WELL, FROM THE ULTIMATE TO THE SUBLIME...ENEMAS.
THAT'S JUST WHAT WE'RE DOING TODAY.
YOU KNOW, YOU GOT TO, KIND OF... - EBB AND FLOW.
- EBB AND FLOW THROUGH THE STRESS LEVELS
AND SO THIS ISN'T EXACTLY HIGH STRESS AND SO THAT'S GOOD.
WHAT WE NEED TO DO IS TALK ABOUT SOME DIFFERENT KINDS OF STOOL SPECIMENS.
WE'LL DO THAT FIRST. AND THEN WHAT WE'RE GOING TO DO AS FAR AS TESTING GOES,
THERE'S TWO PASS-FAILS JUST TO TALK TO...
SPECIMEN COLLECTION AND SOME ENEMA TYPES.
WE'LL TALK ABOUT SOME ENEMA TYPES
AND THEN YOU'RE GOING TO GIVE TWO DIFFERENT KINDS OF ENEMAS.
ONE IS JUST KIND OF A MECHANICAL,
YOU'RE GOING TO GO THROUGH THE DRILL, BUT SKIP THE WATER PART
AND JUST KIND OF DO IT, BUT NOT DO IT,
BECAUSE MY MANNEQUINS WILL EXPLODE IF YOU DO.
AND THEN WE'RE GOING TO DO ANOTHER ONE WITH WATER BECAUSE IT WORKS.
SO WE'RE GOING TO DO A CLEANSING ENEMA, A HARRIS FLUSH
AND THEN TALK THROUGH SOME PASS-FAIL SKILLS.
SO YOU'LL BASICALLY BE DOING TWO ENEMAS --
SHOOT. I FORGOT. I DON'T HAVE A STETHOSCOPE.
RYAN, WOULD YOU DO ME A FAVOR AND GO ASK CONNIE FOR A STETHOSCOPE?
I HAD IT THERE ABOUT THREE TIMES, I GOT DISTRACTED LOOKING AROUND.
ALRIGHT.
LET'S TALK ABOUT SPECIMEN COLLECTION.
WE DO COLLECT SPECIMENS, STOOL SPECIMENS.
AND WHEN YOU COLLECT A STOOL SPECIMEN,
IT'S NICE IF YOU CAN HAVE THE CLIENT
SEPARATE URINE FROM STOOLS SO YOU CAN JUST GET THE STOOL SEPARATELY.
THEY CAN DO THAT BEDPAN-WISE, URINATE,
USE A URINAL, URINATE AND THEN USE A BED PAN IF THEY CAN AND THEN YOU HAVE IT SEPARATE.
ON A COMMODE IF YOU CAN HAVE THEM SEPARATE THE TWO, GREAT.
BUT IT'S KIND OF HARD BECAUSE THE BODY'S NATURAL INSTINCT PERISTALSIS WISE IS THAT
YOU'RE URINATING AND RELIEVING URINE AND
YOUR BODY KIND OF NATURALLY RELAXES AND PERISTALSIS STARTS
AND THEN YOU'RE DEFECATING AND YOU'VE GOT TWO PRODUCTS THERE.
SO IT JUST DEPENDS ON WHAT YOU'RE COLLECTING YOUR STOOL FOR,
IF THEY CAN BE MIXED A LITTLE BIT.
BUT IF YOU CAN SEPARATE IT, IT'S A LITTLE EASIER.
IF THEY CAN GET UP AND GO TO THE BATHROOM,
THEN WHAT YOU NEED TO DO IS GET TWO OF THE POTTY HATS WE TALKED ABOUT
AND YOU HAVE ONE FACING FORWARD,
THAT WOULD BE THE URINE AND THEN TAKE THE OTHER ONE AND FACE IT BACKWARDS
AND HOPEFULLY THAT'LL CATCH THE STOOL AND THEN YOU'LL HAVE YOUR TWO SPECIMENS.
ONCE YOU GET A SPECIMEN, YOU NEED TO GET A --
LIKE A TONGUE BLADE OR A SPOON,
A PLASTIC DISPOSABLE SPOON OR SOMETHING.
AND THEN WHAT YOU WANT TO DO IS SCOOP UP TWO TEASPOONS WORTH.
AND IF YOU CAN, IT'S NICE IF YOU CAN PUT THEM IN THESE, OPAQUE CONTAINERS
COS NO ONE LIKES TO LOOK AT IT.
I MEAN, RIGHT? SO YOU PUT IT IN THERE,
LABEL IT, AN ICE-CREAM CONTAINER, MMM!
NICE SURPRISE, YEAH.
LABEL IT UP, PUT IT IN YOUR BIO-HAZARD BAG AND SEND IT OFF.
IF YOU CAN'T FIND ONE OF THESE NICE, OPAQUE CONTAINERS,
THEN YOU CAN USE A REGULAR, SPECIMEN CONTAINER AND PUT THEM IN.
THERE'S NOTHING SPECIAL OTHER THAN YOU CAN'T SEE THROUGH HERE
AND THAT'S --
CONNIE WASN'T AVAILABLE,
SO SOMEBODY JUST WAS THERE AND SHE WENT AND GOT ONE.
- THIS WILL GET THE JOB DONE. - I FIGURED IT WILL WORK.
OKAY.
ANOTHER KIND OF SPECIMEN THAT WE COLLECT
IF THEY ALLOW YOU AND THIS DEPENDS TOTALLY ON HOSPITAL POLICY,
ARE STOOLS FOR GUAIAC OR STOOLS FOR OCCULT BLOOD. OB
WHAT DOES THAT MEAN? OCCULT?
SOMETHING TO DO WITH A CULT.
- OCCULT. - HIDDEN.
THE HIDDEN DARK THINGS.
YOU HERE THAT IN THE SPIRITUAL WORLD. OH, THE OCCULT.
BECAUSE IT'S HIDDEN. IT'S DARK.
AND IT'S THE SAME THING WITH STOOL. IT'S THE HIDDEN BLOOD.
THE OCCULT BLOOD, OB.
AND THEN GUAIAC IS THE OTHER THING THEY'LL SAY.
AND THEY'LL SAY STOOL FOR OB TIMES THREE. GUAIAC TIMES THREE.
AND WHAT THAT MEANS IS YOU GET A STOOL SPECIMEN
AND IT'S EITHER IN THE BEDPAN OR THE POTTY HAT OR WHEREVER. GLOVES.
OKAY, YOU TAKE A LITTLE STICK LIKE THIS
AND THESE ARE PROVIDED WITH THESE HEMOCCULT SLIDES
AND THAT'S THE THIRD TERM, HEMOCCULT, WHICH IS HIDDEN BLOOD.
COULDN'T POSSIBLY BE TOM, WHO SAYS, "DON'T TURN YOUR PHONES ON FOR MY VIDEOTAPE."
WE'LL BE CUTTING THIS PART RIGHT HERE.
OKAY. OH, PLEASE CUT THAT PART.
I'LL DIE. OKAY.
YOU'RE GOING TO GET IN HERE WITH YOUR STICKS
AND YOUR HEMOSLIDE, YOUR HEMOSCREEN TO GET BLOOD.
AND YOU'RE GOING TO TAKE ONE END OF THIS STICK
AND SCOOP A LITTLE BIT OF STOOL.
YOU'RE GOING TO OPEN THE FRONT OF THE SLIDE
AND IN THE FRONT OF THE SLIDE ARE TWO SCREENS.
YOU'RE GOING TO PUT THE STOOL AND SMEAR IT ON ONE SCREEN.
THEN YOU'RE GOING TO GO TO THE OTHER SIDE OF THE STICK --
I'VE BEEN SPINNING IT SO MUCH I DON'T KNOW WHICH ONE I USED.
BUT YOU'RE GOING TO GO TO ANOTHER PART OF THE STICK
AND ANOTHER PART OF THE STOOL,
SCOOP ANOTHER PART AND SMEAR IT ONTO THE SCREEN.
THRASH, CLOSE IT.
NOW, SOME OF YOUR HOSPITALS WILL HAVE YOU SEND IT TO THE LAB LIKE THIS,
BUT SOME WILL LET YOU CHECK IT.
SO WHAT YOU DO THEN IS OPEN UP THE BACK OF THE SCREEN
AND IF IN DOUBT READ THE DIRECTIONS.
OPEN IT UP AND THEN YOU GET HEMOCCULT DEVELOPER,
HEMOSCREEN DEVELOPER AND YOU HAVE TO GET THE RIGHT BRAND TO MATCH,
MAKE SURE IT HASN'T EXPIRED.
AND THEN WHAT YOU DO IS YOU DROP ONE DROP ONTO EACH OF THE SLIDE AREAS
AND YOU SEE IF IT TURNS BLUE.
IF IT TURNS BLUE, THEN IT'S POSITIVE FOR BLOOD
AND IF IT DOESN'T, IT'S NOT.
AND YOU CAN TELL THE COLOR OF BLUE IT IS
BY YOUR TEST STRIP DOWN AT THE BOTTOM.
IF IT'S NEGATIVE THERE IS NO COLOR CHANGE,
BUT IF IT IS POSITIVE IT IS THAT COLOR OF BLUE.
AND SO I'LL PASS THAT AROUND SO YOU CAN LOOK AT IT.
SOME DON'T ALLOW YOU TO DO IT BECAUSE THEY WANT IT TO BE A LAB VALUE
AND THAT'S ALL THERE IS TO IT.
WHEN YOU GO THEN TO DOCUMENT YOU'LL SAY,
STOOL FOR GUAIAC POSITIVE OR NEGATIVE AND THAT'S ALL.
IT'S NOT SO MUCH POSITIVE OR SO MUCH NEGATIVE. IT EITHER IS OR ISN'T.
- HOW DO YOU SPELL GUAIAC?
- G-U-I..
G-U-I-A-C. SEEMS LIKE THERE SHOULD BE ANOTHER U IN THERE.
- THAT DOESN'T SEEM CORRECT. - G-U-I-A-C. YEAH.
OKAY, SOMETIMES THE DOCTOR STILL WANTS TO CHECK FOR
THE BLOOD IN THE STOOL, BUT THE CLIENT'S GOING TO GO HOME.
SO YOU MAY SEND YOUR CLIENT HOME WITH THREE OF THESE STRIPS LIKE THIS.
AND YOU GIVE HIM THE SAME EXACT INSTRUCTIONS THAT I GAVE YOU.
SEND HIM WITH STICKS, TELL HIM TO TAKE TWO PARTS OF THE STOOL
AND SMEAR IT AND CLOSE IT.
AND THEN WHEN THEY FINALLY HAVE THREE STOOL SPECIMENS
THEN THEY TAKE THIS SLIDE INTO THE LAB AND THE LAB WILL TEST IT.
YOU DON'T SEND THEM EVER HOME WITH THE HEMOCCULT DEVELOPER
TO CHECK THEIR OWN, BUT THEY CAN COLLECT THEM.
THERE'S NO TIME-FRAME, BLOOD DOES NOT BE BLOOD
IN THREE DAYS OR A WEEK OR WHATEVER.
THAT'S JUST WHAT THEY DO.
SOMETIMES, ELDERLY PEOPLE --
I'M KIND OF GETTING INTO THAT AGE GROUP, NOT ME, BUT MY PARENTS NOW.
LIKE FOR STOOL TO CHECK FOR BLOOD,
THE INSURANCE COMPANIES WILL SEND THEM SLIDES LIKE THIS PRIOR TO COLONOSCOPIES
OR TO BE CHECKING PRIOR TO DOING CANCER CHECKS OR SO FORTH.
AND SO THEY'LL SEND THESE SLIDES SO THAT WE CAN BE CHECKING.
AND THEN THIS IS HEMOCCULT DEVELOPER FOR THIS PARTICULAR BRAND,
SO YOU JUST WANT TO MATCH THEM UP.
AND THAT'S ALL YOU NEED TO DO FOR THAT. I THINK THAT'S A PASS-FAIL.
THERE IS ANOTHER INTERESTING ONE THAT SHOWED UP A COUPLE OF YEARS AGO
IN ONE OF THE NEO-NATAL NURSERIES IN THE COMMUNITY.
SO IF YOU FIND SOMETHING NEW ASK THEM IF I CAN HAVE IT.
BUT WHAT THIS IS, IS ALSO TO CHECK FOR STOOL --
FOR BLOOD IN THE STOOL AND YOU HAVE TO GET THESE LITTLE FILTER PAPERS.
THEY COME LIKE THIS WITH TABLETS.
YOU TAKE ONE OF THE LITTLE FILTER PAPERS OFF,
YOU GET A STOOL SPECIMEN AND YOU SMEAR IT ONTO THE FILTER PAPER.
THEN YOU GET A TABLET FROM IN HERE.
IF I GET ONE. I DON'T LIKE TO TOUCH THEM. GLOVES WOULD BE COOL.
YOU GET A TABLET AND YOU PUT THE TABLET ON TOP OF THE STOOL,
THEN YOU GET DISTILLED WATER
AND YOU DROP A DROP ONTO THE TABLET,
THEN YOU DROP ANOTHER DROP
SO THAT THE WATER RUNS OFF THE TABLET AND FINALLY HITS THE STOOL.
THEN YOU HAVE TO KIND OF TAP IT TO MAKE SURE THAT IT -
IS THIS THE MOST RIDICULOUS THING YOU'VE EVER HEARD OF?
BUT EVENTUALLY AFTER TAPPING AND DROPPING AND TAPPING AND DRIBBLING
AND ALL OF THESE DIRECTIONS ARE WONDERFULLY ON HERE FOR YOU.
IF IT TURNS BLUE ON THE FILTER PAPER THEN YOU HAVE A POSITIVE GUAIAC.
WHY WOULD ANYONE PICK THIS OVER THIS?
IT'S BEYOND ME, BUT WHATEVER.
THAT'S WHAT THEY WERE USING IN THE NURSERY AND THE STUDENTS WERE LIKE,
"HAVE YOU EVER SEEN SUCH A THING?" AND I WAS LIKE, "NO."
- IS IT LESS EXPENSIVE?
I HAVE NO IDEA. I DON'T SEE HOW IT COULD BE THAT MUCH LESS EXPENSIVE
BECAUSE YOU'RE PAYING FOR TABLETS AND PAPER.
YOU KNOW THEY ARE GOING TO CHARGE YOU. I DON'T KNOW,
BUT ANYWAY I'LL LEAVE THAT OUT.
HERE I'LL JUST PASS IT AROUND AND YOU CAN HAVE A LOOK AT THE LITTLE DIRECTIONS ON THEM.
OKAY.
WHAT OTHER STOOL SPECIMENS NOT ON YOUR TEST? STOOL FOR O&P,
WHAT IS THAT?
OVA AND PARASITES.
WE CHECK FOR THOSE FREQUENTLY ESPECIALLY, PEOPLE THAT HAVE TRAVELED
OUT OF THE CONTINENTAL UNITED STATES,
YOU MIGHT BE CHECKING FOR PARASITES.
SO WHEN YOU DO A STOOL FOR PARASITES,
YOU COLLECT HOWEVER MUCH THEY NEED FOR THAT SPECIMEN.
SOMETIMES THEY WILL NEED THE WHOLE STOOL.
THEY WON'T JUST WANT TWO TEASPOONS, SO, YOU NEED TO CHECK WITH THE LAB
WHEN YOU'RE GETTING SPECIMENS FOR THAT.
ESPECIALLY, IF THEY'RE LOOKING FOR SOMETHING IN PARTICULAR.
WHEN YOU DO A STOOL FOR OVA AND PARASITES
WHAT DO YOU THINK ABOUT REFRIGERATING VERSUS NOT REFRIGERATING?
REFRIGERATE?
KILL THEM.
THEY WANT TO SEE THE LIVE ONES.
SO, NO REFRIGERATION, GET IT STRAIGHT TO THE LAB.
ALRIGHT, ANOTHER INTERESTING PARASITE THAT WE CHECK FOR
THAT'S VERY, VERY COMMON IS PINWORMS.
VERY, VERY COMMON ESPECIALLY IN LARGE COMMUNITIES,
IN PRISONS, WHERE YOU AROUND A LOT OF DIRT
AND WHERE THERE IS A LOT OF ANIMALS.
A LOT IN THE SCHOOL SYSTEM BECAUSE THEY'RE VERY, VERY CONTAGIOUS.
THEY -- THE PARASITE GETS IN FROM YOUR MOUTH,
NOSE USUALLY, FROM THE DIRT, FROM FINGERNAILS
AND THEN THE CLIENT COMPLAINS OF INTENSE ITCHING IN THEIR RECTUM.
WHAT HAPPENS IS THESE LITTLE THREAD LIKE WORMS COME OUT AT NIGHT TIME,
OUT OF THE ANAL AREA AND THEY ITCH, ITCH, ITCH, ITCH,
SCRATCH, SCRATCH, SCRATCH, SCRATCH.
THEY LAY ABOUT 10,000 EGGS A NIGHT EACH.
AND IF YOU SEE A WHOLE BUNCH OF THE THREADY LITTLE WORMS --
I HAVE VISIONS. MY CHILDREN HAD THEM. OOH
AND SO THEY SCRATCH AND I JUST --
I COULD SEE THIS VISUAL OF JUST EGGS ALL OVER MY HOUSE.
AND SO WHAT THEY DO CHECK -- I MEAN, I SAW THE LITTLE WORMS, RIGHT?
SCOTCH TAPE IS WHAT THEY DO.
I SAW THE WORMS, SO I DIDN'T HAVE TO DO ANYTHING. I MEAN, THEY WERE THERE.
BUT THEY'RE -- YOU'RE NOT SURE, THEY'RE COMPLAINING OF INTENSE ITCHING.
THEY HAVE YOU TAKE A PIECE OF SCOTCH TAPE IN THE MORNING,
STICK IT TO THE RECTUM AND THEN TAKE THE TAPE IN
BECAUSE ALL THE LITTLE EGGS STICK TO THE TAPE.
AND THEN THEY WILL DIAGNOSE FROM THAT.
WHEN SOMEBODY HAS PINWORMS EVERYONE IN THE FAMILY HAS TO BE TREATED,
LITTLE RED CHEW TAB TURNS EVERYTHING RED. IT'S GREAT.
AND THEN -- IT'S AN INTENSE CLEAN UP, IT'S KIND OF LIKE HEAD LICE.
IT'S THE SAME THEORY AS FAR AS CLEAN UP GOES.
A LOT OF VACUUMING, PILLOWS HAVE TO BE BAGGED, LINEN BAGGED,
EVERYTHING WASHED IN AMMONIA, VACUUM, VACUUM, CLEAN, CLEAN.
SOCKS ON LITTLE KIDS HANDS
SO THEY DON'T SCRATCH, KIND OF THING, SO THEY DON'T GET UNDER THE NAILS.
MAKE SURE PEOPLE WEAR UNDERWEAR,
TIGHT UNDERWEAR SO IT -- I MEAN, NOT TO CUT OF CIRCULATION,
BUT NOT LIKE BOXER KIND OF THINGS. YOU KNOW WHAT I MEAN.
SO THAT IT TRAPS THE EGGS.
SO THAT'S FUN.
ALRIGHT. I THINK THAT'S ENOUGH ON SPECIMENS.
LET'S TALK A LITTLE BIT ABOUT ENEMAS.
THERE'S LOTS OF KINDS OF ENEMAS.
AN ENEMA ISN'T JUST AN ENEMA, YOU JUST DON'T PUT WATER IN THEM.
WE'RE DOING THAT, OKAY.
SO WHAT KIND AND WHY ARE YOU PUTTING IT IN?
THERE'S A LOT OF REASONS WHY WE DO ENEMAS
AND A LOT OF DIFFERENT KINDS OF ENEMAS.
SO I'VE GIVEN YOU --
I JUST LOVE THIS LITTLE SHEET THAT I FOUND
THAT BASICALLY SUMMARIZES THE FOUR DIFFERENT KINDS OF ENEMAS
AND THE VOLUMES OF ENEMAS THAT WE GIVE.
BEFORE I GET INTO THE KINDS OF ENEMAS AND WHY WE GIVE THEM,
I WANTED TO TALK ABOUT THE KINDS OF SOLUTIONS
THAT WE WOULD PUT IN AN ENEMA.
AND BASICALLY, I WANT TO TALK A LITTLE PATHOPHYSIOLOGY HERE.
HYPER, HYPO AND ISOTONIC SOLUTIONS
THAT WE WOULD PUT INTO A CLIENT.
IF YOU'RE GOING TO PUT A SOLUTION
AND A COMMON SOLUTION OR A COMMON ENEMA
THAT WE DO IS CALLED THE CLEANSING ENEMA.
NOW, CLEANSING ENEMA IS JUST THAT.
WE'RE TRYING TO GET STOOL OUT AND WE'RE TRYING TO CLEANSE THE BOWEL.
EITHER AS A BOWEL PREP SO THAT THEY CAN DO A TEST
OR BECAUSE THEY'RE CONSTIPATED OR IMPACTED OR SOMETHING.
WHEN WE DO A CLEANSING ENEMA
IT'S VERY COMMON THAT WE GIVE A SALINE ENEMA,
NORMAL SALINE TO CLEANSE.
WHAT KIND OF SOLUTION IS NORMAL SALINE?
IS IT HYPO? HYPER? ISO? - ISO.
ISOTONIC. IT'S NORMAL BODY FLUID.
SO WHAT HAPPENS IF YOU WERE TO PUT IN AN ISOTONIC SOLUTION,
FOR EXAMPLE, IN A CLEANSING ENEMA ON AN ADULT
WE CAN PUT UP TO ABOUT 1,000 CC OF FLUID INTO THE RECTUM AREA.
IF YOU PUT THAT ISOTONIC SOLUTION INTO THE VALVE,
- WHAT'S IT DOING TO THE VALVE? - IT'S DISTENDING.
IT'S DISTENDING IT. DILATING IT. IRRITATING IT.
SO THAT IT WILL COS PERISTALSIS.
DOES THE BODY ABSORB THE ISOTONIC SOLUTION?
- NO. - NO.
IT JUST GOES IN BECAUSE IT'S NORMAL BODY FLUID.
IRRITATES, DILATES AND HOPEFULLY THE STOOL WILL COME OUT.
SOMETIMES, WHAT WE USED TO DO AND YOU STILL WILL SEE ORDERED PERIODICALLY
IS WHAT IS CALLED THE TAP WATER ENEMA AND THEY WILL SAY, TWE.
TAP WATER ENEMAS TO CLEAR OR ENEMAS TO CLEAR
PRIOR TO SURGERY OR SOME EXAM.
- WHAT KIND OF A SOLUTION IS TAP WATER? - HYPO.
HYPOTONIC. SO YOU LOAD UP THE RECTUM WITH A HYPOTONIC SOLUTION.
WHERE DOES THAT GO?
- IN THE BODY. - INTO THE BODY BECAUSE
- WHAT DOES THE SALTS OF THE BODY DO? - ABSORB.
DRAWS THE HYPO OR THE LESSER SOLUTION TO IT.
SO IF WE LOAD UP THE BODY WITH ONE ENEMA,
ALRIGHT, PROBABLY NOT TOO BAD. WE LOAD IT UP WITH TWO
BECAUSE IT'S STILL NOT CLEAR WHEN THE ENEMA COMES BACK, RIGHT.
I SAID TAP WATER ENEMAS TO CLEAR.
WE GIVE AN ENEMA AND STOOL COMES OUT,
BUT THERE'S STILL STOOL COMING SO WE GIVE HIM ANOTHER ENEMA AND
STILL WE'RE SEEING FLECKS OF BROWN STUFF AND BROWN COLORING.
HOW MANY OF THOSE ENEMAS DO YOU SUPPOSE WE CAN LOAD SOMEONE UP WITH
BEFORE THEY BEGIN TO GET WHAT WE CALL WATER INTOXIFICATION?
THEY BEGIN TO ABSORB SO MUCH WATER THAT NOW THEY BECOME ILL.
SO WE HAVE A LIMIT OF ISO..
THE HYPOTONIC SOLUTIONS THAT WE CAN GIVE
AND TYPICALLY NO MORE THAN THREE.
ALRIGHT, YOU ALSO WANT TO MAKE SURE THAT YOUR CLIENT IS APPROPRIATE
FOR A TAP WATER ENEMA
AND THAT YOU WOULDN'T WANT SOMEONE WITH CONGESTIVE HEART FAILURE
GETTING A TAP WATER ENEMA, RIGHT?
THEY ALREADY HAVE CONGESTION PROBLEMS.
YOU MENTIONED ASCITES OR
YOU'RE GOING TO GIVE SOMEONE THAT HAS LIVER FAILURE, KIDNEY FAILURE,
NO, THAT'S NOT APPROPRIATE FOR THEM.
SO YOU WANT TO BE THINKING ABOUT NOT ONLY WHY YOU'RE DOING IT,
BUT WHAT YOU'RE DOING IT WITH.
WHAT'S THE SIDE EFFECTS FOR THE CLIENT. ALRIGHT,
FINALLY WE HAVE A THIRD TYPE OF SOLUTION
WHICH IS CALLED THE HYPERTONIC SOLUTION WHICH WOULD BE WHAT?
- IT'S HYPERTONIC. - HYPERTONIC WHICH..
- DRAWS WATER OUT THE BODY INTO THE COLON. - BUT WHAT'S IN IT?
- SALTS. - SALTS. A LOT MORE SALTS.
IT'S TYPICALLY CALLED THE SALINE ENEMA VERSUS NORMAL SALINE.
SO MAKE SURE YOU CLARIFY WHAT KIND OF ENEMA YOU'RE GIVING,
NORMAL SALINE VERSUS SALINE BECAUSE OF THOSE SALTS.
WHEN YOU DO A SALINE ENEMA,
IT'S A HYPERTONIC SOLUTION. WHAT IS IT GOING TO DO?
- DRAW WATER OUT OF THE BODY. - DRAW WATER FROM THE BODY INTO IT,
SO WHO WOULD NOT BE A GOOD CANDIDATE FOR THAT?
- DEHYDRATED. - A DEHYDRATED CLIENT.
YOU WANT TO BE THINKING ABOUT THAT.
THE NICE THING ABOUT THE SALINE ENEMA IS THAT THEY CAN BE SMALL VOLUME,
RIGHT? YOU'RE NOT GOING TO LOAD SOMEONE UP WITH A 1,000 CC OF SALTY WATER
SO THAT THEY CAN DRAW MORE SALTY WATER.
YOUR POOR CLIENT. THAT WOULD BE HORRIBLE.
SO THE ADVANTAGES OF WHAT THEY TYPICALLY CALL THE FLEET'S ENEMA,
THAT'S THE TRADE NAME,
BUT THE GENERIC NAME IS THIS IS A SALINE ENEMA.
IS THAT YOU CAN USE A SMALL AMOUNT, IT'S GOING TO DRAW BODY FLUIDS TO IT,
THAT'S GOING TO DILATE THEN IRRITATE THE BOWEL AND THEY HAVE TO GO.
ALRIGHT, SO CLEANSING.
WE TALKED ABOUT THE TYPE. LET'S TALK ABOUT HOW WE WOULD USE THEM.
TO CLEANSE THE ENEMA BASICALLY WE'RE LOOKING TO IRRITATE THE COLON,
THE RECTUM BY DISTENDING IT
AND THEN HELP THEM EVACUATE STOOL.
THERE IS A LOT OF DIFFERENT KINDS.
WE TALKED ABOUT TAP WATER, SALINE,
NORMAL SALINE, WHICH WOULD BE MY PICK OF THE THREE,
BUT THE LAST KIND THAT'S ON YOUR LIST HERE
THAT I WANTED TO TALK ABOUT WAS THE SOAP SUDS ENEMA.
REMEMBER WHEN I TALKED ABOUT SHAMPOOING THE HAIR?
AND THAT WE DON'T DO SOAP SUDS VERY MUCH
AND YOU CAN STEAL THE LITTLE CASTILE SOAPS OUT OF THE BUCKET.
THAT'S WHAT I WAS TALKING ABOUT. IT LOOKS LIKE THIS.
AND WHAT WE DO IS WE GET OUR ENEMA BAG OR ENEMA BUCKET,
FILL IT UP WITH WATER AND THEN ADD ONE LITTLE PACKET OF SOAP SUDS
AND THAT GIVES A LITTLE MORE IRRITATION.
IT'S A MILD, MILD SOAP, BUT IT IRRITATES THE BOWEL A LITTLE BIT MORE
SO THAT IT WILL GET RID OF THE STOOL.
THESE ARE REAL OLD ONES THAT HAVE KIND OF DRIED UP,
THIS WHAT REAL CASTILE SOAPS SHOULD LOOK LIKE.
SO IF YOU SEE THESE KIND, YOU'RE KIND OF GOING...OLD.
BUT THAT'S THE SOAP FROM THEM.
ALRIGHT, THERE IS ANOTHER KIND OF ENEMA THAT WE DO
AND IT'S CALLED THE RETENTION ENEMA.
THE RETENTION ENEMA IS WHEN WE GIVE SOMETHING
FOR A SPECIFIED AMOUNT OF TIME,
IT'S SOMETHING THAT THEY'RE GOING TO RETAIN.
IT CAN BE SO THAT THEY CAN GET NUTRIENTS FROM THAT PARTICULAR SOLUTION
OR IT COULD BE TO SOFTEN STOOL.
THE MOST COMMON THAT I HAVE USED IS AS FAR AS A RETENTION ENEMA
WOULD BE OIL RETENTION ENEMA.
FOR EXAMPLE, YOU HAVE SOMEONE THAT'S VERY, VERY CONSTIPATED
AND OFTEN WHAT WE'RE ALLOWED TO DO IS CALLED DIGITALLY EVACUATE THE STOOL.
HONESTLY, IT'S NOT THAT BAD.
I DON'T LIKE SPUTUM, SO I DON'T MIND DOING ALL THESE OTHER LITTLE THINGS.
BUT YOU DOUBLE GLOVE YOUR HAND,
YOU PUT SOME K-Y JELLY ON YOUR INDEX FINGER
AND IF THEY'RE THE APPROPRIATE CLIENT -- I'LL TALK ABOUT THAT IN JUST A MINUTE.
YOU TAKE YOUR FINGER UP INTO THE RECTUM
AND YOU ROTATE AROUND THE INSIDE OF THE RECTUM TRYING TO STIMULATE BOWEL MOVEMENT
AND THEN YOU USE YOUR FINGERS
TO PULL THE BOWEL OUT WHAT YOU CAN REACH.
WELL, SOMETIMES -- I MEAN, EVEN IN SPITE OF A DIGITAL EVACUATION
YOU CAN'T EVEN REACH THE STOOL.
IT'S SO HIGH AND ITS SO HARD UP THERE AND IT'S LIKE YOU CAN'T GET TO IT
AND THEY'RE MISERABLE. SO WHAT DO WE DO? WHAT ARE OUR OPTIONS?
WELL, YOU CAN TRY A CLEANSING ENEMA,
BUT WHAT YOU MIGHT WANT TO DO IF THE STOOL IS REALLY, REALLY HARD
IS TO DO AN OIL RETENTION ENEMA
SO THAT YOU CAN SOFTEN THE STOOL AND GIVE HIM THE SLIPPERY SLIDE OUT.
SO OIL RETENTION ENEMAS COME IN A FLEET SIZED CONTAINER LIKE THIS
AND IT'S JUST EXACTLY THAT. MINERAL OIL,
YOU PUT IT IN THE RECTUM AND THEN YOU TELL HIM TO HOLD IT FOR ABOUT THREE HOURS
AND IT JUST ABSORBS, ABSORBS, ABSORBS
AND THEN SOFTENS AND SLIDES, WOULD BE THE GOAL.
ALRIGHT, THAT'S A FUN ONE, BUT YOU NEED TO REMEMBER THAT.
OKAY, AND THEN FINA-- THERE'S TWO OTHERS.
THE DISTENSION REDUCTION, THE CARMINATIVE AND THE RETURN FLOW.
THE CARMINATIVE IS ACTUALLY PUTTING IN SOME SOLUTIONS
THAT HELP EXPEL FLATUS IS WHAT WE'RE TRYING TO DO.
PEOPLE THAT HAVE A LOT OF GAS POST SURGERY,
A LOT OF YOU GALS THAT HAVE HAD BABIES, IT'S LIKE, "OH BABY."
YOU KNOW, GAS, GAS BECAUSE YOUR BOWELS ARE ALL STIRRED UP.
AFTER SURGERY -- IF YOU GET TO WATCH SOME SURGERIES,
THE ABDOMINAL SURGERIES, THEY OPEN UP THE ABDOMEN
AND THEY ARE GOING FOR SOMETHING ELSE
BUT THEY PLOP ALL THOSE BOWELS OUT TO GET TO STUFF
AND BOWELS KIND OF GET STIRRED UP AND SO THEN THE PERISTALSIS GETS DISTURBED
AND THEY DON'T GO AND THEY BUILD UP GAS, IT'S MISERABLE.
SO SOMETIMES WE CAN GIVE AN ENEMA THAT WILL HELP RELIEVE THE GAS.
ONE OF THE KINDS OF ENEMAS THAT WE'RE GOING TO GIVE IS A HARRIS FLUSH ENEMA.
AND WHAT THAT IS, IS YOU PUT A LITTLE SOLUTION INTO YOUR ENEMA BUCKET
AND YOU INSTILL SOME SOLUTION INTO THE CLIENT.
AND THEN WITHOUT TAKING THE TUBING OUT OF THEIR RECTUM
YOU LOWER LIKE A SIPHON, THE BUCKET BELOW THEM
AND LET THE WATER COME BACK OUT.
AND HOPEFULLY THAT WILL PULL OUT THE GAS.
AND THEN YOU RAISE THE BUCKET AND PUT THE SOLUTION BACK IN
AND THEN YOU LOWER AND RAISE AND LOWER
AND GET ALL THE STUFF GOING.
BUT HOPEFULLY THAT WILL STIMULATES SOME PERISTALSIS
AND THAT HELPS MOVE GAS OUT AND GET THEM GOING
SO WE'RE GOING TO DO ONE OF THOSE AND I'LL TALK A LITTLE MORE ABOUT THAT.
FINALLY, THE LAST KIND OF ENEMA IS THE MEDICATED ENEMA.
AND WE CAN PUT.. IT'S KIND OF LIKE IF YOU HAVE AN ORIFICE OF THE BODY
THEY CAN PUT SOMETHING IN IT AND TAKE SOMETHING OUT OF IT.
BUT THEY FOUND THAT, THAT NEW MUCOSAL MEMBRANE ABSORBS MEDICATION WELL.
IN PARTICULAR A CLIENT THAT MIGHT HAVE AN ELEVATED POTASSIUM,
WE MIGHT NEED TO GET THAT POTASSIUM DOWN.
WHAT'S THE PROBLEM IF YOUR POTASSIUM GETS TOO HIGH?
- YOU GUYS TALKED ABOUT THAT IN PATHO AND STUFF? - HEART ATTACKS.
HEART ATTACKS, HEART PROBLEMS, MUSCULAR PROBLEMS.
SO IF POTASSIUM IS HIGH, IT CAN BE CRITICAL
AND WE GOT TO GET THAT POTASSIUM LOW.
AND ONE OF THE WAYS THEY FOUND WORKED IS IF WE PUT A PRODUCT CALLED
KAYEXALATE. K BEING POTASSIUM RIGHT, KAYEXALATE IT.
SO IF YOU PUT A MEDICATED ENEMA YOU GET THEM FROM PHARMACY
AND YOU PUT THE MEDICINE IN AND HAVE THEM RETAIN IT,
IT WILL DRAW TO ITSELF THE POTASSIUM AND HELP LOWER THE POTASSIUM.
AND SO AGAIN ANOTHER USE FOR THE ENEMA.
NEOMYCIN ANTIBIOTIC SOLUTIONS, AFTER VALVE SURGERIES, AND SO FORTH.
ALSO AT THE TOP OF THIS PARTICULAR SHEET IT HAS THE VOLUMES
THAT YOU WOULD GIVE TO CLIENTS
BECAUSE OBVIOUSLY YOU WOULDN'T GIVE THE SAME AMOUNT TO AN INFANT AS AN ADULT,
BUT WE'LL BE GIVING TO AN ADULT SO YOU CAN KEEP THAT MINDSET.
- ALRIGHT. - WITH THE ELDERLY WOULD THE AMOUNTS CHANGE?
- WE'RE GOING TO TALK ABOUT THAT.
THERE ARE A LOT OF VARIABLES IN GIVING AN ENEMA.
I JUST WANTED TO COVER BASICALLY THAT PARTICULAR AMOUNT OF INFORMATION.
ON THE BACKSIDE OF YOUR PAPER,
I GAVE YOU SOME CRITICAL THINKING
BECAUSE AN ENEMA ISN'T JUST AN ENEMA.
ITS NOT JUST, "OH, HERE'S SOME WATER, YOU'RE GOING TO PUT IT IN
AND ALL IS GOING TO GO WELL AND THEY ARE GOING TO HAVE A STOOL.
OH, IF IT WERE ONLY THAT SIMPLE.
THINGS HAPPEN AND SO WE'VE ADDED A CRITICAL THINKING COMPONENT
TO THIS PARTICULAR EXAM. WHAT YOU'RE GOING TO DO IS --
RIGHT NOW WE'RE JUST GOING TO GO ON TO THAT CLEANSING ENEMA
AND TALK THROUGH SOME THE ASPECTS OF ASSESSMENT AND WHAT YOU'RE GOING TO DO.
BUT TOWARDS -- WHEN YOU'RE GIVING THE ENEMA PART,
WE'RE GOING TO GIVE YOU A CARD LIKE THIS.
AND I'M GOING TO FAN THEM OUT, THEY WILL BE ALL BLANK ON THIS SIDE,
ON ONE SIDE AND YOU GET TO PICK YOUR FATE.
AND YOU WILL PICK SOMETHING AND SOMETHING IS GOING TO HAPPEN
RELATED TO YOUR ENEMA BECAUSE THEY DON'T JUST GO IN.
BUT I DIDN'T WANT IT TO BE SO HARD THAT YOU HAD TO JUST WING IT
AND SO THESE ARE THE THINGS THAT HAPPEN
THAT ARE JUST A WHOLE LOT OF FUN.
I WISH SOMEONE HAD GIVEN ME THAT SHEET WHEN I HAD STARTED ENEMAS
BECAUSE THEY JUST HAPPENED TO ME.
SO WE WILL TALK ABOUT THOSE WHEN WE GET TO THEM.
ALRIGHT, SO, THE FIRST ENEMA THAT I AM GOING TO HAVE YOU DO
IS AGAIN THE CLEANSING ENEMA
AND WE CAN CONSIDER OURS A TAP WATER ENEMA.
WE'RE JUST GIVING A TAP WATER ENEMA, SO THAT'S WHAT WE'RE GOING TO GIVE.
PRIOR TO GIVING AN ENEMA
YOU WANT TO MAKE SURE THAT YOUR CLIENT IS A CANDIDATE FOR AN ENEMA.
FOR ONE. WHO WOULD NOT BE A CLIENT FOR AN ENEMA?
- SURGERY? - RECTAL SURGERY
- AND ANOTHER REALLY IMPORTANT ONE, THERE ARE OTHERS BUT - COLOSTOMY?
WELL, COLOSTOMY, IF -- YEAH. YEAH.
- BECAUSE THEY WOULDN'T REALLY HAVE A RECTUM. - AN ULCERATED VALVE, MAYBE?
YEAH.
HEART PATIENTS.
- CAUSES BRADYCARDIA.
THE VAGAL NERVE, VAGAL STIMULATION IS IN THE RECTUM.
SO THAT'S WHY REMEMBER WE TALKED ABOUT RECTAL TEMPS,
YOU DON'T DO THOSE ON HEART CLIENTS, RECTAL STIMULATION.
SAME THING. IF YOU GOT A HEART CLIENT AND THEY ARE CONSTIPATED,
ENEMAS ARE NOT YOUR METHOD OF CHOICE HERE.
YOU'RE GOING TO BE GIVING THEM A LAXATIVE.
YOU'RE GOING TO BE DOING A LOT OF OTHER THINGS,
BUT YOU'RE NOT GOING TO BE STIMULATING THE RECTUM.
BECAUSE -- WHAT IS THE VALSALVA MANEUVER?
WHAT IS THE VAGAL NERVE? WHAT HAPPENS?
- THEY DON'T EXHALE.
THEY BRADY DOWN. THE VAGAL -- THE NERVE STIMULATION
CAUSES THEIR HEART TO SLOW DOWN.
WE DON'T WANT THAT, SO.
MAKE SURE THAT YOUR CLIENT IS AN APPROPRIATE CANDIDATE FOR AN ENEMA.
IT IS ALSO GOOD TO KNOW WHY THEY'RE GETTING IT.
AND AGAIN IF IT IS ENEMAS TO CLEAR YOU'RE GOING TO LIMIT YOUR AMOUNT
THAT YOU'RE GOING TO GIVE.
YOU WANT TO LOOK AT YOUR CLIENT'S PAST AND PRESENT ELIMINATORY STATUS.
YOU WANT TO KNOW WHEN WAS YOUR LAST BOWEL MOVEMENT
AND HOW OFTEN DO YOU HAVE BOWEL MOVEMENTS.
I MEAN, SOME PEOPLE DON'T GO BUT EVERY TWO OR THREE DAYS,
SOME GO TWICE A DAY, MOST GO AT LEAST ONCE A DAY.
BUT YOU WANT TO FIND OUT WHAT THEY NORMALLY DO,
YOU WANT TO LOOK AT THEIR DIET. YOU WANT TO LOOK AT THEIR ACTIVITY LEVEL.
YOU WANT TO GET A GOOD SET OF VITAL SIGNS
BECAUSE ANYBODY, WHETHER THEY HAVE A HEART PROBLEM OR NOT,
IF THEY HAVE VAGAL STIMULATION CAN HAVE THE SIDE-EFFECT
OF THE VAGAL NERVE ACTIVITY AND HAVE SOME BRADYCARDIA
SO WE WANT TO MAKE SURE THAT WE HAVE A PULSE BEFORE WE DO THAT.
AND FINALLY -- WELL, THERE'S A COUPLE MORE HERE I OBVIOUSLY FORGOT.
YOU WANT TO CHECK WHEN THEIR BLADDER WAS EMPTIED LAST AFTER THE BED PAN
BECAUSE IF YOU'RE FILLING UP THE BOWEL
AND THEY HAVE ALREADY GOT A FULL BLADDER,
THEY WON'T BE ABLE TO TOLERATE AS MUCH LIQUID.
YOU WANT TO ASSESS THEIR CURRENT MEDICAL REGIMEN.
WHY WOULD YOU WANT TO DO THAT?
MEDS? LOOKING AT THEIR MEDS.
THEY'RE ON A DIURETIC ALREADY?
DIURETIC, MAYBE, BUT THINK STOOL.
- A PAIN MEDICINE.
PAIN MEDICINE. WHAT KIND OF MEDICINES ARE CONSTIPATING THEM?
AND WE TALKED ABOUT LIKE YOUR DARVOCET,
ANY NARCOTIC. I KEPT SAYING AT MY STATION.
SIDE-EFFECTS. SIDE-EFFECTS.
BECAUSE THEY WORK ON THAT SMOOTH MUSCLE AND THEY GET CONSTIPATED.
SO IS THIS ENEMA FOR NOT
OR ARE WE GOING TO HAVE TO KEEP FOLLOWING UP AS FAR AS THE BOWEL REGIME.
SO LOOK AT THEIR MEDS, SEE WHAT'S CAUSING THE PROBLEM
AND SEE IF YOU CAN HELP THEM. LOOK AT THEIR DIET HISTORY.
HOW ARE THEY EATING, DO THEY GET ENOUGH ROUGHAGE, DO THEY HAVE ENOUGH FLUIDS.
WHAT'S THE PROBLEM? OR IS THIS, KIND OF, WHO THEY ARE.
AND THEN FINALLY, THE LAST THING ON YOUR SHEET SAYS THAT,
SEE HOW MUCH THEY CAN TOLERATE?
THIS IS WHEN WE, KIND OF, RESPOND TO YOUR QUESTION.
YOU WANT TO ASK THE CLIENT IF THEY HAVE EVER HAD AN ENEMA BEFORE
AND HOW MUCH FLUID COULD THEY HAVE IN.
WELL, ENEMAS AREN'T THAT COMMON OF A TREATMENT.
I MEAN, WHEN WAS YOUR LAST ENEMA, YOU KNOW?
SO IF THEY HAVEN'T THEY WILL KNOW.
MY GRANDMOTHER TAKES ONE EVERYDAY I FOUND OUT, YOU KNOW.
AND SO SHE KNOWS EXACTLY WHAT SHE CAN TOLERATE.
BUT IF YOU ASK ME, I'LL BE, LIKE, "HECK IF I KNOW, YOU KNOW".
SO IT GIVES YOU KIND OF A POINT OF REFERENCE IF THEY DO KNOW
AND THEN OTHERWISE WE'RE JUST GOING TO GUESS.
BUT WE'RE GOING TO CHECK ONE OTHER THING PHYSICALLY
WHEN WE DO OUR ASSESSMENT TO SEE WHAT'S GOING TO HAPPEN
BECAUSE IF THEY DON'T TOLERATE IT, IF THEY DON'T HAVE GOOD SPHINCTER CONTROL,
YOU'RE PUTTING IT IN AND IT'S SQUIRTING OUT.
AND THAT'S A MESS.
OKAY, SO WE'VE ASSESSED OUR CLIENT AS FAR AS GETTING PREPARED.
SO NOW WE'RE GOING TO.. WE'VE CHECKED THE DOCTOR'S ORDERS
AND OUR CLIENT CARE PLAN AND BOY,
IF YOU'RE THE NURSE THAT GAVE AN ENEMA YESTERDAY,
GIVE THE NURSE FOR TOMORROW A HEAD'S UP
SO THAT THEY KNOW THEY ONLY CAN TOLERATE 500 CC,
NO SPHINCTER CONTROL, PUT HIM ON A BED PAN,
GET HIM TO THE BATHROOM POSTHASTE. GIVE THEM A CLUE, SO IT'S NOT, YOU KNOW, SABOTAGE
AND HOPEFULLY YOU WILL LIKE YOUR STAFF OR MAYBE YOU WOULDN'T WANT TO.
RIGHT, NOW. OKAY, YOU'RE GOING TO GATHER UP YOUR EQUIPMENT
AND THIS IS WHAT YOUR EQUIPMENT IS GOING TO BE.
FIRST, YOU NEED AN ENEMA BAG.
WHEN YOU GET YOUR ENEMA BAG FROM YOUR CENTRAL SUPPLY CART,
IT'S CLEAN AND SO YOU CAN HANDLE IT WITHOUT GLOVES.
YOU WANT TO OPEN IT UP, MAKE SURE IT'S ALL INTACT.
YOUR WATER IS GOING TO COME IN HERE AT THE TOP.
YOU HAVE A TUBE THAT LOOKS VERY MUCH LIKE A FEEDING BAG
AND THEN YOU HAVE A SLIDE CLAMP.
THE TUBE IS GOING TO GO INTO THE RECTUM ABOUT FOUR INCHES.
SO YOU WANT TO MAKE SURE THAT THE SLIDE IS DOWN HERE CLOSE ENOUGH TO
WHERE ITS GOING TO GO INTO THE RECTUM THAT YOU CAN GET TO THE SLIDE CLAMP
AND KEEP YOUR HAND HERE TO HOLD IT IN PLACE
SO THEY DON'T SQUIRT OUT AT THE END OF THE TUBE.
SO I AM GOING TO GO AHEAD AND CHECK THIS AND THEN CLOSE MY SLIDE CLAMP
BEFORE I PUT THE WATER IN.
I'VE GATHERED UP WATER.
AND FOR THE FIRST ENEMA YOU'RE GOING TO PUT IN ABOUT 750 TO 1000 CC.
SO YOU CAN GET THAT MUCH FLUID.
AND YOU WANT IT TO BE ABOUT A 105 TO 110 DEGREES.
HAVE YOU SEEN ANY THERMOMETERS AT YOUR INSTITUTION?
I HARDLY EVER SEE THEM. ONCE I DID AND I WAS LIKE, "OH, WOW."
SO YOU'RE GOING TO CHECK IT WITH YOUR WRIST AND MAKE SURE IT'S NICE AND WARM.
YOU DON'T WANT IT TOO HOT
BECAUSE YOU DON'T WANT TO BURN THEM BECAUSE...
MOST OF YOUR HOT WATER HEATERS ARE PRE-SET AT THE HOSPITAL BECAUSE THEY DON'T WANT PEOPLE GETTING BURNT.
BUT CHECK IT AND MAKE SURE IT'S NICE AND WARM.
OKAY, I HAVE MY WATER. I'M GOING TO HAVE A BED PAN NEARBY.
MAKE SURE YOU HANDLE THOSE BED PANS WITH GLOVES, RIGHT.
YOU'VE ALREADY USED THEM AND HAD THEM ON THERE, SO.
PUT THEM ON A BARRIER. I NEED LOTS OF CHUCKS.
I NEED TO BE PREPARED FOR CLEANING.
SO, I HAVE A TOWEL AND A WASH CLOTH
AND I ALSO HAVE K-Y JELLY... SOMEWHERE.
WELL, I DID HAVE K-Y JELLY.
K-Y JELLY. K-Y JELLY, A LUBRICANT.
NEED A STETHOSCOPE TO LISTEN TO BOWELS, YOU NEED A BATH BLANKET
AND YOU NEED AN IV POLE TO HANG YOUR BAG ON.
SO, WE PUT IV POLES BY ALL THE BEDS.
YOU WILL HAVE TO GATHER THE REST OF YOUR STUFF.
OKAY.
WASHED MY HANDS.
GOOD MORNING, MR. CURRY, I THINK.
MR. CURRY, I HAVE AN ENEMA FOR YOU.
I HEARD YOU WERE REALLY CONSTIPATED AND THIS WILL HELP.
ALRIGHT.
PRIVACY.
HAVE YOU EVER HAD AN ENEMA BEFORE?
YOU HAVEN'T.
WELL, HOPEFULLY IT'S NOT PAINFUL.
ALL I'M GOING TO DO IS PUT A TUBE INTO YOUR RECTUM
AND THEN I'M GOING TO INSTILL SOME WATER
AND YOUR RECTUM WILL START FEELING FULL LIKE YOU'VE GOT TO GO.
AND WHAT I WANT YOU TO DO IS TELL ME IF DURING THE PROCESS
YOU HAVE ANY CRAMPS AS IT'S GETTING FULL.
AND THEN I'LL STOP BECAUSE I DON'T WANT YOU TO BE TOO MISERABLE
THAT YOU CAN'T HOLD THE WATER IN AND GET TO THE BATHROOM.
ARE YOU GETTING UP AND GOING TO THE BATHROOM OKAY?
ALRIGHT, SO THAT WILL BE OUR GOAL, TO GET TO THE BATHROOM.
AND THE OTHER THING I NEED TO LET YOU KNOW IS THAT
I NEED YOU TO LAY ON YOUR LEFT SIDE FOR THIS PROCEDURE.
BECAUSE WE GET SOME BETTER RESULTS IF WE PUT YOU ON YOUR LEFT SIDE.
DO YOU HAVE ANY QUESTIONS?
ALRIGHT, BEFORE YOU TURN ON YOUR LEFT SIDE, DON'T TURN YET.
I DO WANT TO ASSESS YOUR ABDOMEN AND GET VITAL SIGNS.
SO, THAT'S WHAT YOU WILL DO.
BECAUSE WE'RE DOING ANOTHER DRILL WITH THE OTHER SEMESTER,
I DON'T HAVE THE BOWEL SOUNDS IN AND I WISH I DID, BUT WE DON'T.
SO LET'S GO AHEAD AND GET AN ABDOMINAL ASSESSMENT HERE.
WELL, I'M GOING TO JUST GO AHEAD AND COVER YOU UP.
A BATH BLANKET WOULD BE A GOOD CHOICE ON THIS.
SOMETIMES I JUST USE MY SHEETS FOR PRIVACY,
BUT WHEN YOU'RE DOING AN ENEMA,
THIS IS AN UNKNOWN ENTITY HERE
AND I'M GOING TO PROTECT THE LINEN AS BEST AS POSSIBLE,
OR DO IT BEFORE YOUR LINEN CHANGE.
ALRIGHT, ABDOMINAL ASSESSMENT. WE'RE GOING TO EXPOSE OUR ABDOMEN
AND SORRY, WE HAVE OSTOMIES GOING SECOND SEMESTER.
IT'S BOWEL WEEK IN THE LAB.
SO, WE'RE GOING TO HAVE STOOL AND BOWEL AND IT WILL BE FUN.
ALRIGHT, WE'RE GOING TO FIRST..
-- WHAT'S THE FIRST THING YOU DO FOR ABDOMINAL ASSESSMENT? - INSPECTION.
INSPECT ALWAYS. SO WE'RE GOING TO LOOK AT THE CONTOUR,
WHICH IS THE SHAPE WE'RE LOOKING FOR. DISTENSION, WHETHER IT'S CONCAVE.
WE'RE LOOKING FOR SYMMETRY, WHICH WE LOOK FOR BY COMING DOWN TO THE BASE.
WE LOOK FOR ANY SCARS, LESIONS, DISCOLORATIONS.
INTERESTING, PEOPLE THAT ARE REALLY CONSTIPATED, SOMETIMES YOU CAN SEE BOWEL
LIKE A LITTLE LOOP OF WHERE IT'S CONSTIPATED AND KIND OF SITTING THERE.
ALRIGHT, SO WE'RE GONG TO INSPECT AND WHAT'S THE SECOND THING WE DO?
- OSCULTATE.
WE'RE GOING TO OSCULTATE.
OBVIOUSLY I DON'T HAVE THEM IN AND YOU CAN'T HEAR EITHER.
WE'RE GOING TO START IN THE RIGHT LOWER QUADRANT.
WHY?
- BECAUSE YOU TOLD US TO. - BECAUSE I TOLD YOU TO.
"COS DIANE SAID."
BECAUSE IT'S WHERE THE ILEOCECAL VALVE IS
AND THAT'S WHERE YOU'RE MOST LIKELY TO HEAR BOWEL SOUNDS.
SO WE START RIGHT LOWER.
OBVIOUSLY IT'S NOT LIFE OR DEATH OR THAT BIG A DEAL WHERE YOU START.
BUT IT'S KIND OF NICE TO HEAR THE BOWEL SOUNDS.
A MINUTE PER SECTION BEFORE YOU CAN CLAIM NO BOWEL SOUNDS.
AND THEN FINALLY WE WOULD PALPATE LIGHTLY,
WHICH IS JUST BARELY QUARTER OF AN INCH TO SEE IF THERE IS ANY TENDERNESS, PAIN,
IF YOU CAN FEEL THE BOWEL GAS DISTENSION, AND SO FORTH.
ALRIGHT.
WELL...
MR. CURRY IF YOU COULD GO AHEAD AND TURN OVER ON YOUR LEFT SIDE THAT WOULD BE GREAT.
AND HE JUST DOES. HE JUST ROLLS RIGHT OVER.
ALRIGHT, NOW IT'S NICE IF THEY CAN COME A LITTLE BIT TOWARDS YOU.
SO THAT YOU DON'T HAVE TO REACH SO FAR.
LEAN ON THERE. THANK YOU.
OKAY.
YOU'RE GOING TO EXPOSE THEIR BOTTOM HERE.
GOING TO LOAD THEM UP. THE CHUX.
AFTER ABOUT THE SECOND OR THIRD ENEMA ON THE MANNEQUINS,
EVEN THOUGH YOU WOULD NEVER LEAVE YOUR CLIENT LAYING ON A BLUE PAD, RIGHT?
NEVER. HOLD THAT THOUGHT.
PLEASE LEAVE A BLUE PAD UNDERNEATH OUR MANNEQUINS BECAUSE THEY LEAK.
AND WE'RE JUST GOING TO BE IN A PUDDLE OF WATER BY THE END OF THE DAY.
WHEN YOU'RE LOOKING, LISTENING AND FEELING THE ABDOMEN,
WHAT ARE THE CONTRAINDICATIONS TO CONTINUING WITH THE PROCEDURE?
- WELL... - I MEAN THEY ARE CONSTIPATED.
THERE AREN'T REALLY. IF THEY HAVE --
IF THEY'RE TENDER YOU MIGHT HAVE MORE TROUBLE WITH CRAMPING
SO THAT'S GIVING YOU AN INDICATION AT THIS POINT
THAT YOU MIGHT NOT BE ABLE TO DO AS MUCH FLUID AS YOU'D LIKE.
BUT BASICALLY WE'VE ALREADY ADDRESSED OUR CONTRAINDICATIONS.
SO IF THEY'RE CONSTIPATED, WE'RE JUST GOING TO GIVE IT A WHIRL.
I DON'T REALLY HAVE ONE -- - SO YOU JUST KIND OF DO IT FOR FLUID?
I'M DOING IT SO THAT I'LL BE ABLE TO ASSESS THE RESULTS AFTERWARDS.
DID THE DISTENSION GO DOWN?
DID IT GET MORE DISTENDED? DID THEY RETAIN THE FLUID?
IT'S GIVING ME A POINT OF REFERENCE FOR EFFECTIVENESS
OR NOT EFFECTIVE AFTER I GAVE THE ENEMA.
ALRIGHT.
ON YOUR SHEET..
- DID I ASTERISK, HAVE A BED PAN NEARBY? - NO.
I SHOULD'VE. THERE'S NOTHING THAT'S REALLY..
- IS THERE ANYTHING ASTERISKED ON THERE IN ENEMAS? - LEFT LATERAL..
- OH, LEFT LATERAL SIMS. OKAY. - OH NO YOU DID. IT'S SAYS THERE BED PAN.
- BED PAN IS IT ASTERISKED? - YES IT IS, 22.
HAVE A BED PAN NEARBY.
IT'S NOT LIKE CRITICAL LIFE AND DEATH. IT'S A CRITICAL MESS.
OKAY, AND THIS IS WHAT I MEAN BY NEARBY. I MEAN HERE. I MEAN, LIKE, HERE.
I DON'T MEAN, LIKE, OVER HERE OR IN THE DRAWER. I MEAN, LIKE, HERE.
ALRIGHT, LET'S ALSO TALK ABOUT LEFT LATERAL SIMS. WHY LEFT VERSUS RIGHT?
WHY WOULD I MARK THAT AS CRITICAL?
- BECAUSE THAT'S THE WAY THE INTESTINE --
YES, THE INTESTINE. OKAY,
FIRST OFF, YOU KNOW, YOUR ANAL OPENING HERE,
THE INTESTINE GOES KIND OF STRAIGHT THERE FOR A BIT, THE IMMEDIATE OPENING.
- BUT THEN WHAT HAPPENS TO THE BOWEL? - SHARP TURN.
- SO IF YOU TURN THIS WAY, WHERE IS THE WATER GOING TO GO? - DOWN.
DOWN AND IT WILL STAY IN VERSUS IF IT'S UP,
THE WATER IS GOING TO TEND TO WANT TO COME DOWN.
SO THAT'S WHY IT'S IMPORTANT THAT WE GO LEFT,
LATERAL SIMS BEING KIND OF STRAIGHT
AND THAT'S ONE LEG OVER THE OTHER CROSSED TO HOLD POSITION THERE.
CAN YOU REMOVE THE BLANKET SO WE CAN SEE?
THERE. HOW IS THAT? - PERFECT.
- ALRIGHT, WE MUST KEEP MODESTY FOR THE FILM.
ALRIGHT.
CLEAN IF YOU NEED TO CLEAN. AND ALSO...
I'VE GOT TO GET MY BAG RIGHT HERE.
I'M GOING TO DOUBLE GLOVE MY RIGHT HAND.
ALRIGHT, LET'S GO AHEAD AND FILL THIS UP.
AND I DO WANT YOU TO FILL THIS UP.
I JUST DON'T WANT YOU TO PUT IT IN THE CLIENT.
JUST SO THAT YOU CAN PRACTICE WORKING THESE CLAMPS
AND HANDLING THE STUFF,
HAVING A LITTLE SPILL AND A LITTLE SQUIRT..
..AND SO FORTH.
OKAY, MY GOAL HERE IS THAT
I WANT THE BAG TO BE NO MORE THAN 12 TO 18 INCHES ABOVE THE ANUS.
SO, I'M ABOUT 12, IT CAN PROBABLY GO A LITTLE BIT HIGHER GRAVITY WISE.
REMEMBER THAT YOUR ADJUSTMENTS GOING TO BE ACCORDING TO HOW HIGH YOUR BED IS,
JUST BECAUSE THE POLE'S ONE WAY,
YOU CAN ADJUST BASED ON BED HERE.
ALRIGHT, THE OTHER THING I WANT TO DO IS GO AHEAD
AND PRIME THE TUBING AND JUST GET ALL THE AIR OUT JUST
BECAUSE IT'S A NICE THING TO DO.
AND THEN -- OH, CATCH. OH, IT'S SO SLIPPERY.
AND THERE WE GO.
OKAY.
GO AHEAD AND PUT K-Y JELLY.
WE HAVE A LOT OF DIFFERENT KINDS OF MANNEQUIN LUBRICANTS
THAT WILL HAVE ALPS ANDSILICON STUFF, BUT K-Y IS FINE FOR THIS.
AND I'M JUST GOING TO COVER THE END.
A LOT OF THEM AREPRE-LUBRICATED WHEN YOU GET THEM OUT THE FIRST TIME,
OUT OF THE PACKAGE AND THEY HAVE A LITTLE CATH ON THEM
SO THAT WILL GET THE JOB DONE FOR YOU AS WELL.
ALRIGHT, THE NEXT THING I WANT TO DO
IS I WANT TO CHECK FOR SPHINCTER CONTROL.
SO, I'M GOING TO DO A LITTLE DIGITAL EXAM HERE.
PUT A LITTLE K-Y ON MY FINGER AND THEN I'M GOING TO TELL THE CLIENT.
"I'M GOING TO PUT MY FINGER IN YOUR RECTUM
AND HAVE YOU BEAR DOWN A LITTLE BIT SO I CAN SEE
IF YOU GOT GOOD SPHINCTER CONTROL TO HOLD THIS ENEMA IN."
IT ALSO GIVE ME THE OPPORTUNITY TO SEE IF THERE IS STOOL THERE.
SO, I AM GOING TO PULL UP THE UPPER GLUTEUS HERE.
AND THEN WHEN YOU LOOK AT THE ANUS YOU WANT TO MAKE SURE
THAT THERE AREN'T HEMORRHOIDS OR SORES BECAUSE, OH, HOW PAINFUL.
IF YOU'VE NEVER SEEN A HEMORRHOID BEFORE
AND DON'T KNOW WHAT ONE LOOKS LIKE,
COMING OUT OF THE ANUS ARE LIKE THESE LITTLE RED PEAS,
OR LITTLE RED GRAPE SIZE.
IT CAN BE EVEN LARGER THAN THAT,
BUT THEY'RE LITTLE FLAPS LIKE SKIN TAGS, LIKE,
COMING OUT AND SO IT DOESN'T MAKE THIS NICE SPHINCTER LOOK HERE.
THEY'RE VERY ITCHY. THEY'RE VERY PAINFUL.
AND SO YOU WANT TO BE CAREFUL NOT TO POKE ON THEM.
SO, MOVE THOSE OUT OF THE WAY AND STICK YOUR FINGER IN HERE.
AND USUALLY THAT'S NOT PARTICULARLY PAINFUL, ONE FINGER
UNLESS THEY HAVE SOME PROBLEM GOING DOWN THERE,
BUT YOU JUST FEEL AROUND AND THEN ASK THEM TO BEAR DOWN.
SO YOU CAN SEE IS THEIR SQUEEZE THERE.
ARE THEY GOING TO BE ABLE TO HOLD THIS ENEMA IN.
IF THEY DON'T...
THAT'S HOW I AM DOING MY ENEMA.
BECAUSE YOU NEED IT THIS WAY, NOT UPSIDE DOWN, TO CHECK.
ALRIGHT, SO THEN ONCE I DO THAT
THEN I CAN REMOVE MY GLOVE AND HAVE TWO CLEAN HANDS HERE.
YOU DO HAVE TO HAVE AN ORDER TO DIGITALLY DISIMPACT SOMEONE.
YOU CAN'T JUST DO IT.
BECAUSE IT'S INVASIVE EVEN THOUGH THEY MAY NEED THE RELIEF.
- ALRIGHT. - DO YOU NEED AN ORDER FOR AN ENEMA?
- OH, YES.
YOU'RE GOING TO OPEN UP THE RECTUM HERE
AND I'M GOING TO PUT THIS IN ABOUT FOUR INCHES
AND THEN I'M GOING TO HOLD IT.
ALRIGHT.
AT THIS POINT YOU'RE JUST GOING TO TALK THROUGH.
I DON'T WANT YOU TO PUT THE WATER IN BECAUSE LIKE I SAID
WE HAVE RESERVOIRS IN THEM RIGHT NOW, BUT THEY WON'T THAT MUCH.
YOU'RE GOING TO OPEN THIS UP
AND YOU'RE GOING TO PUT THE FLUID IN. YOU'RE GOING TO WATCH IT GO IN.
MY BACKS KIND OF TO YOU. BUT YOU WATCH IT GO IN
AND YOU WANT IT TO GO IN OVER ABOUT FIVE MINUTES OR SO,
ABOUT FIVE TO SEVEN, KIND OF, A THING, SLOW.
ALL THE WHILE ASKING THEM, "HOW ARE YOU DOING? ARE YOU HAVING ANY CRAMPS?"
IF THEY'RE HAVING CRAMPS,
SLOW IT DOWN AND IF THE CRAMPS AREN'T RESOLVED, THEN STOP
AND SEE IF THEY CAN GET THEIR COMPOSURE OR RELAX.
AND SO THE CRAMPS WILL STOP.
AND THEN IF THE CRAMPS STOP,
YOU WANT TO TRY AND PUT IT IN A LITTLE MORE, PUT IN A LITTLE MORE.
ALRIGHT, IT'S AT THIS POINT --
MY HAND IS STILL ON THERE.
HOLDING, HOLDING, HOLDING,
THAT WE WILL COME UP TO YOU AND YOU WILL DRAW YOUR FATE.
OKAY, SO LET'S JUST TALK ABOUT SOMETHING THAT HAPPEN.
OH, THIS IS A GOOD ONE.
CLIENT EXPELS SOLUTION PREMATURELY.
YOU'RE PUTTING THE ENEMA IN,
BUT THE ENEMA STARTS COMING OUT. WHAT DO YOU DO?
GOGGLES.
- GOGGLES. - YOU GET THEM ON THAT BED PAN QUICKLY.
LEAVE THE TUBE IN, RIGHT.
BECAUSE IF THEY'RE NOT GOING TO RETAIN IT,
YOU CAN HAVE THE TUBE IN..
OOPS CAN YOU LIFT UP A LITTLE MR. CURRY.
YOU'RE ON YOUR TUBE. THERE YOU GO.
YOU CAN HAVE THE TUBE IN
AND THEN YOU JUST KEEP THE ENEMA GOING.
AND AT LEAST THEY'LL GET A RINSE AND SOME STIMULATION.
AND THEN YOU CAN FINISH UP THE ENEMA IF YOUR BED PAN WILL HOLD IT.
IT WILL PROBABLY BE BETTER TO HAVE THE BIGGER BED PAN
FOR THIS LITTLE MANEUVER.
BUT THAT'S WHAT YOU WOULD WANT TO DO IF THEY'RE EXPELLING.
AND THEN, JUST FINISH YOUR ENEMA,
ROLL THEM BACK OVER AND CLEAN THEM UP.
THEY'RE DONE.
THANKFULLY THIS ISN'T A DRILL IN MANNEQUIN MANAGEMENT.
UP.
ALRIGHT, SO CALM THEM AND EASE THEIR DISTRESS.
OKAY, IN SEQUENCE WISE AS FAR AS THEIR RESPONSE
CLAM THEM SECOND, GET THEM ON THE PAN FIRST.
AND THEN SAY, "IT'S OKAY, THAT HAPPENS TO A LOT OF PEOPLE."
BUT I AM NOT GOING TO CALM AND REASSURE
WHILE THEY'RE SQUIRTING OUT ALL OVER, RIGHT.
I AM TAKING CARE OF THE CLIENT AND CONTAINING.
AND THEN JUST HOLD IT IN PLACE AND CONTINUE THE ENEMA.
ALRIGHT, WE TALKED ABOUT CRAMPING, THAT YOU WOULD DO THAT.
LET'S TALK ABOUT -- YOU'RE PUTTING THE ENEMA IN
AND THE FLOW STOPS. IT WON'T GO IN. WHAT'S THE PROBLEM?
- IT'S STOOL. - IT'S STOOL.
YOU STUCK THE TUBE IN STOOL AND IT JUST ISN'T GOING ANYWHERE.
- SO WHAT DO YOU DO? - MOVE THE TUBE.
YOU CAN MOVE IT A LITTLE BIT BUT BE EVER SO CAREFUL..
I'VE DONE THIS. IT FEELS GREAT.
OH, MY GOSH. YOU KNOW, VISIONS OF DISASTERS.
PULL IT A LITTLE BIT AND SEE IF YOU CAN GET SOME MOVEMENT,
BUT IF YOU PULL IT TOO MUCH SEE THESE LITTLE HOLES ARE DOWN TO HERE
AND SO YOU'LL PULL IT AND IT WILL RELEASE A PHOOOSHK.
IT WILL START SQUIRTING STOOL AND WATER
COS YOU GOT THIS THING OPEN AND BLASTING, RIGHT?
BECAUSE THAT'S HOW IT SHOOTS OUT. SO, JUST BE EVER SO CAREFUL.
YOU MAY NOT BE ABLE TO GET IT TO GO IN.
SO YOU CAN JUST PULL IT OUT AND YOU MAY TRY TO DIGITALLY DIS-IMPACT THEM.
AND IF IT'S HARD AND HIGH AND YOU CAN'T GET IT,
WE'RE BACK TO THE OIL RETENTION SCENARIO.
BUT YOU HAVE TO CALL AND GET AN ORDER FOR THAT.
MY FAVORITE ORDER THAT DOCTORS WRITE AND IF YOU'RE CALLING
IS THAT THEY'LL WRITE ENEMA OF CHOICE. EOC SOMETIMES.
BECAUSE THAT GIVES YOU THE FREEDOM TO JUST..
OIL RETENTION, YOU KNOW, SALINE, SOAP SUDS,
DO WHATEVER YOU GOT TO DO TO GET THE JOB DONE.
WHAT IS IT'S HARD AND YOU STICK YOUR FINGERS UP THERE
AND YOU TRY TO GET IT, WOULD YOU HAVE TO CHECK WITH THE DOCTOR FIRST
BEFORE YOU DID THAT?
USUALLY YOU CAN DO THAT IN THE MIDST OF..
IF THE ENEMA HAS BEEN ORDERED IT'S, KIND OF, PART OF PROCEDURE.
YOU JUST WANT TO MAKE SURE THAT THERE'S NO CONTRAINDICATION
FOR YOUR CLIENT, BUT YEAH.
THEN I'D TELL THEM LATER, I NEED ORDERS TO DIGITALLY DIS-IMPACT,
BUT YEAH, ONCE YOU'RE INTO THE FLOW OF THINGS.
OKAY, HERE'S A GOOD ONE.
YOU GIVE THEM THE ENEMA
AND YOU PUT ALL 1000 CC IN AND YOU TAKE IT OUT
AND THE CLIENT'S THERE AND THE ENEMA DOESN'T COME OUT.
MASSAGE THEIR ABDOMEN.
REPOSITION THEM.
TURN THEM ON THE OTHER SIDE AND MOVE THEM AROUND.
MASSAGE THE ABDOMEN A LITTLE.
WHAT IF IT STILL DOESN'T COME OUT?
MAKE THEM DO SIT UPS?
SIT UPS?
THAT WAS GOOD.
THERE IS NOTHING YOU CAN DO. IT'S JUST IN THERE.
I MEAN THEY MAY HAVE ABSORBED IT,
IT DEPENDS ON WHAT KIND OF ENEMA YOU GAVE THEM, RIGHT?
AND SO IF YOU GAVE THEM A TAP WATER AND THEY ABSORBED IT,
MAYBE THEY'RE A LITTLE DEHYDRATED AND THEY JUST TOOK IT ALL IN,
AND SO YOU WANT TO KEEP TRACK OF THAT IN YOUR I&O.
BUT THERE'S JUST NOT A WHOLE LOT YOU CAN DO OTHER THAN TURN THEM,
MASSAGE THEIR ABDOMEN A LITTLE AND THEN WATCH.
SO, IF THEY'RE ABSORBING UP ON TAP WATER ENEMA,
I PROBABLY WOULD CHANGE MY SOLUTIONS
SO THAT I'D HAVE BETTER LUCK.
OKAY, ALSO THIS ONE SAYS REPLACE THE TUBE
AND LOWER THE ENEMA BAG BELOW THE LEVEL OF THE BED,
KIND OF HAVE TO DO THE HARRIS FLUSH THING.
BUT IF IT'S STUCK UP THERE. IT'S STUCK.
TRY TO RELIEVE AN IMPACTION, BUT IT'S NOT RELIEVED.
YOU GAVE THEM AN ENEMA AND IT DIDN'T WORK, THEN WHAT?
- SHOOT ANOTHER ENEMA. - TALK TO THE DOCTOR.
OIL ANOTHER ONE.
TALK TO THE DOCTOR.
IF IT'S ENEMA OF CHOICE, TRY ANOTHER ENEMA, YOU MIGHT TRY AN OIL RETENTION,
CHECK THEM DIGITALLY, SEE IF THINGS ARE BLOCKED UP
AND TRY ANOTHER ONE LATER.
ENEMA RETURNS ARE NOT CLEAR PRIOR TO SURGERY.
OKAY, THIS WAS A.. BOY, I'VE GIVEN LIKE 1,000 ENEMAS, I THINK, IN MY LIFE.
I WORKED THE DAY SHIFT ON A SURGERY FLOOR AND WE GAVE ENEMAS.
SO ENEMAS, DON'T COME BACK CLEAR. WHAT DO YOU DO?
- TILL YOU CAN DO IT. - YOU JUST KEEP DOING IT AGAIN,
BUT MAKE SURE YOU GOT THE RIGHT SOLUTION.
MAKE SURE YOU'VE SWITCHED TO A NORMAL SALINE SOLUTION
SO YOU DON'T HAVE THE SIDE-EFFECTS.
AND THEN ALSO BE WATCHING YOUR VITAL SIGNS
SO THAT YOU'RE NOT CAUSING THE BRADYCARDIA.
AND YOU MAY NEED TO GET SOMETHING ORALLY.
BUT YOU MAY NEED A STRONGER SOLUTION AS WELL.
SO MAYBE SOAP SUDS OR SOMETHING LIKE THAT.
OKAY, AND LAST, BUT NOT LEAST, CLIENT COMPLAINS OF SEVERE, SEVERE PAIN.
NOT JUST SOME CRAMPING, SEVERE DOUBLED-OVER,
SCREAMING OUT, SEVERE PAIN. WHAT'S HAPPENED?
POSSIBLY PERFORATED THE VALVE, WE'VE GONE THROUGH.
THIS IS VERY BAD.
SO, WHAT DO WE DO?
CALL THE DOCTOR, STAT.
STOP THE ENEMA, OBVIOUSLY. BE DONE WITH IT.
WE NEED TO MAKE SURE THAT THERE IS AN IV LINE AVAILABLE
BECAUSE THEY'RE GOING TO HAVE TO GO TO SURGERY
AND TO GIVE APPROPRIATE MEDICATIONS AND BE CHECKING THEIR VITAL SIGNS.
- HAS THAT EVER HAPPENED TO YOU? - NO.
I WOULD HAVE A REALLY GOOD STORY FOR YOU, BUT NO.
AND HOPEFULLY IT WILL NEVER HAPPEN TO YOU.
BE CAREFUL, ONLY GO IN FOUR INCHES
AND THAT'S REALLY IMPORTANT WHEN YOU'RE PUTTING IT IN
BECAUSE WE'VE GOT PLENTY OF ANUS OPENING THERE,
BUT IF SOMEONE'S GONE UP TO HIGH, USUALLY YOU'RE IN TO ROUGH.
ALRIGHT, WELL BACK TO OUR ENEMA.
WE'VE HELD ON. ALL HAS GONE WELL.
WE PUT THE WATER IN. WE CLAMPED IT OFF.
WE TAKE THIS OUT. AND WE ASK THE CLIENT
AND IT DOES DRIP AND DRIBBLE ALL OVER THE PLACE.
WE ASK THE CLIENT IF THEY CAN HOLD IT FOR A FEW MINUTES
OR DO THEY WANT TO GET UP RIGHT NOW, AND GO TO THE BATHROOM?
WHATEVER THEY NEED TO DO, DO IT.
WIPE THEM OFF. IF THEY CAN STAY ON THEIR LEFT SIDE, BETTER.
YOU CAN, KIND OF, JUST TALK THROUGH THE REST OF THIS.
COVER THEM UP, YOU CAN PUT THE BED DOWN AND THE SIDE RAILS UP.
AND...JUST LEAVE THEM TO BE OR GET THEM TO THE BATHROOM.
WHEN YOU COME BACK, ONCE THEIR READY, YOU CAN GET THEM ON THE BEDPAN.
THEY CAN DO THEIR BUSINESS. THEN CLEAN THEM UP.
TAKE CARE OF THE CLIENT FIRST. ALWAYS.
CLEAR OUT YOUR CHUX.
AFTER THEY'RE ALL DONE.
OVER. YOU'RE GOING TO BE NOTING OBVIOUSLY.
I'M LEAVING THEM ON THE CHUX, JUST BECAUSE THEY'RE GOING TO BE LEAKING.
AND YOU WONDER HOW DIRTY THOSE ARE.
NOTE THE COLOR, QUANTITY, AND THE QUALITY OF THE STOOL.
WE DON'T USUALLY DO I&O OF STOOL AND MEASURE THE WATER AND LIQUID.
ONLY IF THEY'RE ON STRICT I&O.
GET VITALS AGAIN IF YOU NEED TO.
GET YOUR CLIENT TAKEN CARE OF
AND THEN YOU CAN TAKE THIS STUFF TO THE REST-ROOM,
EMPTY IT, THROW AWAY YOUR THRASH, CLEAN UP YOU EQUIPMENT.
AND THEN YOU'RE GOING TO DOCUMENT ON I&O,
THE RESULTS OF YOUR ENEMA AND HOW MANY AND ALL THAT.
ALRIGHT, ANY QUESTIONS ON THAT ONE.
OKAY, SO THAT'S YOUR CRITICAL THINKING EXERCISE.
THEN YOU'RE GOING TO REGROUP A LITTLE BIT.
AND YOU'RE GOING TO DO ANOTHER ENEMA.
AND IT'S PRETTY MUCH THE SAME AS FAR AS...
THIS THING CAN GO UP HERE.
BUT WE'RE GOING TO USE A DIFFERENT PIECE OF EQUIPMENT
AND A LITTLE DIFFERENT VOLUME OF LIQUID.
- LBM STANDS FOR LAST BOWEL MOVEMENT, RIGHT? - UH-HUH, YES.
I'M DOING EVERYTHING ELSE FOR THE NEXT PERSON.
OKAY, THIS TIME...
BASICALLY SAME SET UP,
BUT WE'RE GOING TO DO AN ENEMA BUCKET.
WE'RE GOING TO DO A HARRIS FLUSH. WHAT'S HARRIS FLUSH FOR?
- FLATULENCE. - FLATULENCE, WHICH IS?
- GAS. - GAS.
SO, AS FAR AS YOUR LIST OF KINDS OF ENEMAS WHAT IS IT?
- CLEANISING? - NO.
IT'S NOT A CLEANSING
- RETENTION? - IT'S NOT A RETENTION BECAUSE THEY'RE NOT GOING TO HOLD IT IN.
- EXPELMENT. EXPELS. - DISTENTION.
DISTENTION REGIME.
OKAY, WE'RE GETTING RID OF DISTENTION, GAS FILLS UP.
IT'S LIKE THAT FUNNY COMMERCIAL. THOSE THREE LADIES AT MOVIE.
YOU KNOW IT'S KIND OF THAT SAME THING.
WE'RE TRYING TO GET RID OF GAS, OUR WAY.
ALRIGHT, SO WE'VE CHECKED OUR DOCTOR'S ORDERS.
WE KNOW THERE IS NO CONTRAINDICATIONS FOR THIS.
WE'VE CHECKED CARE PLAN AND SO FORTH.
WE'RE GOING TO ALSO THEN LOOK TO SEE
IF THERE'S ANY REASON OR WHAT'S GOING ON WITH OUR CLIENT.
ONE OF THE THINGS I LIKE TO KNOW IS ARE THEY PASSING ANY GAS?
WHEN WAS THEIR LAST BOWEL MOVEMENT?
HOW ARE THEY EATING? WHAT'S THEIR ACTIVITY LEVEL?
PEOPLE THAT HAVE A LOT OF GAS, ARE THEY GETTING UP AND WALKING?
COS ONE OF THE BEST THINGS FOR GETTING RID OF GAS IS JUST MOVING.
GET THEM MOVING. GET THEM WALKING AND THAT HELPS PERISTALSIS.
SO IS YOUR CLIENT ABLE TO GET UP AND AROUND?
AGAIN YOU'RE LOOKING AT DIETARY HISTORY, THEIR MEDICATION HISTORY,
VITAL SIGNS, WHEN IS THE LAST TIME THEY EMPTIED THEIR BLADDER
AND THAT KIND OF THING PRIOR TO DOING THIS.
SO GET ALL THAT STUFF DONE, MAKE SURE THAT THEY ARE A GOOD CANDIDATE,
NO RECTAL SURGERY AND NO HEART CLIENTS HERE.
ALRIGHT, I'VE GATHERING MY EQUIPMENT, WHICH IS MY BUCKET, MY WATER.
THIS TIME I AM ONLY GOING TO USE ABOUT 300 CC OF WATER.
INTERESTINGLY ON YOUR PAPERS AND IN YOUR BOOK IT SAYS
TO FILL THE BUCKET WITH 100 TO 200 OF WATER.
AND BEING, THE READ THE RULES
AND MEMORIZE THEM KIND OF A GIRL THAT I WAS GOING TO SCHOOL.
AND THAT'S WHEN I DID MY FIRST TWO OR THREE LITTLE HARRIS FLUSHS.
AND I PUT THE 100 IN AND WENT TO MY CLIENT
AND THEN I PUT THE BUCKET IN AND I PUT THE 100 IN
AND THEN YOU'RE SUPPOSED TO LOWER IT AND THEN 100 IS SUPPOSED TO COME BACK OUT.
NOTHING CAME BACK OUT. AND THEN I WAS OUT OF JUICE.
I'M NOT GOING TO GO BACK AND FORTH WITH IT.
YOU KNOW, SO I GO, "OH THIS IS NO GOOD."
SO I STARTED PUTTING ABOUT 300 IN MY BUCKET,
SO THAT I COULD PUT IN LIKE ABOUT 100
AND THEN IF IT CAME BACK, WELL GOOD FOR ME, I HAD SOME FLUID,
BUT IF DIDN'T I STILL HAD SOMETHING TO WORK WITH IN THE UP AND DOWN OF IT.
SO THAT I COULD GET SOMETHING IN BECAUSE USUALLY,
EVENTUALLY IT DOES EQUALIZE AND YOU GET SOME FLUID BACK.
SO THAT'S WHAT YOU'RE TRYING TO ACCOMPLISH HERE.
SO AGAIN YOU WANT IT TO BE 105 TO 110 DEGREES
OF TEMPERATURE AS FAR AS THAT GOES.
AND YOU WANT A BED PAN NEARBY, CHUX.
AND YOU GOT TO CHECK 1000.
ALRIGHT, WASHED MY HANDS
AND I AM GOING TO GO AND IDENTIFY MY CLIENT.
GOOD MORNING, CAN YOU TELL ME YOUR NAME?
MR. CURRY. ALRIGHT, MR. CURRY..
PROVIDE PRIVACY.
I HEAR -- WE TALKED EARLIER THIS MORNING THAT YOU'RE NOT PASSING SOME GAS.
SO I DID GET AN ORDER FROM THE DOCTOR TO DO WHAT'S CALLED A HARRIS FLUSH.
AND WHAT THAT IS IS A KIND OF A SIPHONING ENEMA.
I'M GOING TO PUT A LITTLE WATER INTO YOUR BOWEL
AND LOWER THIS BUCKET AND LET THE WATER DRAIN OUT.
AND SOMETIMES JUST HAVING THAT WATER GO IN AND OUT
KIND OF STARTS THINGS MOVING DOWN THERE AND PULLS OUT SOME OF THE GAS.
SO HOPEFULLY YOU'LL GET SOME RELIEF FROM THAT.
AND THEN ONCE WE DO THAT IF YOU CAN GET UP AND WALK IN THE HALLS
THAT WILL BE GREAT AND THAT WILL HOPEFULLY GET THINGS MOVING.
ALRIGHT, WELL, FIRST THING I WANT TO DO, THOUGH,
IS LOOK AT YOUR ABDOMEN AND LISTEN TO YOUR BOWEL SOUNDS AND...
SEE HOW THINGS LOOK NOW SO YOU CAN TELL US IF IT DID ANY GOOD.
SO GET VITAL SIGNS.
SORT OF HAND FOLD.
ALRIGHT.
ABDOMINAL ASSESSMENT, INSPECT FOR?
CONTOUR, COLOR, HAIR DISTRIBUTION, SYMMETRY.
THEN WE'RE GOING TO OSCULTATE, RIGHT LOWER QUADRANT, BECAUSE?
- ILEALCECAL VALVE. - ILEALCECAL VALVE.
MOST LIKELY TO HAVE BOWEL SOUNDS, EACH QUAD, ONE MINUTE.
AND THEN WE'RE GOING TO LIGHTLY PALPATE FOR?
- TENDERNESS. - TENDERNESS, PAIN, GAS,
SOMETIMES WHEN THEY'RE REALLY GASSY,
YOU CAN JUST, KIND OF, FEEL IT AND YOU CAN HEAR IT RUMBLING ALL OVER.
ALRIGHT, SO WE GOT AN IDEA THEY'RE A LITTLE DISTENDED, THERE'S GAS,
THE BOWEL SOUNDS ARE HYPERACTIVE, YOU CAN JUST HEAR THE GAS GOING.
THEY NEED A HARRIS FLUSH.
ALRIGHT, MR. CURRY COULD YOU JUST ROLL OVER ON TO YOUR LEFT SIDE PLEASE?
ALRIGHT, GET SOME GLOVES ON.
I SUPPOSE YOU CAN CHECK SPHINCTER
AND YOU COULD DO THE RECTAL EXAM, BUT WHY?
THIS IS ABOUT GAS. SO I AM NOT CONCERNED THAT THEY'RE HOLDING IT IN.
I'M NOT GOING TO PUT ENOUGH IN FOR IT TO REALLY MATTER.
SO I DON'T THINK THE OLD SPHINCTER CHECK IS THAT BIG OF A DEAL HERE.
BUT I DO WANT MY BED PAN NEARBY JUST BECAUSE
I'VE HAD MY SHARE OF SQUIRTING OUT.
ALRIGHT, THESE BUCKETS CAN BE A LOT OF FUN.
MAKE SURE THAT THIS TUBE IS REALLY CONNECTED INTO THAT BUCKET
BECAUSE SOMETIMES THESE DISCONNECT
AND THESE GO SHOOTING OUT AND THAT'S JUST EXCITING.
NONE OF THIS IS LIFE OR DEATH. IT'S JUST VERY MESSY. VERY, VERY MESSY.
- ALRIGHT? - DO YOU LIKE WEARING DOWN.
YOU CAN. I USUALLY DON'T.
MY MISTAKE, PROBABLY, GOGGLES I SHOULD, BUT.
I JUST NEVER THINK IT WILL BE THAT BAD TILL IT'S SQUIRTING AND GOING.
IT'S THE AFTER THOUGHT.
ALRIGHT, THERE ARE NUMBERS ON HERE SOMEWHERE.
IT DOESN'T HAVE TO BE PERFECT. I JUST WANT TO KNOW HOW MUCH I HAVE
SO I KNOW WHAT I GOT BACK. SO I PUT 400 IN MY BUCKET.
OH, AND THIS IS A GREAT BUCKET.
THEY USUALLY HAVE THESE LITTLE HANGERS HERE TO HOLD ON TO.
THESE HAVE BUSTED OFF. SO I'LL BE DOING IT WITHOUT THEM.
I DON'T USE A POLE FOR THIS EITHER BECAUSE YOU HAVE TO HOLD IT.
NOTICE YOU HAVE TO HAVE GRAVITY TO GET IT THROUGH.
I THINK ONE OF THE HARDEST THINGS IS JUST MANAGING THE LITTLE CLAMP FOR THIS.
ALRIGHT, AGAIN K-Y JELLY.
AND MR. CURRY, I AM GOING TO PUT THIS TUBE IN YOUR RECTUM.
PULL UP, EXPOSE, AGAIN CHECKING FOR HEMORRHOIDS OR SORES OR ANYTHING.
AND I AM GOING TO PUT IT IN ABOUT FOUR INCHES, AND HOLD IN PLACE.
ALRIGHT.
I AM GOING TO RELEASE THE CLAMP
AND I AM GOING TO PUT IT UP AND I'M GOING TO PUT IN ABOUT 100.
THEN I AM GOING TO DROP IT DOWN.
OH, WE GOT SOME.
THAT'S GOOD. THAT'S WHAT IT'S SUPPOSED TO DO.
AND THEN YOU COME AND YOU PUT IT BACK UP.
AND YOU DO THIS SIX TIMES OR SEVEN OR EIGHT OR WHATEVER.
BUT I ONLY WANT YOU TO DO IT TWICE, THAT'S GOOD ENOUGH.
PUT IN ABOUT 100 AND COME BACK DOWN AND TRY TO DRAIN IT ALL BACK OUT.
NOW I TOLD YOU THE FIRST TWO OR THREE TIMES
I DID ONE OF THESE IT FELT PATHETIC.
NOTHING CAME OUT. I MEAN, EVEN IF SOME WATER CAME OUT,
NO GAS CAME OUT AND THEY WERE JUST..
AND I THOUGHT WHAT A DUMB PROCEDURE,
BUT YOU KNOW THEY ORDER IT, SO YOU DO IT.
SO ABOUT THE FOURTH OR FIFTH ONE I DID. OH, IT WAS A GOOD ONE.
I PUT IT IN AND I PUT IT DOWN
THE GAS STARTS COMING AND THE GAS STARTS COMING.
I NEVER THOUGHT ABOUT THAT PART.
OH, MAN, IT WAS SO POTENT. IT WAS LIKE, "FEELING BETTER?"
YOU KNOW BECAUSE IT WAS WORKING GOOD.
NOW, ANOTHER THING THAT HAPPENS WHEN THEY WORK GOOD IS YOU PUT IT..
WELL STUFF COMES OUT, STOOL COMES OUT
AND THIS CAN GET KIND OF MURKY AND THAT CAN KIND OF GROSS YOU OUT.
BUT IT'S THEIR STOOL AND SO YOU KEEP GOING BACK AND FORTH ANYWAYS
UNLESS IT GETS TOO MURKY TO PASS.
SO I NEVER REALLY HAD TOO MUCH PROBLEM.
I HAD IT GET FAIRLY MURKY, BUT...IT WOULD STOP.
SO YOUR LAST PASS IS DOWN,
GET BACK AS MUCH AS YOU CAN AND PLEASE GET AS MUCH AS YOU CAN OF THE WATER
BECAUSE THE MANNEQUINS GET PRETTY FULL.
SO THIS IS KIND OF OUR SIPHONING BACK PROCESS.
AND THEN ONCE IT'S DONE YOU WANT TO CLAMP OFF HERE
BECAUSE LOOK WHAT HAPPENS EVEN AS I COME UP.
THE WATER STARTS GOING BACK.
SO YOU NEED IT TO BE IN THE LOW POSITION TO CLAMP
BECAUSE YOU DON'T WANT TO LEAVE THEM WITH WATER IN.
THAT'S NOT THE IDEA. IT'S THAT YOU DRAINED EVERYTHING OFF.
ALRIGHT, SO CLAMP IT.
AND THEN AGAIN MY GOAL..
I DON'T KNOW. DID ANY OF YOU PAY ATTENTION TO HOW HIGH I WAS RAISING IT?
YOU'RE STILL NOT SUPPOSED TO GO MORE THAN 12 TO 18 INCHES.
HOW HIGH DID I GO?
HOW HIGH IS THAT?
- 3 FEET. - IT'S ABOUT 18. TWO FEET AT THE MOST PROBABLY.
DID YOU HEAR THAT? WHOOSH.
OUT, VERY GASSY, MY MANNEQUINS ARE GASSY.
ALRIGHT, CLEAN THEM UP.
HAVE YOUR CLIENT LAY ON THEIR SIDE
AND THEN IF THEY NEED TO GO TO THE BATHROOM IN A LITTLE BIT,
THEY CAN GO TO THE BATHROOM. BUT THEN YOU WANT TO ENCOURAGE
THEM TO GET UP AND AMBULATE.
YOU WANT TO BE NOTING THE RESULTS OF YOUR HARRIS FLUSH.
IF YOU GOT GOOD RESULTS. IT'S KIND OF SUBJECTIVE I MEAN.
IF YOU SEE A LOT OF GAS, IT FEELS LIKE IT WAS GOOD.
SO BASICALLY YOU JUST HAVE TO ASK THEM.
CLEAN THEM UP. DO PERI CARE...
COS THEY GOT GOOD RESULTS AND IF THEY'RE PASSING GAS.
AND THEN YOU CAN COME BACK AND CHECK THEIR ABDOMEN AGAIN FOR DISTENTION.
IF NECESSARY YOU CAN CHECK VITAL SIGNS AFTERWARDS.
CLEAN UP YOUR EQUIPMENT.
PUT THE BED DOWN.
AND DOCUMENT.
DID I DO EVERYTHING?
ALRIGHT, SO THAT'S WHAT YOU DO.
WE'LL TALK YOU THROUGH THOSE TWO OR THREE SPECIMEN COLLECTIONS,
PASS-FAIL, REAL QUICK. AND IF IT'S X-OUT, I DON'T WANT TO HEAR ABOUT IT.
I JUST WANT YOU TO TELL ME WHAT'S NOT.
IN OTHER WORDS I AM GOING TO SAY SALINE ENEMA,
HOW MUCH SOLUTION DO YOU PUT IN AND HOW LONG DO YOU HOLD IT?
OIL RETENTION, HOW LONG DO YOU HOLD IT?
QUICKLY TELL ME HOW YOU'RE GOING TO GET --
OR HOW MUCH DO YOU NEED FOR A STOOL SPECIMEN?
AND ON THE OTHER ONE TELL ME HOW YOU WOULD GET A STOOL FOR GUAIAC.
SO AND ON PASS-FAILS ALL YOU HAVE TO SAY IS HIGH FIVE AND THEN MOVE ON.
ONLY WHEN YOU'RE GETTING TESTED FOR A GRADE DO YOU HAVE TO ITEMIZE EVERY SINGLE ONE,
FOR A TEST GRADE.
ALRIGHT, AND THEN YOU'LL DO A HARRIS FLUSH AND THEN YOU'LL DO AN ENEMA
FROM START TO FINISH.
HIGH FIVE, WASH YOUR HANDS, DOCUMENT, PUT THE BED DOWN,
AND THEN START ALL OVER.
WE DO THAT SO YOU CAN START GETTING A ROUTINE FOR YOURSELF.
- ALRIGHT. - ON THE PASS-FAIL YOU DON'T WANT US TO DO HIGH FIVE?
JUST SAY HIGH FIVE, JUST SAY IT.
YOU DON'T HAVE TO ITEMIZE IT ALL OUT.
I'VE CHECKED MY DOCTOR'S ORDERS, I MEAN, I KNOW.
WE DO THAT FOR HERE. GETTING YOUR THOUGHTS AND YOUR EQUIPMENT SET UP.
ALRIGHT, ANY QUESTIONS?
- NO. - ALRIGHT.