OKAY. WELCOME BACK.
WE ARE ROLLING NOW.
LAST WEEK WAS OUR "GET IT TOGETHER".
THIS IS IT, WE ARE...
HOW DID YOU PROGRAM THIS AND THE OTHER INTO THIS SCREENING.
DID YOU DO THAT ON PURPOSE?
- I ALREADY PUT MY CAMERA ON. YOU DIDN'T KNOW?
- WE DIDN'T EVEN KNOW HOW WE DID IT.
- I WONDER HOW WE DID THAT.
- THAT IS INTERESTING.
- THAT'S A DIFFERENT CAMERA. IT'S THAT LITTLE ONE OVER THERE.
- OH, IT'S A PROJECTOR.
THAT IS HYSTERICAL. I DIDN'T KNOW.
[ALL TALKING AT ONCE]
WOW. THAT'S WILD.
IS HE OVERHEAD? - IS HE OVERHEAD?
- UH-HUH. COS IT'S A DOCUMENT CAMERA.
BUT INSTEAD OF LOOKING DOWN, IT'S FACING US.
I THOUGHT IT WAS YOU.
- AND WE ARE ALL BACKWARD. - YES.
ALRIGHT. WE ARE STARTING A NEW MODULE. WE ARE GIVING SHOTS.
BUT BEFORE WE START A NEW MODULE I ALWAYS LIKE TO,
KIND OF, BRIEF ON THE MODULE WE JUST PASSED
JUST TO HIGHLIGHT SOME OBSERVATIONS AND SO FORTH,
SO YOU'LL BE ALL READY TO GO. YOU GUYS DID A GREAT JOB.
IN FACT, THIS COURSE ON STERILE GLOVING WORKED JUST INCREDIBLE.
YOU GUYS DID REALLY WONDERFUL ON THAT.
SO DON'T GET COCKY AND THINK YOU ARE PERFECT
BECAUSE THE THING ABOUT STERILE TECHNIQUE IS THERE ARE SO MANY WAYS TO CONTAMINATE YOURSELF.
SO JUST BE ANTICIPATING
AND REMEMBER HANDS UP AND OUT AND LOOK AT A BIGGER PICTURE
THAN FOCUSING ON JUST THE EXACT THING YOU ARE DOING AT THE TIME.
AND YOU CAN START LOOKING AT A BRIGHT, BROADER SCOPE, A BROADER AREA.
YOU WILL PICK UP THE FEEL BETTER AND NOTICE CONTAMINATIONS
MORE THAN JUST GETTING REAL FOCUSED ON THE THUMB
AND, YOU KNOW, NOT NOTICE YOUR LITTLE FINGERS, SOMETHING LIKE THAT.
DID YOU CATCH THE DISCREPANCY IN THE READING FROM MY CHECKLIST?
- ABOUT THIS HAND WASHING ONE?
- NO. AND I'M STILL GLOVING PRETTY MUCH THE SAME.
- THE HAND WASHING ONE? - NO.
YEP.
OKAY, GARRETT, YOU CAN'T GIVE THEM CLUES LIKE...
- BUT HE WAS WITH ME.
- OKAY. THE DRESSING ON THE CENTRAL LINE.
IN THE BOOK AND ACTUALLY IN MY ARTICLE, AND I TOTALLY FORGOT ABOUT IT.
I MEAN, I JUST FORGOT ABOUT IT.
I AM THE ONE THAT PUT THE ARTICLE IN THERE.
WELL, THE NEW STANDARD FOR CENTRAL LINE DRESSING CARE
IS THAT GAUZE DRESSINGS ARE 24 TO 48 HOURS.
SO BE SURE AND FOLLOW WHAT YOUR HOSPITAL PROTOCOL IS.
MOST OF THE TIME YOU ARE GOING TO FIND 24 BECAUSE OF THE GAUZE.
BUT THE INTERESTING CHANGE HAS BEEN IN THE TRANSPARENT DRESSING
FOR CENTRAL LINES AND IT'S SEVEN DAYS AS OPPOSED TO EVERY THREE.
BUT AGAIN FOLLOW THE HOSPITAL POLICY. IT'S SEVEN DAYS AND PRN.
SO IF IT'S ALL WRINKLY AND WARTY AND LOOKING BAD,
THEN YOU'RE GOING TO GO AHEAD AND CHANGE IT.
MOST OF OURS ARE WRINKLY, WARTY AND LOOK BAD AND WHY WAS THAT?
- BECAUSE MANNEQUINS DON'T DRY.
- THEY WEREN'T DRY. THEY WERE WET.
SO YOU GOT TO MAKE SURE YOUR CLIENTS ARE REALLY DRY
AND WHEN THEY ARE, THEN THAT TRANSPARENT DRESSING WILL STICK
TOTALLY TO THE SKIN AND TO THAT LINE.
AND YOU SHOULD HAVE GOOD ADHERENCE AND IT SHOULD LAST
AT LEAST FIVE DAYS, FIVE TO SEVEN THEY ARE OKAY.
BUT IF IT'S PEELING IN ANY WAY, GET RID OF IT.
SO, YOU GUYS HAVE NEW TEXTS AND I AM IN THE PROCESS OF READING ALONG WITH YOU
AS WE ARE DOING THIS SECTION BECAUSE OF A NEW ADDITION OF A TEXT BOOK.
SO HOPEFULLY THE ARTICLES I'VE KEPT UP TO DATE
AS FAR AS KEEPING THE CHECKLIST UP TO DATE.
BUT EVERY NOW AND THEN WE'RE GOING TO FIND A DISCREPANCY,
SO DON'T HESITATE TO LET ME KNOW.
"OH, I DIDN'T READ IT IN THE BOOK. THIS IS DIFFERENT."
AND HOPEFULLY, WE'LL, KIND OF, ALL CATCH UP.
I READ EVERYTHING LAST NIGHT OF THE IM MED STUFF AND WE ARE LOOKING PRETTY GOOD.
THEY JUST GAVE A FEW CRITERIA THAT I WILL HIGHLIGHT TODAY WHEN WE DO OUR SHOTS.
ALRIGHT. MOVING ON.
THIS IS A TWO-WEEK MODULE SO ONE BLACKBOARD.
WE HAVE FIVE SHOTS WE ARE GOING TO GIVE.
WE'RE GOING TO DO TWO THIS WEEK AND THE IM,
WE ARE GOING TO DO 'EM TO MANNEQUINS AND FOCUS ON THE GLUTEAL MUSCLE.
SO BUTT THIS WEEK.
AND THEN NEXT WEEK WE'RE GOING TO DO DELTOID, INTRADERMAL AND WORK OUT OF AMPOULES.
I THINK THERE'S -- OH, VASTUS LATERALIS.
SO THREE SHOTS THE FOLLOWING WEEK. THERE'S NO BLACKBOARD,
BUT YOU'RE GOING TO WANT TO READ UP ON ALL THOSE SITE LOCATIONS
AND THE DIFFERENT TECHNIQUES.
OUR MAIN OBJECTIVE IS WE WANT TO USE EVERY KIND OF SYRINGE
THAT'S OUT IN THE FIELD, EVERY KIND OF NEEDLELESS DEVICE,
SO THAT YOU KNOW HOW TO USE THE NEEDLELESS DEVICES WHEN YOU ARE FACED WITH THEM
AND ANTICIPATE A LITTLE BIT BETTER.
EVERY SINGLE MUSCLE, EVERY SINGLE SITE AND EVERY KIND OF NET.
SO WE'RE GOING TO REALLY BE WORKING IT AS FAR AS THAT GOES.
BUT, AGAIN, IT'S JUST, THE SHARP PART IS REALLY THE EASY PART.
DART IN WHICH YOU'VE DONE WITH YOUR SUBCUTANEOUS INJECTIONS.
SO THERE WON'T BE A LOT OF CHANGE FROM THAT, THAT WE'RE DOING INTRAMUSCULAR NOW.
SO, TO GET STARTED, WE WANT TO FOCUS ON INJECTIONS.
THE FIRST SHOT WE'RE GOING TO DO IS THE DEMEROL INJECTION.
WHEN YOU ARE LOOKING AT YOUR CHECKLIST.
I THINK IT'S THE FIRST ONE THAT SAYS USING Z-TRACK METHOD.
WE ARE GOING TO DO A DEMEROL INJECTION, Z-TRACK METHOD.
AND -- LET ME SEE WHICH MUSCLE.
IN THE DORSAL GLUTEAL.
ALRIGHT. I WANTED TO READ ONE MORE THING TO YOU BEFORE WE GET GOING AS WELL.
LAST YEAR A STUDENT GAVE ME THIS AT THE END OF THE SEMESTER AND I THINK IT'S SO GOOD.
ONE OF THE THINGS ABOUT THE LAB IS THAT YOU WANT IT TO BE PERFECT,
BUT IT'S NOT ALWAYS GOING TO BE PERFECT.
BUT THAT WOULD BE OUR GOAL AND IT'S PRETTY --
WHAT'S THE WORD I WANT. THE SIMULATIONS ARE SO SCRIPTED.
I MEAN, WE'RE GOING TO -- WE'RE DOING THINGS BY MEMORY. BUT THINGS AREN'T PERFECT.
AND THAT'S THE WHOLE IDEA IS THAT WE LEARN HOW TO ANTICIPATE, BE FLEXIBLE,
AND TO ADJUST BECAUSE IN A CLIENT SETTING, WE HAVE TO MAKE ADJUSTMENTS.
SO WE'RE GOING TO HAVE TO ANTICIPATE THAT.
AND SHE GAVE ME THIS ARTICLE ON MISTAKES "THE VALUE OF MISTAKES."
A MASTER CARPENTER IS LOOKING TO TAKE ON A YOUNG APPRENTICE
TO HELP HIM WITH THE WORK IN HIS SHOP.
ONE ABLE YOUNG MAN ENQUIRES ABOUT THE POSITION.
THE MASTER CARPENTER ASKS THE YOUNG STUDENT,
"TELL ME, WHAT MISTAKES YOU'VE MADE."
"I NEVER MADE A SINGLE ERROR.",
THE CONFIDENT, YOUNG STUDENT REPLIES, CERTAIN THAT THE JOB IS HIS.
THE MASTER CARPENTER THEN RESPONDS,
"IN THAT CASE, I WOULD NEVER HIRE YOU.
WHEN YOU MAKE A MISTAKE, YOU WON'T KNOW HOW TO FIX IT."
ISN'T THAT THE TRUTH OF IT?
AND SO I AM HOPING -- I MEAN, WE WANT TO BE PERFECT,
BUT WE HAVE TO ALSO BE ABLE TO ANTICIPATE AND TO FIX.
AND NOT ONLY FIX OUR MISTAKES, BUT FIX THE MISTAKES OF OTHERS.
YOU MAY BE PERFECT, BUT OTHER PEOPLE AREN'T.
SO, WE WANT TO LEARN HOW TO DO IT ALL,
TO DO IT RIGHT AND TO FIX AS WELL.
SO, HOPEFULLY THAT WILL HELP YOU GET SOME PERSPECTIVE.
ALRIGHT.
LET ME GO TO THE BOARD HERE. I'M GOING TO SWITCH GEARS A LITTLE BIT
SO WE CAN LOOK AT THE ORDERS.
I CAN'T SEE WHO'S BACK THERE. YOUR HEADS ARE ALL DOWN.
COULD SOMEONE GET THAT FIRST LIGHT AND KNOCK THIS LIGHT OUT, SO YOU CAN SEE A LITTLE BETTER.
- THIS LIGHT? - WELL, I DON'T KNOW.
I THINK. YEAH.
OKAY. YOU HAVE A DOCTOR'S ORDER AND THE ORDER SAYS,
START AMPICILLIN 300 MG/IM/Q6 HOURS.
ALRIGHT?
THE ORDER HAS BEEN TRANSCRIBED AND IT'S NOW ON THE MAR.
YOU SHOULD HAVE A MAR IN YOUR...SYLLABUS.
AND THE MAR, AGAIN, THAT JUST MY DOCTOR'S ORDERS.
I'VE CHECKED AND YOU CAN SEE MY INITIALS.
AND IT SAYS, AMPICILLIN 300 MG/IM/Q6 HOURS.
I HAVEN'T PLUGGED IN THE TIME,
WHICH MOST OF YOUR MAR'S SHOULD HAVE WHEN YOU'RE ON THE FLOOR,
BUT THE TIME WILL BE THE TIME YOUR APPOINTMENT IS,
IF YOU ARE GOING TO START IT THEN.
ALRIGHT. SO BECAUSE WE ARE DOING ALL KINDS OF INJECTIONS,
ALL KINDS OF MUSCLES, ALL KINDS OF SHOTS AND EVERYTHING. I WAS CONFUSING MYSELF.
SO I WROTE UP ON THE TOP WHICH SYRINGE I WANT YOU TO CHOOSE
AND WHICH MUSCLE I WANT YOU TO PUT IT IN.
SO THAT WE HAVE SOME UNIFORMITY THERE AND WE ARE GETTING IT INTO THE RIGHT SPOT.
SO, WE'RE GOING TO GIVE AMPICILLIN, 300 MG, TO AN ADULT CLIENT
WITH THE SAFETY LOCK SYRINGE IN THE VENTRAL GLUTEAL MUSCLE.
- DIANE, YOU ALREADY MENTIONED WE'RE GOING TO DO DEMEROL FIRST.
- OH, I'M SORRY THERE. THANK YOU.
GOOD MAN, LARRY, KEEP ME ON TRACK.
EDIT THAT, ALRIGHT?
DEMEROL, 60 MG/IM, NOW.
THIS HAS BEEN TRANSCRIBED.
THE DEMEROL, 60 MG/IM, NOW.
WE'RE GOING TO DO AN ADULT CLIENT,
CARPUJECT, Z-TRACK,
DORSAL GLUTEAL.
ALRIGHT.
YOU DON'T NEED TO BRING YOUR MAR WHEN YOU COME TO TEST, WE'LL HAVE MARS FOR YOU.
BUT I WANTED YOU TO JUST BE ABLE TO ANTICIPATE
AND PRACTICE WRITING AND EVERYTHING, AS FAR AS I GO.
SO, RIGHT NOW, PICTURE ME IN THE NURSING STATION.
- YOU DIDN'T REALLY SAY LIKE NOW OR...
- YES. IF IT'S A NOW, IT'S REALLY A PRN ORDER
AND IT WILL BE ON THE PINK SHEET THAT WILL BE IN YOUR PRN SECTION.
IF THEY'RE A PRE-OP, THEY MAY HAVE IT.
IF THEY'RE SURGERY OR IF THEY'RE MAYBE GOING TO GET A PATIENT CONTROLLED ANALGESIA,
YOU MAY GIVE A SHOT NOW, UNTIL YOU CAN GET IV THINGS GOING
OR TILL YOU CAN GET THEM UNDER CONTROL OR SO FORTH.
SO, YES, IT WILL BE NOW. - WOULDN'T IT BE STAT?
IT CAN BE STAT AND IT CAN BE NOW, EITHER ONE.
"STAT" MEANS EMERGENCY, "NOW" MEANS NOT QUITE SO EMERGENT.
- SO THEY ACTUALLY DO HAVE "NOW"?
- YES.
- OH. - YES.
THEY HAVE "NOW". THEY HAVE "TODAY".
YEAH. "BEFORE NOON".
THEY CAN WRITE IT ANYWHERE THEY WANT.
AS LONG AS IT GETS DONE AND WITHIN THEIR TIME FRAME.
SO. YES.
ALRIGHT. I AM IN THE NURSING STATION
AND PICTURE YOURSELF IN THE NURSING STATION, FIRST.
I'VE CHECKED MY DOCTOR'S ORDERS.
I ALSO LOOK TO SEE IF THERE IS ANY ALLERGIES,
BUT ON THIS PARTICULAR FORM, IT DOESN'T SAY ALLERGIES.
SO I AM WANTING TO NOTE THAT AND I WOULD CHECK THE CHART IF POSSIBLE,
BUT I AM NOT GOING TO GET A GOOD CUE UNTIL I GET TO MY PATIENT'S ID BAND.
I DON'T KNOW WHICH PATIENT YOU'RE GOING TO GO TO.
BECAUSE WE ARE GOING TO HAVE YOU GO TO AVAILABLE STATIONS,
SO I AM NOT ABLE TO EXACTLY TELL YOU WHAT THE ALLERGIES ARE.
SO I WANT YOU TO PUT ALL OF OUR ALLERGIES THAT WE HAVE IN THE LAB TO THE TEST.
AND THEY ARE PENICILLIN, CODEINE, SULFA.
THAT'S ALL WE HAVE OF OUR PATIENTS.
SO WHEN YOU ARE LOOKING IN THE DRUG BOOK,
BECAUSE YOU ARE GOING TO BE MAKING DRUG CARDS,
SEE, IS THERE ARE PROBLEM WITH ANY OF THOSE DRUGS?
YOU KNOW THAT DEMEROL IS WHAT KIND OF DRUG?
A NARCOTIC?
AND SO, OF ALL OF THOSE THREE DRUGS,
WHICH WOULD BE THE ONE THAT WE WOULD BE SUSPICIOUS OF?
CODEINE.
SO BE LOOKING TO SEE IF THERE'S ANY PROBLEM. DEMEROL, CODEINE.
ALRIGHT. IT APPEARS THAT MY CLIENT HAS NO ALLERGIES
AND I AM GOOD TO GO.
PRIOR TO DOING ANY MED PREP, I'M GOING TO WASH MY HANDS
AND THAT'S SOMETHING THAT HAPPENS IN THE NURSING STATION TOO.
OKAY. DEMEROL, BECAUSE IT'S A NARCOTIC,
AND THE GATHERING UP OF EQUIPMENT STAGE IS GOING TO BE IN THE NARCOTICS CABINET.
WE'VE ALREADY BEEN CHECKED UP ON NARCOTICS CABINETS.
I'M NOT GOING TO GO THROUGH THAT. BUT WHAT WE'RE GOING TO DO IS GIVE YOU THESE CARPUJECTS.
THESE PRE-FILLED SYRINGES THAT WOULD BE IN THE NARCOTICS CABINET.
THEY'RE IN BOXES OF 10
AND THAT'S WHAT YOU'RE GOING TO GET OUT OF THE NARCOTICS CABINET.
ALRIGHT, LET'S THINK FOR A MINUTE. YOUR GATHERING EQUIPMENT.
THE DOCTOR'S ORDER IS DEMEROL 60 MG.
THIS IS HOW DEMEROL IS SUPPLIED, IN CARPUJECTS.
LIKE THIS AND THEY ARE PRE-FILLED WITH 50 MG/ML,
75 MG/ML,
AND 100 MG/ML.
THERE ARE ALSO 25 MG, BUT THAT SEEMS PRETTY OFF FROM OUR 60.
SO, IF YOU ARE CHOOSING A CARTRIDGE
TO GIVE TO YOUR CLIENT, WHICH WOULD YOU CHOOSE THE 50,
THE 75 OR THE 100?
- 75 - 50.
- I HEARD ONE 50 AND A LOT OF 75'S.
SOMEONE WHO HAS PICKED 75 TELL ME WHY?
- BECAUSE IF YOU PICK 50, IT'S TOO LESS.
BUT IF YOU PICK 75, YOU CAN JUST PUSH IT IN UNTIL IT GETS TO THE 50 MILS.
- OKAY. ANYONE WANT 100?
- IN FACT, IT'S EASIER TO SEE WHERE YOU'RE GOING.
- YES. I AM PICKING 100.
MATH'S EASIER. THAT'S THE ONLY REASON.
MOST OF THE TIME PEOPLE WANT TO PICK 75 COS THEY'LL WASTE LESS,
BUT THE CHARGE IS THE SAME.
SO WHEN YOU'RE PICKING, PICK WHAT'S GOING TO MAKE EASIER MATH.
IF I WANTED TO GIVE LESS THAN 1 ML.
MAYBE SOMEONE DIDN'T HAVE GOOD MUSCLES
AND I HAVE THE CHOICE BETWEEN 50 AND 75 AND I WANTED TO GIVE LESS,
I MIGHT PICK 75 JUST BECAUSE IT'S AN EASY INCREMENT TO FIGURE MATH.
BUT DO IT ON YOUR MATH.
THE THING HERE IS IF I NEED TO GIVE 60 MG
AND A 100 MG IS IN 1 ML, HOW MAY MILLILITERS FOR 60 MG?
- 0.6.
- 0.6. RIGHT?
BECAUSE 90 MG WOULD BE 0.9 AND SO FORTH. AND SO IT'S AN EASY MATH.
WHEREAS, IF YOU WANTED TO GIVE 60 MG AND 75 MG/ML?
WHAT IS IT? I CAN'T MUSCLE IT OUT OF MY BRAIN.
I AM GOING TO HAVE TO GET A CALCULATOR.
SO, EITHER ONE IS FINE,
BUT YOU CAN CHOOSE AND YOU HAVE THE FREEDOM.
SO, I SUGGESTED IN YOUR SYLLABUS THAT YOU LABEL YOUR CARTRIDGE AS THE 100 MG/ML
SO THAT YOU CAN FIGURE YOUR DOSE FROM THERE.
THESE CARTRIDGES ARE JUST NORMAL SALINE THAT I PURCHASED FOR PRACTICING,
AND SO MOST OF THEM ARE PRE-FILLED TO 2 ML OF SOLUTION.
AND THEN ONCE YOU USE THEM UP WE JUST PUT TAP WATER IN THEM AND THEN KEEP USING THEM UNTIL --
WHATEVER, BUT THEY YOU GO.
OKAY. I'VE GONE TO THE NARCOTICS CABINET, I'VE CHECKED THIS OUT
LIKE I AM SUPPOSED TO AND THIS IS HOW IT COMES.
I HAVE A 2 ML AND -- ACTUALLY IT WILL ONLY COME IN 1 ML,
BUT I HAVE A 100 MG/ML IN THIS CARTRIDGE.
THIS CARTRIDGE APPEARS TO BE A NEEDLE, BUT IT'S NOT.
WHAT IT IS, IS AN ADAPTOR AND THERE IS NO NEEDLE ON IT WHATSOEVER.
AND THE REASON WE HAVE TO HAVE AN ADAPTOR IS BECAUSE THIS IS LIKE A VIAL.
REMEMBER WHEN YOU GOT THE INSULIN OUT OF THE VIAL
AND YOU PUT THE STOPPER, YOU PUT YOUR NEEDLE IN
AND THEN DREW YOUR MEDICATION OUT, THIS IS SIMILAR TO THAT.
BUT WITH THIS ADAPTOR, WE CAN HOOK OUR NEEDLE ONTO THAT.
THE NEEDLE IS HERE IN THE ADAPTOR
AND IT JUST STICKS ON TO THE END OF THIS CARTRIDGE LIKE THIS.
PRESENTLY, BECAUSE THERE IS A GAP RIGHT HERE, AND I KNOW IT'S REALLY HARD TO SEE,
BUT YOU WILL SEE IT WHEN YOU ARE PRACTICING,
THE NEEDLE HASN'T YET PUNCTURED THE VIAL TOP.
SO IT'S NOT OPEN YET. IT'S STILL A CLOSED SYSTEM, A CLOSED VIAL.
BUT YOU HAVE YOUR ADAPTOR.
OKAY. THE OTHER THING ABOUT THIS VIAL IS THAT AT THE END
THERE IS A RUBBER STOPPER, SO THAT YOU CAN ATTACH A PLUNGER.
THIS IS IMPORTANT TO KNOW BECAUSE THIS ISN'T A TRUE VIAL.
IF YOU WERE TO PUT AIR IN THIS LIKE YOU DID YOUR INSULIN,
SO THAT YOU HAVE PRESSURE TO PULL THE MEDICINE OUT OF HERE LIKE THE VIAL,
YOU'LL SHOOT THE STOPPER OUT THE OTHER END, BECAUSE IT'S THE PLUNGER.
SO NEVER PUT AIR IN THESE,
IF YOU'RE GOING TO TAKE THE MEDICINE OUT
AND PUT IT IN A DIFFERENT KIND OF SYRINGE.
I'M GOING TO TEACH YOU HOW TO USE THE HOLDER
THAT WAS CREATED FOR THE CARPUJECT SYRINGE.
BUT IF YOU DON'T LIKE USING THE HOLDER, YOU COULD GO GET A REGULAR SYRINGE.
PUT THE NEEDLE ON IT, DRAW THE MEDICINE OUT AND USE THE OTHER SYRINGE.
AND THAT'S THE DIFFERENCE, COS SOMETIMES THESE AREN'T AVAILABLE
OR THEY'RE AWKWARD AND PEOPLE DON'T LIKE USING THEM.
ALRIGHT. WELL I'VE GOT MY STOPPER...ON.
AND SO I PUT IT BACK TOGETHER.
OKAY, WHAT I WANT TO DO TO GET READY. I FIGURED MY MATH.
I NEED TO GIVE 60 MG, SO HOW MUCH AM I GOING TO HAVE IN MY SYRINGE?
0.6.
SO I GOT MY HOLDER. AND YOUR HOLDER LOOKS LIKE THIS.
YOU HAVE A PLUNGER AND YOU HAVE -- I DON'T EVEN KNOW WHAT YOU CALL THIS,
BUT YOU HAVE AN ADAPTOR THAT SECURES THE CARTRIDGE IN.
YOU WANT TO LAY THE CARTRIDGE INTO THE HOLDER
AND STABILIZE IT WITH YOUR HAND
AND THEN TWIST THE PLUNGER ONTO THE SCREW PIECE, THE RUBBER STOPPER.
SO YOU CAN SCREW THE PLUNGER ON TO THIS CARTRIDGE,
SO IT DOESN'T FALL OUT OF HERE.
BUT REMEMBER WE STILL DON'T HAVE OUR NEEDLE INTO THAT VIAL STOPPER YET.
WE DO THAT BY TWISTING THIS BLUE PIECE IN
AND THAT SQUEEZES THESE TWO PIECES TOGETHER
AND THAT'S WHAT PUNCTURES THE VIAL.
SO WATCH HOW IT GOES RIGHT HERE.
SEE HOW I GO HERE AND...
IT PUSHED IT TOGETHER AND NOW THE NEEDLE THAT WAS IN THIS ADAPTOR PIECE
IS IN THE VIAL AND NOW I CAN SQUIRT MY FLUID OUT.
IF YOU GO TO PLUNGE AND SQUIRT YOUR FLUID OUT
AND IT WON'T GO AND IT WON'T GO,
IT'S BECAUSE YOU DIDN'T PUSH THE NEEDLE INTO THE VIAL.
ALRIGHT. BUT I STILL HAVE NO NEEDLE, RIGHT?
THAT'S NOT A HUGE DEAL RIGHT NOW. I CAN GO AHEAD AND SET MY DOSE.
SO...
I GOT TO SEE THAT IT DOESN'T SNAPPED.
HOLD YOUR SYRINGE STRAIGHT UP, GET ALL THE AIR OUT.
AND BECAUSE THIS IS A NARCOTIC, YOU NEED TO MAKE SURE
THAT YOU HAVE AN RN WATCHING YOU TO CHECK YOUR WASTE, OKAY?
COS THEY HAVE TO CO-SIGN THE SHEET,
THE NARCOTIC SHEET, THAT YOU'VE WASTED 40 MG OR 0.4.
SO IN THE SINK OR IN THE MED HOPPER OR SOMETHING,
YOU'RE GOING TO SQUIRT THIS MED OUT.
MAKE SURE ALL MY AIR IS OUT AND THEN YOU CAN SQUIRT THE --
ONCE ALL YOUR AIR IS OUT AND YOU'RE SOLID FLUID,
THEN YOU CAN TURN YOUR SYRINGE DOWN.
BUT IF YOU HAVEN'T DISPLACED ALL THE AIR STRAIGHT UP,
THE AIR IS GOING TO STICK TO THE SIDE AND YOU'LL HAVE A WRONG DOSE.
GET ALL THE AIR OUT FIRST, THEN SET YOUR DOSE.
OKAY, I HAVE 0.6.
I'M HAPPY, BUT I STILL HAVE NO NEEDLE.
I'M GOING TO PUT THIS CAP ON, WE GOT TO TALK ABOUT NEEDLES A LITTLE BIT.
YOU'RE ALREADY FAMILIAR WITH THE SYRINGE. JUST A BRIEF REVIEW.
YOU GOT THE PLUNGER, THE FLANGE,
THE BARREL, THE HUB AND NOW WE NEED A NEEDLE.
WHEN YOU'RE PICKING A NEEDLE, YOU PICK IT BY THE SIZE OF THE MUSCLE
RELATED TO YOUR CLIENT AND THE VISCOSITY OF THE SOLUTION
THAT YOU ARE GOING TO PUT INTO THE CLIENT.
VISCOSITY BEING THE THICKNESS OF THE SOLUTION.
DEMEROL, MORPHINE. WATERY.
THEY'RE JUST WATER SOLUTIONS, SO WE CAN HAVE A RELATIVELY THIN NEEDLE.
BUT WE'RE GOING INTO MUSCLE,
SO WE DON'T WANT TO BE TOO THIN, BECAUSE WE DON'T WANT IT TO BEND.
IT NEEDS TO BE SOLID TO GO THROUGH MUSCLE.
WHEREAS BEFORE, WHEN WE WERE DOING SUBCUTANEOUS INJECTION,
REMEMBER HOW MICRO-THIN THEY WERE?
DO YOU REMEMBER THE GAUGE OF OURS?
27. THAT WAS OUR INSULIN SYRINGE.
IT WAS JUST A LITTLE THIN HAIR LIKE. 27.
AND WE DIDN'T REALLY WANT TO GO MUCH BIGGER THAN 25.
SO WE'RE TALKING GAUGE. REMEMBER GAUGE IS WIDTH.
THE BIGGER THEN NUMBER, THE SMALLER THE WIDTH.
ALRIGHT. SO NOW WE'RE GOING TO GO INTO A MUSCLE AND WE NEED TO CONSIDER TWO THINGS,
THE GAUGE AND THE LENGTH OF THE NEEDLE. LET'S TALK GAUGE.
WE KNOW IT'S A WATERY SOLUTION, BUT WE KNOW IT'S MUSCLE.
SO YOU WANT TO BE CONSIDERING A GAUGE OF 20 TO 23.
18 STARTS BEING PRETTY BIG.
I USE 18'S FOR FIXED SOLUTIONS. LIKE THINGS LIKE A GOLD SHOT
WHICH IS REALLY FLECKS OF GOLD AND THICK TYPE OF A SOLUTION.
SO SOMETHING THICK, YOU HAVE TO HAVE A BIGGER GAUGE.
BUT FOR THE MOST PART, FOR AN AVERAGE MUSCLE, 20 TO 23.
ALRIGHT. WE'RE ALSO GOING INTO BUTTOCKS.
OUR FOCUS IS GLUTEAL MUSCLES AND WE'RE GOING TO DO DORSAL GLUTEAL AND VENTRAL GLUTEAL.
THIS SHOT I HAVE ASKED YOU TO DO DORSAL GLUTEAL.
I WANT YOU TO KNOW THAT I KNOW
THAT THE DORSAL GLUTEAL MUSCLE IS NOT RECOMMENDED ANY MORE.
IT'S NOT. WE'RE NOT TO DO ANY SHOTS IN THE DORSAL GLUTEAL MUSCLE.
WHY? BECAUSE THE DORSAL -- WHAT DOES DORSAL MEAN?
- THE BACK. - BACK. SO IT'S BACK BUTT.
OKAY. SO IF ALL OF THIS IS GLUTEUS AND THIS IS MY FAVORITE LECTURE.
EVERYONE IS STARING AT MY BUTT.
OKAY. BUT HERE WE GO. BUT HERE WE GO.
WHEN YOU JOIN THE BUTTOCKS,
YOU'RE THINKING OF ONE SIDE, RIGHT? SO DORSAL GLUTEAL IS BACK BUTTOCKS.
NOW, I DON'T KNOW ABOUT YOU, BUT WHEN I GOT SHOTS,
I ALWAYS THOUGHT THEY GAVE IT INTO THAT BEEFY BOTTOM BUTTOCKS.
BUT YOU DON'T BECAUSE THAT'S WHERE THE SCIATIC NERVE IS.
THIS YELLOW THING RIGHT HERE.
AND IF YOU HIT THE SCIATIC NERVE, YOU CAN CAUSE NUMBNESS.
THIS IS NOT GOOD.
SO WHAT WE DO FOR DORSAL GLUTEAL
IS REALLY, IT'S IN THE UPPER, OUTER QUADRANT OF THE BUTTOCKS.
OKAY. THERE ARE SOME REAL LANDMARKS THAT THEY WANT YOU TO PICK.
AT LEAST WE CAN DO MINE. I CAN POINT 'EM OUT OKAY.
FIND YOUR OWN ON YOUR HIPS.
YOU WANT TO FIND YOUR GREATER TROCHANTER.
OKAY? JUST REMEMBER WHERE IT IS. POINT AT IT.
IT'S THE TOP OF YOUR FEMUR BONE AND THE TOP OF THAT BONE IS YOUR GREATER TROCHANTER.
OKAY. YOUR ILIAC CREST IS THE TOP OF YOUR HIP BONE.
THE HIGHEST PLACE. THAT'S THE CREST, ILIAC.
OKAY. IF YOU FOLLOW THE ILIAC SPINE DOWN
TO THE OTHER HIGHEST POINT IN THE BACK,
THAT'S CALLED THE POSTERIOR, RIGHT? WHICH IS BACK.
POSTERIOR, SUPERIOR HIGHEST BACK POINT,
ILIAC SPINE.
IT CAN'T BE A CREST, YOU CAN ONLY HAVE ONE CREST.
ONE HIGHEST POINT AND THAT'S YOUR CREST.
OKAY. SO ONCE YOU'VE FOUND YOUR POSTERIOR, SUPERIOR, ILIAC SPINE
AND YOUR GREATER TROCHANTER, YOU DRAW AN IMAGINARY LINE...ACROSS
AND IT'S EVERYTHING ABOVE THE LINE AND BELOW THE ILIAC CREST.
SO IT'S THAT MUSCLY PLACE RIGHT HERE.
NOW WHEN I WENT TO SCHOOL, AGES AGO, THEY DIDN'T TEACH US THESE LANDMARKS.
THEY JUST SAID QUARTER OF THE BUTT, THE UPPER, OUTER QUADRANT.
SO WE JUST TOOK THE BUTTOCKS CHEEK, QUARTER.
IT'S THE SAME PLACE.
SO IN YOUR MIND, IT'S NOT LIKE IT HAS TO BE THIS BULL'S-EYE,
THIS ONE LITTLE SPECK OF A PLACE.
YOU GOT A LITTLE BIT OF A TARGET THERE. UPPER, OUTER.
BUT WHAT THEY FOUND IN THE RESEARCH IS AND BECAUSE OF VARYING TECHNIQUES
AND VARIATIONS IN CLIENTS IS THE SCIATIC NERVE IS IN DIFFERENT PLACES IN PEOPLE.
IT'S NOT ALWAYS AS LOW AS IT'S SUPPOSED TO BE.
SO BECAUSE OF THE NERVE ENDING THERE,
THEY RECOMMENDED THAT WE DON'T GIVE IT.
PEOPLE GIVE IT THERE ALL THE TIME.
I WANT YOU TO KNOW WHERE IT IS.
BECAUSE IF I WAS AN OLD NURSE STILL WORKING AND I HADN'T BEEN TO SCHOOL
AND I HADN'T HEARD THAT YOU'RE NOT SUPPOSED TO GIVE THEM THERE,
I'D STILL BE GIVING THEM THERE.
SO I WANT YOU TO BE SEEING WHAT THEY'RE DOING
AND KNOWING IF THEY'RE DOING IT RIGHT OR WRONG,
IF THEY'RE IN GOOD LOCATION. THEY GOT TO BE UPPER, OUTER QUADRANT.
THE OTHER THING IS, I'VE HAD CLIENTS THAT HAD SICKLE-CELL
AND HE HAD NO MORE MUSCLE LEFT. ANYWHERE.
HE HAD TAKEN DEMEROL SHOTS FOR SO MANY YEARS.
YOU KNOW SICKLE CELL CAUSES A LOT OF PAIN.
HE HAD BEEN ON DEMEROL FOR A LONG, LONG TIME.
SOMETIMES YOU NEED AN ALTERNATIVE PLACE
WHEN THERE ARE NO SOFT PLACES LEFT OF ALL YOUR OPTIONS.
AND SO I WOULD STILL HAVE IT IN THE BACK OF MY MIND AS A LAST RESORT.
OKAY. SO, WE'RE STILL GOING TO WORK ON IT.
I'M NOT READY TO TOTALLY GIVE UP YET.
ALRIGHT. IF I AM GOING INTO THE DORSAL GLUTEAL, BUTTOCKS MUSCLE,
THE RECOMMENDATION IS THAT WE MINIMALLY, ON AN AVERAGE ADULT,
I'M AN AVERAGE ADULT,
USE A ONE-AND-A-HALF INCH NEEDLE, UP TO TWO INCHES.
ACCORDING TO NURSING 2002,
THEY GAVE A LITTLE BIT CLEARER PARAMETER.
BECAUSE SOMETIMES IT'S LIKE, "WELL, HOW DO YOU KNOW
WHAT'S AVERAGE OR NOT AVERAGE?"
AND THEY SAID ANYONE OVER 100LB CAN TAKE A ONE-AND-A-HALF INCH NEEDLE.
AND ANYONE OVER 200LB,
YOU NEEDED TO AUTOMATICALLY GO TO A TWO-INCH NEEDLE.
SO, OVER 200LBS, GIVES YOU A LITTLE BETTER CRITERIA.
YOU'RE STILL GOING TO PALPATE MUSCLE.
YOU'RE STILL GOING TO LOOK.
BUT IT HELPS YOU DECIDE, WHEN DO I MOVE UP TO THAT.
I MEAN, THAT IS LONG,
A LONG, LONG NEEDLE AND YOU GOT TO GET INTO THAT MUSCLE.
ALRIGHT. KNOWING ALL OF THAT,
KNOWING THAT I AM GOING DORSAL GLUTEAL, I'M GOING BUTTOCKS,
I HAVE CHOSEN A 21 GAUGE,
ONE-AND-A-HALF INCH SAFETY GLIDE NEEDLE.
NOTICE THAT ON THIS CARTRIDGE THERE IS NO SAFETY DEVICE
TO PROTECT ME FROM THAT NEEDLE AFTER THE SHOT HAS BEEN GIVEN AND I NEED SOMETHING.
SO, WE PRACTICE WITH THE SAFETY GLIDE.
WAS IT ON OUR DEMO -- NO, OUR INSULIN?
DID WE HAVE IT ON THERE AND IT JUST FLICKS IT DOWN.
AND SO THIS IS A NEEDLE THAT'S SEPARATE,
BUT I'M GOING TO PEEL OPEN FROM THE TOP.
TAKE THIS. ALWAYS HANDLE FROM THE BOTTOM OF THE NEEDLE.
DON'T PULL IT OUT OF YOUR PACKAGE AND START HANDLING IT
BECAUSE YOU'RE LIKELY TO CONTAMINATE THIS TOP EDGE.
PUT THE TWO TOGETHER AND SCREW IT ON.
THIS CARPUJECT ISN'T VERY, VERY GOOD.
OKAY. I GOT MY NEEDLE ON, SO I HAVE MY ONE-AND-A-HALF,
21-GUAGE, DEMEROL, O.6...
LONG NEEDLE.
YOU KNOW, I AM SO VISUAL. I KNOW YOU'RE VISUAL TOO.
AND I WENT TO SURGERY THE FIRST TIME AND THEY OPENED UP SOMEBODY
AND THEY WERE PEELING AWAY THE LAYERS OF FAT.
WE GOT PLENTY. PLENTY.
AND THE THING IS WE GOT TO CLEAR THE OUTER POST TISSUE
AND GET TO MUSCLE SO THAT IT WILL BE ABSORBED CORRECTLY.
WHICH ABSORBS FASTER? SUBCUTANEOUS OR INTRAMUSCULAR?
- INTRAMUSCULAR. - INTRAMUSCULAR.
SO WE WANT OUR CLIENT TO GET THE MEDICATION.
IT TAKES 10 TO 30 MINUTES TO GET INTRAMUSCULAR MEDICATION,
WHEREAS SUBCUTANEOUS CAN TAKE UP TO AN HOUR.
THAT'S A BIG DIFFERENCE WHEN YOU'RE IN PAIN
AND YOU'RE NEEDING YOUR MEDICATION.
SO WE WANT TO GET TO MUSCLE, THAT'S THE KEY.
ALRIGHT. SO I HAVE A PLAN.
I KNOW HOW TO FIND MY MUSCLE.
I'VE GOT MY SYRINGE READY.
I HAVE A BAND-AID.
I HAVE A 2 BY 2 AND I HAVE AN ALCOHOL SWAB.
AND I DO HAVE ANOTHER ADAPTOR HERE.
AND LET ME JUST SHOW YOU THIS ADAPTOR.
CONNIE, ON THAT BACK SHELF, YOU'LL SEE SOME MORE --
THERE'S A BLUE TRAY THAT'S GOT MORE DEMEROL.
PASS THAT UP AND I'LL SHOW YOU HOW TO DO THIS ONE.
SORRY, YOU SHOULD HAVE GRABBED TWO. THANKS.
THIS IS ONE KIND OF HOLDER AND THIS IS WHAT THE MANUFACTURER
USUALLY SENDS WHEN THEY SEND THEIR DEMEROL,
THEIR NARCOTICS ORDERS TO THE PHARMACY.
IF YOU CAN'T FIND THESE HOLDERS, IT'S BECAUSE PHARMACY HASN'T SENT ENOUGH
AND YOU JUST NEED TO CALL THEM AND GET SOME MORE.
SOMETIMES NURSES WILL KEEP A HOLDER IN THEIR POCKET,
AND IT'S THEIR PRECIOUS TREASURE AND THEY WON'T SHARE.
BECAUSE THEY DON'T WANT TO LOSE IT COS THEY KNOW HOW HARD THEY ARE TO COME BY,
WHICH IS RIDICULOUS BECAUSE PHARMACY HAS THEM BY THE CASE.
BY THE CASE. SO YOU CAN GET THEM.
THE OTHER THING WE NEED TO CONSIDER IS THAT
YOU DON'T WANT TO BE USING THE SAME THING FOREVER ON SOMEONE.
IT NEEDS TO GET WIPED OFF IF THIS IS TOUCHING ON THE SKIN AND POSSIBLY BLOOD.
SO, IT SHOULDN'T BECAUSE OF THE ADAPTOR AND THAT'S WHAT'S GOING TO KEEP US FROM TOUCHING SKIN.
ALRIGHT. BUT THERE IS ANOTHER ONE THAT'S MADE BY TUBEX.
AND IT LOOKS LIKE THIS, AND IT SERVES THE SAME PURPOSE.
BUT YOU HOOK IT ON HERE.
YOU SCREW THIS ON AND THEN YOU SCREW THIS PIECE ON TIGHT.
AND THEN YOU SCREW THIS ON TO YOUR PLUNGER,
AND YOU GO TO GIVE IT, AND YOU CAN'T, RIGHT?
BECAUSE WE HAVE A PUNCTURE.
AND THIS DOES NOT HAVE THE HOLDER TO PUSH THE TWO PIECES TOGETHER.
SO YOU'RE GOING TO HAVE TO DO IT MANUALLY TO MAKE IT WORK AND PUSH IT DOWN.
AND NOW IT'S GOING TO WORK, OKAY?
AND THAT'S IT. YOU GOT TO BE --
PUNCTURE IT YOURSELF AND THAT'S HOW YOU KNOW THE DIFFERENCE.
SO THESE ARE NICE BECAUSE THEN THE TUBEX DOESN'T HAVE THIS BOTTOM PIECE
THAT MIGHT GET IN TOUCH WITH THE CLIENT.
YOU'RE ALWAYS HANDLING IT BY THE CARTRIDGE ITSELF
AND THIS STAYS RELATIVELY CLEAN AND SO YOU'RE NOT PASSING CONTAMINATION ON.
THESE ARE ALSO PRECIOUS AND NURSES WON'T SPRING WITH THESE.
THEY HAVE THEM IN THEIR POCKETS.
SO IF YOU CAN'T FIND THEM ON THE MED CARTS,
START ASKING THE FLOOR NURSES, "DO YOU HAVE A TUBEX HOLDER?"
THEY HAVE THEM. THEY'RE IN THEIR POCKETS. OKAY?
ALRIGHT.
OKAY, WE'RE STILL IN THE NURSING STATION,
WE'RE GETTING OURSELVES CLEANED UP AND READY.
I AM A STICKLER ABOUT CLEANLINESS.
DON'T LEAVE ALL YOUR TRASH AND YOUR MESS AT THE STATION
BECAUSE SOMEONE ELSE IS GOING TO BE BEHIND YOU GETTING THEIR STUFF READY.
AND THE MORE CLUTTER THERE IS, THE MORE DISTRACTION THERE IS
AND THE MORE POTENTIAL OF CREATING A WRONG DRUG DOSE.
AND YOU DON'T WANT TO CREATE SOMEONE ELSE'S ERROR.
ALRIGHT. SO I'VE CLEANED UP MY STATION, AND I NEED TO TALK --
WELL, I WILL TALK ABOUT THAT WHEN I GIVE THE SHOT.
I'M READY TO GO. SO, I HAVE MY MAR.
I HAVE MY MEDS, MY PENS, I HAVE CLEARED MY TRASH AND I AM GOOD TO GO.
SO WE'LL COME OVER HERE TO OUR CLIENT AND SAY,
GOOD MORNING MR. SPADE. HOW ARE YOU?
ARE YOU READY FOR THAT SHOT?
ALRIGHT, IT NEEDS TO GO INTO YOUR BOTTOM.
DO YOU REMEMBER WHICH ONE YOU HAD THE LAST ONE ON?
ON THE RIGHT? OR YOU HAVEN'T HAD ONE?
OKAY. WELL, WHY DON'T WE PUT IT IN THE RIGHT THIS TIME
AND THEN WE'LL KIND OF ROTATE.
COS IT CAN MAKE YOUR BOTTOM SORE, AND YOU NEED TO KEEP MOVING IT.
ALRIGHT. BUT I DO WANT TO CHECK YOUR ID BAND.
I NEED A TABLE.
"CAN YOU TELL ME YOUR NAME?
SAM SPADE?
ALRIGHT, LET ME CHECK YOUR ID BAND.
I'VE ALREADY WASHED MY HANDS SO I AM GOOD TO GO ON THAT.
SO, YOU'RE SAM SPADE DR. FEEL GOOD 001010001.
AND, OH, YOU'RE ALLERGIC TO SULFA.
THAT'S NOT A PROBLEM WITH DEMEROL.
HAVE YOU EVER TAKEN DEMEROL BEFORE? ARE YOU AWARE OF AN ALLERGY?
OKAY. SO I CHECKED MY ALLERGIES,
I'VE CHECKED BANDS, I'VE CHECKED MAR'S.
PRIVACY. THEY'VE GOT THIS WHOLE HIGH FIVE DEAL.
ALRIGHT, I AM GOING TO PUT YOU UP,
AND THE THING ABOUT DOING THE DORSAL GLUTEAL IS
YOU HAVE TO GET HIM IN POSITION TO DO THE DORSAL GLUTEAL.
YOU WANT TO GET TO THE BACK BUTTOCKS.
WHERE WHEN WE DO THE VENTRAL GLUTEAL, THEY CAN ACTUALLY LAY ON THEIR BACK.
THEY DON'T HAVE TO MOVE AND THAT ALLOWS THE PAIN MEDICATION TO WORK, SO THEY CAN MOVE.
BUT I GOT TO MOVE THEM SO...
LET'S SEE. I GOT MORE PEOPLE ON THAT SIDE,
SO I PROBABLY SHOULD DO IT THE OTHER WAY, BUT HERE WE GO.
MAKE THEM TURN ALL THE WAY ON THEIR STOMACH AND BE PRONE.
I'M GOING TO START USING A LOT MORE TECHNICAL TERMS THIS TIME
AND MAKE SURE THAT YOU ARE COMFORTABLE WITH POSITIONS,
BECAUSE ON THE INCLEX,
THEY'LL DESCRIBE WHAT PRONE IS AND MAKE YOU PICK PRONE.
THEY'LL DESCRIBE POSITIONS AND MAKE YOU DECIDE WHAT IT IS OR WHAT DIAGNOSIS SHOULD BE THAT.
AND SO PRONE IS FACE DOWN, WHEREAS SUPINE IS FLAT, FACE UP.
ALRIGHT. THIS IS AN ADULT MANNEQUIN HERE.
THIS ABOUT JUST ROLLING OVER.
SO ON THE MANNEQUIN'S, ON THE RIGHT SIDE OF THEIR BOTTOM
THEY HAVE A PAD AND THAT'S THE DORSAL GLUTEAL.
ON THE LEFT OF THEIR BOTTOM IS THE VENTRAL GLUTEAL PAD.
SO THAT, MAYBE, WILL HELP YOU FIND YOUR LANDMARKS
AND LET YOU KNOW YOU ARE IN THE RIGHT PLACE.
ALRIGHT.
HANG ON THERE, MR. SPADE, I NEED SOME GLOVES,
BUT EVERYTHING IS ON THE OTHER SIDE.
OKAY.
I AM ALREADY, KIND OF, EYEBALLING MY TARGET.
BECAUSE I AM LOOKING TO SEE IF THERE IS ANY REDNESS,
ANY ABRASIONS, ANY NECROSIS, ANY SWELLING,
ANYTHING THAT MIGHT MAKE THIS NOT A GOOD LOCATION TO GIVE A SHOT.
BUT I AM ALSO GOING TO PALPATE. I KNOW IT'S IN THAT UPPER QUADRANT.
AND I WANT YOU TO KNOW THAT AS A KIND OF DOUBLE CHECK,
BUT YOUR INSTRUCTORS ARE GOING TO INSIST THAT YOU IDENTIFY LANDMARKS.
IN ALL OF THE WRITTEN EXAMS THAT I GIVE IN THE INCLEX WILL GIVE,
WILL DESCRIBE LANDMARKS WITHOUT SAYING DORSAL GLUTEAL.
SO YOU GOT TO BE CLEAR ON THOSE LANDMARKS.
SO I KNOW THAT FOUND THE POSTERIOR, ILIAC ANTERIOR -- LET ME START OVER.
POSTERIOR SUPERIOR ILIAC SPINE.
I FOUND THE GREATER TROCHANTER AND I'VE DRAWN AN IMAGINARY LINE.
AND IT'S ABOVE THE LINE.
BELOW THE ILIAC CREST.
I AM GOING THE PALPATE THE SIDE AND MAKE SURE THERE'S NO PAIN OR TENDERNESS.
I AM PALPATING FOR SOFTNESS, FOR FIRMNESS, FOR BONE
BECAUSE YOU WANT TO BE OFF OF THAT ILIAC CREST.
OKAY. SO I'M PRETTY COMFORTABLE WITH MY SITE LOCATION THERE.
I AM GOING TO MAKE MY THIRD CHECK OF MY MEDICATION AT THE BEDSIDE.
LOOKING TO SEE THAT IT IS DEMEROL.
ONE OF THE THINGS I DIDN'T MENTION IS,
WHEN YOU ROTATE YOUR CARTRIDGE, MAKE SURE THAT YOU PUT
THE NUMBERS HERE WHERE YOU CAN SEE THEM.
NOTICE I DIDN'T LABEL THIS ONE.
THERE'S REALLY NO NEED TO BECAUSE IT ALREADY SAYS DEMEROL,
IT ALREADY SAYS O.6
IT WOULD JUST BE A DOUBLE DO AND WASTE MY TIME.
AND ALL THE INFORMATION I NEED IS ALREADY ON THE CARTRIDGE.
SO, O.6. IT SAYS 100 PER MIL, 60 MG.
OKAY, I AM HAPPY.
OKAY, THAT'S GOOD.
NORMALLY YOU WOULD GIVE IT ON A CLIENT, BUT I NEED TO SEE WHAT I AM DOING.
SO WE ARE GOING TO COME UP HERE WITH THE PADS.
YOU HAVE TWO PADS UP HERE FOR YOU TO PRACTICE WITH.
WE HAVE ONE THAT'S INJECT AIR ONLY AND WE WOULD APPRECIATE JUST AIR.
IT WILL HELP OUR PADS LAST LONGER.
AND THEN IF THEY DON'T SAY ANYTHING,
YOU CAN PUT FLUID IN THEM. THAT'S ALL.
ALRIGHT.
ONCE I FIND THE MUSCLE, WE ARE GOING TO INTRODUCE
A DIFFERENT TECHNIQUE AS WELL AND WE ARE GOING TO Z-TRACK.
Z-TRACK CAN ACTUALLY BE DONE WITH ALL INTRAMUSCULAR INJECTIONS.
DOESN'T HAVE TO BE, BUT IT CAN BE.
AND WHAT A Z-TRACK IS, IS YOU STRETCH THE SKIN OVER AN INCH TO AN INCH AND A HALF,
YOU GIVE THE INJECTION AND THEN WHEN YOU ARE PULLING OUT THE NEEDLE,
YOU RELEASE THE SKIN AND RATHER THAN THERE BEING A TRACK IN AND OUT OF MEDICATION.
YOU PUT THE NEEDLE IN AND YOU SQUIRT IT
AND THEN THE LIQUID COMES RIGHT OUT OF THAT TRACK.
THE SKIN SWITCHES OVER AND IT SHUTS OFF THE TRACK.
SO YOU DON'T LOSE THE MEDICATION. SO A Z-TRACK.
THEY HAVE A GOOD PICTURE OF IT IN YOUR BOOK.
SO WE ARE GOING TO Z-TRACK THIS.
I AM GOING TO GO AHEAD AND CLEAN THE SKIN
BECAUSE I CAN'T PULL AND CLEAN AND GET ALL MY STUFF READY.
SO IT CAN BE CLEANED WITH ALCOHOL AND DRY.
AFTER I AM DONE WITH MY Z-TRACK,
I RECOMMEND THAT YOU USE A 2 BY 2 AND JUST DAB,
RATHER THAN USE AN ALCOHOL SWAB.
BECAUSE THE MOISTURE WIPES AWAY ANY CLOT
AND CAUSES A LITTLE BLEEDING AND SOMETIMES SOME BURNING.
SO ON A Z-TRACK, A DRY 2 BY 2 AND YOU JUST DAB, NO MASSAGING.
YOU CAN GO AHEAD AND HAVE YOUR BAND-AID READY.
AND WE DON'T REALLY NEED ONE ON A PAD,
SO MY BAND-AID'S READY TO GO.
OKAY.
THIS IS REAL IMPORTANT AGAIN, I JUST WANT TO REITERATE ON NEEDLE SAFETY.
WHEN YOU PULL THE CAPS OFF YOUR NEEDLES, HOLD IT BY THE BARREL,
HOLD IT BY THE END OF THE CAP AND PULL AWAY FROM YOU, BECAUSE IT'S LONG.
OKAY. SO PULL FAR AWAY.
BECAUSE IT'S MUSCLE YOU ARE GOING TO HAVE TO GIVE IT SOME UMPH THIS TIME.
WHEN YOU GIVE SUBCU, I TALKED ABOUT GOING SLOW
AND PUSHING AND IT'S NOT A BIG DEAL, BECAUSE IT'S SOFT TISSUE.
BUT WE GOT TO GET INTO MUSCLE. SO YOU'RE GOING TO DART THIS THING IN,
GIVE IT A LITTLE UMPH.
I'LL TALK TO YOU ABOUT SOME VARIATIONS ON THAT.
OKAY. I'VE CHECKED MY CLIENT, I'M GOING TO PULL MY SKIN ACROSS
AND I AM GOING TO WARN HIM, LITTLE STICK.
MAKE SURE THAT YOUR BEVEL IS UP AND YOU ARE GOING TO DART IN.
SO... OH! I HIT BONE.
DID YOU HEAR?
ALRIGHT. NOW, I AM GOING TO HAVE TO WALK UP THIS SYRINGE
BECAUSE THIS IS A ONE-HANDED TECHNIQUE.
I HAVE TO KEEP HOLDING THE SKIN IN Z-TRACK MODE,
BUT WE ARE GOING TO ASPIRATE NOW.
WE ASPIRATE WITH ALL INTRAMUSCULAR INJECTIONS
BECAUSE WE WANT TO MAKE SURE WE ARE NOT IN A BLOOD VESSEL.
SO YOU ARE GOING TO PULL BACK ON THE PLUNGER
AND SEE IF YOU GET ANY BLOOD.
AND YOU'RE GOING TO PULL BACK, IT SAYS FOR FIVE TO TEN SECONDS.
I THINK THAT'S A WHOLE LOT. BUT THIS IS WHAT THE RESEARCH SAYS.
THAT IF IT'S A SMALL VESSEL AND A SMALL NEEDLE,
IT MIGHT TAKE A LITTLE BIT TO PULL THE BLOOD INTO THE SYRINGE.
I HIT A BLOOD VESSEL ONCE IN MY CAREER.
IT'S BLIND. YOU DON'T KNOW.
YOU ARE STICKING IN AND SO YOU DON'T KNOW,
AND IT'S POSSIBLE ON ANYBODY TO HIT BLOOD.
I HAD NO RESISTANCE WHATSOEVER.
I PULLED THE PLUNGER UP AND WHISK, BLOOD.
WHEREAS IF YOU ARE NOT IN A VESSEL, YOU'RE IN TISSUE,
AND THERE'S RESISTANCE AT THE PLUNGER SIDE,
AND IT'S KIND OF STIFF. YOU WILL FEEL THE DIFFERENCE.
SO ANYWAYS, YOU ARE GOING TO PULL BACK, LOOK FOR BLOOD.
IF YOU GET BLOOD, YOU JUST PULL THE NEEDLE OUT AND START OVER.
YOU JUST START OVER, YOU CAN'T JUST READJUST.
- DO YOU PULL BACK AND HOLD? - I PULL BACK ON THE PLUNGER.
YOU CAN SEE I AM JUST DOING IT EVER SO SLIGHTLY. DON'T JUST PULL REAL HARD.
IT HURTS IF YOU ARE SUCKING ON TISSUE.
SO YOU JUST PUSH UP LIKE I AM WITH MY THUMB HERE A LITTLE BIT.
I'M FEELING RESISTANCE IN THE PAD AND THAT FEELS JUST LIKE A PERSON.
AND THEN IF I SEE THERE'S NOTHING,
THEN I'M GOING TO INJECT MY MEDICATION EVER SO SLOWLY.
THEN I'M GOING TO PULL THE NEEDLE OUT
AS I RELEASE THE SKIN.
AND IT SHOULD -- WELL, MY PAD'S LOST ITS RESILIENCY,
BUT SKIN WILL SHIFT, KIND OF, OVER.
OKAY. I AM JUST NOT COORDINATED ENOUGH
TO PULL, SWITCH AND FLIP ALL AT THE SAME TIME.
THAT'S JUST MORE THAN ANYBODY TO HAVE TO DO.
SO IN NEEDLE SAFETY, AS LONG AS YOU KEEP YOUR HAND BEHIND THE NEEDLE,
YOU CAN FLICK THIS DOWN AFTER.
BUT YOUR HAND HAS TO STAY. YOU DON'T DO ANY OF THIS KIND OF STUFF.
NO SWIMMING AROUND.
YOU STAY BACK HERE AND YOU FLIP IT DOWN AND THEN IT'S PROTECTED.
ALRIGHT. BUT I DON'T WANT TO FORGET MY CLIENT HERE,
SO I DO WANT TO LOOK AND SEE IF THERE IS ANY OOZING.
AND YOU CAN SEE AN EVER SO SLIGHT LITTLE DAB HERE
SO I CAN JUST KIND OF PAT IT.
BUT NO MASSAGING WHATSOEVER
BECAUSE IF YOU MASSAGE YOU DEFEAT THE POINT OF THE Z-TRACK.
DAB, THAT'S GOING TO GO IN THE TRASH,
AND THEN A BAND-AID IF NECESSARY.
ALRIGHT. SO MY CLIENT HAS HAD THEIR SHOT AND I WOULD SAY,
DO YOU WANT TO STAY ON THE SIDE FOR A WHILE OR YOU WANT TO MOVE BACK.
AND HE'S JUST SO HAPPY RIGHT THERE. OKAY.
AND I AM GOING TO PUT THE BED DOWN BECAUSE I WOULD HAVE BEEN OVER THERE, RIGHT?
AND THE SHARPS CONTAINER IS OVER HERE, SO TAKE CARE OF YOUR PERSON FIRST.
THE RULE OF NURSING, THE RULE OF TESTING IS PATIENT BEFORE EQUIPMENT ALWAYS.
DON'T BE SO WORRIED ABOUT THIS NEEDLE THAT YOUR PATIENT GETS LEFT,
YOU KNOW, WITH THEIR BUTT SHINING UP THERE.
ALRIGHT. NOW YOU NEED TO DISPOSE OFF THIS THING.
YOU ALREADY CAN APPRECIATE THAT THIS IS A REUSABLE CARTRIDGE, RIGHT?
SO WHAT I WANT YOU TO DO IS PUT ONE HAND HERE
AND STABILIZE THE CARTRIDGE.
YOU NEED TO RELEASE THE CARTRIDGE WITH THE BLUE PIECE,
AND THEN YOU'VE GOT TO RELEASE THE PLUNGER
WITH THE PLUNGER PIECE AND GET OFF THE SCREW AND PULL IT OUT,
OTHERWISE IT WILL HOLD ON TO YOUR CARTRIDGE
AND IT WON'T GO INTO THE SHARPS CONTAINER.
AND THEN WITH ONE HAND, YOU JUST COME UP HERE AND YOU DROP IT INTO THE SHARPS CONTAINER.
KEEP THIS.
IF YOU ARE FUSSING AND FUSSING AND FUSSING AND YOU CAN'T GET IT,
JUST THROW IT ALL INTO THE SHARPS.
THERE ARE MORE OF THESE IN THE PHARMACY. I'M TELLING YOU, OKAY?
BUT TRY. ESPECIALLY IF YOU GOT A NEEDLE, A GUARD ON THAT NEEDLE,
YOU'RE NOT GOING TO GET STUCK, BUT TRY TO GET IT OUT.
ALRIGHT. THEN I WOULD CLEAN UP MY MESS,
TAKE MY GLOVES OFF, WASH MY HANDS AND DOCUMENT.
BEFORE I FORGET, I DO WANT TO MENTION THAT CONNIE AND I
DON'T WANT YOU TO THROW YOUR CARTRIDGES INTO THE SHARPS CONTAINER.
THESE CARTRIDGES COST ME 50 BUCKS A BOX.
IT'S RIDICULOUS, WHEN I PAY FOR SALINE IN A CARTRIDGE THAT'S FAKE.
SO WE'RE GOING TO PUT OUT SOME JUST PLAIN EMPTY BOXES
AND THEN YOU CAN DUMP THEM IN THERE LIKE YOUR SHARPS AND PRACTICE.
AND THEN WHEN YOU TEST, I'LL EVEN HAVE YOU DUMP THEM INTO THIS LIKE IT'S YOUR SHARPS.
EVERYTHING ELSE, ALL YOUR OTHER SYRINGES WHEN YOU TEST
YOU'LL ACTUALLY PUT INTO SHARPS BECAUSE I CAN GET MORE OF THEM.
OKAY. LET'S DOCUMENT.
BECAUSE DOCUMENT IS ASTERISKED AND IT WILL BE ASTERISKED ALL SEMESTER.
OKAY.
IT IS 1:45, SO WE'RE GOING TO THE SEVEN TO THREE SLOT.
SO -- OH, BROTHER, I HAVE ALREADY ERRORED.
ERROR DB.
13:45 AND THEN I GOT THE TIME, THE SITE AND MY INITIALS.
SO I HAVE TO GO DOWN HERE TO THE KEY HERE.
IT'S NOT VERY EASY TO SEE.
YOU CAN SEE PROBABLY BETTER ON YOUR OWN SHEET.
BUT I'M LOOKING FOR A DORSAL GLUTEAL.
AND IT IS NOT VERY SPECIFIC ON THIS.
AND THIS HAPPENS TO BE, I BELIEVE ST. AGNES' SHEET, YES.
AND ALL THEY SAY IS LEFT GLUTEAL OR RIGHT GLUTEAL.
WELL, I WANT TO BE A LITTLE MORE SPECIFIC
COS WE'RE NOT GOING TO BE DOING ANY DORSAL GLUTEAL FOR THE MAIN THING,
AND WE WANT TO BE MORE SPECIFIC.
SO I WROTE MY OWN KEY CODE DOWN HERE
AND I WROTE LDG FOR LEFT DORSAL GLUTEAL.
WELL, I HAPPENED TO DO THIS ONE IN THE RIGHT,
SO I AM GOING TO SAY RDG FOR RIGHT DORSAL GLUTEAL.
THIS PEN IS JUST TOO BIG, BUT YOU GET THE IDEA.
SO UP HERE, I'M GOING TO WRITE...
RDG AND THEN MY INITIALS DB.
SO I HAVE THE TIME, THE SITE, MY INITIALS
AND I SIGN BELOW MY INITIALS, DB RN.
AND REMEMBER YOUR SN CSUF.
AND YOU WILL LOSE ALL YOUR POINTS FOR CREDENTIALS.
I KNOW IT'S HARD, BUT WE JUST GOT TO FINISH OFF THE SHEET.
YOU GOT TO DO ALL OF PIECES OF IT, SO MAKE SURE YOU SIGN.
YOU CAN SIGN YOUR NAME ON YOUR MAR BEFORE YOU GO INTO THE ROOM.
YOU JUST CAN'T SIGN THE MED GIVEN UNTIL YOU GIVE IT.
ALRIGHT. SO THAT'S YOUR FIRST SHOT.
WHEN YOU GET PREPARED,
NEXT WEEK WHEN YOU COME IN WE'LL HAVE THE CARTRIDGES
AND THE SYRINGES ALREADY READY FOR YOU.
SO YOU CAN GO AHEAD AND PREPARE YOUR DEMEROL.
WE ARE NOT GOING TO WATCH YOU, OKAY?
SO HAVE YOUR CARPUJECT SET IN THE HOLDER AND YOUR DOSE SET.
AND THEN YOU'LL COME IN AND YOU'LL JUST GO TO THAT STATION
AND GIVE THAT SHOT AND IT WILL GO PRETTY FAST.
ANY QUESTIONS ON THAT ONE?
EVERYTHING IS AGAIN, UP IN THIS UPPER CORNER.
ALRIGHT. NOW WE ARE GOING TO MOVE TO AMPICILLIN.
WE'VE REVIEWED THIS ORDER. YOU KNOW, IT'S GOOD TO GO.
AMPICILLIN 300 MG HAS BEEN ORDERED FOR YOUR CLIENT, IM.
Q6 HOURS. YOU HAVE IT ON THE MAR.
300 MG. WONDERFUL.
I HAPPEN TO KNOW HOW AMPICILLIN COMES
AND SO WE NEED TO BE LOOKING AT --
AND IF YOU BROUGHT YOUR SYLLABUS, FIND THE LABEL FOR YOUR AMPICILLIN.
OKAY.
I'M IN THE NURSING STATION. DRAMA CLASS. HERE WE ARE.
WHAT WE'RE GOING TO HAVE YOU DO ON THIS ONE IS YOU'LL GATHER UP YOUR SUPPLIES,
BUT YOU'RE GOING TO GO TO A STATION AND DRAW UP FOR SOMEONE,
AND THEY'LL CHECK YOU OFF AT THE STATION.
MAKING, DOING YOUR AMPICILLIN, DILUTING IT,
RECONSTITUTING IN THE VIAL AND THEN GETTING THE RIGHT DOSE.
SO THAT'S ONE STATION AND THEN YOU'LL GO GIVE IT AT ANOTHER STATION.
YOU'LL HAVE THREE STATIONS THAT YOU'LL BE GOING BETWEEN
AND ROTATING TO NEXT WEEK.
ALRIGHT. FROM THE TOP.
I'VE CHECKED MY DOCTOR'S ORDERS, AMPICILLIN 300 MG/IM/Q6.
I CHECKED ALLERGIES. AGAIN, MY CHART DOESN'T SAY,
BUT I'M PRETTY SURE IF IT'S THE SAME CLIENT, I HAVE SULFA.
SO SULFA AND AMPICILLIN AREN'T A PROBLEM.
WHAT DO YOU THINK ABOUT PENICILLIN OR CODEINE?
- PENICILLIN IS A PROBLEM. - PENICILLIN IS A PROBLEM.
SO, IF YOU GET TO THE BED AND THE NAME TAG SAYS,
"OH! PENICILLIN, CAN'T GIVE THIS."
WE'LL SAY, "YEP, YOU'RE RIGHT. NOW, GO AHEAD AND GIVE IT."
SO YOU STILL GOT TO NOTE IT.
WE WANT YOU TO BE AWARE OF THE ID BAND,
BECAUSE THAT'S YOUR LAST CHECK IN ANY CLINICAL SITUATION.
BUT LIKE I SAID, I DON'T KNOW WHICH BED YOU'RE GOING TO SO...
AND WE NEED TO GIVE THE SHOT.
ALRIGHT. SO I KNOW MY SHOT,
I KNOW ALLERGIES ARE PROBABLY NOT AN ISSUE AND MY DOSE IS OKAY.
NOW I NEED TO GATHER MY EQUIPMENT.
I'M GOING TO NEED A SAFETY LOCK SYRINGE
TO GIVE IN THE VENTRAL GLUTEAL MUSCLE,
AND I'M GOING TO GIVE AMPICILLIN.
SO WHEN I GO TO THE DRAWER TO GET MY MED OUT,
WHAT I FIND IS AMPICILLIN AND A VIAL.
BECAUSE YOU HAVE TO CREATE AMPICILLIN.
AMPICILLIN IS ONLY GOOD FOR ONE HOUR, ONCE IT'S BEEN RECONSTITUTED.
SO PHARMACY CAN'T MIX IT UP
AND EXPECT YOU TO DO IT WITHIN THAT SHORT PERIOD OF TIME.
SO THEY SEND THE POWDER UP AND THEY SEND THE SOLUTION AND YOU GET TO MIX.
THIS IS A TEST ON YOUR MED MATH EXAM.
THERE WILL BE A LABEL OF HOW TO RECONSTITUTE YOUR DRUG.
I GAVE YOU THE LABEL SAMPLE AND THEN YOU COME UP WITH THE INFORMATION.
THE LABEL ALWAYS HAS EVERYTHING YOU NEED TO KNOW ON THE LABEL.
SO IT'S JUST AN EXERCISE IN READING
AND MAKING SURE THAT YOU KNOW WHAT MEANS WHAT.
I TOLD YOU IN YOUR SYLLABUS, WHEN IT TELLS YOU WHAT YOU ARE GOING TO BE DOING FOR THE DAY,
TO LABEL YOUR PRACTOR POWDER VIAL AS A 500 MG AMPICILLIN.
SO I PUT A PIECE OF TAPE ON MINE. AMPICILLIN, 500 MG.
ALRIGHT. AND ALSO, BEFORE I'M GOING TO GET INTO THE LABEL,
I WANT TO TALK A LITTLE BIT ABOUT MY SYRINGE THAT I PICKED.
WELL, YOU CAN'T REALLY PICK YOUR SYRINGE TILL YOU KNOW WHAT YOU GOT GOING.
SO LET'S GO TO OUR LABEL.
LET'S SEE WHAT WE NEED TO DO.
I HAVE THINGS I NEED TO NOT FORGET TO TELL YOU.
OKAY. NO POST-IT NOTE.
NO, EVERY SEMESTER THERE'S ONE MORE POST-IT NOTE.
WHEN YOU LOOK ON THE LABEL, IT TELLS YOU THE ORDER
AND IT TELLS YOU HOW IT'S STOPPED.
AND THESE FIVE QUESTIONS ARE THE FIVE QUESTIONS
THAT I'M GOING TO ASK YOU ON THE MED MATH EXAM IN A FEW WEEKS.
YOUR BOOK DOESN'T ALWAYS ASK ALL OF THESE QUESTIONS.
IT MAY ASK YOU ONE QUESTION.
LIKE, HOW MAY MILLILITERS WILL YOU USE TO RECONSTITUTE?
OR, HOW MANY MILLILITERS TO GIVE THIS DOSE?
OR SOMETHING LIKE THAT. SO THEY'LL PICK PIECES OF IT.
I NEED YOU TO APPRECIATE ALL OF IT EVERY TIME.
SO THESE WILL BE THE FIVE QUESTIONS
AND ALL THE INFORMATION WILL ALWAYS BE ON YOUR LABEL.
SO THE FIRST THING THAT I NEED TO KNOW IS ACCORDING TO THIS LABEL,
WHAT DILUTING FLUID AND HOW MANY MILLILITERS WILL I USE
TO RECONSTITUTE THIS, TO MAKE THIS POWDER LIQUID.
THAT'S WHAT RECONSTITUTE MEANS.
SO WHEN YOU LOOK AT THE LABEL,
THE FIRST THING I DO IS LOOK AT INTRAMUSCULAR. "USE A 125 MG VIAL."
THAT'S NOT ME. MOVE ALONG.
"250 MG VIAL." THAT'S NOT ME. MOVE ALONG.
"FOR DILUTION OF 500 MG..." THAT'S ME. ONE GRAM OR TWO GRAM VIAL.
SO NOW I'M IN THE RIGHT SECTION.
IN SOME WAYS YOU HAVE TO, KIND OF, PERUSE THROUGH.
MAKE SURE TO PAY ATTENTION TO IM AND IV,
BECAUSE THOSE WILL BE DISTINGUISHED OFF AND ON A LABEL
AND YOU DON'T WANT TO GET IN THE WRONG SECTION.
OKAY. ACCORDING TO THIS LABEL, 500 MG,
I WOULD SAY ON ANY LABEL THAT YOU PUT A LINE STRAIGHT ACROSS
SO THAT YOU DON'T GET OFF WHEN YOUR READING.
SO I PUT MINE STRAIGHT ACROSS HERE ON MY 500 MG VIAL
TO SEE WHAT I AM SUPPOSED TO DO.
AND IT SAYS, "THE RECOMMENDED AMOUNT OF DILUTANT IS 1.8 ML."
OKAY, WELL, THAT TELLS ME THE NUMBER OF MILLILITERS,
THOUGH I STILL HAVEN'T FIGURED OUT WHAT IS THE DILUTANT?
WHAT'S THE LIQUID?
IT'S UP THERE IN THAT PARAGRAPH. WHAT DOES IT SAY?
STERILE WATER, USP OR BACTERIAL STATIC,
WHICH IS JUST A UNIT OF DILUTION OR THE BACTERIAL STATIC FORM.
SO I HAVE STERILE WATER VIAL AND IF YOU GUYS --
I CAN'T REMEMBER IF I GAVE YOU STERILE WATER OR NORMAL SALINE,
BUT IF IT IS NORMAL SALINE JUST MAKE IT STERILE WATER FOR THE DRILL.
WE MAKE EVERYTHING WHAT WE NEED IT TO BE FOR THE TIME.
OKAY, SO I HAVE MY STERILE WATER
AND I KNOW I NEED 1.8 ML TO DILUTE THIS.
WHEN I PUT IN 1.8 ML, HOW MUCH SOLUTION WILL BE IN THAT VIAL?
- 2 MILLILITERS.
- 2 ML, BECAUSE THE POWDER PLUS THE LIQUID IS GOING TO MAKE TWO.
THEN MY NEW CONCENTRATION IS GOING TO BE 250 MG/ML.
SO THAT ANSWERS MY NEXT QUESTION,
WHAT IS MY SOLUTION AND NEW STOCK?
I HAVE NOW CREATED AMPICILLIN, 250 MG/ML.
HOW MUCH THEN WILL YOU GIVE?
WHAT DOES THAT MEAN?
WHAT AM I SUPPOSED TO GIVE? - THE DOSE.
- A DOSE. 300 MG.
AND I HAVE 250 MG/ML.
SO I WOULD SET UP A SIMPLE PROPORTION.
IF 250 MG EQUALS 1 ML,
300 MG IS GOING TO EQUAL X ML.
CROSS MULTIPLY.
I KNOW 300 IS MORE THAN 250, SO IT'S GOING TO BE MORE THAN ONE.
OKAY, SO MAKE THAT VISUAL CONNECTION.
AND I HAVE DONE MY MATH, AND I KNOW IT IS 1.2.
I THINK I HEARD SOME PEOPLE SAY THAT.
OKAY, 1.2 ML IS MY DOSE.
SO THE ANSWER IS AMOUNT TO GIVE 1.2 ML.
SO IT'S ALWAYS REFERRING TO THE DOSE.
ON "D" IT SAYS, WHAT DO YOU WRITE ON THE LABEL?
WHENEVER YOU POP THE LID OFF AND YOU RECONSTITUTE YOU ARE GOING TO LABEL THIS,
SO IF THE NEXT GUY USES IT THEY WILL KNOW HOW OLD IT IS AND IF IT'S OKAY.
SO YOU WOULD PUT THE DATE, THE TIME,
YOUR INITIALS AND THE CONCENTRATION THAT YOU HAVE CREATED.
SO I WOULD NEED TO PUT ON HERE...
1/28/04,
13:50, DB,
250 MG/ML...
IF I WAS SAVING THIS. BUT WHAT DID I TELL YOU?
IT'S ONLY GOOD FOR AN HOUR. SO I AM GOING TO WRITE NOTHING AND SAY,
"NOTHING, IT'S ONLY GOOD FOR AN HOUR."
BUT THERE ARE MANY AND YOU WILL SEE AS YOU LOOK AT YOUR LABELS. GET INTO YOUR MED BOOKS.
I AM GOING TO GIVE YOU AN ASSIGNMENT NEXT WEEK AND HAVE YOU TURN IN SOME OF YOUR LABELS,
SO I CAN MAKE SURE YOU'RE READING IT AND YOU'RE OKAY.
BUT IF YOU'RE SAVING IT, YOU NEED TO PUT THAT INFORMATION.
BECAUSE SOME DRUGS ARE GOOD, REFRIGERATED FOR THREE DAYS
OR SOME ARE GOOD FOR SEVEN DAYS AND SOME ARE, YOU KNOW,
WHATEVER THE LABEL SAYS. WE'RE GOING TO LOOK AT A FEW.
AND THEN STORAGE. HOW WOULD WE STORE IT?
WE'RE NOT. WE'RE GOING TO THROW IT AWAY ON THIS ONE.
BUT SOME WILL SAY REFRIGERATE, ROOM TEMPERATURE AND SO FORTH.
ALL THE INFORMATION IS ALWAYS GOING TO BE ON YOUR LABEL.
IT'S NEVER A TRICK, IT'S NEVER A -- THEY WANT YOU TO KNOW,
BUT YOU NEED TO BE ABLE TO FIND THAT INFORMATION.
ALRIGHT. I NEEDED TO KNOW HOW MUCH SOLUTION I WAS GOING TO
DROP INTO MY SYRINGE SO I COULD PICK THE RIGHT SYRINGE.
WE TALKED A LITTLE BIT ABOUT SYRINGE SIZES THE LAST TIME.
IF YOUR DOSE IS 0.5 OR LESS, WHAT SIZE SYRINGE DO YOU HAVE TO PICK?
OKAY, YOU GUYS, YOU GOT TO REMEMBER THIS,
BECAUSE WE ARE TESTING ON ALL OF THESE AT THE END.
CRITICAL THING AND FOR THE REST OF YOUR LIFE.
0.5 AND BELOW HAS TO BE IN A 1 ML SYRINGE FOR ACCURATE DOSING.
BECAUSE REMEMBER THE TB SYRINGE, THE 1 ML SYRINGE,
GOES TO THE HUNDREDTH.
BUT ANYTHING OVER 0.5 CAN BE IN A THREE, FIVE OR TEN.
BECAUSE OUR DOSE IS 1.2 ML,
A 3 ML SYRINGE WILL WORK PERFECTLY FINE.
SO I PICKED A 3 ML SYRINGE.
IT HAPPENS TO BE THE SAFETY LOCK BRAND. REMEMBER THEM.
THAT'S SHEATH ON THE OUTSIDE THAT SLIDES DOWN WHEN YOU PULL IT OUT.
AND I NEED A NEEDLE ON HERE.
OKAY. MY NEEDLE, I'M GOING TO GO VENTRAL GLUTEAL.
AGAIN VENTRO -- GLUTEAL, BUTTOCKS,
BUT VENTRO, WHAT DOES THAT MEAN? - SIDE.
- SIDE. SO NOW, WE'RE GOING TO GO SIDE BUTTOCKS, SIDE GLUTEAL.
THE RULES ARE THE SAME FOR ALL THE GLUTEAL MUSCLES.
ON AN AVERAGE ADULT 100 TO 200 POUNDS, HOW LONG?
- ONE AND A HALF INCHES. - ONE AND A HALF INCHES.
CLOSER TO 200LB YOU MAY WANT TO CONSIDER A 2 INCH,
BUT OVER 200LB, A 2-INCH NEEDLE.
SO I PICKED OUR AVERAGE MANNEQUIN OVER HERE.
AN AVERAGE ADULT, A ONE-AND-A-HALF INCH NEEDLE.
WHAT GAUGE WOULD I PICK? WHAT'S THE RANGE?
BECAUSE THIS IS WATERY. - 20.
- 20 TO 23. WE'RE GOING INTO MUSCLE.
SO I HAVE A 22 GAUGE, ONE-AND-A-HALF INCH NEEDLE
ON MY 3 CC SYRINGE.
STILL GATHERING MY EQUIPMENT. CAN YOU BELIEVE IT, HERE WE ARE.
NOW THERE IS ONE OTHER THING I KNOW ABOUT MIXING A POWDER.
AND THAT IS ANY TIME YOU MIX A SOLUTION YOU'RE GOING TO HAVE TO FILTER IT
BECAUSE THERE IS A RISK OF PARTICLES BEING IN THE SOLUTION.
WE'RE GOING TO BREAK THEM INTO AN AMPOULE.
THERE IS A RISK OF GLASS BEING IN THE AMPOULE.
SO ANY TIME THERE IS A MIXING GOING ON, UNLESS THEY TELL YOU NOT TO,
YOU NEED TO PUT A FILTER NEEDLE ON TO FILTER OUT ALL OF THE PARTICLES.
SO I HAVE GOTTEN A FILTER NEEDLE TO DO MY MIXING.
ALRIGHT. SO YOU ARE GOING TO HAVE A FILTER NEEDLE, YOUR SYRINGE.
I HAVE MY ALCOHOL SWAB, TAPE TO LABEL THINGS. I AM READY TO GO HERE.
REMEMBER WHAT ALL GOOD NURSES HAVE IN THEIR POCKETS?
ALCOHOL SWABS AND?
- CARPUJECTS? - I THOUGHT IT WAS BAND-AIDS.
- BAND-AID. BAND-AIDS, YEAH.
CARPUJECTS. THAT, YOU ARE JUST LUCKY IF YOU HAVE ONE OF THOSE.
AND THAT'S WONDERFUL. BUT ALCOHOL SWABS AND BAND-AIDS FOR SURE.
YOU WANT TO HAVE IN YOUR POCKETS AT ALL TIMES.
BUT I HAVE THEM ON MY TRAY, READY TO GO.
OKAY, MY HANDS ARE WASHED.
I HAVE GATHERED MY EQUIPMENT, I'VE DONE THE TOP THREE OF THE HIGH FIVE.
I AM GOING TO GO AHEAD NOW AND GET INTO MY STUFF.
WHEN I OPEN MY BACTERIAL STATIC WATER, I AM GOING TO MAKE SURE THAT IT HASN'T EXPIRED.
SO CHECK YOUR EXPIRATION DATE ON YOUR VIAL.
AND MINE'S VERY EXPIRED.
BUT IT'S FOR PRETEND, SO IT DOESN'T MATTER.
BUT MAKE SURE THAT YOU'RE NOTING THE DATE.
YOUR STUFF'S NEW, YOU JUST BOUGHT IT, SO IT SHOULD BE GOOD TO GO.
CHECK THE DATE.
IF THIS IS A MULTIDOSE VIAL, THEN AFTER I POP THE LID OFF IT'S GOOD FOR 30 DAYS.
HOW WOULD YOU KNOW WHEN 30 DAYS HAS PASSED?
- CHECK THE LABEL.
- DATE, TIME, INITIALS, IT GOES ON EVERYTHING.
SO I WOULD -- I'M GOING THE POP THE LID OFF,
AND I AM GOING TO GO AHEAD
BECAUSE I ALWAYS HAVE INK PENS IN MY POCKET AS WELL.
AND ON THOSE LABELS, I'M GOING TO WRITE 1/28/04,
13:55, DB.
AND NOW SOMEBODY KNOWS HOW LONG IT'S BEEN OPEN.
HOWEVER MOST OF THE INSTITUTIONS HAVE GOTTEN AWAY FROM MULTIDOSE VIALS.
HOW COMFORTABLE WOULD YOU BE USING A MULTIDOSE VIAL ON DAY 25?
I WOULDN'T. I WOULD THROW IT AWAY.
THEY'RE CHEAP AND I WOULD GET A NEW ONE.
SO MOST EVERYTHING IN YOUR INSTITUTIONS IS NOW A SINGLE DOSE.
YOU USE A VIAL AND YOU THROW IT AWAY
AND IT WILL SAY AT THE BOTTOM, "SINGLE DOSE ONLY."
SO YOU'LL MIX AND TRASH
BECAUSE WE DON'T KNOW WHAT PEOPLE ARE DOING WITH THIS STUFF.
OKAY. AND THEN I WANT ALSO ON MY MEDICATION, CHECK THE EXPIRATION DATE
AND BECAUSE THIS IS A PRACTICE THING, THERE'S NOTHING WRITTEN ON IT,
BUT ALWAYS LOOK FOR MANUFACTURE DATES ON HERE.
COS ONCE IT'S RECONSTITUTED, THEN WE GO BY WHAT IT SAYS AS FAR AS HOW LONG IT'S GOOD.
SO IF THIS IS GOOD UNTIL 2005
AND I RECONSTITUTE IT TODAY AND THEY SAY IT'S ONLY GOOD FOR 24 HOURS,
I GO WITH THE 24 HOURS, NOT THE 2005.
THAT JUST MEANT SEAL. IT WAS GOOD FOR TWO YEARS.
ALRIGHT, POP THAT OPEN.
AND NOW A VIAL IS A VIAL, JUST LIKE IT WAS WHEN YOU DID YOUR INSULIN.
BUT WE'RE GOING TO ADD TO OUR STUFF.
SO, OPEN UP.
THESE ARE LUER LOCK SYRINGES. DID YOU GUYS DO THE LUER LOCK...?
NO, YOURS WERE ALL CONNECTED..
THE NEEDLE WAS CONNECTED TO THE END...THE 1 ML.
THIS IS A LUER LOCK SYRINGE.
LUER LOCK MEANS THAT IT HAS GOT THE THREADS LIKE YOU WOULD SEE ON A JAR.
SO THAT YOU CAN SCREW THE NEEDLE ON AND THAT KEEPS IT FROM SLIPPING OFF.
WE'RE GOING TO USE A SYRINGE NEXT WEEK THAT IS A NON LUER LOCK SYRINGE.
BUT LUER LOCKS ARE WONDERFUL
BECAUSE YOU CAN SCREW THEM AND GET THEM TIGHT.
SO YOU WANT TO CHECK WHEN YOU OPEN UP THE PACKAGE
COS THEY DON'T ALWAYS SCREW THEM TIGHTLY.
AND WHEN YOU GO TO PULL UP STUFF, YOU'RE NOT GETTING YOUR SOLUTION IN
AND YOU CAN'T FIGURE OUT WHY.
IT'S BECAUSE IT'S LEAKING AIR OUT OF YOUR SYRINGE.
ALRIGHT. SO TIGHTEN IT UP.
AND I'M GOING TO DRAWING UP -- OH, I GOT TO GO BACK TO MY PAPER.
NEVER WORK OUT OF YOUR MEMORY, IT'S A SCARY PLACE.
MY 1.8 ML.
AND DO I NEED TO CLEAN THIS TOP AGAIN?
INDECISION OUT THERE.
I AM NOT GOING TO. I POPPED THE LID OFF OF IT, I HAVEN'T DONE ANYTHING,
I HAVEN'T TOUCHED IT AND I KNOW IT'S STERILE.
IF I TURNED MY BACK AWAY FROM IT OR IT'S BEEN USED,
IT MUST BE WIPED WITH ALCOHOL.
SHAKY-HAND SYNDROME. PULL THOSE HANDS IN.
GET THAT NORMAL -- OH, I DON'T WANT THIS NEEDLE.
I GOT TO TAKE THIS NEEDLE OFF.
SHOOT, I DIDN'T MEAN TO DO THAT EITHER.
I GOT TO SAVE THIS, SO I AM GOING TO PUT IT IN HERE
AND WHAT I WOULD RECOMMEND IS THAT YOU JUST TWIST IT OFF
AND LEAVE IT IN HERE AND NEVER TOUCH IT.
BECAUSE WE'VE GOT TO PUT OUR FILTER NEEDLE ON.
WHICH THERE IS REALLY NOTHING TO FILTER.
EVEN IF I HAD FORGOTTEN AT THAT POINT AND PULLED UP THE WATER, THAT'S OKAY.
THERE'S NOTHING THAT'S AN ISSUE THERE, BUT IT'S JUST SIMPLER.
YOU CAN GET YOUR FILTER NEEDLE ON AND PULL THAT OFF.
SO SCREW THAT ON GOOD. THIS THING IS HUGE.
IT'S ONE-AND-A-HALF INCHES AND IT'S A 19 GAUGE,
IT'S A BIG, OLD FAT THING.
OKAY, I AM GOING TO PUT THAT IN, PUT MY AIR IN,
TURN IT UPSIDE DOWN, PULL UP MY 1.8.
BUT I'M ACTUALLY GOING TO PULL UP LIKE TWO AND A HALF.
PULL UP A LOT, GET ALL YOUR AIR TO THE TOP,
TAP IT AND THEN SQUIRT THE AIR OUT.
MAKE SURE THAT THE AIR PASSES THROUGH THE HUB OF THE SYRINGE
BECAUSE YOU'LL FIND THAT YOU GET SOME TRAPPED IN THERE
AND THAT WILL AFFECT YOUR DOSE.
SO I KNOW I PASSED ALL THE AIR.
I'M STILL A LITTLE SHORT OF THIS FLUID,
BUT SEE ONCE I'VE SET IT, THEN NO AIR COMES BACK AND FORTH.
ONCE I'VE HAVE GOTTEN RID OF ALL THE AIR.
AND I AM GOING TO SET MY DOSE AT 1.8.
YOU DON'T HAVE TO HAVE IN THE NURSING WORLD SOMEONE RECHECK YOU,
BUT IN OUR ENVIRONMENT YOU DO.
BECAUSE HOW WOULD I KNOW YOU HAD IT RIGHT.
SO YOU ARE GOING TO SHOW YOUR INSTRUCTOR, "I HAVE 1.8. 1.8."
AND THEY WILL BLESS IT AND YOU CAN TAKE IT OUT. WHOOPS.
ALRIGHT. I TOOK MY EYE OFF THIS AND WALKED AWAY,
ALTHOUGH I AM PRETTY CONFIDENT NO ONE MESSED WITH IT.
BUT I AM GOING TO GO AHEAD AND WIPE THIS OFF.
NOTICE THAT I HANDLED MY NEEDLES OUT AWAY FROM ME
BETWEEN MY FINGERS AND I KEEP MY CAP IN MY HAND.
I DON'T LIKE TO SET IT DOWN BECAUSE I DON'T LIKE THEM TO GET CONTAMINATED.
IF YOU DO SET IT DOWN, IT'S BEST IF YOU CAN SET IT DOWN ON YOUR STERILE SURFACE
RATHER THAN ON THESE DIRTY, OLD TRAYS.
ALRIGHT, I AM GOING TO PUT MY NEEDLE IN.
REMEMBER THESE SAFETY LOCKS.
THAT OUTSIDE SHEATH SLIDES,
SO YOU'RE GOING TO BE BETTER SERVED TO HANDLE IT BY THE FLANGE,
SO YOU DON'T GET A LOT OF SLIPPAGE.
AND NOW YOU WANT TO SQUIRT IN THAT 1.8.
AND I TRY TO SQUIRT IT ALL OVER THE EDGES TO GET ALL THE POWDER.
LEAVE YOUR SYRINGE IN, HOLD THE TWO OF THEM AND SHAKE IT UP.
THIS ISN'T INSULIN AND YOU GOT TO GET IT ALL OFF OF THERE.
THIS IS SOME SUGAR CRYSTALS OR SOMETHING, SO IT'S GOT TO DISSOLVE.
SO SHAKE, SHAKE, SHAKE.
SOMETIMES I HAVE HAD POWDERS GET LIKE STUCK ON THE SIDE OF THE VIALS
AND YOU ARE SHAKING FOR EVER TO GET THAT LOOSE.
I'VE TRIED TO GET NEEDLES DOWN THERE TO SCRAPE IT OFF AND JUST GET IT LOOSE,
BUT YOU NEED ALL OF IT DISSOLVED OR YOU WON'T HAVE THE RIGHT DOSE.
OKAY. SO I HAD IT ALL DILUTED. IT LOOKS GOOD.
I DON'T SEE ANY PARTICLES IN THERE.
SO NOW I WANT TO REVISIT MY DOSE WHICH IS...1.2 ML.
1.2 YOU GET 300. OKAY.
SO YOU CAN BARELY SEE THROUGH THIS LITTLE LABEL, TO PEER THROUGH.
BUT CAN YOU SEE THAT MY NEEDLE IS WAY OUT OF THE SOLUTION.
SO YOU'RE GOING TO HAVE TO COME DOWN AND STABILIZE.
PULL YOUR NEEDLE ALL THE WAY DOWN HERE INTO THE SOLUTION,
HOLD IT STEADY AND THEN PULL YOUR SOLUTION OUT.
IT'S KIND OF THICK.
YOU GUYS CAN PUT MORE IN TO TRAP THIS FLUID.
I WANT TO SET IT AT 1.2.
AND IT'S AT THIS POINT AGAIN, THAT YOU'LL LOOK AT YOUR INSTRUCTOR,
ONCE YOU ARE SET AND YOU ARE HAPPY.
ONCE YOU SHOW IT TO HIM, THAT'S IT.
YOU CAN FUSS ALL YOU WANT OVER THERE.
BUT ONCE YOU GO LIKE THIS, THAT'S WHEN WE DECIDE IF IT'S A MED ERROR OR NOT.
1.2, 1.2 AND IT'S GOOD TO GO.
WAIT TO SEE IF I COULD FIND THE BRAND.
OKAY.
YOU ARE GOING TO CAP IT.
BECAUSE YOU WANT THE CAP COS YOU'RE GOING TO HAVE TO TAKE
THE FILTER NEEDLE OFF. VERY CAREFUL.
PUT YOUR HANDS DOWN HERE. OOPS, I AM DRIBBLING ALL OVER MY MED SHEET.
PUT IT DOWN, GET IT IN HERE, HANDLING IT BY THE FLANGE
AND THEN ONCE IT'S ON DOWN HERE AT THE END,
I AM HANDLING THE FLANGE AND I AM TWISTING HERE
AND I AM GOING TO TWIST MY FILTER NEEDLE OFF,
AND THEN THIS IS GOING TO GO INTO THE SHARPS CONTAINER.
FOR NOW I AM JUST GOING TO SAVE IT BECAUSE WE'RE GOING TO REUSE THEM FOR A WHILE.
THEN I'M GOING TO COME IN TO MY PACKAGE.
AND AGAIN, TRY NOT TO EVER TOUCH THESE ENDS.
AND I AM GOING TO TWIST ON MY ONE-AND-A-HALF INCH CLEAN, BEAUTIFUL NEEDLE,
BUT NOT A FILTER NEEDLE.
YOU DO NOT EVER WANT TO GIVE A SHOT WITH THE FILTER NEEDLE ON.
THAT WOULD BE MISERABLE.
OKAY. NOW BECAUSE THERE ARE NO MARKINGS WHATSOEVER ON THIS SYRINGE,
I AM GOING TO LABEL THIS ONE BECAUSE I DON'T KNOW WHAT IT IS.
SO YOU ARE GOING TO GET YOUR PAPER TAPE.
YOU CAN ALREADY HAVE THESE PRE-LABELED
BEFORE YOU COME TO THE TESTING AREA TO SAVE A LITTLE TIME.
THIS IS AMPICILLIN, 300 MG.
AND I ALREADY KNOW HOW MANY MILLILITERS IT IS.
I CAN SEE THAT ON THE SYRINGE, SO I DON'T WANT TO WASTE MY TIME.
AND I AM GOING TO PUT MY LABEL ON MY CAP.
DON'T PUT IT ON HERE, BECAUSE IF THIS SHIFTS THEN YOU CAN'T SEE YOUR DOSE
AND YOU DON'T WANT TO PUT ON YOUR PLUNGER BECAUSE THEN YOU CAN'T PLUNGE.
OKAY. MY DOSE IS SET.
I AM GOING TO DO MY SECOND CHECK.
1.2 AMPICILLIN. AMPICILLIN 500. I AM HAPPY.
I'M NOT GOING TO THROW THIS AWAY UNTIL I AM ABSOLUTELY DONE
BECAUSE WHAT IF I'M WALKING DOWN THE HALL
AND HAVE A SPAS AND SHOOT OUT A LITTLE.
AT LEAST I COULD GO BACK TO THIS AND RESET MY DOSE.
SO I'M GOING TO SAVE IT UNTIL I REALLY NEED TO THROW IT AWAY,
BUT EVERYTHING ELSE. YOU WANT TO CLEAN UP ALL OF YOUR TRASH,
GET IT OFF OF YOUR CART IN THE MED ROOM,
AND GET READY TO GO.
OKAY.
I HAVE MY TRAY. I KNOW I'M GOING TO GO VENTRAL GLUTEAL.
I HAVE A BAND-AID. I HAVE ALCOHOL SWABS I DON'T REALLY NEED.
I AM NOT GOING TO Z-TRACK THIS ONE,
JUST SO YOU CAN USE A DIFFERENT TECHNIQUE.
SO I DON'T NEED THE 2 BY 2, ALCOHOL SWAB WILL WORK,
AND I HAVE EVERYTHING I NEED.
ALRIGHT, THE LAST THING I DO NEED, HOWEVER, IS A PLAN AND YOU NEED A PLAN.
YOU NEED TO KNOW WHERE THE VENTRAL GLUTEAL MUSCLE IS.
AND THIS IS WHERE I NEED A VOLUNTEER. SOMEBODY. SIDE BOTTOM.
OKAY, YOU GUYS, I'LL JUST GOING TO CALL YOU.
YOU'RE IN A UNIFORM. YOU DON'T LOOK TOO...
AND THE REASON I HAVE TO DO IT ON YOU IS BECAUSE I CAN'T DO IT ON ME,
BECAUSE YOU HAVE TO USE THE OPPOSITE HAND OF THE HIP YOU'RE DOING.
SO I WILL HAVE TO USE THE LEFT HAND ON THE RIGHT HIP
OR THE RIGHT HAND ON THE LEFT HIP AND IT HAS TO FACE THE RIGHT WAY.
AND YOU TEND TO... SO COME UP HERE AND JUST STAND SIDEWAYS.
FIRST THING IS OUR GOAL,
JUST A LITTLE MEMO HERE THAT WE'RE GOING TO BE TURNING OFF THOSE CELL PHONES AND PAGERS
BECAUSE NOW IT'S ALL ON OUR VIDEO TAPE.
WE'RE GOING TO TAKE A LITTLE PAUSE FOR EDITING.
WHEN YOU FIND THE VENTRAL GLUTEAL MUSCLE, BOTTOM-LINE, JUST FROM THE EASE OF IT,
APPRECIATE THAT IT IS SIMPLY BETWEEN YOUR ILIAC CREST AND YOUR GREATER TROCHANTER.
IT'S THE MUSCLE SMACK IN THE MIDDLE.
BUT THEY'RE GOING TO SHOW YOU IN YOUR TEXT BOOK HOW TO FIND IT,
AND THIS IS HOW THEY DESCRIBE IT ALL THE TIME.
WHEN A CLIENT'S IN BED, YOU WANT THEM, IF THEY CAN,
TO BE SIDELINED AND THEY CAN PUT THEIR LEG OVER A LITTLE BIT
SO THAT THERE IS A LITTLE BIT OF A BEND.
SO THAT YOU CAN START FINDING YOUR ANATOMICAL SPOTS.
HOWEVER, I TOLD YOU THEY CAN BE LAYING FLAT ON THEIR BACK
BECAUSE YOU CAN GET TO THE SIDE FROM...FOR THE VENTRAL GLUTEAL.
WHAT YOU WANT TO DO IS LOCATE THE GREATER TROCHANTER.
FIND YOUR OWN AND THEN YOU ARE GOING TO FOLLOW THAT SPINE DOWN
TO THE ANTERIOR SUPERIOR ILIAC SPINE.
OKAY, THEY ARE BOTH SUPERIORS,
BUT THIS IS ANTERIOR AND THIS IS POSTERIOR.
ANTERIOR SUPERIOR ILIAC SPINE, NOT A CREST.
THIS IS THE CREST.
THIS IS THE SPINE.
AND THEN THE GREATER TROCHANTER. OKAY?
SO ONCE YOU'VE FOUND THOSE THREE,
WHAT YOU HAVE TO DO IS TAKE THE OPPOSITE HAND OF THE HIP YOU'RE ON.
SO I AM TAKING MY LEFT HAND FROM HER RIGHT HIP
AND I AM GOING TO PUT MY PALM ON HER GREATER TROCHANTER.
I AM GOING TO POINT MY THUMB TOWARDS GROIN
AND I AM GOING TO PUT MY INDEX FINGER ON ILIAC SPINE.
THEN I'M GOING TO STRETCH MY FINGERS AS FAR AS THEY'LL GO
AND IT'S SUPPOSED TO BE RIGHT THERE.
AND I'M FEELING AND I AM HAPPY.
BECAUSE IT HER, KIND OF, A LITTLE POOCHY MUSCLE THERE.
EVERYONE. I MEAN, FEEL. IT SHOULD HAVE A LITTLE GIB.
THERE SHOULD BE MUSCLE AS OPPOSED TO, IF YOU WERE UP HERE ON THE CREST,
THERE IS NO GIB THERE, THAT'S BONE.
AND TROCHANTER IS BONE. YOU CAN FEEL THE DIFFERENCE.
SO FEEL THE BONE AND THEN FEEL THE MUSCLE.
PALPATE FOR BRUISING, SOFTNESS, ALL RIGHT THERE.
THANK YOU. THAT'S ALL I NEEDED.
AND IT LOOKS LIKE THIS ON HERE.
IF THIS WERE THE HIP, THE GREATER TROCHANTER,
MY PALM, INDEX TOWARDS GROIN, FINGER ON THAT SPINE
AND SPREAD BACK AS FAR AS YOU CAN GO AND THEN RIGHT HERE IN THE MIDDLE.
NOW, YOU DON'T HOLD YOUR HAND LIKE THAT AND GIVE THE SHOT LIKE THIS.
YOU WILL BE SURPRISED.
AND ACTUALLY IN THE TEXT BEFORE AND I LOOKED TO SEE IF THEY HAVE THAT PICTURE
AND THAT'S HOW THEY SHOWED IT IN THE PICTURE,
IN THE SECOND EDITION OF YOUR TEXT, LIKE THIS.
THERE IS NO WAY UNDER THIS EARTH I WOULD GIVE A SHOT BETWEEN THOSE TWO FINGERS.
THERE IS NOT ENOUGH SPREAD. AND I'M SUCH A SPAS.
YOU KNOW MY HANDS SHAKE.
AFTER YOU FIND THE SPOT, YOU PALPATE IT AND THEN YOU GO LIKE THIS.
GIVE YOURSELF A WIDE GIRTH WITH WHICH YOU WILL BE STABBING, OKAY?
ALRIGHT. WE HAVE A PLAN, WE HAVE A SHOT,
WE HAVE A CLIENT AND WE ARE GOING TO DO IT FROM THIS SIDE.
HELLO, MR. SPADE, I'M DIANE YOUR NURSE AND I HAVE A SHOT FOR YOU.
WE'RE GOING TO START YOU ON AN ANTIBIOTIC FOR YOUR CELLULITIS.
CAN YOU TELL ME YOUR FULL NAME?
SAM SPADE? GREAT. CAN YOU ROLL OVER?
WELL, HOW NICE THEY PUT NAME BANDS ON BOTH YOUR ARMS THAT WAS HELPFUL?
SAM SPADE, LET ME JUST CHECK YOUR NAME BAND.
DR. FEEL GOOD 001010001, GREAT.
AND I SEE YOU'RE ALLERGIC TO SULFA.
HAVE YOU EVER TAKEN A PENICILLIN DRUG BEFORE? AMPICILLIN?
YOU HAVE NO PROBLEM WITH IT.
NO RASH, NO DIFFICULTY BREATHING. GREAT.
SO I'VE CHECKED ALLERGIES.
AND I ALREADY DID THE WASH HANDS WHEN I DID MY MED, SO NOW PROVIDE PRIVACY.
OKAY, WE GAVE YOU YOUR DEMEROL SHOT ON YOUR RIGHT HIP.
SO I WOULD LIKE TO GIVE YOUR AMPICILLIN ON YOUR LEFT HIP.
WE ARE GOING TO ROTATE. ALWAYS BE THINKING.
YOU DON'T WANT TO JUST KEEP PLOUGHING THE SHOT INTO THE SAME PLACE ALL THE TIME
OR THEY WILL GET NECROSIS INTO THAT SPOT.
YOU KNOW, GET HARD.
SO I THINK IT WOULD BE EASIER IF YOU COULD ROLL ON YOUR SIDE FOR ME.
GREAT. AND HE'LL JUST ROLL ON RIGHT OVER.
I WILL PUT THE BED UP...
TO A GOOD WORKING HEIGHT.
ALRIGHT MR. SPADE, YOU GOT A FOLEY CATHETER THERE, HUH?
SO IF THEY CAN, ROLL OVER IS THE BEST.
AND I WILL SHOW YOU HOW IT LOOKS.
YOU TAKE AND PUT ONE LEG OVER.
THAT'S THE POSITION YOU WANT.
THAT'S KIND OF A RIGHT SIMS' POSITION.
SIDE-LYING POSITION.
AND NOW WE'VE GOT TO SEE HIS BOTTOM, SO THERE YOU GO.
I KNOW IT'S HIS SIDE.
SO AGAIN -- IT'S ACTUALLY, MAYBE, EVEN EASIER TO SEE IT
IF I WENT TO THIS SIDE OF THE BED, INSTEAD OF STANDING BEHIND HIM.
AS FAR AS SITE LOCATION GOES.
BECAUSE I CAN PUT MY HAND HERE ON HIS GREATER TROCHANTER,
THUMB TOWARDS GROIN, INDEX FINGER ON SPINE AND SPREAD.
AND IT'S HERE. IT'S MUCH EASIER THAN IT WAS FOR ME TO REACH OVER THAT WAY.
SO EITHER SIDE OF THE BED MAY WORK BETTER FOR YOU.
AND I AM GOING TO PALPATE. ALWAYS PALPATE.
ONE OF THE THINGS THAT I HAVE NOTICED WITH AS MANY PEOPLE AS I SEE CHECKING PEOPLE
IS SOME OF YOU HAVE LITTLE, TINY HANDS, SOME OF YOU HAVE TALLER TORSOS.
SOME OF YOU HAVE BIG, OLD HANDS, SHORTER TORSOS.
AND SO I HAVEN'T FOUND THIS TO BE THE MOST ACCURATE TECHNIQUE
BECAUSE OF THE VARIATIONS FROM PERSON TO PERSON.
SO EVEN THOUGH YOU HAVE DONE EVERYTHING LIKE YOU'RE SUPPOSED TO,
MAKE SURE THAT YOU PALPATE THAT SITE
OVER AND ABOVE EVERYTHING ELSE YOU'VE DONE.
AND VISUALLY LOOK FROM THE SIDE LINE, IS IT IN THE RIGHT PLACE.
OKAY, I'M HAPPY WITH MY SITE LOCATION.
I AM GOING TO DO MY THIRD CHECK. AMPICILLIN. I HAVE 1.2 MG,
300 MG AND IT IS AMPICILLIN.
I'M HAPPY WITH MY DOSE. I'M GOING TO GO AHEAD AND GET MY BAND-AID READY.
AND I GET THEM READY. I PUT BAND-AIDS ON EVERYBODY,
COS ALMOST ALWAYS WITH MOVEMENT THERE'S A LITTLE BIT OF BLOOD THAT COMES OUT.
SO I TAKE A BAND-AID AND JUST PEEL ONE HALF OFF.
GET MY ALCOHOL READY
AND I WOULD EITHER STAND LIKE THIS OR IF I WAS ON THE OTHER SIDE,
STAND AND FACE THAT WAY.
ONCE I'VE FOUND MY SITE LOCATION, AGAIN, I AM GOING TO PALPATE.
AND ON THIS ONE, I'M GOING TO CLEAN
AND I'M GOING TO PUT MY ALCOHOL SWAB EITHER IN MY FINGERS READY TO USE
OR I LIKE TO TELL STUDENTS JUST TO LAY ON THE SKIN
AND POINT IT TOWARDS WHERE YOU WANT TO AIM.
AND IT KIND OF GIVES YOU A LITTLE TARGET AND IT WILL STICK RIGHT TO THE SKIN.
OKAY, PULL THE CAP OFF.
I GOT MY NEEDLE I AM PLEASED WITH, ONE AND A HALF INCHES.
I AM GOING TO SQUEEZE THE SKIN ON THE SQUEEZER.
YOU CAN ALSO SPREAD IT TAUT.
BUT THE WHOLE POINT IS THAT YOU WANT THE SKIN TO BE A LITTLE BIT TAUT,
SO THAT WHEN YOU PUT THAT NEEDLE THROUGH,
YOU DON'T GET A PUCKER OF LOOSE SKIN, RIGHT?
SO, I SQUEEZE.
I AM GOING TO MAKE SURE THAT I GO IN AT 90 DEGREE ANGLE.
SO THAT'S GOING TO BE STRAIGHT DOWN.
I AM GOING TO WARN THE CLIENT. A LITTLE POKE.
POKE. I AM GOING TO ASPIRATE RIGHT BY TO 10 SECONDS.
IF THERE IS ANY BLOOD, I AM GOING TO PULL MY NEEDLE STRAIGHT OUT.
IF THERE'S NOT, I AM GOING TO PUT IT IN
AND I AM GOING TO GO SLOWLY HOLDING ON THE FLANGE.
YOU ACTUALLY ARE SUPPOSED TO PUT IN 1 ML OVER ABOUT 10 SECONDS.
SO THAT'S WHAT SLOW TRANSLATES.
AND THAT'S A NEW CRITERIA THAT THEY PUT IN THIS TEXT BOOK.
WE'VE ALWAYS SAID SLOW, BUT NO ONE EVER SAID HOW SLOW SLOW WAS.
AND THAT'S WHAT THEY SAID.
ALRIGHT. I FORGOT TO HOLD MY OTHER SHOT 10 SECONDS SO I'LL TAKE ONE OUT.
I'M GOING TO STABILIZE THIS, BECAUSE I CAN. YOU CAN RELEASE.
IN FACT, I COULD HAVE RELEASED TO PLUNGE IF I WANT,
BUT YOU WANT TO STABILIZE THIS SYRINGE.
NONE OF THIS STUFF. NONE OF THIS, OKAY?
STABILIZE AND THEN I AM GOING TO HOLD THAT OUTER SHEET
AND PULL STRAIGHT UP. AND PULL FAST.
DON'T JUST GIGGLE AND TRY TO TUG, COS THAT HURTS.
I'D RATHER YOU PULL OUT, KEEP YOUR HANDS BEHIND AND THEN SHOVE IT DOWN.
BUT PULL IT DOWN AND BLOCK.
I'M GOOD TO GO AND THEN I CAN MASSAGE THIS ONE.
BECAUSE IT'S NOT A Z-TRACK AND I CAN DO IT WITH MY ALCOHOL SWAB.
MASSAGE. HOW ARE YOU DOING? GREAT.
PUT THE BAND-AID ON, WHICH YOU REALLY DON'T HAVE TO BECAUSE IT'S NOT REALLY A PERSON.
AND THEN REPOSITION THEM FOR COMFORT.
I DON'T HAVE A THRASH CAN ON THE SIDE.
THESE SYRINGES YOU CAN LAY DOWN ON YOUR TRAY COS THERE'S NO NEEDLE EXPOSURE.
AND SO YOU DON'T HAVE TO WORRY ABOUT BLOOD GETTING ON TO THE TRAY.
I DON'T LIKE LAYING THOSE SAFETY GLIDES DOWN
BECAUSE ONE SIDE OF THE NEEDLE YOU CAN GET ON TO THE TRAY
AND THE OTHER SIDE HAS THE GLIDE PROTECTOR,
SO YOU SHOULD HOLD THOSE RATHER THAN SET THEM DOWN.
ONCE THOSE ARE LOCKED, THEY'RE NO GOOD.
TAKE MY GLOVES OFF, PUT THEM IN MY AREA.
REPOSITION MY CLIENT. ARE YOU HAPPY ON THAT SIDE? GOOD.
PUT HIM DOWN.
- SO DIANE, WE'RE HOLDING THE INJECTION 10 SECONDS AFTER.
- NO, NOT ON THIS ONE. - NOT ON THIS ONE.
- WE SHOULD HAVE ON THE Z-TRACK. I'M SORRY, I FORGOT THE 10 SECONDS.
SO YOU PUT THE NEEDLE IN, YOU ASPIRATE FOR --
I MEAN, DO YOU EVER REMEMBER YOUR SHOTS BEING FAST IN YOUR LIFE?
BUT THEY'VE MADE US BE SLOW AND I JUST THINK IT WOULD HELP THE CLIENT
TO KNOW THAT THIS TAKES A FEW SECONDS TO DO.
I'M USING A DIFFERENT TECHNIQUE SO THE MEDICATION STAYS IN YOUR MUSCLES,
SO I AM GOING TO HOLD IT THERE. YOU SHOULDN'T FEEL THE NEEDLE.
YOU MIGHT FEEL A LITTLE BIT OF THE MEDICATION,
BUT HOLD STILL SO THAT THE MEDICINE WILL ABSORB BEFORE I TAKE THE NEEDLE OUT.
AND I'LL TELL YOU. SO POKE, PULL UP.
ONE, TWO, THREE, FOUR, FIVE. THAT'S FOREVER TO ME.
I'M HAVING A HARD TIME BUYING INTO THAT ONE.
PUT THE MEDICATION IN SLOWLY ON THE Z-TRACK AND THEN HOLD 10 SECONDS.
ONE, TWO, THREE, FOUR, FIVE, SIX,
SEVEN, EIGHT, NINE, TEN.
FLICK.
DAB.
ALRIGHT. YOU'LL GET ALL THAT. THE SEQUENCING ISN'T THAT BAD.
WE'LL DOCUMENT HERE IN A MINUTE. I JUST NEED TO TELL YOU A STORY.
MY VERY FIRST SHOT.
MOST OF YOU WON'T FORGET ANY OF YOUR VERY FIRST THINGS AND THIS IS MY VERY FIRST.
AND THIS VERY FIRST SHOT,
I'LL NEVER FORGET THIS LADY'S BOTTOM UNTIL THE DAY I DIE.
SHE WASN'T MY CLIENT, BUT THEY CALLED ME IN.
SHE HAD JUST COME OUT FROM SURGERY AND THEY SAID,
"WHOEVER. SHE HAD JUST HAD AN HYSTERECTOMY AND SHE NEEDS A SHOT.
DIANE, YOU HAVEN'T GIVEN ONE YET, DO YOU WANT TO GIVE THIS?"
BUT YOU KNOW IN YOUR HEART YOU KIND OF WANT TO, BUT YOU'RE SCARED TO DEATH.
I WAS TERRIFIED, ABSOLUTELY TERRIFIED.
AND SO I SAID OKAY. SO I GOT MY LITTLE DEMEROL SHOT READY AND I WENT INTO THE ROOM.
AND YOU KNOW MY HANDS SHAKE NORMAL.
BUT WHEN I AM SCARED, OH, MY GOODNESS. SPASTIC.
MY LITTLE HANDS ARE JUST SHAKING. I'M SHAKING.
I AM SO SCARED. I DON'T KNOW WHY I AM SO SCARED, BUT I WAS SO SCARED.
THE LADY'S JUST KIND OF MOANING AND SHE ROLLED OVER.
SHE NEVER EVEN LOOKED AT MY FACE. I'VE NEVER SEEN HER FACE, ALL I SAW WAS HER BOTTOM.
THERE WAS JUST HER BOTTOM IN FRONT OF ME.
AND WE HAD IT EASY THOSE DAYS.
WE DON'T HAVE TO DO THE LANDMARK THING, RIGHT? JUST QUARTER OF THAT BUTT.
AND I LOOKED AT MY INSTRUCTOR AND WENT. AND SHE WENT.
OKAY. SO I TOOK THE CAP OFF.
AND I WENT TO GIVE IT.
AND I BOUNCED OFF HER BUTT. THE NEEDLE COULDN'T GO IN.
ARGH! WHAM!
AND THEN, I MEAN, MY HANDS WERE REALLY SHAKING.
OH, MY GOSH. AND I DIDN'T THINK.
I DON'T KNOW IF I ASPIRATED OR NOT.
I COULD HARDLY HOLD ON AND I PUT IT IN AND I PULLED IT OUT.
AND WE WERE OF THE NON-RECAP PEOPLE.
AND SO WE HAD TO RECAP AND I WAS TRYING TO RECAP AND MY HANDS WERE LIKE THIS.
AND MY INSTRUCTOR PUT HER LITTLE HAND ON MY BACK AND SAID,
"WHY DON'T WE STEP OUT?"
OKAY. OKAY! SO I STEP OUT AND I SAY,
"DID YOU SEE IT BOUNCE OFF HER BUTT. OH, MY GOD! IT BOUNCED OFF HER BUTT."
AND SHE GOES, "YES." AND I SAID, "THAT SCARED ME SO BAD."
SO...THE MORAL OF THE STORY IS
IF IT BOUNCES OFF,
PUSH IT IN!
YOU MIGHT GET SCARED BECAUSE IT TAKES A LITTLE MORE UMPH FOR THAT IM.
YOU GOT TO PUT IT IN.
NOW SINCE THEN, I'VE GIVEN HUNDREDS AND MAYBE THOUSANDS OF SHOTS,
BUT NEVERTHELESS,
I ONLY HAVE DONE IT MY WAY AND I WAS TAUGHT TO DART
AND I HAVE DARTED FROM THAT DAY ON.
WHAM! WHAM! WHAM!
BUT I STARTED DOING STUDENTS AND STUDENTS ARE SOMETIMES A LITTLE TENTATIVE.
SO I WATCH STUDENTS DO THEIR SHOT
AND PUSH THE NEEDLE AND ONLY GO IN A QUARTER OF AN INCH,
AND THEY MAY HAVE AN INCH NEEDLE.
AND THEY'LL TAKE IT AND THEY'LL JUST GO, WHOOP!
NOW, I SEE YOU GOING -- I DID THE SAME THING.
AND THE STUDENT WOULD GO, COS WE WERE GIVING TO EACH OTHER AND THEY WOULD SAY,
"I DIDN'T FEEL A THING."
"NO WAY."
BUT SEE THE NEEDLES ARE SO MUCH SHARPER THAN THEY USED TO BE
AND THEY'RE SILICON-COATED THAT THEY SLIDE RIGHT IN.
SO DON'T BAIL OUT. IF YOU'VE GOT IT IN,
JUST GIVE IT A LITTLE MORE UMPH AND GO STRAIGHT.
- I DID THE SAME THING ONCE TO THIS GIRL WITH A GUARDIAN.
AND SOMETHING WITH HER SKIN. I WAS GIVING HER A SUBCU BEHIND THE ARM.
AND I WENT TO PUSH THE NEEDLE IN AND IT JUST GOT STUCK.
AND I WAS LIKE, "OH, MY GOD!"
I'M LIKE, "I WANT TO TRY THAT ONE MORE TIME."
SHE WAS LIKE, "YOU POKED ME ALREADY."
AND I FELT SO BAD.
YOU DO, BECAUSE IT'S A NEEDLE, YOU KNOW?
BUT THE THING IS IT'S THEIR FLORA
AND SO YOU'RE NOT CONTAMINATING THEM WITH ANYTHING BUT THEM.
SO THAT'S NOT A PROBLEM. AND WHERE I HIT
AND PROBABLY WHERE YOU HIT WAS THE CLEANED PLACE.
SO YOU CAN. AND HIT AGAIN.
OKAY. MY SECOND SHOT.
MY SECOND SHOT. I AM DETERMINED NOW.
YOU KNOW, BECAUSE OF MY FIRST SHOT, I BOUNCED OFF.
SO I AM GOING TO GET THIS ONE IN.
AND THEY GAVE ME A MAN. I'LL NEVER FORGET THESE TWO.
I CAN'T REMEMBER ANY OTHER SHOTS, BUT THESE TWO.
MY SECOND ONE AND HE -- A NICE, NICE GENTLEMAN,
WHO HAD HAD SICKLE-CELL FOR YEARS AND YEARS AND YEARS. HE HAD NO MUSCLES LEFT.
AND RIGHT GLUTEAL, THAT'S WHERE YOU GIVE SHOTS, OR MAYBE VASTUS LATERALIS.
BUT HE HAD NOTHING LEFT AND SO WE WERE GIVING DEMEROL IN HIS DELTOIDS WHICH IS LIKE,
OH, YOU KNOW? IT'S JUST THE LAST RESORT.
SO I WENT TO HIS DELTOID AND I FELT AND FELT AND IT WAS AS HARD AS A ROCK.
HIS MUSCLES -- THERE WAS NOTHING LEFT.
HE HAD HAD SO MUCH, SO MANY SHOTS.
I FOUND THIS ONE, EVER SO SOFT PLACE RIGHT THERE.
IT WAS ABOUT THAT BIG.
I'M GOING TO DO IT. AND I WASN'T SCARED THIS TIME, BUT I WAS DETERMINED.
SO, I FOUND MY SPOT AND I WENT TO SART IT IN AND WHAM!
HE WAS SO TOUGH, THAT THING WOULD NOT GO IN.
AND I PUSHED IT IN, GAVE MY SHOT.
YOU CAN PUSH THEM. DON'T FREAK OUT.
THEY WILL PUSH RIGHT IN, EVEN ON THE TOUGHEST OF SKIN.
ANOTHER SCENARIO, NOT MINE, JUST THINGS YOU NEED TO KNOW.
SOMETIMES YOU UNDER OR OVER ESTIMATE
THE BUTTOCKS AND YOUR NEEDLE AND YOU MAY HIT BONE.
IF YOU HIT BONE. THEN YOU HIT BONE, PULL BACK A LITTLE BIT.
IT'S ALL YOU CAN DO.
YOU DON'T KNOW, IT'S BLIND.
YOU'RE MAKING YOUR BEST GUESS.
AND THAT'S WHY I AM KIND OF A PINCHER BECAUSE I JUST DON'T WANT TO.
I'VE HIT BONE ONCE AND THAT'S A FUNNY FEELING.
AND I JUST PULL BACK, AND GAVE MY SHOT AND THE SAME THING.
- WHAT WOULD HAPPEN IF YOU WOULD INJECT THE BONE WITHOUT KNOWING?
IT WOULDN'T BE IN THE MUSCLE, IT WOULD JUST BE AT BONE LEVEL,
AND YOU WANT IT TO BE ABSORBED IN MUSCLE SO YOU'RE GOING TO PULL BACK.
THERE ARE SHOTS CALLED INTRAOSSEOUS AND WE DON'T WANT TO GIVE THOSE.
WE DON'T WANT TO GIVE A BONE INJECTION.
- BUT NOTHING WILL HAPPEN TO THE PATIENT IF THEY WERE TO GET --
- I DON'T REALLY KNOW THE ANSWER TO THAT QUESTION.
WHAT THEY MIGHT GET? IT MIGHT DEPEND ON WHAT YOUR PUTTING IN THEM.
- WHEN YOU HIT THE BONE, CAN THE PATIENT FEEL THAT?
- SOMETIMES AND SOMETIMES NOT.
THE ONE I DID SAID THEY DIDN'T FEEL IT,
BUT I'VE HAD OTHER PEOPLE SAY THAT THEY'VE FELT THE BONE BE HIT.
AND THEY FEEL LIKE A LITTLE --
WELL, PAIN IS RELATIVE. I MEAN, TO HOWEVER THEY DESCRIBE IT.
BUT THEY FELT THE PRESSURE OR TINGLING OR A HIT.
- COULD YOU BREAK THE NEEDLE?
- YOU COULD, AND THAT WOULD BE A RISK IF YOU WERE REALLY LIKE WHAMMING IT.
BUT I DON'T KNOW OF ANYONE WHO DOES IT THAT HARD.
SO, DID YOU EVER HIT A BONE, TOM?
- NO, I'VE HAD SOMEBODY HIT BONE ON ME ONCE.
AND YOU COULD FEEL IT. - HOW DID IT FEEL?
- IT WAS LIKE SOMEBODY SCRATCHING.
- SO ASK THEM. HOW DID THAT FEEL, YOU KNOW?
- DO YOU THINK THE SHOT HURTS MORE, THE BIGGER IT IS...
- IT VARIES AND WE'RE GOING TO GIVE SHOTS TO EACH OTHER NEXT WEEK.
WE'RE JUST GOING TO GIVE A LITTLE SALINE WITH A NICE, LITTLE THIN NEEDLE DOWN TO IT.
YOU'VE ALL HAD YOUR HEPATITIS, SO COME ON.
AND WHAT WE'RE GOING TO DO IS WE CAN TALK TO EACH OTHER.
AND THAT'S A NICE THING.
YOU CAN GO, "WHAT DID YOU FEEL? WHAT DID YOU THINK?"
AND ALMOST ALL THE TIME, PEOPLE DON'T FEEL THE NEEDLE,
IT'S THE MEDICATION THAT THEY FEEL.
AND IF YOU ASPIRATE TO HARD.
THAT'S WHERE, YOU KNOW, JUST ANALYZING IT OVER THE LAST FEW YEARS.
I MEAN, SERIOUSLY, I DO HOW MANY SHOT WITH ALL THESE STUDENTS
AND THEN I DO CLINICS AND WHAT NOT.
AND FOR THE MOST PART THOSE ARE THE TWO COMPLAINT PLACES.
MED'S LIKE COMPAZINE, THEY BURN LIKE FIRE GOING IN.
SO CERTAIN MEDICATIONS DO BURN AND HURT AND FAR MORE THAN THE NEEDLE IS.
THE FEAR USUALLY IS OVER THE NEEDLE
AND THE NEEDLE IS USUALLY THE LEAST OF THE PROBLEM,
IT'S THE MEDICATION.
OKAY. SO JUST TO KIND OF HELP YOU.
A LITTLE MORE DART THIS TIME, LONGER NEEDLES,
YOU'RE GOING IN MUSCLE, BUT HANDLE THOSE NEEDLES EVER SO CAREFULLY.
WE TRY TO KEEP THE NEEDLES, WE KEEP RECYCLING THEM,
BUT FOR THE DAY WE USUALLY USE NEEDLES
OVER AND OVER AND OVER, IN AND OUT OF THE PADS.
SO IF YOU WERE TO STICK YOURSELF, PLEASE LET US KNOW,
WE NEED TO DISCARD THAT NEEDLE,
YOU NEED TO SCRUB WITH BETADINE AND THEN WE NEED TO SEND YOU OVER TO THE HEALTH CENTER,
SO THAT YOU CAN FILL OUT A REPORT AND THEN THEY'LL ASK YOU ABOUT YOUR TETANUS SHOT
TO MAKE SURE THAT YOU'RE CLEAR ON THAT.
SO JUST BE VERY, VERY CAREFUL. WATCH EACH OTHER, YOU KNOW?
AND MAKE SURE THAT EVERYONE IS USING GOOD TECHNIQUE.
NONE OF THIS STUFF. IT'S NO GOOD.
ALRIGHT. LET'S DOCUMENT THIS AND THEN I JUST HAVE
ONE OTHER LITTLE THING WE NEED TO DO.
ALRIGHT. WE GAVE OUR AMPICILLIN.
300 MG AND WE PROBABLY GAVE IT AT 2:15.
AND WE GAVE IT IN THE...
LEFT VENTROGLUTEAL.
SO WE'RE GOING TO GO DOWN HERE AND I HAVE CREATED A T-CODE.
I OBVIOUSLY DID IT OPPOSITE LAST SEMESTER.
SO RIGHT VENTROGLUTEAL. SO I HOGGED UP ALL MY SPACE.
I NEED A LEFT VENTROGLUTEAL AND I WOULD WRITE IT ALL OUT THERE.
SO LEFT VENTROGLUTEAL AND MY INITIALS, DB,
AND I HAVE SIGNED DOWN HERE.
SO MAKE SURE YOU HAVE ALL YOU SIGNATURE.
AND DO IT IN THIS ORDER, TIME, SITE, INITIALS.
IT REALLY HELPS COS IT STARTS LOOKING LIKE THE ALPHABET SOUP THERE AFTER A WHILE
AND IT'S LIKE WHAT'S WHAT IN THERE, YOU KNOW?
ESPECIALLY IF YOU HAVE INITIALS LIKE LG OR SOMETHING.
LG, LG.
OKAY, I WANTED TO DO JUST ONE -- A COUPLE OF LABELS WITH YOU
AND THEN I WANT TO SHOW YOU HOW TO USE THE CATH SIMULATOR FOR IV THERAPY
COS YOU GUYS NEED TO START DOING SOME IV STUFF, ALREADY.
AND YOU'LL LIKE THAT.
BUT LET'S JUST DO A COUPLE OF MATH THINGS SO THAT YOU CAN APPRECIATE...
WELL, MAYBE YOU CAN'T APPRECIATE TO WELL.
CAN YOU SEE IT AT ALL?
WHAT WE NEED IS ACTUALLY THIS.
YOU CAN'T SEE IT, HUH?
WELL, I'LL JUST TELL YOU.
LET'S LOOK AT YOUR LABEL THAT YOU HAVE.
WHAT ARE THE FIRST THINGS WE'RE LOOKING FOR?
LET'S SAY WE NEED TO GIVE PENICILLIN 300 MG.
OKAY. THAT'S OUR ORDER.
WE HAVE A POLYCILLIN...LABEL.
EITHER WAY, IF IT'S UPSIDE DOWN OR NOT.
POLYCILLIN ONE-GRAM VIAL.
WE NEED TO GET 300 MG. HOW MANY MILLIGRAMS IN ONE GRAM?
- 1000. - 1000. THAT'S GOOD TO KNOW.
ALRIGHT.
LET'S SEE IF I CAN BLOW THAT UP FOR YOU. HOW IS THAT?
OKAY. NOW WE'RE GOOD.
OKAY. SO THE FIRST QUESTION IS WHAT'S OUR DILUTING FLUID AND HOW MUCH?
CAN YOU TELL FROM THE LABEL?
WHAT DOES IT SAY?
RECONSTITUTE WITH STERILE WATER OR SODIUM CHLORIDE.
SO THAT'S THE ANSWER TO THAT QUESTION.
STERILE WATER OR SODIUM CHLORIDE. HOW MUCH?
WELL, IT LOOKS LIKE I HAVE TWO CHOICES.
IF I PUT IN A 100 ML OF STERILE WATER,
THEN I'M GOING TO GET ONE GRAM IN 100 ML.
AND THAT WILL BE 10 MG/ML.
OR IF I DO 50 ML OF DILUTANT,
I'LL GET ONE GRAM IN 50 ML OR 20 MG/ML.
I NEED TO GIVE 300 ML, BUT IT'S IV.
THINK ABOUT THAT.
I FORGOT TO TELL YOU, WHEN YOU GIVE AN IM,
WHAT'S THE MOST FLUID THAT YOU WOULD EVER PUT IN A MUSCLE?
FIVE MILLILITERS.
MOST OF THE TIME WE DON'T LIKE TO DO MORE THAN TWO,
BUT THE MUSCLE ON AN AVERAGE, HEALTHY ADULT CAN HANDLE UP TO 5 ML OF FLUID.
WELL, IF WE'RE LOOKING AT THIS
THAT'S A LOT OF FLUID EITHER WAY YOU FIGURE IT.
SO IT WOULDN'T WORK AS AN IM.
IV, WE CAN PUT IN LOTS OF FLUID BY VEIN.
SO IT DOESN'T MATTER WHICH ONE YOU PICK,
IT WILL JUST AFFECT HOW MUCH YOUR DOSE IS.
SO LET'S SAY THAT WE PICKED, JUST FOR THE EASE OF MATH, A 100 ML AS OUR DILUTANT.
SO A 100 ML OF STERILE WATER.
SO WHAT WILL WE HAVE CREATED?
POLYCILLIN, 10 MG/ML.
SO HOW MUCH WILL WE GIVE TO GIVE THE DOSE?
WE NEED TO GIVE 300 MG AND WE HAVE 10 MG/ML.
- 30. - 30 ML TO GIVE THE DOSE.
WHAT WILL WE WRITE ON THE LABEL?
THIS IS A COOL LABEL
BECAUSE IT HAS EVERYTHING YOU NEED TO WRITE ON THE LABEL.
BUT WE'RE GOING TO WRITE 10 MG/ML ON THE LABEL.
AND THEN PREPARED ON, THE DATE, TIME
AND THEN PUT YOUR INITIALS ON THE END.
HOW LONG ARE YOU GOING TO STORE IT? OR WHAT'S THE STORAGE ON HERE?
DISCARD AFTER 8 HOURS AT ROOM TEMPERATURE
OR 72 HOURS UNDER REFRIGERATION.
AND YOU JUST WRITE THAT EXACT WORDING IN THAT SPOT.
OKAY, SO LOOK AT SOME LABELS IN YOUR MED BOOKS
AND MAKE SURE YOU'RE CLEAR AND UNDERSTAND WHAT THOSE "A" THROUGH "E" MEAN
AND HOW YOU WOULD FIND THAT INFORMATION.
IS EVERYONE GOOD TO GO ON THAT?
OKAY, LET ME JUST GO OVER MY POST-IT NOTES AND MAKE SURE I TOLD YOU THAT.
- DIANE, YOU GLOVED UP ON THE SECOND SHOT, NOT THE FIRST.
THERE IS A DIFFERENCE BETWEEN... - OH, YES, I DID.
I PUT GLOVES ON THE SECOND SHOT.
WE REPLAY THAT VIDEO. YEAH, I DID.
YEAH. ALWAYS.
AND YOU WILL SEE BAD EXAMPLES OUT THERE.
BAD EXAMPLES, TAKE NOTE.
AND YOU'LL SEE GOOD EXAMPLES, TAKE NOTE.
BE THE GOOD EXAMPLE.
- AT THE HEALTH CENTER THEY RECAP THEIR NEEDLE.
AND SHE GOES, "OH, YOU'RE A NURSING STUDENT." AND SHE PULLS IT BACK ON THERE.
THAT IS BAD AND YOU KNOW WHAT ELSE GETS ME?
WATCH WHEN THEY DO THOSE FLU CLINICS AND THEY'LL GO OUT
AND THEY'LL DO MEDIA COVERAGE OF SHOT CLINICS AND STUFF.
THEY NEVER HAVE GLOVES ON. THAT REALLY BOTHERS ME.
OR THEY'LL GO AND THEY'LL SAY THE FLU IS REALLY UP
AND THEY'LL SHOW AN OFFICE NURSE GIVING A SHOT IN THE OFFICE.
AND THEY'LL VERY RARELY HAVE GLOVES ON.
YOU KNOW WHAT? THAT IS YOU THAT IS AT RISK, NOT THE CLIENT. YOU!
TAKE CARE OF YOU ABOVE ALL ELSE.
AND I AM JUST -- I MEAN, I'M GETTING BAD.
AND I GUESS I AM OVER 40 SO I CAN JUST DO THAT.
BUT I JUST START ASKING, "HAVE YOU WASHED YOUR HANDS?
YOU SHOULD PUT GLOVES ON. YOU DON'T KNOW WHERE I'VE BEEN."
AND I JUST SAY, AND I SAY THAT FOR MY FAMILY BECAUSE COME ON!
YES, GOOD EXAMPLES, BAD EXAMPLES, BOTH OF THEM ARE OUT THERE.
OKAY, I TALKED ABOUT Z-TRACK
AND I JUST WANT TO MAKE SURE IT'S RECOMMENDED FOR ALL IM INJECTIONS.
AND YOU COULD DO IT FOR EVERYONE.
YOU JUST DON'T HAVE TO FOR SOME,
BUT IT'S REALLY IMPORTANT FOR CERTAIN INJECTIONS LIKE GOLD...
OH, WHAT ELSE LEAKS BACK?
IRON, BIG. IT HAS TO BE DONE FOR IRON.
THINGS THAT MIGHT BE IRRITATING TO THE TISSUE, JUST MUST BE DONE.
SO IT'S A FINE TECHNIQUE TO USE FOR ALL WHEN YOU'RE GOOD AT IT.
LET'S TALK ABOUT ALL THE MUSCLES FOR RECOMMENDATIONS.
THERE'S FOUR MUSCLES THAT WE GIVE SHOTS IN.
DELTOID, WE'RE GOING TO DO THAT NEXT WEEK.
VASTUS LATERALIS, WHICH IS LIKELY WE'RE GOING TO DO NEXT WEEK.
VENTROGLUTEAL, DORSOGLUTEAL.
DORSOGLUTEAL, NOT RECOMMENDED.
OKAY? BUT YOU KNOW WHERE IT IS.
VENTROGLUTEAL, RECOMMENDED FOR ALL INJECTIONS
AND FOR ALL AGE GROUPS OVER SEVEN MONTHS.
IT'S THE PREFERRED MUSCLE.
SO, ANYTIME YOU HAVE AN IM INJECTION,
YOU SHOULD GIVE IT IN THE VENTROGLUTEAL.
YOU JUST ABSOLUTELY SHOULD. UNLESS IT'S...
NOT HEPATITIS, WHAT'S THE OTHER ONE YOU GUYS GET?
NO, HEPATITIS. THAT IS IT. HEPATITIS NEEDS TO BE GIVEN IN THE DELTOID
AND THAT'S THE ONLY ONE THAT'S RECOMMENDED THAT HAS TO BE GIVEN.
I DON'T KNOW WHY? IT JUST IS.
OKAY, THE SECOND SHOT,
THE SECOND RECOMMENDED MUSCLE IS THE VASTUS LATERALIS.
THE VASTUS LATERALIS IS THE NUMBER ONE PREFERRED MUSCLE
FOR CHILDREN UP TO SEVEN MONTHS.
BECAUSE THEY'RE JUST NOT WELL DEVELOPED ENOUGH
AND THEY SHOULD NEVER GET A DELTOID.
THEY'RE JUST NOT DEVELOPED ENOUGH IN THE ARMS TO GET A DELTOID.
AND THEN THE DELTOID IS THE LAST MUSCLE GROUP OF THE THREE.
SO THERE'S A BOX IN YOUR READING.
READ THROUGH THAT BOX FOR THE REASONS,
RATIONALES, WHY ONE MUSCLE GROUP OVER THE OTHER.
OKAY, ANY QUESTIONS ON SHOTS AND WE'LL MOVE ON.
OKAY, WHAT I NEED YOU TO DO
IS I NEED YOU TO SEE HOW THE CATH SIMULATOR WORKS.
YOU'VE SEEN THE VIRTUAL REALITY COMPUTERS THAT ARE IN THE TWO ROOMS,
THE TWO TESTING AND PRACTICE ROOMS?
WE'VE PUT YOUR NAMES IN AND WE NEED YOU TO PRACTICE STARTING AN IV ON THEM.
YOU HAVE THREE WEEKS TO DO THE ASSIGNMENT.
IV'S ARE COMING UP.
I AM STARTING AN IV AFTER OUR TWO WEEKS OF IM INJECTIONS.
SO, THE CATH SIMULATOR JUST LETS YOU GET ORGANIZED,
GETS YOU FAMILIAR WITH YOUR EQUIPMENT
AND JUST GOING TO GET YOU READY FOR THAT LECTURE.
SO I WANT TO SHOW YOU HOW IT WORKS.
IT ACTUALLY IS A TUTORIAL ITSELF AND IT WILL TEACH YOU
HOW TO DO IT IF YOU FORGET EVERYTHING I SAID,
BUT I JUST WANT YOU TO KNOW WHERE IT IS.
SO WE NEED TO ALL GO TO 179.