IN YOUR BOOK.

I'LL TALK ABOUT IT SOME --
WHEN WE GET THERE.

OKAY. WHEN I DO
THE NITRODERM PATCH,

I KNOW IT HAS A LITTLE
STICKY STUFF ON IT,

BUT I'M GOING TO GO AHEAD
AND GET A PIECE OF PAPER TAPE

JUST TO STABILIZE IT
A LITTLE MORE.

AND IT HAS MY DATE, TIME
AND INITIALS ON IT.

AND I'M ALSO GOING TO BRING
ANOTHER WASH CLOTH,

SO THAT I CAN CLEAN
ANY NITRODERM OFF OF
THE SKIN IF IT'S THERE.

BECAUSE WE DON'T WANT TO GET
A LOT OF BUILD-UP OF PASTE
ONTO SKIN.

ALRIGHT. SO I THINK I HAVE
ALL OF MY SUPPLIES.

THAT IS THEORETICALLY
MY SECOND CHECK

BECAUSE I CHECKED IT WHEN I
PULLED 'EM OUT OF THE DRAWER,

THEN I CHECKED THEM AGAIN IN
FRONT OF YOU, CHECK NUMBER 2.

I HAVE ALL OF MY SUPPLIES
READY TO GO.

MY HAND'S WASHED AND NOW I'M
GOING TO GO INTO MY CLIENT ROOM.

AND THEN I'LL DO
MY TEACHING WHILE I'M THERE.

YOU'LL NOTICE THAT CONRAD'S KIND
OF TAKING ON A LITTLE
FEMININE LOOK,

BUT THAT'S BECAUSE CONRAD HAS
OTHER THINGS GOING OVER HERE

AND I COULDN'T STICK
ALL THIS STUFF ON.

SO WE'RE JUST GOING TO HAVE TO
ADAPT HERE A LITTLE BIT
TO MY CLIENT.

ALRIGHT.
GOOD MORNING, MR. CURREY.

I'M DIANE, I'M YOUR NURSE TODAY

AND I WANT TO GIVE YOU
SOME OF YOUR MEDS

THAT YOU HAVE FOR
6 O'CLOCK THIS MORNING.

COULD YOU TELL ME
YOUR FULL NAME? GREAT.

AND I JUST WANT TO
CHECK YOUR NAME BAND,

WHICH YOU HAPPEN TO HAVE NONE.

CONRAD CURREY,
DR I.M SMART, 33770000.

AND AT THIS POINT,
CHECK THE ALLERGY BAND AS WELL.

PEOPLE AT MY STATION,
I KEPT SAYING THAT ALL DAY.

CHECK YOUR ALLERGIES
WHILE YOU'RE HERE.

THIS IS THE LAST TIME
I WANT TO HEAR YOU SAY,

"THEY'RE ALLERGIC TO SULFA OR
THEY'RE ALLERGIC TO PENICILLIN

AND THAT'S NOT A PROBLEM
WITH MY DRUGS TODAY."

OKAY, SO THAT GIVES YOU
A LAST FINAL CHECK.

YOU'VE GOT THAT BIG,
OLD RED BAND THERE

AND THAT SHOULDN'T BE A PROBLEM.

PROVIDED PRIVACY.

ALRIGHT. NOW, WHEN YOU
GIVE YOUR DRUGS,

YOU DON'T HAVE TO
GIVE THEM IN THE ORDER

THEIR ON THE MEDICATION
ADMINISTRATION RECORD.

IT'S OUR SAFE WAY
OF CHECKING THEM,

BUT YOU DON'T HAVE TO
GIVE THEM IN THAT ORDER.

AND THINK WITH ME FOR A MINUTE
WHY THAT MIGHT BE A PROBLEM.

NITROGLYCERIN.
IF IT'S A PASTE

OR IF IT'S A PATCH
WHAT DOES IT DO?

DILATES THE CORONARY ARTERIES.

IF YOU'VE EVER GOTTEN IT
ON YOUR FINGERS,

KIND OF, BURNS A LITTLE BIT
AS IT IS IN CONTACT.

AND THEN IT STARTS DILATING.

WHAT IF YOU INADVERTENTLY
GOT A LITTLE ON YOUR FINGERS

AND WENT TO DO EYE DROPS?

THEY CAN GET A LITTLE
BURN IN THEIR EYES.

NOW GRANTED, IT'S THEIR BODY
AND IT'S DILATING THEIR VESSELS

AND IT'S THEIR DRUG, BUT
NEVERTHELESS, IT STILL BURNS.

THE WAY I KNOW THAT FOR SURE IS

WE HAVE SOME REAL NITROGLYCERIN
IN SOME OF THE DRAWERS

THAT YOUR OTHER PATIENT HAS
AND IT'S A PASTE.

AND PEOPLE ARE MESSY
WITH THE PASTE

AND I'VE GOTTEN IT ON MY HANDS
TWO OR THREE TIMES

AND I'VE TOUCHED MY LIP.

WHOA! BURN BUZZ KIND OF A THING.

AND SO YOU DON'T WANT TO
GET THAT ON THEM.

SO YOU WANT TO START WITH
WHAT'S CLEANEST AND GO TO
WHAT MIGHT BE DIRTIEST.

FOR EXAMPLE, YOU WOULDN'T DO A
SUPPOSITORY AND THEN DO EYES.

YOU WOULD DO EVERYTHING
AND YOU WOULD DO SUPPOSITORIES.

SO YOU WANT TO BE
THINKING LOGICALLY.

THE OTHER THING I KNOW
IS SOME OF THESE MEDS

REQUIRE MY CLIENT TO BE
IN DIFFERENT POSITIONS

AND THEY HAVE TO STAY
THERE A WHILE.

FOR EXAMPLE, EARDROPS.

THEY HAVE TO LAY ON
THAT SIDE WITH THEIR --

EAR UP FOR FIVE MINUTES.

WELL, WHY WOULD I GIVE
THEM THAT FIRST

AND THEN WAIT FIVE MINUTES
AND GIVE THEM AN INHALER?

I'M GOING TO DO THIS ONE LAST

SO THAT I CAN LEAVE THE ROOM
AND COME BACK LATER.

SO YOU WANT TO KIND OF
PLAN YOUR LIFE

SO THAT IT'S EFFICIENT
WHEN YOU'RE DOING YOUR DRUGS.

THE INHALER,
IT CAN GO EITHER WAY.

INTERESTINGLY,
ON THE INHALER

WHEN YOU GET TWO PUFFS
OF AN INHALER,

YOU NEED TO WAIT ONE MINUTE
BETWEEN EACH PUFF.

SO YOU COULD GIVE ONE PUFF
OF AN INHALER,

GIVE EYE DROPS,
GIVE THE SECOND PUFF OF INHALER

AND NEVER WASTE A SECOND

BECAUSE EVERYTHING'S CLEAN
IN THAT SCENARIOS.

AND THEN DO YOUR PATCH LATER.

NOW YOU CAN ALSO DO YOUR PATCH
FIRST, CHANGE YOUR GLOVES
AND DO EVERYTHING ELSE,

BUT BE THINKING ABOUT
WHAT YOU'RE DOING AND HAVE
A REASON FOR YOUR PLAN.

I'M GOING TO DO IT A WAY.

YOU CAN DO IT ANYWAY YOU WANT.

JUST KEEP IN MIND,
THIS IS YOUR PLAN.

SO, ALL THAT SAID.

MR. CURREY, I THINK
WHAT I WOULD LIKE TO DO

IS GIVE YOU YOUR INHALER FIRST.

BECAUSE YOU KNOW THAT WHEN
YOU TAKE YOUR INHALER,

IT'S A CORTICOSTEROID,
IT'S A CORTISONE DRUG.

AND WHAT THAT DOES,
IT'S AN ANTI-INFLAMMATORY

AND SO IF IT CAN GET DOWN
INTO YOUR LUNGS,

YOU WAIT ANOTHER MINUTE,
THEN YOU TAKE THE SECOND PUFF,
IT'LL BE MORE EFFECTIVE.

SO THAT'S WHAT I'D
LIKE TO DO WITH THAT.

SO BETWEEN PUFFS, I'LL
GIVE YOU YOUR EYE DROPS

AND MAYBE EVEN
YOUR NITRODERM PATCH.

BEFORE I DO ANY OF YOUR MEDS,

WHAT I'D LIKE TO DO
IS GET YOUR VITAL SIGNS

BECAUSE I KNOW THAT
NITROGLYCERIN WILL LOWER
THE BLOOD PRESSURE,

PILOCARPINE CAN POTENTIALLY
LOWER THE BLOOD PRESSURE,

SO I WANT TO GET A GOOD IDEA
OF WHAT'S GOING ON.

AND IF YOU'RE TAKING
A CARDIAC DRUG, NITROGLYCERIN,

THEN I STILL WANT TO HAVE
A GOOD SET OF VITAL SIGNS.

SO GET ONE WHOLE SET OF
VITAL SIGNS RIGHT NOW

BEFORE YOU START THIS
WHOLE GROUP OF DRUGS

AND IT COUNTS FOR ALL OF 'EM.

YOU DON'T HAVE TO REPEAT IT,
EVERY SINGLE DRUG,

IT'S A DONE DEAL.
ALRIGHT.

SO I'VE GOT A GOOD SET OF
VITAL SIGNS AND I THINK
I'M READY TO GO.

MY CLIENT IS SITTING UP
AND BECAUSE THIS IS AN INHALER,
I'D WANT TO LISTEN TO LUNGS.

SO ONCE AGAIN, I'VE INSPECTED
AS I WAS TALKING.

COLOR LOOKS GOOD,
BREATHING EASILY.

I'M GOING TO LISTEN TO LUNGS,
OSCULTATING.

FOUR, SIX SIDES FRONT,
SIDE, SIDE

AND THEN HAVE THE CLIENT
SIT UP AND GET THE BACK.

GOOD DEEP BREATHS,
IN AND OUT THEIR MOUTH.

LISTEN TO THE FULL INSPIRATION
AND EXPIRATION.

IF SOMEONE'S ON AN INHALER,

WOULD YOU EXPECT TO HEAR
NORMAL BREATH SOUNDS?

- NO.
- MAYBE, MAYBE NOT.

IF THE MEDICINE'S WORKING,
THEN MAYBE THEY'RE DOING FINE,

BUT IF THEY HAVE A HISTORY
OF ASTHMA AND THEY'RE
ON AN INHALER,

I WOULD SUSPECT TO HEAR
SOME WHEEZING

AND DIMINISHED BREATH SOUNDS,
PARTICULARLY IN THE BASES.

THEY TEND TO GET WORSE
AT THE BOTTOM AND COME UP

BECAUSE IT'S HARDER TO GET THE
AIR ALL THE WAY TO THE BASE.

SO A TYPICAL SOUNDS YOU MAY
HEAR WITH THE LUNGS IS...

BECAUSE THEY'RE NOT GETTING
GOOD AIR EXCHANGE

AND THAT'S CALLED WHEEZING,
OKAY?

RALES, TAKE YOUR HAIR LIKE
THIS AND PUT IT TO YOUR EAR
AND JUST MOVE IT.

AND THAT'S RALES, AND THAT'S
WHEN THEY BREATHE IN.

AND IT KIND OF CRACKS A LITTLE.

AND SO THOSE ARE SOUNDS
THAT YOU WOULD TYPICALLY
HEAR WITH SOME ASTHMA.

THE WORSE SOUND YOU CAN HEAR
WITH AN ASTHMATIC IS NO SOUND.

RIGHT?

BECAUSE THEY'RE NOT GETTING
AIR EXCHANGE AND SO

THAT'S AN EMERGENCY SITUATION
THAT WE WANT TO ADDRESS.

OKAY, SO I'VE ASSESSED
MY CLIENT.

WHAT I WANT TO DO NOW
IS GET THIS MED READY.

THIRD CHECK AT BEDSIDE.

BECLOVENT, EXPIRATION DATE,
2 PUFFS, ONE MINUTE.

I WANT TO MAKE SURE THE
CANISTER IS INSIDE
THE...INHALER PIECE.

I WANT TO TAKE
THE MOUTH PIECE OFF.

I WANT TO SHAKE THIS. IT
REALLY NEEDS TO BE SHAKEN WELL.

AND THEN I WANT TO
EXPLAIN TO MY CLIENT

THAT WHAT THE DOCTOR
HAS PRESCRIBED FOR YOU

IS TWO PUFFS...EVERY
FOUR TIMES A DAY.

WE PUT IT ON A Q6 HOUR
SCHEDULE, BUT FOUR TIMES A DAY.

SO IN THE MORNING,
AT LUNCH TIME,

AT DINNER TIME AND THEN AT
BEDTIME WOULD BE THE BEST.

SPREAD IT OUT AS EVENLY
AS YOU CAN.

AND YOU SHOULD NOT TAKE MORE
THAN WHAT THE DOCTOR PRESCRIBED.

YOU SHOULD TAKE THIS EXACT DOSE.

AND IF YOU MISS A DOSE,
YOU NEED TO TAKE IT

AS SOON AS YOU REMEMBER
THAT YOU'VE MISSED A DOSE

SO THAT YOU KEEP
YOURSELF ON SCHEDULE.

BECAUSE IT'S A CORTISONE,
AN ANTI-INFLAMMATORY,

IT'S REALLY IMPORTANT THAT YOU
MAINTAIN THIS DRUG PRESCRIPTION.

THAT'S HOW THE DOCTOR KNOWS THAT
IT'S WORKING OR NOT WORKING TO
MAKE ADJUSTMENTS.

ASTHMATICS,
TYPICALLY,

IF IT ISN'T ENOUGH,
THEY'LL TAKE A LITTLE MORE.

AND IT'S BAD BECAUSE YOU
JUST CAN'T SELF-MEDICATE
ON SOME OF THIS.

YOU GET TOO MUCH CORTISONE
ON BOARD AND SO YOU WOULDN'T
WANT TO DO THAT.

OKAY. IT'S BEST IF THE CLIENT
CAN DO THIS THEMSELVES

AND HANDLE THE EQUIPMENT

BECAUSE IT'S EASIER FOR THEM
TO COORDINATE THEIR INSPIRING

AND THEIR EXPIRING WITH THE
PUFF THAN IT IS FOR ME.

BUT IT'S A MANNEQUIN
AND THAT'S A PROBLEM.

OKAY. IF THEY'RE SITTING UP
NICE AND TALL,

WHAT YOU WANT TO EXPLAIN TO
THEM IS HOW TO TAKE THE DRUG

AND THAT IS THAT I WANT YOU
TO INHALE IN YOUR NOSE
NOT YOUR MOUTH.

AND THEN ON YOUR NEXT INHALE,
IM' GOING TO PUFF

HOLDING THIS 2 TO 3 INCHES
AWAY FROM THE MOUTH.

PUFF AND WHEN I PUFF,
BREATHE IN.

HOLD IT.
10 SECONDS IF YOU CAN.

AND THEN BREATHE IT OUT
THROUGH PURSED LIPS.

IT'S LIKE WHISTLING
OR BLOWING OUT A CANDLE.

IT'S HOW PEOPLE HAVE TO FIND IT.

WHAT THAT DOES IS IT
HOLDS THE DRUG IN

FOR A LITTLE BIT LONGER TIME
SO THAT THEY JUST DON'T...

OKAY. I KNOW I HAVE
SOME ASTHMATICS IN HERE
THAT TAKE THEIRS AND GO,

"I ALWAYS PUT MY MOUTH AROUND,
HOW COME I DON'T GET
TO DO THAT?"

AND THIS IS THE REASON.

THEY FOUND THAT IF WE PUT OUR
LIPS TIGHTLY AROUND THE DRUG.

THE CANISTER HERE
AND THEN WE PUFF IT IN.

WHAT WE TEND TO DO IS SHOOT IT
TO THE BACK OF THE THROAT

AND MORE GETS ABSORBED INTO
THE BACK OF THE THROAT

THAT GETS INHALED
INTO THE LUNGS.

AND THE IDEA IS THAT
IT'S AN INHALER.

IT'S INHALED TO THE BASES OF
THE LUNGS SO THAT IT WILL --

NO. IT WILL BRONCHO --
IT'S NOT A BRONCHODILATOR.

SO THE ANTI-INFLAMMOTORY
ACTION WILL THEN HELP THOSE
BRONCHIOLES

TO OPEN UP AND THAT'S
WHAT WE WANT TO HAPPEN.

ALRIGHT.
SO I'VE EXPLAINED ALL THAT.

ARE YOU READY? GOOD DEEP
BREATH. IN, OUT.

BREATHE IN.

HOLD IT.
OKAY.

YOU CAN DO ONE WAY
OR THE OTHER.

OUT THROUGH PURSED LIPS.

FORGOT TO TELL HER TO
BREATHE OUT -- GOT TO DO
THAT.

ALRIGHT.
THAT'S ONE WAY TO DO IT.

THERE'S ANOTHER WAY WHICH
I THINK IS SO MUCH EASIER.

AND ALL CHILDREN SHOULD USE
SPACERS, BUT EVEN ADULTS.

I'D WANT ONE BECAUSE I'M JUST
A SPAZ WITH SOME OF THIS STUFF.

AND WHAT YOU WANT TO DO IS
PUT WHAT'S CALLED A SPACER HERE

AND NOW, THE CLIENT CAN TAKE
THEIR DEEP BREATH -- OUT.

AND NOW PUT
THEIR LIPS AROUND IT.

WHEN THEY TAKE THE PUFF,

THE PUFF THEN WILL BE
TRAPPED IN HERE

AND THEN THEY STILL HAVE
CONTROL OF BREATHING IT.

SO YOU DON'T HAVE TO COORDINATE
THE WHOLE ACTIVITY.

OKAY. SO, INHALER.

TAKE THEIR BREATH
AND SO FORTH.

ALRIGHT. THEY'VE HAD THEIR
ONE BREATH AND --

OH, MAN. I HAD SOMETHING
I NEEDED TO TELL THEM

AND IT WENT OUT OF MY HEAD.

ONE OF THE THINGS I WANT TO
BE SURE AND TEACH THEM
ABOUT TAKING THIS DRUG

IS THEY NEED TO KEEP TRACK
OF THEIR DOSES

AND THEY NEED TO KEEP TRACK OF
HOW MUCH IS IN THIS CANISTER.

THIS CANISTER ALWAYS
GIVES A METER DOSE

AND THE CLIENT
NEEDS TO KNOW THIS.

WHENEVER YOU PRESS IT,
YOU GET THE SAME AMOUNT OF
MEDICATION EVERY SINGLE TIME.

IT'S NOT A HALF OF A PUFF
OR QUARTER OF A PUFF.

IT'S ALWAYS ONE FULL PUFF
TO GET THE METER DOSE.

IT WILL ALWAYS GIVE YOU
THE SAME AMOUNT OF MEDICATION.

WHAT THEN YOU NEED TO DO
IS KEEP TRACK OF IT

SO THAT YOU DON'T TAKE TOO MANY
PUFFS FROM THIS CANISTER

AND GET PROPELLANT OR NOTHING
INSTEAD OF DRUG.

SO LET'S THINK FOR A MINUTE.

THIS CANISTER HAS
200 ACTUATIONS.

IT HAS 200 DRUG DOSES IN IT.

IF THE CLIENT GETS TWO PUFFS,
FOUR TIMES A DAY,

HOW MANY PUFFS A DAY?
- EIGHT.

- EIGHT PUFFS A DAY.

DIVIDE IT INTO 200 PUFFS,
HOW MANY DAYS?

20 SOMETHING.

AND YOU GET YOUR CALCULATOR
AND YOU FIGURE OUT EXACTLY.

25? YOU LIKE THAT, OKAY.

25 DAYS.

WHAT YOU NEED TO DO IS
GET ON THE CALENDAR

AND MARK THE 25TH DAY
YOU ARE DONE WITH THIS.

IF FOR SOME REASON THEY GOT
INTO TROUBLE RESPIRATORY-WISE,

AND THE DOCTOR SAID, "YES, TAKE
TWO MORE OF THAT FOR TWO WEEKS."

OR SOMETHING, AND THEN THEY
WOULD MOVE THEIR DATE UP.

AND THAT'S YOUR MOST EFFECTIVE
WAY OF TRACKING YOUR CANISTER.

IN SOME BOOKS YOU'LL READ AND
SOME THINGS YOU'LL COME ACROSS.

THEY SAY IF YOU TAKE YOUR
CANISTER OUT AND YOU PUT IT
IN SOME WATER,

IF IT'S FULL, IT WILL
FLOAT TO THE BOTTOM.

IF IT'S HALF FULL,
IT'LL GO TO THE MIDDLE.

AND IF IT'S EMPTY,
IT'LL FLOAT AT THE TOP.

WELL, HOW DO YOU KNOW WHEN IT'S
EMPTY IF YOU HAVE MISSED
EMPTY THE FIRST TIME?

I MEAN, DO YOU DUMP IT IN
WATER EVERY TIME YOU USE IT?

SO PEOPLE DON'T TEND TO BE
CONSISTENT WITH THAT

AND IT'S NOT A GOOD
MEASURE OF DOSING.

A NEW PRODUCT SPIN ON THE
MARKET FOR A LITTLE WHILE.

YOU'VE PROBABLY SEEN IT ON TV,
ADVAIR.

IT'S A LITTLE PURPLE DISPENSER

AND YOU TAKE YOUR
INHALATIONS THROUGH THAT

AND IT COUNTS THE ACTUATIONS.

AND EVERY TIME YOU FLICK
THE LITTLE LEVER TO SHOOT
THE MED IN,

IT COUNTS HOW MANY DOSES.
SO IT KEEPS TRACK OF IT.

BEAUTIFUL. EVEN BETTER.

YOU DON'T HAVE TO
DO ANY CALENDAR,

YOU JUST GOT TO LOOK AT
YOUR LITTLE APPARATUS
AND YOU'RE GOOD TO GO.

SO THEY'RE GETTING BETTER
AT HELPING US TRACK

BECAUSE IT'S SO IMPORTANT
THAT YOU GET MEDICINE
VERSUS NOT GET MEDICINE.

AND SO THAT'S WHAT WE WANT
OUR CLIENT TO KNOW.

WELL, I'VE CHATTED A BIT HERE
WITH MY CLIENT,

AND I'VE USED UP MY MINUTE
SO I COULD GIVE THEM
THEIR SECOND PUFF.

SO WHAT THE HECK?
LET'S JUST GIVE THEM.

OKAY. YOU COULD GIVE YOUR
EYE DROP, YOU DON'T HAVE
TO TELL ME ON THIS ONE.

OKAY. SHAKE,
TAKE A DEEP BREATH.

I'VE ALREADY TOLD MY CLIENT,
TAKE AS PRESCRIBED,

DON'T TAKE ANY MORE
THAN THE DOCTOR ORDERED.

I ALSO WANT TO CLEAN THIS.

THIS NEEDS TO BE CLEANED
EVERYDAY WITH SOAP AND WATER.

AND I ALSO WANT TO TEACH MY
CLIENT ABOUT GOOD ORAL HYGIENE,

BECAUSE ONE OF THE SIDE
EFFECTS OF THIS IS COARSENESS,

DRYNESS OF MOUTH
AND FUNGAL INFECTIONS.

SO YOU NEED TO LOOK AT
THEIR TONGUE AND THEIR MOUTH.

WHAT DOES A FUNGAL
INFECTION LOOK LIKE?

WHITE COATING.

TONGUE, CHEEKS AND COMPLAINTS OF
PAIN, FISSURES IN THEIR MOUTH.

SO, GOOD ORAL HYGIENE AND MAKE
SURE THAT THEY'RE DOING OKAY

AND TEACH THEM ABOUT THAT.

ALRIGHT. I'M GOING TO MOVE ON.

I'M GOING TO PUT SOME GLOVES ON
BECAUSE I'M GOING TO BE UP HERE
AROUND THE EYES.

AND I JUST WANT GLOVES ON
HERE. POTENTIAL BODY FLUID. YES?

- WHAT IF I'M TAKING TWO
DIFFERENT TYPES OF INHALERS?

- OH, THANK YOU.
I FORGOT TO MENTION THAT.

IF YOU'RE TAKING TWO DIFFERENT
TYPES OF INHALERS,

YOU HAVE TO WAIT A FULL FIVE
MINUTES BETWEEN INHALERS.

OKAY? WELL, WHY WOULD YOU TAKE
TWO DIFFERENT KINDS?

WHAT DID I SAY THIS WAS?
- CORTISONE.

- CORTICOSTEROID
ANTI-INFLAMMATORY.

THE OTHER TYPE OF INHALER --
YOU HEARD ME KIND OF FUMBLE

AND MENTION THE WORD,
WAS A BRONCHODILATOR.

SOMETHING THAT IMMEDIATELY
HELPS SHRINK THOSE TISSUES

SO THAT THE BRONCHIOLES WILL
DILATE, AIR WILL GO THROUGH.

IF YOU HAVE THOSE TWO
INHALERS TO CHOOSE FROM,

WHICH ONE WOULD GO FIRST?

YOU WANT TO DILATE THEM
OR ANTI-INFLAME THEM?

- DILATE.
- DILATE THEM,

SO THAT THE ANTI-INFLAMMATORY
WILL GET DEEPER.

SO YOU WANT TO GIVE YOUR
BRONCHODILATOR FIRST.

SAME RULE, ONE MINUTE
BETWEEN EACH PUFF.

BUT THE FIVE MINUTES
BETWEEN EACH TYPE OF INHALER.

SO YOU HAVE TO WAIT A FULL FIVE

AND THEN GIVE THEM
THE ANTI-INFLAMMATORY.

WE JUST HAPPEN TO BE IN
A MAINTENANCE MODE HERE
WITH ANTI-INFLAMMATORY.

USUALLY, YOUR BRONCHODILATORS
ARE FOR WHEN THERE'S AN ACUTE
ATTACK. YOU CAN'T BREATHE.

AND THEY TAKE THEIR QUICK
TWO PUFFS OF THAT.

ONE OF THE FUNNIEST THINGS
I'VE SEEN IS...

OLDER PEOPLE.
I DON'T KNOW WHY.

MAYBE I'VE BEEN AROUND THEM
MORE THAN YOUNGER PEOPLE.

BUT LITTLE OLD LADIES,
I JUST HAVE THIS PICTURE,

THEY TAKE THEIR LITTLE INHALER,

IF YOU WATCH THEM TAKE THEIR
INHALERS AND TELL THEM
THEIR DOSE.

"YEAH, YEAH. I KNOW. I'VE BEEN
DOING THIS ALL THE TIME."

YOU PUT IT CLOSER ON THEIR
MOUTH AND THEN THEY TAKE
THEIR TWO PUFFS.

GET ALL -- YOU CAN SEE THE
CLOUD COMING OUT THEIR MOUTH.

THEY'RE NOT GETTING
ALL THEIR DRUG.

WELL, BOY, TRY TO TEACH
THEM A NEW WAY.

TRY.
YOU CAN ONLY TRY.

BUT IT'S BETTER IF THEY
GET ALL THE DRUGS.

THEY'RE JUST NOT GETTING IT
WHEN IT CLOUDS AND SHOOTS
OUT THEIR MOUTH.

ALRIGHT, MOVING ALONG.
MY CLIENT HAS SOME GLAUCOMA.

YOU HAVE GLAUCOMA
AND IT SAYS HERE

THAT I NEED TO GIVE YOU SOME
EYE DROPS IN YOUR LEFT EYE.

HELP ME WITH THAT.
SOMETIMES I GET TURNED AROUND
A LITTLE AND SO WILL YOU.

I'VE YET TO HAVE A SEMESTER
WHERE WE GET FILL OUT
AN INCIDENT REPORT

BECAUSE SOMEONE PUT THEIR
DROPS IN THE RIGHT EYE INSTEAD
OF THE LEFT EYE.

YOU GET TURNED AROUND
AND IT'S VERY EASY TO DO

BECAUSE YOU FACE THIS WAY
AND YOU HAVE A LITTLE
DYSLEXIC MOMENT.

SO WHAT I WANT TO DO IS
IDENTIFY THE EYE THAT I NEED.

I'M GOING TO GET MY WASHCLOTH.
IT WOULD BE DAMP.

AND I'M GOING TO LOOK
AND SEE IF THERE'S ANY CRUSTING

AND I'M GOING TO CLEAN THE EYE
FROM INSIDE TO OUT

AND THEN INSIDE TO OUT.

I'M GOING TO DO MY THIRD CHECK.
FIND MY PILOCARPINE HERE.

THIS IS REALLY JUST NORMAL
SALINE THAT WE'VE LABELED UP.

PILOCARPINE, THIRD CHECK, 2%.

TAKE MY LITTLE CAP OFF.

I'M GOING TO EXPLAIN TO
MY CLIENT THAT WHAT
I WANT TO DO IS,

I'M GOING TO PULL DOWN ON YOUR
EYE HERE AND HAVE YOU LOOK UP

AND THEN I'M GOING TO PUT IT
INTO THAT CONJUNCTIVAL SAC.

AND THEN I'M GOING TO PUT
PRESSURE HERE ON THE INNER
CAMPUS OF YOUR EYE.

I MIGHT CAUSE A LITTLE TEARING
SO I WILL GIVE YOU A KLEENEX,

IN CASE YOU NEED
TO WIPE YOUR EYES.

ALRIGHT. SO THIS IS A LITTLE
TRICKY BECAUSE SHE'S NOT
ON THIS SIDE.

I'D WANT TO BE BECAUSE I'M
RIGHT HANDED.

OKAY.
HERE WE GO.

CAN YOU LOOK UP?
AND SHE DOES.

AND I'M GOING TO GO DOWN
INTO THE CONJUNCTIVAL SAC.

ONE DROP FOR THE LEFT EYE.

AND THEN I'M GOING TO
IMMEDIATELY PUT MY FINGER HERE

SO THAT THE SOLUTION DOESN'T GO
DOWN INTO HER SYSTEMIC SYSTEM.

THIS BLOCKS IT FROM GOING
DOWN INTO THAT DUCT.

AND THEN I WANT HER TO MOVE
HER EYE AROUND A LITTLE BIT

SO THAT IT WILL MOVE THE DRUG
AROUND IN HER EYE.

OKAY. NOTICE THAT I STAND
THE SAME WAY AS THE CLIENT

TO MAKE SURE THAT THE EYE AND
THE DRUG IS ON THE RIGHT SIDE.

AND THEN I TELL THEM
THIS IS FOR YOUR LEFT EYE.

I HAD A CLIENT ONE TIME,
A MOTHER,

I WAS GIVING A SHOT TO HER
BABY AND SHE WAS VERY
CONCERNED

THAT I ROTATED THE SHOTS
INTO THE OTHER LEG.

"OH, YES. OH, YES.
LAST ONE WAS IN THE RIGHT,
I'LL GIVE IT IN THE LEFT."

AND SHE ASKED ME THREE TIMES
AND I SAID, "OH, YES.

LAST ONE WAS IN THE RIGHT,
I'LL GIVE IT IN THE LEFT."

I WRAPPED THAT BABY TO GIVE
THE SHOT IN THE RIGHT
EVEN THOUGH I SAID LEFT.

AND SHE GOES, "COULD YOU PUT
IT IN THE OTHER LEFT?"

"YES, I COULD."
YOU KNOW?

YOU GET TURNED AROUND IN SPITE
OF SAYING IT THREE TIMES.

SO IF YOU HAVE SOMEONE
ACCOUNTABLE TO YOU

THAT WILL ALSO HELP YOU
NOT MAKE A DRUG ERROR.

ALRIGHT. NOW THESE GLOVES
ARE TO HELP ME --

I DON'T HAVE A TRASH CAN
SO I'M GOING TO JUST PUT
THAT IN THE GLOVE.

I REALLY DON'T NEED
TO CHANGE GLOVES.

THEY'RE TO PROTECT ME FROM HER,
NOT HER FROM ME.

I WASH MY HANDS AND I'M OKAY.
SO I JUST DID IT BECAUSE I DON'T
HAVE A TRASH CAN.

I'M GOING TO GO AHEAD
AND GIVE YOU YOUR NITRODERM.

AND...BEFORE I DO THAT,
YOUR VITALS WERE FINE.

ARE YOU HAVING ANY CHEST PAIN?

NO. THIS IS MANAGING IT WELL?
GOOD.

SOMETIMES PEOPLE THAT HAVE
ATTACKS OF ANGINA

WILL TAKE NITROGLYCERIN
UNDER THEIR TONGUE.

YOU'VE HEARD OF THAT.
THEY'RE HAVING CHEST PAIN

AND SO THEY'LL TAKE THE
NITROGLYCERIN, THAT GIVES THEM A
QUICK DILATION OF THEIR VESSEL,

AND THEY GET RELIEVE
FROM THE CHEST PAIN.

BUT SOME PEOPLE HAVE MORE
CHRONIC CHEST PAIN

AND THEY NEED SOMETHING
ON ALL THE TIME.

AND SO THIS IS FOR MORE
OF A CHRONIC MAINTENANCE
OF CHEST PAIN.

SO, WHEN THEY HAVE THIS,

WE NEED TO...KNOW THAT
WITH THE DRUG

IT'S GOING TO DILATE
THEIR VESSELS,

IT SHOULD RELIEVE
THEIR CHEST PAIN.

WHEN ARE THEY MOST LIKELY
TO HAVE CHEST PAIN?

DURING THE DAY OR DURING
THE NIGHT?

DURING THE DAY,
WHEN THEY'RE ACTIVE.

THEIR VESSELS ARE PROBABLY
BLOCKED A LITTLE BIT AND THAT'S
WHAT'S CAUSING THE CHEST PAINS.

SO WHEN THEY'RE MORE ACTIVE
AND NEEDING MORE BLOOD,

THEY'RE HAVING CHEST PAIN.

SO, WE NEED TO THINK
OF SOMETHING.

IF THIS DRUG WERE ON THEIR
SKIN, 24 HOURS A DAY,

THEY BEGIN TO DESENSITIZE TO
IT. IT BEGINS TO NOT WORK.

SO WE NEED TO TAKE
IT OFF SOMETIME

SO THAT THEIR BODY CAN
REACCLIMATE AND APPRECIATE
THIS MEDICATION.

SO THIS DRUG NEEDS TO BE OFF
AT LEAST EIGHT HOURS.

IT NEEDS TO BE OFF AT BEDTIME.

THAT'S WHY WE WROTE THE ORDER
LIKE THIS SO THAT IT COMES OFF.

BUT YOUR JOB WHEN YOU COME ON
THE DAY TO PUT THE PATCH ON

IS TO MAKE SURE THAT THERE
AREN'T ANY PATCHES LEFT ON
AND SOMEONE DIDN'T FORGET.

BECAUSE SEE, THERE'S
NO TIME THAT SAYS --

LIKE, MY NITRODERM PATCH.

THAT THERE'S NOTHING
THAT SAYS, "22:00, TAKE OFF."

RIGHT? SO...

WHEN I COME TO CHECK MY
CLIENT,

I'VE CHECKED ABOUT PAIN,
I'VE CHECKED VITAL SIGNS,

BUT NOW I WANT TO LOOK AT THE
PATCH AND SEE IF THEY'RE OFF.

SOMEBODY LEFT THIS PATCH ON.

I'M GOING TO FILL OUT
AN INCIDENT REPORT

BECAUSE IT'S NOT RIGHT.

IT DOESN'T MEAN THEY'RE
GOING TO GET IN TROUBLE,

IT MEANS THAT WE'VE GOT TO
FIND A WAY OF TRACKING.

QUALITY ASSURANCE,
TO MAKE SURE THAT THIS HAPPENS

SO THAT OUR CLIENTS
GET TREATED BEST.

SO ANYTHING OUT OF THE
ORDINARY, YOU FILL OUT AN
INCIDENT REPORT.

I'M GOING TO TAKE THE PATCH OFF,

AND THEN I'M GOING TO CLEAN
THE SKIN WHERE THE PATCH WAS

AND MAKE SURE I GET ALL
OF THAT OFF OF THERE.

AND THEN I'M GOING TO REAPPLY
THE PATCH IN A DIFFERENT PLACE,

SO THAT IT'S --
DOESN'T IRRITATE THE SKIN.

ALRIGHT, I'M MAKING
MY THIRD CHECK.

NITRODERM PATCH, 0.2MG,
EVERY HOUR.

IT SHOULD HAVE BEEN REMOVED
AT BEDTIME AND THEN
REAPPLIED HERE AT SIX.

WE HAVE TWO NITRODERM PATCHES.

WE LOST OUR REAL ONES AND SO
WE CREATED THESE PRETEND ONES.

BUT A REAL ONE LOOKS LIKE THIS.

IT LOOKS LIKE ANY OF THOSE
SKIN PATCHES.

YOU KNOW, THEY HAVE
BIRTH CONTROL NOW

AND THEY'VE SHOWN YOU
THE LITTLE PATCH ON HER STOMACH,

IT'S THE EXACT SAME THING.

WHAT YOU DO IS YOU
PEELED OFF THE PLASTIC COAT

AND THEN IT'S STICKY UNDERNEATH
AND THAT'S THE MEDICATION.

I DON'T WANT YOU TAKE
THE PLASTIC OFF

AND KEEP STICKING IT ON MY
MANNEQUINS, IT MAKES IT A MESS.

BUT I WANT YOU TO SAY TO ME,
"I WOULD TAKE THE PLASTIC OFF."

BECAUSE YOU WOULD, OTHERWISE
THEY GET NO MEDICINE.

TAKE THE PLASTIC OFF AND
THEN I'M GOING TO PUT IN ON
A CLEAN PART OF THE BODY.

CLEAN PART OF THE TRUNK
THAT'S NON-HAIRY.

AND IT CAN GO ANYWHERE.
IT CAN GO ON THE BACK,

ON THE FRONT. IT CAN GO
ANYWHERE ON THE BODY.

THEY TEND TO LIKE THEM ON
THE TRUNK JUST BECAUSE IT'S

NOT SHOWING WITH THEIR CLOTHING
AND IT'S EASY TO FIND.

I'M THEN GOING TO PUT
A PIECE OF TAPE ON IT

THAT HAS THE DATE,
THE TIME AND MY INITIALS,

SO WE'LL KNOW HOW LONG THAT
PATCH STAYED ON THEIR BODY.

ALRIGHT. THAT'S GOOD.

I JUST WANTED TO LET YOU KNOW
THAT WITH THAT,

YOU CAN GET A LITTLE HEADACHE,
A LITTLE DIZZINESS

AND ALSO, IT CAN MAKE YOUR BLOOD
PRESSURE COME DOWN A LITTLE BIT.

AND WITH ALL THE MEDICATION
YOU'RE TAKING LIKE THE LASIX,

YOU NEED TO BE REALLY CAREFUL
WHEN YOU CHANGE POSITIONS.

SO WHEN YOU GO FROM LYING TO
SITTING AND SITTING TO STANDING,

STAY THERE FOR A MINUTE
OR TWO AND MAKE SURE

THAT YOU'RE NOT
GOING TO GET DIZZY.

ARE YOU FEELING ANY BURNING
WITH THAT OR HOW IS IT DOING
ON YOUR SKIN? OKAY?

SO, DO SOME TEACHING AND
THEN MAKE SOME CORRELATION
WITH THE DRUGS YOUR GIVING.

IS THIS A GOOD COMBINATION?

AND I WANT TO JUST SAY
THAT THESE DRUGS ARE ALL
HORRIBLE COMBINATION

AND A HORRIBLE COMBINATION
OF DIAGNOSIS.

I JUST GAVE YOU A DIAGNOSIS
TO GO WITH,

BUT TO DIFFERENT KIND OF
MEDS THAT WE GIVE,

SO IT'S NOT A PERFECT SCENARIO.

ALRIGHT.
LAST BUT NOT LEAST, EARDROPS.

AND BECAUSE I HAVE HAD
NITRODERM ON MY HAND,

I AM GOING TO GO AHEAD AND
GET ANOTHER PAIR OF GLOVES.

AND GIVE THE EARDROPS.

AND MY EARDROPS ARE MY
NEOMYCIN OTIC SOLUTIONS.

NEOMYCIN OTIC.
TWO DROPS, RIGHT EAR.

OKAY. SO YOU HAVE A LEFT EYE
AND A RIGHT EAR.

I PRE-WARMED THESE AND SO THEY
ARE GOOD. I HAVE MY COTTON.

ALRIGHT. THIS NEEDS TO GO
IN YOUR RIGHT EAR.

SO, I AM GOING TO CLEAN THE EAR.

I WAS A SCHOOL NURSE FOR A VERY
BRIEF PERIOD OF TIME IN MY LIFE.

AND ONE OF THE THINGS -

A CHILD CAME IN WITH A
RUPTURED EARDRUM ONE TIME.

AND HE HAD, SERIOUSLY, EAR
FLUID RUNNING DOWN HIS NECK

AND THE WHOLE SHOULDER OF HIS
SHIRT WAS JUST COVERED
WITH FLUID.

SO IT IS A BODY FLUID AND YOU
WANT TO BE CAREFUL ABOUT THAT.

CLEANED HIM UP,
PUT COTTON IN HIS EAR,

CALLED HIM MOM,
SENT HIM TO THE DOCTOR.

HE NEEDED ATTENTION.
HIS EARDRUM HAD BROKEN

AND HE WAS NOT
A COMFORTABLE YOUNG MAN.

SO CHECK AND SEE.
ALRIGHT.

IF THEY CAN JUST TURN THEIR
HAD FOR YOU, THAT'S FINE.

I COULD PUT HER A LITTLE
FLATTER WHICH MIGHT EVEN BE
BETTER, I THINK.

ALRIGHT.
LET'S TURN HIM THIS WAY.

I AM GOING TO PUT
SOME EARDROPS IN YOU EAR

AND YOU NEED TO STAY WITH YOUR
HEAD TURNED FOR ABOUT
FIVE MINUTES,

SO THAT WILL GET DOWN
INTO YOUR EAR CANAL.

OKAY. WHAT YOU WANT TO DO WHEN
YOU ARE DOING EARDROPS INTO EARS

IS YOU WANT TO KNOW IF YOU
HAVE AN ADULT OR A CHILD

BECAUSE THE TECHNIQUE IS JUST
A LITTLE BIT DIFFERENT
FOR ONE AND THE OTHER.

IF YOU HAVE A CHILD,
YOU NEED TO PULL THE PINNA DOWN.

AND I THINK OF CHILDREN
BEING SHORT.

SO PULL DOWN TOWARDS CHILD,
SHORTNESS AND BACK.

AND THAT STRAIGHTENS THE EAR
CANAL SO THAT THE FLUID
GOES TO THE BOTTOM.

IF IT IS AN ADULT,
ADULTS ARE TALL.

SO YOU PULL THE PINNA UP
OR AURICLE UP.

WHICH IS -- BASICALLY, THEY
USE THOSE TWO WORDS
INTERCHANGEABLY.

BUT PULL UP AND THAT STRAIGHTENS
THE EAR CANAL AND BACK,

SO THAT IT WILL GO TO THE
BOTTOM OF THE ADULT EAR CANAL.

SO THAT'S THE POSITION I WANT.

MANY OF YOUR EARDROPS
WILL HAVE A LITTLE MARK,
A LITTLE LINE ON HERE

THAT WILL TELL YOU THAT
THAT'S TWO DROPS OR ONE DROP,
SO THAT YOU CAN TELL.

BUT HERE IS MY ADULT
AND I WANT TO SEE YOU

TAKING YOUR HANDS TO EARS,
PULLING UP AND BACK.

AND THEN I AM GOING TO
COUNT ONE, TWO...

AND PUT MY COTTON BALL IN THERE,

JUST TO KELP THAT
FROM RUNNING OUT.

AND THEN IF YOU COULD JUST LAY
THERE FOR ABOUT FIVE MINUTES
THAT WOULD BE GREAT.

OKAY. THAT'S ALL
THE MEDS I HAVE.

YOU GOT BOTH YOUR
PUFFS OF INHALER.

YOU HAVE BOTH YOUR EARDROPS.
YOU GOT YOUR EYE DROPS.

YOU HAVE YOU PATCH.
YOUR VIALS WERE GOOD.

AND I AM GOING TO
TAKE OFF MY GLOVES.

THROW ALL THIS STUFF AWAY.

MAKE SURE ALL THE LIDS ARE ON.

CAPS.
THIS GOES BACK.

AND THIS WOULD ALL BE TRASH.

NOW...DON'T THROW AWAY
OUR PATCHES.

I JUST REMEMBERED I HAVE
A PATCH IN THESE GLOVES

BECAUSE WE NEED TO RECYCLE THEM
AND WE DON'T HAVE THAT MANY.

ALRIGHT. ONCE I AM DONE
AND I HAVE CLEANED UP MY AREA,

I AM GOING TO GO
AND I AM GOING TO DOCUMENT.

SO, I'LL BE BACK IN A LITTLE BIT
OT TAKE THAT OUT OF YOUR EAR.

IN FIVE MINUTES, TEN MINUTES,
I AM GOING TO COME BACK -

THE CLIENT CAN TAKE IT OUT
TOO, IF THEY ARE CAPABLE.

TAKE THE COTTON BALL OUT, MAKE
SURE THAT THEIR EAR IS CLEAN,

CHECK ANY VITALS
I NEEDED TO AFTERWARDS

TO SEE HOW THEY WERE TOLERATING
ANY OF THOSE MEDICATIONS.

I AM PROBABLY CONCERNED
ABOUT THE GLAUCOMA

AND ABOUT THE NITRODERM PATCH
AT THE SAME TIME,

BECAUSE THE GLAUCOMA
ACTUALLY WORKS

BY INCREASING THE OUTFLOW
OF AQUEOUS HUMOR.

AND IF IT GETS INTO THE
SYSTEM, ITS SIDE EFFECT,

ITS SYSTEMIC EFFECT,
IS IT CAN LOWER BLOOD PRESSURE.

SO, THIS CLIENT JUST HAS
A LOT OF STUFF ONBOARD

AND SO WE JUST WANT TO BE ALERT
TO THE VITAL SIGNS ON THAT.

ALRIGHT, I WILL DOCUMENT IN A
MINUTE, BUT I WANTED TO SHOW YOU
A COUPLE OF OTHER VARIATIONS

OF DRUGS THAT YOU WILL
SEE WITH YOUR ORDERS.

I TALKED TO YOU ABOUT
THE NITRODERM PATCH.

NITRODERM ALSO COMES IN PASTE
AND IT LOOKS LIKE THIS.

AND SO THE ORDER IS GOING
TO READ - I AM SORRY.
BECKY, RIGHT?

CAN YOU SWITCH THE OVERHEADS
THAT HAVE THE ORDER?

THIS IS CONRAD'S AND
HE HAS HIS PATCH,

BUT WHOEVER IS
THE NEXT ONE HAS PASTE.

AND I THINK IT'S A HALF AN INCH,
I CAN'T REMEMBER.

YOU SEE THE MAR? IT'S THAT ONE.
THERE YOU GO.

AND IT IS ORDER LIKE --
THAT'S WHAT SHE WAS SORTING
THROUGH THE ORDER.

SO, IF YOU LOOK CLOSELY ON
THERE, IT SAYS, "NITROGLYCERIN
OINTMENT, 2% --"

IS THAT A HALF INCH?
- ONE.

- I THINK IT IS A HALF.
- YEAH.

- WHO IS LOOKING CLOSE,
CAN YOU SEE?

I THINK IT IS A HALF.
IT IS KIND OF BLURRY.

WHAT YOU WANT TO DO, WHEN YOU
TAKE THE CAP OFF,

MAKE SURE THAT YOU SET CAPS
WITH THE INSIDE UP.

DON'T PUT IT DOWN, COS THEN THEY
GET DIRTY AND CONTAMINATED

AND YOU WANT OT KEEP
'EM LIKE THAT.

I WOULD REALLY PREFER DOING
THIS WITH GLOVES ON.

GETTING IT READY, EVEN THOUGH
IT IS MEDICATION.

IT'S BECAUSE AGAIN, REMEMBER
I SAID THIS TUBE CAN HAVE
NITROGLYCERIN ON IT.

SO, WHAT YOU WANT TO DO
IS GET OUT ONE OF THESE
MEASURING GUIDES.

AND THIS IS WHAT COMES IN
THE PACKAGE WITH THE DRUG

AND YOU NEED TO MEASURE
OUT YOUR HALF OF AN INCH.

AND WHEN YOU DO YOUR HALF
AN INCH, IT'S A HALF OF AN
INCH OF A FULL BEAD OF PASTE.

IN OTHER WORDS, IT IS NOT
A HALF INCH SMEAR,

IT IS A HALF INCH BEAD.

LIKE THIS. LOOK, FULL WIDTH OF
THE TUBE FOR YOUR HALF INCH.

YOU CAN SEE IT IS NOT PERFECT OR
EXACT, BUT IT IS REALLY CLOSE.

DID YOU ALSO NOTICE THAT THERE
IS NOTHING SACRED

ABOUT THE FIRST HALF INCH
OR THE SECOND HALF INCH OR
THE THIRD OR THE FOURTH.

I PUT THE HALF INCH
IN THE MIDDLE,

SO THAT WHEN I SQUISH IT
ON THE CLIENT, IT STAYS
UNDER THE PAPER.

IF YOU PUT IT TOO CLOSE TO THE
EDGE AND YOU SQUISH IT DOWN,

THEN IT SQUIRTS OUT AND THEY
DON'T GET ALL OF THEIR MEDICINE.

ALRIGHT. ONCE I HAVE THE DRUG
ONE THERE, PUT THE LID ON.

YOU WOULD GET A PIECE OF TAPE...

TO HOLD THIS ON.

AND IT HAS THE SAME CRITERIA
AS THE PATCH DOES,

AS FAR AS GETTING VITAL SIGNS
AND PUTTING IT ON CLEAN SKIN.

WHAT YOU WANT TO DO...

IS PUT IT ON AND THEN
SQUISH IT DOWN,

BUT DON'T RUB IT IN.

YOU DON'T WANT IT
TO ACT TOO FAST,

YOU WANT IT TO JUST ABSORB
AS IT WAS PREPARED TO DO.

SO, YOU ARE GOING TO PUT IT
ON, JUST SQUISH IT AND TAPE IT.

AND THEN PUT YOUR DATE, TIME
AND INITIALS ON THE PATCH.

AND THEN IT WILL BE FINE.

USUALLY, THESE GET
CHANGED EVERY SIX HOURS.

AND AGAIN, IT SHOULD
COME OFF AT NIGHTTIME.

IT SHOULDN'T STAY
ON ALL 24 HOURS.

SO IF SOMEONE MISUNDERSTOOD
AND WROTE THAT ORDER,

THEN YOU NEED TO FOLLOW UP
ABOUT THAT COS IT DOES
NEED TO COME OFF.

PEOPLE SHOULD LEAVE THEM ON.

AND IF THEY SHOWER, THEY
SHOULD JUST LEAVE THEM ON.

YOU CAN'T TAKE IT ON AND OFF,
AND ON AND OFF.

IT JUST STAYS ON.

AND THE OLD ONES COME OFF,
WHEN YOU'RE USING THOSE.

WE ALSO MADE FAKE
NITROGLYCERINE.

I THINK IT'S JUST ZINC OXIDE
OR SOME CREAM OR SOMETHING,
I DON'T KNOW.

SO IT'S A LITTLE, NOT QUITE
AS THICK, BUT YOU GET THE
JOB DONE WITH THAT.

AND THEN WE JUST
COPY THESE STRIPS.

THE OTHER THING
I WANTED TO SHOW YOU

WAS THERE ARE SOME INHALERS THAT
WE HAVE THAT LOOK LIKE THIS.

THEY HAVE A BUILT-IN SPACER.

THEY'RE COOL.

SO EVERYTHING'S THERE. YOU STILL
CAN REMOVE YOUR DRUG.

AND THIS IS AN ACTUAL BECLOVENT.

MOST OF THEM AREN'T, WE HAVE
JUST LABELED THEM BECLOVENT.

MOST OF THEM ARE JUST ANY
INHALER THAT WE COULD GET.

SO IF YOU HAVE OLD INHALERS,
WE ARE HAPPY TO TAKE 'EM.

AND THEN IT GOES IN THERE.

AGAIN, SHAKE IT UP, THEY PUT
THEIR MOUTH AROUND IT
AND THEN...

PUFF.

HOLD FOR TEN SECONDS.

PURSED LIPS. OUT.

SO, THAT'S HOW THESE WORK
IF YOU HAPPEN TO PULL THIS
ONE AND THE SPACER.

BUT AGAIN, YOU ONLY HAVE TO
TELL ME ONE WAY OR THE OTHER,
I DON'T REALLY CARE.

SO IF YOU CAN'T FIND A SPACER,
THEN DO THE, YOU KNOW, TWO
INCHES AWAY FROM THE MOUTH.

AND IF YOU CAN'T FIND
THE SPACER, DO A SPACER.
IT DOESN'T MATTER. EITHER ONE.

ALRIGHT.

FOLLOWING ALONG?
DID I DO EVERYTHING?

ANY QUESTIONS OR PROBLEMS?

IF THE PATCH
IS LEFT ON OVER NIGHT,

IS THERE A PROBLEM WITH
PUTTING ON ANOTHER ONE?

- NO. YOU NEED TO PUT IT ON
BECAUSE THEY NEED IT FOR
DURING THE DAY.

SO IF THAT WERE THE CASE
WHAT I WOULD DO,

IS I MIGHT EVEN MAKE ANOTHER
LINE ON MY MAR

THAT SAYS, "REMOVE NITRODERM
PATCH AND PUT A 22:00."

SO THAT PEOPLE WILL CATCH
THAT FOR THEIR NIGHTTIME
ACTIVITY. SO.

ALRIGHT. SO WE NEED TO DOCUMENT.

AND I HAVE CHECKED ALL MY MEDS.

SO I AM GOING TO SAY,
10 DB.

10 DB.
10 DB.

AND 10, DB.