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.
AND 10, DB.