SO, YOU KNOW?
THIS IS THE SECOND WEEK OF A TWO-WEEK MODULE
AND WHAT YOU'RE GOING TO BE DOING
IS JUST AGAIN, MORE IM INJECTIONS,
DIFFERENT KINDS OF SYRINGES,
DIFFERENT LOCATIONS, DIFFERENT MUSCLES.
WE'VE GOT TO LEARN 'EM ALL AND LEARN ALL OF OUR APPARATUS.
SO, IF YOU GUYS -- THIS IS THE WORST SEATING OVER HERE.
IF YOU GUYS WANT TO MOVE TO HERE YOU'LL SEE BETTER,
BEFORE WE GET THE CAMERA GOING.
BECAUSE I'M GOING TO BE STANDING AND DOING EVERYTHING HERE
AND YOU WON'T BE ABLE TO SEE QUITE SO WELL.
SO A LITTLE SHIFT.
FIRST ONE WE'RE GOING TO DO IS WE'RE JUST GOING TO DO PEOPLE
AND GET IT OVER WITH, BECAUSE THAT'S OUR HIGHEST ANXIETY AREA.
AND SO WHAT I'D LIKE FOR YOU TO DO IS GIVE TWO SHOTS TO A PERSON
AND YOUR GOING TO BE IN YOUR PARTNER GROUPS.
SO, I THINK ALL OF THE GROUPS HAVE SIX.
THERE'S TWO IN EACH GROUP.
ONE GROUP HAS FIVE, AND WE'LL JUST DO A THREESOME AND A TWOSOME.
SO SOMEONE WILL STICK THAT ONE, THAT ONE WILL STICK THAT ONE,
THAT ONE WILL STICK THAT ONE. IT WILL ALL WORK OUT, OKAY?
WHAT WE'RE GOING TO DO IS GIVE TWO SHOTS.
YOU CAN BARELY SEE IT. I'M GOING TO TURN THE LIGHT UP OVER THERE.
BUT YOUR GOING TO GIVE SODIUM CHLORIDE, A HALF CC IM NOW,
AND THAT'S GOING TO BE OUR DELTOID INJECTION.
AND THAT'S TO BASICALLY SIMULATE OR MOCK THE FLU SHOT.
BECAUSE IF WE -- THEY DIDN'T ASK ME TO HELP
WITH THE FLU CLINIC THIS YEAR, BUT YOU WILL.
THEY DID IT IN FIFTH SEMESTER INSTEAD.
SO AT SOME POINT IF YOU'RE INVOLVED IN FLU CLINICS,
THIS IS WHAT THAT INJECTION IS TOTALLY LIKE.
AND THIS IS THE SYRINGE THAT THE COUNTY USES TO GIVE THAT SHOT.
SO I WANTED YOU TO PRACTICE WITH THAT EXACT SCENARIO.
THE SECOND SHOT YOU'RE GOING TO BE GIVING IS THE 0.1 CC IV,
WHICH IS YOUR INTRADERMAL INJECTION
AND THAT IS TO SIMULATE YOUR TB SHOT.
THE SAME ONE YOU GET WHEN YOU GO TO GET
YOUR TB SKIN TEST TO SEE HOW THAT WORKS.
AND SO WE'RE USING THE SAME VOLUME OF SOLUTION,
JUST SODIUM CHLORIDE.
EVERYTHING WITH US IS FAKE.
NOW, YOU'VE USED UP YOUR SODIUM CHLORIDE.
YOU'VE PRACTICED. IT'S CONTAMINATED. IT'S NO GOOD.
SO YOU CAN USE IT FOR PRACTICE AND TO,
YOU KNOW, HANDLE THE SYRINGES AND SO FORTH.
BUT WHEN YOU COME TO THE STATIONS NEXT WEEK, WE'LL HAVE EVERYTHING THERE SET.
YOU DON'T HAVE TO GATHER UP ANY SUPPLIES EXCEPT FOR THE INFANT
THAT YOU'RE GOING TO DO THE VASTUS LATERALIS ON.
WE NEED TO MAKE SURE EVERYTHING IS STERILE BECAUSE IT'S REAL PEOPLE.
SO, YOU WILL DO THAT ONE TOTALLY WITH US
AND GATHER UP YOUR SUPPLIES
SO WE CAN WATCH AND KEEP TRACK OF ALL OUR SUPPLIES.
OKAY? SO THAT WILL HELP.
ALRIGHT, SHANNON'S GOING TO HELP ME.
SHE'S GOING TO COME UP HERE AND BE MY PERSON.
AND I WANT HER TO SIT HERE WITH ME
BECAUSE WHEN YOUR DRAWING UP YOUR STUFF,
I WANT YOU TO BE DOING IT TOGETHER,
AND KIND OF CHECKING EACH OTHER.
I'M REALLY NOT WATCHING THAT MUCH ANYMORE
AND I DON'T REALLY CARE TO EVER CHECK OFF ANOTHER DROP IN A VIAL EVER AGAIN.
BECAUSE I'VE CHECKED YOU OFF ALREADY ON INSULIN,
I CHECKED YOU OFF ON HEPARIN, I CHECKED YOU OFF ON AMPICILLIN,
I'VE CHECKED YOU, CHECKED YOU. YOU KNOW THE PRINCIPLES OF IT.
SO, YOU GUYS BE THE CHECK FOR EACH OTHER,
I'LL BE WATCHING FOR BASIC BREAKS IN STERILITY OR WHOEVER THE INSTRUCTOR IS.
SO, I'VE CHECKED MY DOCTOR'S ORDER.
AND ACTUALLY, I COULD'VE GIVEN YOU A LITTLE BETTER GUIDANCE ON HERE.
IT SAYS YOU SELECT YOUR OWN SYRINGE. YOU WON'T EVEN HAVE THAT OPTION.
I'M GOING TO SELECT FOR YOU AND I'LL TELL YOU WHAT THEY ARE GOING TO BE.
BUT WE'RE GOING TO GIVE OUR INJECTION
AND SO I AM GOING TO GATHER UP MY SUPPLIES.
THE FIRST THING I WANT TO DO IS GATHER UP MY SODIUM CHLORIDE, WHICH I HAVE,
AND I'VE CHECKED THE EXPIRATION DATE.
AND MY PARTNER APPRECIATES THAT IT'S GOOD.
GOOD STUFF, OKAY?
I HAVE MY SODIUM CHLORIDE. I HAVE A BAND-AID BECAUSE SHE'S REAL
AND WE ARE REALLY GOING TO PUT THEM ON NOW,
UNLIKE ON OUR PRACTICE PADS.
OKAY? SO I'M GOING TO REALLY GET MY BAND-AID READY.
SHE'S GOT CLOTHES ON AND SO VERSUS LIKE A GOWN --
EVEN THOUGH IT MAY NOT BLEED -- WELL, SHE MAY OR MAY NOT, I DON'T KNOW, BUT WHATEVER.
SOMETIMES YOU DO IT AND IT LOOKS GOOD AND YOU DON'T PUT ANYTHING ON,
BUT THEN THERE'S THIS LITTLE OOZE.
HAVE YOU GONE FROM THE DOCTOR'S OFFICE
AND THEN THERE'S THAT LITTLE SPECK ON YOUR WHITE SILK BLOUSE?
OH, MAN! SO GO AHEAD AND PUT A BAND-AID ON
WHEN ANYONE'S IN PLAIN CLOTHES AND TELL THEM THEY CAN TAKE IT OFF IN 10 OR 15 MINUTES,
WHEN YOU KNOW IT'S NOT GOING TO OOZE.
I LIKE TO HAVE MY BAND-AIDS READY.
AND BY THE WAY, I REALLY HAVE WASHED MY HANDS, REALLY.
AND I REALLY WANT YOU TOO.
I JUST DID IT LIKE TWO MINUTES AGO BEFORE I STARTED.
SO I AM REALLY WASHED AND REALLY CLEAN.
- YOU BETTER BE. - I AM.
BECAUSE I LIKE YOU SHANNON, I WILL DO THE BEST FOR YOU.
AND I'M GOING TO GET MY BAND-AID READY.
I TAKE THE FIRST STRIP OFF. THE SECOND ONE PROTECTS THE TELFA.
BUT MY FIRST ONE KEEPS IT READY, SO IT'S AN EASY STICK FOR ME.
SO MY BAND-AID IS READY.
AND I HAVE MY ALCOHOL MY 2 BY 2'S AND LOTS OF STUFF HERE.
ALRIGHT. I NEED TO PICK A SYRINGE.
NOW YOU NEED TO THINK AGAIN ABOUT VISCOSITY AND MUSCLE, OKAY?
SO, SODIUM CHLORIDE?
PRETTY THIN.
SO HOW BIG A GAUGE WOULD YOU WANT TO PICK?
WHAT'S OUR RANGE. LET'S START WITH THAT.
WHAT'S THE RANGE? - 20 TO 23?
- 20 TO 23. WE KNOW THAT 20 IS GOING TO BE PRETTY BIG, RIGHT?
AND WE LIKE EACH OTHER A LOT HERE.
AND THERE'S REALLY NO NEED FOR THAT BIG, OLD NEEDLE FOR NICE, SOFT MUSCLE.
SO WE'RE GOING TO GO WITH THE 22 GAUGE.
THESE ARE PRE-ATTACHED.
SO I HAVE MY 22 GAUGE.
AND I ALSO KNOW THAT I'M GOING TO BE IN THE DELTOID.
NOW, SHE DOES NOT HAVE A HUGE DELTOID HERE.
AND SOME -- YOU KNOW, I LOOK AT SOME OF THESE GUYS,
THEY HAVE BIGGER DELTOIDS.
THEIR MUSCLE MASS IS DIFFERENT AND GREATER IN THE DELTOID.
SO WE ARE GOING TO PICK OUR NEEDLE LENGTH APPROPRIATELY.
HONESTLY, ALMOST EVERY AVERAGE ADULT,
UNLESS THEY ARE ANOREXIC OR SO VERY, VERY LEAN,
CAN TAKE UP TO AN INCH. AN INCH TO AN INCH AND A HALF
DEPENDING ON HOW BIG THE MUSCLE -- HOW BIG THAT BICEP IS.
SO, I'M PICKING A ONE INCH
BECAUSE IT'S GOING TO BE SAFE AND I AM A SQUEEZER.
SO I SQUEEZE UP THE MUSCLE AND I KNOW I WILL BE WAY FINE.
OKAY? SO 22 GAUGE, ONE-INCH NEEDLE.
AND I PICKED A NEW SYRINGE YOU HAVEN'T DONE YET.
AND THEY'RE MY FAVORITE.
THEY'RE SO FUN.
THEY'RE CALLED VANISHPOINT, AND I'LL SHOW YOU HOW IT WORKS.
IF I CAN GET IT TO OPEN HERE.
ON THE VANISHPOINT SYRINGE, THE SAME FEATURES AS ALL THE OTHERS,
EXCEPT THAT AT THE END OF THE PLUNGER IS A BUTTON.
OKAY? SO THERE'S A BUTTON.
WE'VE GOT A PLUNGER THAT WILL RELEASE.
YOU HAVE GOT YOUR FLANGE. YOU HAVE GOT YOUR BARREL.
BECAUSE THIS IS A HALF CC, WE CAN GO WITH A 3 CC SYRINGE.
BECAUSE WE'RE RIGHT AT THAT BREAKPOINT
AND WE DON'T HAVE ANY "HUNDREDTH OF" TO DEAL WITH.
SO 0.5, WE'RE OKAY.
AND THEN WE HAVE THE NEEDLE.
NOTICE HOW I PULL AWAY STILL. I'VE WATCHED A FEW OF THIS.
STILL SCARES ME. DOCTOR, SCARE ME.
ALRIGHT. WHEN YOU LOOK HERE AT THE HUB,
IF YOU LOOK CLOSELY, THERE'S A SPRING IN HERE.
IT'S SPRING LOADED.
THERE'S ALSO -- AT THE END OF THE PLUNGER,
AND IT'S A LITTLE DIFFICULT TO SEE,
BUT CAN YOU SEE THIS YELLOW THING STICKING OUT?
THIS YELLOW IS CALIBRATED SO THAT IT PUSHES THE DOSE THROUGH.
I JUST NEED YOU TO APPRECIATE THAT
SOMETIMES AIR BUBBLES GET STUCK AROUND THAT YELLOW THING
AND YOU JUST CAN'T GET THEM OFF.
DON'T WORRY ABOUT IT, BECAUSE WHEN YOU LOOK,
IT DOESN'T GO ANY FURTHER THAN THAT ANYWAYS, OKAY?
SO DON'T FIGHT THE AIR BUBBLES STUCK ON THE YELLOW.
ALRIGHT, I JUST WANT YOU TO SEE HOW THIS WORKS.
I'M GOING TO CLEAN. I'M GOING TO GET MY MED.
I'M GOING TO GIVE MY SHOT.
I'LL PROBABLY STABILIZE MY SHAKY LITTLE HANDS.
DOES THAT BOTHER YOU? - NO.
- GOOD, BECAUSE I HAVE SHAKY LITTLE HANDS.
I AM GOING TO ASPIRATE. I AM GOING TO GIVE MY DOSE
AND THEN I'M GOING TO PUSH THIS BUTTON.
NOW, THIS BUTTON IS STIFF,
AND SO YOU HAVE TO HOLD THE BARREL STEADY,
SO THAT WHEN YOU PUSH ON HERE,
YOU DON'T PUSH INTO THE CLIENT, OKAY?
SO IT'S A TECHNIQUE.
WHEREAS BEFORE REMEMBER THAT WE DID LIKE Z-TRACK.
YOU WOULD HAVE TO REALLY STABILIZE WITH THESE FINGERS TO PUSH.
AND I AM JUST -- I AM STRONG TWO-HANDED.
SO I'M GOING TO TAKE THIS, I'M GOING TO PUT IT IN,
PINCH UP, PUT IT IN, STABILIZE,
IN, IN AND THEN LISTEN TO THIS BUTTON.
IT'S GOT TWO CLICK FEATURES.
LIKE IN THE DRAWING AND PREPARING OF YOUR MED,
YOU MIGHT PUSH THIS BUTTON A LITTLE HARD
AND YOU DON'T WANT TO RETRACT THE NEEDLE OR IT'S ALL WASTED MED.
SO IT'S GOT A TWO-CLICK FEATURE.
ONE, IN CASE YOU PUSH A LITTLE HARD IN THE PREP OF MED,
BUT IT'S THE SECOND CLICK THAT RETRACTS THE NEEDLE BACK.
SO IT WOULD BE IN HER SKIN RIGHT NOW
AND I WOULD BE STABILIZING --
HAS EVERYONE GOT IT. ON CAMERA AND EVERYTHING AND BE QUIET.
OKAY? SO YOU NEVER TAKE IT OUT OF THEM,
YOU JUST GO CLICK-CLICK.
AND I COULDN'T HEAR IT THE WAY I WAS PUSHING BECAUSE I'M HAVING TO HOLD.
I'M JUST PUSHING FIRMLY. I'M PULLING BACK ON THE FLANGE.
PUSHING, SO THAT I'M NOT PUSHING IT IN TO THE CLIENT.
YOU GOT TO KEEP IT STEADY.
OKAY? SO THAT'S WHAT YOU ARE GOING TO WANT TO PRACTICE.
- SO YOU LET GO OF YOUR PINCH?
- UH-HUH. YEAH, YOU NEVER HAVE TO HOLD ON TO THE PINCH.
IT'S JUST TO KEEP THE SKIN TAUT
SO THERE'S NO PUCKERING WHEN THE NEEDLE GOES IN.
AND THAT'S WHY WE EITHER SPREAD OR PINCH
SO THAT SKIN IS TAUT.
PUT IT IN, GIVE IT AND THEN STEADY, STEADY.
I HAVE STABILIZED HERE AND HERE AND THEN PUSH.
AND IT'S JUST...DONE.
NO NEEDLE. AND YOU SET IT DOWN
AND I NEVER FORGET THE BUTTON BECAUSE THE BUTTON IS SO FUN.
DO YOU FORGET THE LITTLE SHEAFY THING?
BECAUSE IT'S NOT FUN. IT'S JUST NOT FUN.
OKAY. SO THIS WOULD STILL GO IN THE SHARPS CONTAINER,
BUT IT'S SELF-CONTAINED AND THAT'S THE BEAUTY OF IT.
ALRIGHT. SO NOW WE'RE REALLY PREPARED.
AND WHAT I WANT YOU TO DO BECAUSE WE'RE GOING TO BE EFFICIENT
IS WE'RE GOING TO DRAW UP BOTH SYRINGES AT THE SAME TIME.
BECAUSE YOU'RE GOING TO GIVE BOTH TO THE SAME CLIENT.
JUST SO I WOULD CHECK MY MAR TO THE NAME BAND
WHEN I IDENTIFY MY CLIENT AND SO FORTH.
BUT THE GLOVES ARE TO PROTECT ME FROM HER, NOT HER FROM HERSELF.
SO YOU WANT TO JUST KEEP ONE SET OF GLOVES ON,
GIVE THE SHOT, GIVE THE SHOT.
ALRIGHT. SO GO AHEAD AND DRAW THEM BOTH UP.
I HAVE MY NEEDLE FOR MY INTRADERMAL,
MY SHEDDING. THANK YOU.
- ARE THESE EXPENSIVE NEEDLES?
- YES, THESE ARE EXPENSIVE SYRINGES.
SO I DON'T PUT TONS OUT FOR YOU TO JUST PUNCH AND PUNCH THEM.
I REALLY ONLY WANT YOU TO DO ONE.
THANK YOU FOR THAT REMINDER BECAUSE THEY'RE VERY EXPENSIVE.
A BOX OF A HUNDRED COSTS ME ABOUT $150 TO $200, SOMEWHERE IN THERE.
SO IT'S JUST LIKE TRA-- I MEAN, IT IS A LOT OF MONEY.
SO WE HAVE ENOUGH FOR YOU TO GIVE AND ONLY ONE TO PRACTICE WITH.
WE'LL HAVE OTHER SYRINGES SO YOU CAN PRACTICE DARTING
AND HOLDING AND THINKING THROUGH THE PROCESS.
BUT TO JUST SPRING ALL OF MY NEEDLES, THAT WOULD BE NICE.
ALRIGHT, I'M GOING TO POP MY LID OFF
AND BECAUSE I'M THE FIRST ONE TO OPEN IT --
I DON'T REALLY NEED TO CLEAN THAT OFF,
I HAVE GOT MY HALF CC OF AIR.
I LIKE TO HOLD IT, SO I DON'T CONTAMINATE.
I DROP A LOT.
KEEP IT STRAIGHT. KNOCK THOSE OUT.
CANDY IS GOING TO BE MY PUNCTURE PERSON.
I HAD ASKED CONNIE, BUT SHE WON'T DO IT.
AND I'M GOING TO SQUIRT MY AIR STRAIGHT OUT.
- WELL, SHE SHOWING US SOMETHING IN THE SKILLS LAB YESTERDAY,
DURING THE TEST FOR PEOPLE THAT CAN'T DO THIS.
- HERE'S A FEW THINGS.
OR YOU CAN KNOCK IT EVEN ON THE TABLE,
IF YOU WANT TO GET 'EM LOOSENED.
THE KEY IS JUST TO GET IT -- GET YOUR SYRINGE STRAIGHT UP.
AND AIR TENDS TO GET CAUGHT IN THE HUB AND THAT'S WHAT'S TRIPPING YOU UP.
AND SO YOU'VE GOT TO PULL IT OUT.
AND IF YOU PULL THE PLUNGER DOWN,
IT WILL RELEASE THOSE BUBBLES THAT ARE STUCK.
KIND OF SNAG IT.
AND THEN GET IT CENTERED AND THEN STICK IT STRAIGHT UP.
BUT SOMETIMES IT HURTS TO FLICK WITH YOUR FINGER.
YOU KNOW, SO I TAP WITH THIS
OR YOU CAN HIT WITH YOUR PEN TO LOOSEN THEM UP.
BUT DON'T FIGHT THOSE LITTLE CHAMPAGNE BUBBLES,
FIGHT THOSE BIG ONES THAT ADHERE TO THE SIDE AND CHANGE YOUR DOSE.
SO I'M GOING TO LET HER CHECK AND SEE IF SHE'S HAPPY WITH HER DOSE
IF AND SHE'S GETTING IT. ARE YOU HAPPY?
OKAY. STEADY DOWN, NO SHAKY HANDS
AND GET IT IN THERE NICE AND STERILE.
I AM NOT GOING TO LABEL ANYTHING BECAUSE I AM NOT LEAVING MY AREA.
I'VE GOT MY SOLUTION HERE.
WE'RE GOING TO DRAW AND GIVE, SO DON'T WASTE YOUR TIME.
IF I WAS GOING SOMEWHERE, I WOULD.
ALRIGHT. NOW I AM GOING TO GO AHEAD AND DRAW UP MY INTRADERMAL
AND I WANT TO TALK THROUGH THIS SYRINGE A LITTLE BIT.
WE HAVE A O.1 CC VOLUME OF WATER.
ALRIGHT. SO WHAT KIND OF SYRINGE DO I NEED?
- ONE CC. - ONE CC.
BECAUSE IT IS LESS THAN A HALF OF A CC.
ANYTHING LESS THAN 0.5, YOU NEED TO GO TO THE 1 CC
BECAUSE IT'S IN -- ACCURATE TO THE HUNDREDTH.
I PICKED A 1 CC SYRINGE
AND IT'S VERY THIN, WATERY.
AND SO I KNOW I DON'T NEED A THICK GAUGE AT ALL.
AND I KNOW I AM JUST GOING UNDER SKIN LAYER.
I AM INTO THE SKIN, NOT EVEN UNDER.
I DON'T WANT TO GO SUBCUTANEOUS AT ALL.
I WANT TO GO INTO SKIN.
I ALSO KNOW THAT WHEN YOU DO AN INTRADERMAL,
YOU DON'T PUT THE WHOLE NEEDLE IN.
YOU JUST MAKE THE SKIN TAUT
AND YOU ONLY PUT THE BEVEL AND A LITTLE BIT MORE.
SO JUST EVER SO SMALL OF AN AMOUNT
AND THEN YOU FORM A WHEEL WITH THE SOLUTION.
SO I HAVE PICKED A 27 GAUGE, HALF-INCH NEEDLE.
VERY, VERY THIN. VERY, VERY SHORT.
AND ITS SAFETY FEATURE IS GOING TO BE THE SAFETY GLIDE.
SO I'VE GOT ALL THE FEATURES I NEED IN THIS PARTICULAR SYRINGE.
YOU KNOW HOW TO WORK THE GLIDE.
SO -- I GOT TO GET THE SPECS OUT HERE NOW.
THIS IS SERIOUS. I CAN'T SEE THE LITTLE LINE.
DOES THAT MAKE YOU NERVOUS? SEE, SHE'S GOOD. SHE'S OKAY.
ALRIGHT. I HAVE MY LITTLE 0.1.
AGAIN SAME -- PULL IT AWAY FROM YOU.
HOLD ON TO THE CAP OR SET IT IN YOUR PACKAGE.
AND STEADY MY LITTLE HANDS DOWN AND DRAW --
I DRAW UP A WHOLE BUNCH.
MAKE SURE I CLEARED ALL THE AIR OUT OF THAT HUB
AND THEN I AM GOING TO SQUISH IT ON UP
AND GET MY O.1.
- DIANE, THE TEXT DESCRIBES 0.5 CC SYRINGES --
ARE THOSE JUST TOO SMALL TO DEAL WITH?
- THE ONLY 0.5 I HAVE SEEN IS IN AN INSULIN.
AND I HAVEN'T EVER SEEN THE 0.5 SYRINGE
FOR GIVING INTRADERMAL INJECT-- THERE MAY BE OUT THERE.
JUST BECAUSE I DON'T KNOW, IT DOESN'T MEAN IT DOESN'T EXIST.
I WORKED IN AN ALLERGIST'S OFFICE FOR MANY, MANY MONTHS,
BUT EVEN THAT'S BEEN A FEW YEARS.
SO, AND WE ALWAYS USED JUST THE 1 CC.
OKAY. SO SHE'S BLESSED BOTH OF THESE.
I'M GOING TO CLEAN UP MY AREA
AND GET ME SOME GLOVES.
NOW, I WANT TO DO ONE OTHER THING.
THIS IS A MULTI-DOSE VIAL, RIGHT?
SO -- BECAUSE I AM THE ONE THAT OPENED IT.
BEFORE I GET AWAY FROM IT HERE, I AM GOING TO SAY A DATE,
WHICH IS -- 4TH TODAY?
- HMM-MM.
- 2/4/04, 13:00 DB.
SO IF YOU CAME TO THE VIAL --
YOU ARE THE NEXT ONE AT THE STATION AND YOU DON'T FIND THESE,
THE FIRST PEOPLE, THE ONE-O'CLOCKERS
ARE GOING TO BE THE ONES TO OPEN MY VIALS.
I AM GOING TO USE A FRESH ONE EVERY DAY.
SO YOU WILL OPEN IT AND YOU WILL TIME AND DATE IT.
THE ONE'S OF YOU THAT COME AFTER,
YOU'RE GOING TO CHECKING IS THE EXPIRATION DATE GOOD FROM THE MANUFACTURER.
AND DID THEY SIGN THIS WHEN THEY OPENED IT.
AND THEN AFTER THAT EVERYONE THAT USES THIS
HAS TO CLEAN THE TOP WITH ALCOHOL, OKAY?
SO IT'S DATED. GOOD.
ALRIGHT. SO I'M DONE IN THE MED ROOM.
I HAVE PLANS AND I KNOW WHAT I AM GOING TO DO.
I HAVE MY GLOVES SO I AM READY FOR MY CLIENT.
I AM GOING TO IDENTIFY MY CLIENT.
SHE'S AN ADULT CLIENT. THIS IS SHANNON.
IT HAS TO BE A STUDENT NURSE, STUDENT NURSE.
OKAY. AND PRIVACY. SORT OF, YOU DON'T GET ANY TODAY.
SHANNON, I'M GOING TO GIVE YOU YOUR DELTOID SHOT FIRST
AND FOR WHATEVER YOU WANT IT TO BE,
BUT I'LL PRETEND FLU SHOT.
AND, OH, SHANNON HAS SOME FRECKLES AND THAT IS SO COOL.
BECAUSE I LIKE FRECKLES, AND EVEN TATTOOS,
BECAUSE IT'S LANDMARKS FOR YOU.
SO WE WILL HELP THEM TO BE OUR BULL'S EYES.
NOW, THE OTHER THING I WANT TO TALK ABOUT A LITTLE BIT BEFORE IS NEEDLE ANXIETY.
PEOPLE HAVE IT, IT'S REAL. ADULTS HAVE IT AND IT'S REAL.
SO I JUST WANT TO SAY THAT IF YOU ARE ONE THAT HAS NEEDLE ANXIETY,
IF YOU'VE EVER PASSED OUT WITH A SHOT,
IF THEY JUST MAKE YOU NERVOUS AS CAN BE, LET US KNOW.
SO THAT WE CAN JUST BE A LITTLE MORE AWARE.
THAT SHOULDN'T BE A SECRET AND YOU SHOULDN'T BE EMBARRASSED ABOUT IT.
YOU NEED TO TELL US. YOU'RE A SHOT GIVER.
I PASSED OUT TWICE OR WHATEVER.
OR I AM SCARED TO DEATH.
AND ALSO I JUST NEED TO MENTION I WON'T FORCE ANYONE TO DO IT.
IF YOU'RE JUST TOO SCARED AND THIS IS JUST TOO MUCH AND OVER THE TOP.
YOU DON'T HAVE TO DO IT. I'M NOT --
YOU KNOW, I CAN'T MAKE YOU DO THAT.
BUT YOU PROBABLY WANT TO GIVE ONE.
AND SO IF YOU WON'T TAKE ONE, I WON'T LET YOU GIVE ONE
AND IT ALL BALANCES OUT LIKE THAT. OKAY.
NEEDLE ANXIETY. LET'S SAY SHANNON HAD NEEDLE ANXIETY.
WE HAVE ALREADY TALKED ABOUT THIS AND SHE DOESN'T.
BUT IF SHE DID, I WOULD WANT TO MAKE SURE
THAT SHE WAS SITTING SO THAT SHE'S COMFORTABLE.
I WANT TO HELP HER RELAX. I WANT TO GIVE HER DISTRACTIONS.
AND I'M GOING TO BE WATCHING FOR SOME CUES.
PEOPLE WITH NEEDLE ANXIETY HAVE DONE --
SOMETIMES THEY LOOK SO NORMAL AND THEN BINK.
BUT IF YOU KNOW, THEIR COLOR TENDS TO PALE OUT IN THEIR FACE.
THEY GO WHITER THAN WHITE.
SOMETIMES THEY GET REALLY FLUSHED.
I'VE WATCHED THEM GET REAL FLUSHED IN THE NECK AND IN THE CHEEKS
AND YOU WATCH THE COLOR RISE AND YOU KNOW THE ANXIETY LEVEL
HAS JUST GROWN TO ALMOST UNBEARABLE.
THE OTHER THING I WATCHED -- ONE DAY I WAS GIVING SHOTS IN A FLU --
IN A HEPATITIS CLINIC. HEPATITIS B CLINIC AT AN ELEMENTARY SCHOOL.
AND WE WERE GIVING THEM TO KIDS.
AND I WAS WONDERING ABOUT HOW THAT WAS GOING TO BE.
IT WAS MY FIRST TIME DOING IT WITH THAT GROUP.
AND I WAS WORKING WITH ANOTHER NURSE WHO IS A VETERAN OF KID SHOTS.
AND SHE WAS GIVING THE SHOTS AND I WAS THE HELPER.
BUT SHE WAS JUST, I MEAN, SHE WAS JUST DOING 'EM AND SENDING 'EM,
DOING 'EM AND SENDING 'EM, AND NOT REALLY LOOKING AT 'EM.
I WAS KIND OF LOOKING AT 'EM.
AND I LOOKED OUT AT THIS LITTLE GAL AND SHE TURNED WHITE AS A GHOST.
AND SHE WAS REALLY QUIET. AND THAT'S USUALLY A CUE, QUIET.
QUIET ISN'T ALWAYS A GOOD SOUND.
AND I LOOKED ACROSS THE TOP OF HER UPPER LIP
AND LITTLE BEADS OF SWEAT WERE COMING OUT.
AND I WENT, "SHE'S GOING."
SO, "OKAY, HONEY, ARE YOU OKAY? I WANT YOU TO TAKE SOME GOOD, DEEP BREATHS FOR ME.
GOOD DEEP BREATHS, LOOK AT ME. TALK TO ME.
GOOD, DEEP BREATHS, IN YOUR NOSE."
DISTRACT THEM, GET THEM BREATHING,
TALK TO THEM
AND THEN I SAT HER DOWN ON THE FLOOR.
YOU KNOW, IT WAS KIDS AND IT WAS IN A GYM KIND OF DEAL.
AND SO GET THEM DOWN, SO THAT THEY ARE NOT GOING TO HARM THEMSELVES
AND HELP THEM KEEP THEIR BEARINGS.
AND I ALSO KEEP AMMONIA SALTS IN MY POCKET,
SO THAT I AM READY FOR A QUICK WHOOSH
AND WE'LL HAVE THEM ALL FOR THAT DAY ANYWAYS,
BUT JUST TO, KIND OF, YOU KNOW, WAKE THEM UP.
SO IF YOU ARE GIVING SHOTS.
OKAY. WE NEED ONE OTHER PLAN AND THAT'S HOW DO WE FIND
OUR LANDMARKS FOR THE DELTOID INJECTION.
WHEN YOU ARE LOOKING AT THE ARM,
IT'S BASICALLY JUST TO EYEBALL IT.
IT'S THE UPPER THIRD OF THE ARM.
SO WE ARE GOING FOR UPPER THIRD.
BUT YOU DON'T WANT TO BE INTO THIS BONY AREA AT ALL, UP AT THE SHOULDER.
SO, THIS BONE THAT COMES OFF THE SHOULDER BONE HERE
IS THE ACROMION PROCESS.
SO YOU WANT TO PUT ONE FINGER ON THE ACROMION PROCESS.
AND DEPENDING ON WHICH TEXT YOU READ ON --
YOURS SAYS THREE FINGERS, ONE FINGER AND THREE FINGERS DOWN.
YOU DRAW THE BASE OF THE TRIANGLE
AND THEN THE TRIANGLE AND IT'S RIGHT THERE.
SO THAT GETS YOU OFF OF THAT BONY AREA.
YOU CAN FEEL THE DIFFERENCE EVEN WITH YOUR FINGERS.
THAT TO THE CONSISTENCY OF THE TISSUE.
SHE'S GOT A SMALLER ARM SO THREE FINGERS WOULD WORK.
BUT EITHER WAY, IT'S STILL GOING TO PUT ME IN THAT TERRITORY.
SO, REALLY, THIS FRECKLE IS KIND OF THE BASE OF THE TRIANGLE
AND THIS EVER SO TINY LITTLE FRECKLE IS GOING TO BE MY LANDMARK, OKAY?
I AM GOING TO SQUEEZE UP AND GO RIGHT IN THERE, ALRIGHT?
ACROMION PROCESS. THAT RIGHT THERE.
OKAY. NOW, THAT'S IS THE OTHER THING, SHE KEEPS LOOKING.
WHEN SHE DOES, THIS MUSCLE GETS REALLY, REALLY TIGHT.
AND THAT'S THE OTHER THING THAT HAPPENS
TO PEOPLE THAT ARE NERVOUS OR LOOKING.
SO I AM GOING TO TELL SHANNON, "YOU KNOW, IT WILL HELP IF YOU RELAX THIS MUSCLE
BECAUSE YOU WANT TO KEEP IT NICE AND SOFT.
IF YOU KEEP YOUR ELBOW BENT AND JUST RELAX ACROSS YOUR LAP THERE
AND THEN THEY NOT TO TWIST. I DON'T CARE IF YOU LOOK,
BUT THAT WILL TIGHTEN UP THE MUSCLE.
SO CHECK THE MUSCLE AND AGAIN DISTRACTION.
IF YOU CAN GIVE 'EM HEADSETS TO LISTEN TO MUSIC,
IF YOU CAN GET A TV GOING, TALKING,
SOMETHING TO RELAX AND DISTRACT WILL HELP.
THEY ALSO SUGGEST FOR KIDS, IF YOU ARE GIVING SHOTS AND YOU HAVE TIME,
THERE IS A PRODUCT CALLED IMLA. HAVE I TALKED ABOUT THAT YET?
IT'S A TOPICAL ANESTHETIC. AND YOU CAN PUT IT ON THE SKIN, IT'S A CREAM,
AND THEN YOU PUT LIKE SARAN WRAP OVER IT AND IT SITS THERE FOR ABOUT AN HOUR.
AND IT JUST NUMBS OUT THAT AREA, SO THEY DON'T HAVE PAIN WITH THE SHOT.
SO IT'S KIND OF NICE IF YOU HAVE THE TIME TO DO IT,
BUT SOMETIMES WE DON'T HAVE THAT LUXURY.
- THEY USED THAT TO -- LIKE, I HAD MOLES REMOVED AND THEY --
IS THAT THE SAME THING? - YES.
IT HAS THE ANESTHETIC TYPE PROPERTY SO THERE'S NOT SO MUCH PAIN.
AND ALSO, IF YOU HAVE EVER HAD AN ANESTHETIC THAT THEY PUT IN,
DOESN'T THAT HURT WORSE THAN USUALLY ANYTHING ELSE.
AND SO IF YOU CAN PUT THAT CREAM ON, THEN YOU DON'T EVEN FEEL THE ANESTHETIC GOING.
SO THEY MAY HAVE DONE TWO THINGS FOR YOU.
SO I PUT IN NOVOCAIN ON TOP OF IT SO THAT --
WITH THE SUTURING OR FOR WHATEVER THEY DID.
ALRIGHT. SO, THERE IS NOT MUCH TO IT AT THIS POINT.
I AM JUST GOING TO GIVE A SHOT.
SHANNON AND I HAVE ALREADY TALKED ABOUT IT, WE ARE GOING TO DO IT A LITTLE SLOW,
SO WE COULD TALK THROUGH EACH PIECE OF WHAT
THE SHOT LOOKS LIKE AND YOU CAN APPRECIATE THAT.
AGAIN, IF YOU CAN'T SEE, JUST MOVE OVER.
I HAVE FOUND MY SPOT AND I AM GOING TO CLEAN IT GOOD WITH ALCOHOL.
I AM ALSO GOING TO WIPE IT WITH ALCOHOL IN THE END.
SO YOU CAN DO A COUPLE OF THINGS,
YOU CAN STICK YOUR LITTLE PAD THERE
TO KIND OF POINT TO YOUR TARGET AND IT WILL BE READY
OR YOU CAN STICK IT IN YOUR FINGERS. SO WHATEVER HELPS YOU.
CHECKED MY DOSE. MY THIRD CHECK. IT'S A HALF CC.
MAKE SURE YOU GET BEVEL UP.
I AM GOING TO PULL HERE.
AND YOU CAN WATCH EACH OTHER IF YOU WANT TO OR WHATEVER.
AND THEN I AM GOING TO MAKE MY DART.
SO WATCH HOW HARD I DO IT AND HOW IT GOES IN.
READY. LITTLE POKE.
DID YOU FEEL IT? SHE FELT IT, OK. BUMMER.
ALRIGHT, NOW, I LIKE TO KEEP MY OWN PERSONAL SCORE.
I AM GOING TO TAKE MY HANDS AND HOLD IT AND I AM GOING TO ASPIRATE IT.
AND YOU HAVE TO PULL A LITTLE BIT ON THESE TO GET IT TO COME BACK.
CAN YOU FEEL THAT? - I CAN'T FEEL THAT.
- OKAY. SOME PEOPLE SAY THEY DO.
NO BLOOD. I AM GOING TO GO ON IN, SLOWLY,
AND SEE HOW THIS HAND IS HOLDING AND I AM STABILIZING.
I AM DONE. THERE IS NO NEED TO STAY 10 SECONDS, BUT I GOT TO PUSH THIS OUT.
- I CAN FEEL THAT. - DONE.
I GOT A LITTLE BLOOD. BLOOD HAPPENS. AND RUB.
YOU FELT IT GOING OUT? - I FELT MORE WHEN GOING IN.
- REALLY? WAS IT SLOW?
- MAYBE. WELL, IT DIDN'T HURT.
- SO IF THEY HAVE LIKE A LOT OF BLEMISHES OR MOLES --
- YOU JUST DON'T HIT 'EM OR YOU GO AROUND. YOU GO AROUND.
BECAUSE YOU CAN AIM FOR 'EM LIKE THIS --
- WHAT IF THERE'S A MOLE RIGHT IN YOUR SPOT?
- YOU GOT A WHOLE LOT OF SPOT, REMEMBER I --
OH, THERE'S BLOOD ON THAT TOO. SORRY.
- OH, SHE'S GETTING FLUSHED, BACK UP. - BREATHE.
- DID YOU HEAR THE JOKE ABOUT THE FARMER'S DAUGHTER AND...?
- THAT'S GOING TO BE SOAKING IN BLOOD, DON'T PUT BLOOD ON THERE.
BECAUSE WE HAVE REAL BLOOD AND WE DON'T HAVE A WAY OF TRACKING.
- THIS DOESN'T BOTHER ME.
- I AM JUST GOING TO DRY THIS OFF.
I DIDN'T REALIZE I HAD BLOOD ON THAT ONE PIECE.
- YOU NEED A MIT.
- MESSES HAPPEN.
I WON'T THINK OF IT ONE SECOND WHEN I GO HOME.
I AM OVER IT. I AM OVER MESSES. YOU KNOW WHAT I MEAN?
GET OVER IT. MESSES HAPPEN.
I AM GOING TO GO AHEAD AND PUT THIS ON.
TRY NOT TO TOUCH THE SURFACE OF THE BAND-AID.
- SOME NURSES WILL LEAVE THE 2-BY-2 UNDER THERE?
- YES. USUALLY FOR PRESSURE, LIKE WHEN WE DO IV'S.
AND WE JUST GIVE IT A LITTLE PRESSURE ON THERE TO STOP THE BLEEDING FASTER,
BUT WE DON'T NEED PRESSURE, PARTICULARLY.
THERE, CLEAN UP MY MESS.
OK, I THINK MY GLOVES ARE CLEAN TO DO MY NEXT SHOT.
ALRIGHT. I WILL WRITE IN A MINUTE, BUT MY HANDS HAVE MAYBE GOT BLOOD THEM.
SO, WE ARE DONE. ANYTHING YOU WANT TO SHARE?
DID YOU FEEL THE MEDICINE GO IN?
OKAY, SO SHE FELT THE NEEDLE GO IN A LITTLE BIT.
SHE DIDN'T FEEL ASPIRATED, SHE DIDN'T FEEL MEDICINE GO IN
AND THEN SHE FELT THE NEEDLE COME OUT.
THAT'S HER STORY.
YOU WILL HAVE YOUR OWN STORY.
YOU MAY NEVER FEEL IT AND STILL GO, "I DIDN'T FEEL THAT AT ALL."
AND THEY WILL ASPIRATE AND GO, "OH, I FEEL THAT."
GIVE THE MED, NEEDLE COMES OUT, NOTHING.
YOU KNOW, EVERYONE'S DIFFERENT.
BUT I ALWAYS TRY TO WARN THE CLIENT,
YOU MAY FEEL A LITTLE SOMETHING AND I ALWAYS WE SAY A LITTLE POKE.
TO WARN 'EM SO THAT THEY DON'T JUMP.
YOU NEED THEM TO KNOW THAT YOU ARE COMING,
BECAUSE IF THEY DON'T, THEY WILL JUMP ON YOU.
ALRIGHT. THE NEXT THING, SHANNON, I THINK --
SIT STRAIGHT.
ALRIGHT, INTRADERMAL.
INTRADERMALS NEED TO GO IN THE FOREARM AREA
AND THEY NEED TO BE IN THIS MIDDLE PART OF THE FOREARM.
SO, YOU ARE BASICALLY GOING TO PUT A HAND ON THE WRIST AND NOT USE ANY OF THE WRIST,
AND YOU ARE GOING TO PUT THREE OR FOUR FINGERS DOWN FROM THE ANTECUBITAL,
AND, BASICALLY, USE THIS SPOT RIGHT HERE.
WHEN YOU GET TO THIS MIDDLE SPOT OF THE FOREARM,
YOU ARE GOING TO LOOK AGAIN FOR HAIRY AREAS.
BECAUSE YOU ARE TRYING TO SEE IF THERE IS REACTION.
SO YOU DON'T WANT TO BE IN SOMETHING THAT WILL NOT ALLOW YOU GOOD VISIBILITY.
SO YOU WANT TO MOVE UP THERE, YOU WANT TO AVOID VEINS,
BRUISES, DISCOLORATION, ABRASIONS.
ANYTHING THAT MIGHT DETER FROM YOUR ABILITY TO READ THE SKIN TEST.
WHAT ARE WE LOOKING FOR WHEN WE DO A TB SKIN TEST?
- AN ALLERGIC REACTION.
- A RESPONSE TO THE ANTIGEN HERE.
SO WHAT HAPPENS IS AFTER YOUR 48 OR 72 HOURS, RIGHT? IS WHAT THEY DO.
YOU ARE LOOKING TO SEE IF THERE'S BEEN INDURATION.
NOT REDNESS.
JUST COS IT TURNS A LITTLE RED,
DOESN'T MEAN YOU HAVE HAD A REACTION TO THE TB TEST.
BUT IF IT'S INDURATED.
IF YOU CAN FEEL THE BORDERS, THE EDGES, IF THERE IS A LUMP THERE,
THAT'S WHEN WE START GETTING WORRIED.
AND THE OTHER CRITERIA IS THAT INDURATION
HAS TO BE ONE CENTIMETER OR GREATER.
IF IT IS LIKE A LITTLE HALF OF A CENTIMETER SPECK, NO ONE CARES.
IT'S THAT FULL CENTIMETER THAT MAKES SOMEONE BE CONCERNED.
ALRIGHT. SO WE NEED TO FIND A GOOD PLACE IN THE FOREARM.
JUST LET ME SAY THAT THE MORE YOU GO TOWARDS THE INNER ASPECT HERE,
THE TENDERER IT IS FOR THE INJECTION.
THE CLOSER YOU COME TO THIS -- THE CARRIER EDGE OF YOUR ARM IS WHERE THE SUN HAS BEEN
AND THE SKIN ISN'T GOT QUITE AS SENSITIVE AS IT IS OVER TO THE EDGE.
WE WILL BASICALLY COME HERE OR TOWARDS THE MIDDLE WHEREVER WE CAN AVOID A VEIN.
SOMETIMES YOU MAY HAVE TO GIVE ONE OR TWO SHOTS
OR YOU DON'T WANT TO MISS WHERE YOU GAVE THE SHOT.
SO YOU MAY GIVE THE SHOT AND THEN WITH A SKIN PENCIL,
OR A MARKER THAT'S BEEN APPROVED,
YOU WILL CIRCLE WHERE YOU GAVE THE SHOT
SO YOU KNOW EXACTLY WHERE TO LOOK FOR THE REACTION.
- HOW ABOUT DRAWING A KITTY FACE?
- I MEAN, THAT'S A LITTLE OVERKILL.
I DON'T WANT KITTY FACES ON ME. BUT, YEAH, SO THEY CAN FIND IT.
AND IT IS USUALLY A SKIN PENCIL.
SOMETHING THAT HAS BEEN APPROVED FOR DRAWING ON SKIN.
SO THEY FIND IT, YOU KNOW?
COS EVERYONE DOES IT IN A LITTLE DIFFERENT SPOT AND THEY WANT TO MAKE SURE.
ALRIGHT.
MY GOAL HERE IS THAT I WANT TO STRETCH THE SKIN DOWN...
WITH ONE HAND.
SEE IF SHE HAS GOT FLEXIBILITY HERE IN HER SKIN TISSUE.
I AM GOING TO PULL IT DOWN AND THEN I AM GOING TO SLIDE MY NEEDLE ALMOST FLAT.
LIKE A FIVE DEGREE ANGLE UNDER THE SKIN.
STAYING IN SKIN SO THAT YOU CAN ALMOST SEE THE BEVEL OF THE NEEDLE IN THE SKIN.
AND THEN I NEED TO GIVE THE SHOT.
OR YOU WILL SEE THAT WHEN I GO TO DO THIS,
I SLIDE IT UNDER BY THE PLUNGER.
AND I NEED ANOTHER HAND.
BUT I GOT TO HOLD THIS REALLY STEADY
BECAUSE IF I JUST HAVE EVER SO LITTLE BEND IN THAT LITTLE BEVEL,
IF I RELEASE HER SKIN TO PLUNGE, HER SKIN IS GOING TO GO WHOOSH,
COS IT IS STRETCHY. IT IS GOING TO SLIDE OFF.
SO I AM GOING TO PULL, PUT MY SYRINGE IN
AND AS I RELEASE WITH MY THUMB, I AM GOING TO DO IT EVER SO SLOWLY
AND FOLLOW IN WITH MY SYRINGE, WITH THIS HAND.
I AM MOVING A LITTLE BIT WITH THE SKIN.
SO I CAN TAKE THIS HAND. THIS HAND IS NOT MOVING, IT IS HOLDING THAT SYRINGE
AND THEN THIS ONE IS GOING TO PLUNGE IT IN.
THERE IS NO ASPIRATION ON THIS BECAUSE WE ARE NOT IN ANY THING
WHERE THERE WOULD BE A BLOOD VESSEL.
WE'RE IN THE SKIN LAYER, OKAY?
YOU HAVE TO GET A WHEEL OR YOU ARE IN SUBCUTANEOUS TISSUE
AND IT'S NOT GOING TO BE AN EFFECTIVE TEST, SO IT HAS TO BE A WHEEL.
YOU HAVE TO SEE SHADOWING OF THE NEEDLE.
NOW, THIS ISN'T VERY EASY TO SEE
SO IF YOU GUYS WANT TO COME AROUND AND KIND OF COME BACK BEHIND THEM.
YOU HAVE GOT TO BE ABLE TO SEE THE BEVEL AND HOW FAR,
BUT YOU CAN'T STAND, LIKE, RIGHT HERE IN FRONT OF THE CAMERA,
SO JUST GET LIKE THIS.
ONE OTHER THING I WANT YOU TO KNOW IS THAT,
ON THIS PARTICULAR INJECTION, I DON'T USE ALCOHOL.
IN YOUR BOOK IT SAYS,
CLEANSE WITH ALCOHOL AND LET IT DRY COMPLETELY.
WHEN I WORKED IN THE ALLERGIST'S OFFICE, WE HAD SOME FALSE, POSITIVE READINGS,
AND IT WAS BECAUSE PEOPLE DIDN'T LET THE ALCOHOL DRY.
AND IT GOT DRUG IN A LITTLE BIT WITH THE INJECTION AND SO REDNESS CAME UP,
AND IRRITATION RELATED TO ALCOHOL.
AND HE WAS A BIG RESEARCHER AND THE TRUTH IS
WHEN IT'S YOUR SKIN AND YOUR FLORA THAT YOU CAN HANDLE IT.
SO IF IT WERE SOILED, YOU COULD WIPE IT WITH JUST WATER OR SOMETHING,
BUT THE ALCOHOL REALLY ISN'T NECESSARY.
SO I AM NOT GOING TO USE ANY AT ALL
AND I REFUSE IT WHEN THEY DO MINE.
IF THEY PUT ALCOHOL ON YOU, YOU KNOW IF IT'S DRY,
YOU CAN FEEL IF THE COLDNESS HAS GONE AWAY.
YOU MAKE SURE THAT THING IS DRY, DRY, DRY.
NOW THERE IS A WHOLE SCHOOL OF PEOPLE THAT JUST CAN NOT GET UP THEIR ALCOHOL.
YOU KNOW? IT IS A PROBLEM. ALRIGHT.
I TAKE MY CAP OFF AND I AM NOT GOING TO RECAP SO I WILL JUST DROP THAT.
JUST A BIT RELAXED, OKAY? I AM NOT GOING TO GO HERE.
SHE HAS JUST NOTHING
AS FAR AS MARKS OR ABRASIONS, VEINS,
SO I AM GOING TO JUST GO RIGHT HERE. IT WON'T BE AS TENDER.
OKAY.
THIS IS A TINIEST THING AND YOU LITTLE -- SLIDE CLAMP,
HERE HOLD THIS. IT'S CALLED A LITTLE SAFETY GLIDE
CAN GO ON THE TOP AND IT SWIVELS.
SO MOVE IT SO THAT YOU CAN GET THIS NICE AND FLAT, OKAY?
I AM NOT GOING TO WORRY ABOUT THE SAFETY GLIDE TILL I GET IT OUT OF HER SKIN.
LIKE GET IT OUT OF THE WAY AS WELL. OKAY, MY DOSE IS GOOD.
THE OTHER THING I WANT TO MAKE SURE WHEN YOU DRAW THESE UP,
MAKE SURE YOU DRAW UP A LOT SO THAT YOU KNOW YOU HAVE GOT SOLUTION AND NOT AIR.
IT'S SUCH A TINY DOSE, THAT SOME PEOPLE HAVE MISTAKENLY GO, "SEE, I AM GOOD."
CAN YOU SEE THAT IT'S AIR OR SOLUTION. IT'S REALLY HARD TO TELL.
MAKE SURE YOU'VE GOT SOLUTION.
ALRIGHT, I AM GOING TO STRETCH YOUR SKIN DOWN.
I AM LIKE LAYING THIS. I HAVE SHAKY HANDS, YOU GUYS KNOW THAT.
SO I STEADY MYSELF DOWN ON HER,
AND THEN I AM GOING TO JUST -- LITTLE POKE -- GO IN EVER SO SHALLOWLY.
I HAVE JUST CLEARED THE BEVEL AND A LITTLE BIT MORE.
I AM GOING TO RELEASE. SEE HOW I AM KIND OF MOVING.
AND THIS HAND IS HOLDING IT EVER SO SECURELY.
YOU CAN ALMOST SEE THE SHADOW OF THE NEEDLE IN THERE. CAN YOU SEE?
YOU CAN SEE THE NEEDLE.
I AM JUST GOING TO PUT IT IN AND I HAVE --
I HAVE TO BE STABLE HERE BECAUSE THERE IS RESISTANCE IN SKIN.
NOT LIKE WITH A MUSCLE. IT GOES IN REAL EASY.
SO YOU HAVE TO HOLD IT VERY, VERY STEADY AND PUSH FIRMLY
AND I GOT A BEAUTIFUL WHEEL.
AND THEN SLIDE OUT.
AND THEN CLICK DOWN.
I CAN'T DO ALL THAT SLIDE, HOLD, CLICK.
SO STAY BEHIND THE NEEDLE AND YOU ARE GOOD TO GO.
AND TA-DA. YOU CAN SEE HOW FIRM I HELD.
THAT'S MY FINGERNAILS.
SORRY. AND THAT WAS IT.
SO, SHANNON, DID YOU FEEL THE NEEDLE GO IN?
DID YOU FEEL THE SOLUTION? DID YOU FEEL ANYTHING?
OKAY, I GET A POINT. THAT'S MY OWN PRIVATE SCORING SYSTEM.
ONE, NO PAIN. ACTUALLY, PEOPLE SAY THAT THIS ONE HURTS,
AS MUCH OR MORE THAN ANY.
JUST BECAUSE IT IS THAT SURFACE AND LIKE SCRAPING
AND SO SOMETIMES THAT WILL HURT.
ALSO BECAUSE IT'S SO SHALLOW AND BECAUSE WE ARE BEING PARTICULARLY SLOW.
SOMETIMES YOU WILL SEE LITTLE NEEDLE TRACKING, LIKE A BRUISE,
JUST A LITTLE, SMALL LITTLE THING
AND THAT'S JUST GOING TO HAPPEN WITH THE SHOT.
OKAY. THAT'S IT.
MY NEEDLE IS IN THE SHARP'S CONTAINER
WHICH YOU WILL HAVE AT THE STATION.
AT THIS POINT YOU WOULD REALLY WANT TO WASH YOUR HANDS
BECAUSE YOU DID A REAL PERSON.
WE WILL HAVE GELS OR SOMETHING THERE. GO TO THE SINK AND WASH.
AND THEN YOU WILL DOCUMENT JUST LIKE YOU DID YESTERDAY.
I AM NOT EVEN GOING TO GO OVER DOCUMENTATION.
YOU GUYS JUST WERE PERFECT YESTERDAY. IT WAS BEAUTIFUL.
SO, WHEN WE LOOK AT THIS, WE GAVE IT AT 1:15.
BOTH OF THEM, 1:15, 1:20, WHATEVER.
THE IM ONE IS GOING TO BE LEFT DELTOID
AND SO THEIR KEY CODE WHEN I GO TO IM IS LD,
LEFT DELTOID AND THEN MY INITIALS.
AND THEN THEY DON'T HAVE ANYTHING FOR INTRADERMAL,
SO I WOULD WRITE AGAIN MY OWN KEY CODE.
AND I WOULD JUST SAY LEFT FOREARM.
SO, LFA.
AND THERE'S JUST NOT MUCH MORE TO SAY THAN THAT WHEN YOU DO YOUR SITE.
SO THAT WE KNOW WHERE THAT PARTICULAR ONE WAS GIVEN.
OKAY, ANY QUESTIONS?
ONE OF THE HARDEST THINGS ABOUT THIS PARTICULAR DRILL IS THAT
YOU CANNOT PRACTICE ON EACH OTHER.
YOU HAVEN'T GOT ME THERE.
NO PRACTICING ON PEOPLE.
SO YOU'RE JUST GOING TO HAVE TO DRAW UP,
YOU KNOW, GET COMFORTABLE WITH THE SYRINGE.
YOU ALREADY KNOW HOW TO DART, YOU KNOW HOW TO DO MOST EVERYTHING
THAT YOU NEED TO KNOW. I PASSED YOU YESTERDAY ON ALL OF YOUR SKILLS.
SO, IT'S JUST BEING COMFORTABLE WITH THIS SYRINGE AND KNOWING THAT.
THE OTHER ONE THAT I THINK IS THE MOST AWKWARD
AND I THINK YOU MAY WANT TO PRACTICE IS THIS INTRADERMAL,
JUST CO-COORDINATING THAT PULL-PUSH, MOVE, THIS AND HOLD.
AND SO WE HAVE THESE LITTLE INTRADERMAL MANNEQUINS.
MAY I SAY, THEY'RE PATHETIC.
BUT AT LEAST YOU CAN GET YOUR SYRINGE AND JUST, KIND OF,
PRACTICE THE LOOK, AND KIND OF WORK THROUGH YOUR STEPS.
AND I WILL SHOW YOU HOW IT WORKS, AND IT'S JUST SAD.
GLOVES, CLEAN, CLEAN, AND DO YOUR THING.
CLEAN WITH ALCOHOL, JUST WANT A DOSE HERE.
DRAW UP A LOT, SQUEEZE BACK THE REST.
YOU CAN BARELY SEE THAT THERE'S
THESE FOUR LITTLE BUTTONS ON EACH SIDE OF IT.
FOUR LITTLE BUTTONS.
THEY'RE SUPPOSED TO BE KIND OF LIKE BALLOONS,
SO LIKE YOU PUT THE MEDICINE IN,
AND IT SWELLS A LITTLE BIT AND THEN YOU SAY, "OH, GOOD, WE'LL..."
THEN YOU HAVE TO SUCK THE MEDICINE BACK OUT.
BUT TO KEEP IT FROM STICKING,
WHICH IT PROBABLY WILL WHEN I DEMONSTRATE THIS.
THERE'S LITTLE SLITS IN THE STUFF
AND SO IT SQUIRTS OUT ALL OVER THE PLACE.
AND IT JUST DOESN'T WORK VERY GOOD, BUT YOU CAN STILL KIND OF DO IT.
SO, I'VE DONE MY HIGH FIVE. I AM GOING TO SWIVEL THIS AROUND.
I WOULD PULL. I WOULD SET THIS DOWN.
I WOULD SLIDE IT IN EVER SO SLIGHTLY,
AND JUST GET THE BEVEL PLUS A LITTLE MORE. NICE AND FLAT.
AS I RELEASE, I'M GOING TO RIDE IN,
PULL IT, SEE IT, BUT WHAT HAPPENS IF IT JUST KIND OF PLUCKS OUT?
WELL, IT'S THEIR FLORA, SO TRY AGAIN.
STRETCH, SLIDE IN, GO A LITTLE BIT FURTHER, BUT NOT MUCH,
RELEASE, HOLD STEADY, COME BACK,
NO ASPERATE, AND YOU CAN SEE,
IT COMES OUT ALL OVER THE PLACE AND THEN YOU SLIDE OUT.
YEAH, SO IT'S NOT PERFECT, BUT AT LEAST YOU CAN DO
THE HOW TO HANDLE EVERYTHING AND THEN WORK THROUGH.
NOW, SOME PEOPLE LIKE TO DO ALL SORTS OF INTERESTING THINGS,
BUT THINK THROUGH THIS WITH ME.
SOMEONE WILL SAY, "WELL, WHY DON'T I PULL THIS WAY? AND GO IN THIS WAY?"
WELL, IT COULD WORK.
I MEAN, THEORETICALLY IT COULD WORK AND YOU COULD GO IN.
BUT NOW WHAT DO YOU DO WHEN THE SKIN RELEASES?
- IT GOES UP. - IT'S GOING TO GO UP HERE.
SO YOU'RE GOING TO HAVE TO SHIFT BACK.
SO IT'S GOING TO GIVE SOME WAY.
SO YOU GOT TO BE PREPARED, AND SO IF THE SKIN COMES BACK ON IT,
IT'S GOING TO PUCKER UP ON IT, AND BE TOO THICK, IF YOU DON'T RIDE.
THE OTHER TECHNIQUE I'VE SEEN IS
PEOPLE LIKE TO STRETCH BOTH WAYS AND GO IN SIDEWAYS.
AND THAT WORKS OKAY.
AND THEN SOME PEOPLE ARE REALLY COORDINATED
AND THEY'LL DO A ONE-HANDED DEAL.
AND THAT'S OKAY, IF YOU CAN.
THE BOTTOM LINE IS THERE'S AN ASTERISK ON WHETHER YOU GOT A WHEEL OR NOT.
YOU GOT TO GET THE WHEEL.
SO YOU KNOW, LIKE THERE'S A MILLION WAYS TO SKIN A CAT.
FIND YOUR WAY THAT'S MOST STEADY,
THAT HOLDS THIS AND THAT YOU CAN STABILIZE THIS SYRINGE
BECAUSE YOU'RE GOING TO HAVE TO PUSH A LITTLE BIT.
BECAUSE THERE IS RESISTANCE IN SKIN
VERSUS JUST PUTTING IT INTO SUBCUTANEOUS TISSUE
AND IT JUST GOES REAL EASILY.
ANY QUESTIONS ON THOSE TWO?
ALRIGHT, PRACTICE, THINK IT THROUGH,
AND WE WILL BE STANDING BY YOUR SIDE COACHING YOU.
WILL YOU APPLY A BAND-AID ON THE TB SKIN TEST?
ON A REAL TB SKIN TEST, I DON'T LIKE TO BECAUSE IT KIND OF SWEATS IT OUT,
AND SO IF IT'S NOT BLEEDING, I'LL NOT PUT ANYTHING.
IF I DO FEEL LIKE THERE'S A LITTLE OOZE AND I'LL PUT ONE ON A CLIENT,
AND SAY, "REMOVE THIS IN 10 MINUTES,
YOU DON'T WANT THIS TO SWEAT THIS TEST OUT."
YOU WANT IT OFF OF THERE. AND THEY CAN SHOWER WITH IT, AND SO FORTH.
AND TELL THEM NOT TO WORRY ABOUT REDNESS THAT COMES UP IN THE FIRST 48 HOURS
BECAUSE YOU'RE NOT EVEN GOING TO READ IT TILL THE 48TH HOUR.
SO THEY DO TURN KIND OF RED SOMETIMES IN THAT FIRST 24 AND YOU'RE GOING,
"OKAY, I SEE I'VE GOT IT. I FINALLY GOT IT." AND IT'S NOT.
IT'S JUST THE BODY RESPONDING TO THE LIQUID.
ALRIGHT, BEFORE I FORGET, I'VE DECIDED TO GIVE YOU HOMEWORK.
AS IF YOU DIDN'T HAVE ENOUGH TO DO, RIGHT?
BUT IT'S NOT BAD. I JUST WANT YOU TO LOOK AT...
I GAVE EACH OF YOU THREE LABELS FOR WHICHEVER BOOK YOU HAD.
AND I WANT YOU TO TURN IT IN WITH YOUR CHECKLIST NEXT WEEK.
SO JUST STAPLE IT ON THE BACK, AND I HAVE TWO PAGES,
AND ONE LOOKS SIMPLER THAN THE OTHER, BUT THEY'RE ACTUALLY QUITE EVEN.
WHO HAS THE BLUE BOOK? DID ANYONE DO THE BLUE BOOK?
THE DIMENSIONAL ANALYSIS.
IF YOU DO, YOU GUYS HAVE IT FAIRLY SIMPLE.
TAKE THIS SHEET AND THEY NUMBERED EACH AND EVERY QUESTION.
IF YOU HAVE THE WHITE BOOK, WHICH IS THIS ONE,
WHAT THEY DID WAS LIKE QUESTION NUMBER FIVE,
THEY HAD LIKE FIVE QUESTIONS UNDERNEATH IT,
BUT THEY DIDN'T NUMBER THEM IN ANY WAY, A, B, C, D.
AND I JUST WANT THE ANSWERS TO THOSE.
NOW I KNOW YOU COULD JUST COPY THE ANSWERS OUT OF THE BOOK
AND THAT'S JUST A WASTE OF EVERYONE'S TIME.
WHAT I WANT IS FOR YOU TO LOOK AT THE LABEL,
MAKE SURE YOU CAN FIND EVERYTHING,
AND THEN WHERE THERE'S MATH INVOLVED, SHOW ME YOUR MATH.
LIKE IF IT SAYS HOW MANY MILLILITERS WOULD YOU GIVE FOR THIS DOSE
OR TO ADMINISTER THIS DRUG? THEN YOU WORK THE MATH.
SO I CAN SEE EVERYONE'S FLARE AND REMIND IT AND GOOD TO GO ON THAT.
BOTH OF THE BOOKS HAVE A LOT OF GOOD LABELS.
SO I GO THROUGH ALL OF THEM WITH THAT,
BUT I DON'T WANT YOU TO RIP OUT YOUR BOOKS
AND IF SOMEONE DIDN'T GET ONE AND THEY WANT TO SHARE A BOOK,
AND BLAH, BLAH, FEEL FREE. OKAY.
- VIDEO. - NO. WE HAVE ONE LAST SHOT TO GIVE,
AND THEN IT'S ENDED HERE.
OKAY, YOU HAVE TO GIVE A SHOT TO A BABY SO,
YOU MAY NOT START BY GIVING THE SHOT TO EACH OTHER,
EVEN THOUGH THAT'S YOUR HIGH ANXIETY.
WE MAY SEND YOU TO THE BABY STATION FIRST.
AND SO, SOMEBODY BACK THERE, CAN YOU TURN...?
JENNIFER OR SOMEBODY, CAN YOU SWITCH THE MAR OFF OF THE OVERHEAD?
AND THAT'S ON TOP OF THE KEYBOARD.
- I HAVE A QUESTION.
DO WE HAVE TO ACTUALLY WRITE UP THESE MED CARDS AND STUFF?
- YES. - YEAH.
YEAH, AND THERE...
NOTICE I DIDN'T QUIZ YOU A LOT ABOUT THEM,
BUT I WANT YOU TO KNOW THESE DRUGS
BECAUSE THEY'RE THE MOST COMMON DRUGS
YOU WILL EVER HAVE ON THE FACE OF THE EARTH.
THE LIKELIHOOD OF BEING TESTED ON THEM ON YOUR BOARDS IS LIKE HIGH.
AND YOU WILL ALSO HAVE THEM EVENTUALLY IN ALL YOUR CLASSES.
SO THEY'RE THE MOST COMMON, COMMON OF ANY MED SEARCH DRUG.
I REALLY WAS PLEASED, A LOT OF PEOPLE DID
GOOD NURSING INTERVENTIONS RELATED TO THE DRUG.
FOR EXAMPLE, GIVING DEMEROL.
THERE WERE A LOT OF PEOPLE WHO TOOK VITAL SIGNS PRIOR TO GIVING IT.
IT'S NOT ON THE CHECKLIST BECAUSE I DON'T KNOW
WHICH DRUG I'M GOING TO ALWAYS GIVE ON THAT CHECKLIST.
BUT TAKING VITAL SIGNS, KNOWING YOUR CLIENT,
MAKING SURE YOU HAD GOOD RESPIRATIONS RELATED TO THAT DRUG.
SO, YEAH, SO MAKE IT MAKE SENSE TO YOU.
I'M GOING TO COME BACK ON -- YOU KNOW I AM TEACHING ABOUT CONSTIPATION.
I'M GOING TO TEACH THEM, YOU KNOW THINGS WHAT I AM WATCHING FOR.
I'M GOING TO CHECK THIS AFTER AND THAT KIND OF STUFF.
WATCH FOR IF THE STAT CHANGES,
AND I REALLY HEARD A LOT OF GOOD INFORMATION YESTERDAY.
SO, MAKE IT MAKE SENSE TO YOU,
LIKE YOU'RE REALLY TAKING CARE OF A CLIENT, AND IT HELPS.
I DID WANT TO CLARIFY AND I THINK I DID AT MOST STATIONS.
THE CODEINE VERSUS DEMEROL SCENARIO.
A LOT OF PEOPLE SAID I WON'T GIVE IT.
THEY'RE ALLERGIC TO CODEINE SO I AM NOT GOING TO GIVE DEMEROL.
AND I WOULD SAY, "I WOULD."
BUT WE TALKED THROUGH THAT,
AND IT'S KIND OF LIKE BEING ALLERGIC TO AN ANTIBIOTIC.
I'M ALLERGIC TO AMPICILLIN AND SULFA AND KEFLEX AND I HAVE AN INFECTION.
ARE YOU GOING TO SAY SORRY FOR YOU, YOU GET TO ROT?
NO, YOU JUST FIND ANOTHER ANTIBIOTIC,
ANOTHER, YOU KNOW, ANOTHER FAMILY OF DRUGS.
SO, SAME THING WITH NARCOTICS.
IF THEY'RE ALLERGIC, REALLY ALLERGIC TO CODEINE,
YOU CAN STILL TRY DEMEROL, BUT IF YOU'RE GOING TO WATCH THEM CLOSELY
TO MAKE SURE THAT THEY DO OKAY WITH THIS ONE.
AND IF THEY HAVE THE SAME KINDS OF EFFECTS,
YOU WILL BE WATCHING FOR THAT SO.
KNOW YOUR CLASSIFICATIONS.
YOU WOULDN'T GIVE AMPICILLIN TO SOMEONE WHO
IS ALREADY ON PENICILLIN COS THEY'RE OF THE SAME FAMILY.
SAME GROUP OF DRUGS, BUT YOU MIGHT TRY.
OH I DON'T KNOW, ZITHROMAX, A Z-PATCH
BECAUSE IT'S A DIFFERENT GROUP OF DRUGS.
OKAY, WE NOW ARE GOING TO DO THE VASTUS LATERALIS.
FINALLY, OUR LAST MUSCLE.
AND ON THIS ONE WE'RE GOING TO DO IT ON THE BABY
BECAUSE THAT'S THE MOST COMMON SHOT THAT YOU WILL GIVE IN THE LEG.
SO OUR DRUG. I CAN'T THINK VERY WELL.
YOU HAVE IT IN YOUR THUMB SHEETS THERE.
AQUAMEPHYTON, ONE MILLIGRAM IM NOW.
AQUAMEPHYTON, ANYONE KNOW WHAT THAT IS?
VITAMIN K.
EVERY BABY THAT'S BORN IN A HOSPITAL GETS A SHOT OF VITAMIN K.
EVERY SINGLE ONE.
THE LIKELIHOOD OF YOU GETTING TO DO THAT IN OB IS PRETTY HIGH.
YOU KNOW IF YOU SEE A DELIVERY,
YOU FOLLOW THAT BABY INTO THAT NURSERY AND SAY, I WANT TO GIVE THAT SHOT.
BECAUSE THAT SHOT IS SUPPOSED TO BE GIVEN
WITHIN THE FIRST HOUR OF BIRTH.
WHY DO THEY NEED VITAMIN K?
- WHAT DOES IT DO? - SKIN PIGMENTATION.
BLOOD CLOTTING.
ALRIGHT, AND VITAMIN K IS ALSO THE ANTAGONIST FOR WHAT DRUG?
IT CLOTS BLOOD.
- HEPARIN. - HEPARIN. ALRIGHT, SO IF THEIR PT...
THEIR PTT GETS TO HIGH, THEIR BLOOD IS GETTING TOO THIN
THEY MIGHT GIVE THEM SOME VITAMIN K
SO THAT THEY INCREASE THEIR CLOTTING, OKAY.
BUT BABIES BECAUSE THEIR FLORA IS SO IMMATURE IN THEIR VALVES
THAT'S WHERE VITAMIN K IS CREATED, IS IN THE VALVES
BECAUSE THEY DON'T HAVE A LOT OF FLORA IN THERE
AND BECAUSE WE DON'T WANT THEM TO BLEED,
THEY ALL GET A SHOT OF VITAMIN K.
AND THIS IS THE DOSE AND THIS IS EXACTLY THE SCENARIO.
ALRIGHT, ON AN ADULT,
IF YOU WERE GOING TO DO THE VASTUS LATERALIS,
IT'S LATERAL, NOT MEDIAN, RIGHT?
SO IT'S GOING TO BE OFF TO THE SIDE.
YOU WOULD COME TO THE THIGH MUSCLE,
YOU WOULD PUT IT ONE HAND AT THE GROIN AND DOWN
AND ONE HAND ABOVE THE KNEE.
MY PANTS HAVE A NICE SEAM HERE, SO THAT'S MEDIAN.
SO LATERAL WOULD BE OFF TO THE SIDE.
SO NOT ABOVE THIS HAND,
BELOW THIS HAND, AND RIGHT HERE IN THE SIDE.
OKAY, IF YOU DO THE TOP YOU'RE IN THE RECTUS FEMORIS,
AND WE DON'T WANT RECTUS FEMORIS, WE WANT VASTUS LATERALIS.
SO, IT'S A LITTLE BIT SIDE-MIDDLE LEG.
IF I WAS ON A BABY AND I PUT MY HAND ON MY HEAD,
THE THIGH IS GONE.
SO BASICALLY IT GETS TO DOING A FINGER OR TWO OFF.
BE OFF THE KNEE AND BE OFF THE GROIN AND BE IN THAT MIDDLE STRIP
OF THE THIGH AND IT'S THE SAME PRINCIPAL.
IT'S NOT CENTER, IT'S LATERAL. IT'S OFF TO THE SIDE.
SO IT'S SIDE-MIDDLE MUSCLE.
OKAY.
WE'RE GOING TO GIVE AQUAMEPHYTON. WE'VE CHECKED OUR DOCTOR'S ORDERS.
OH, YOU KNOW WHAT I NEVER SAID THIS WHOLE TIME?
TAKE OFF TWO POINTS. DO YOU HAVE ANY ALLERGIES?
I KNOW NO ONE IS ALLERGIC TO SODIUM CHLORIDE,
BUT YOU STILL GOT TO SAY IT TO GET YOUR POINTS. SO TAKE OUT A POINT.
AQUAMEPHYTON. I'M GOING TO THINK ABOUT ALLERGIES FOR MY BABY
COS THIS IS A REAL DRUG, AQUAMEPHYTON.
WHAT'S THE LIKELIHOOD OF US KNOWING ANY ALLERGIES FOR BABY ONE HOUR...?
NONE, SO THEY -- IT KIND OF, ON THIS DRILL BECOMES A NON-ISSUE,
BUT YOU DON'T WANT TO GET OUT OF THE HABIT OF
NOT THINKING THROUGH ALLERGIES.
I'VE CHECKED MY ORDERS, I'VE CHECKED MY CARE PLAN,
I'VE CHECKED MY ALLERGIES. I AM GATHERING UP MY EQUIPMENT.
AND WHAT I AM GATHERING IS,
WELL, THE FIRST THING I WILL GATHER IS MY AQUAMEPHYTON.
AQUAMEPHYTON IS GOING TO BE IN YOUR AMPOULE.
SO YOU'RE PRACTA-AMP THAT YOU GOT -- DID I GIVE YOU GUYS ONE OR TWO?
- ONE. - OKAY, YOU HAVE A PRACTA-AMP
AND I WANT YOU TO LABEL IT AQUAMEPHYTON,
2 MILLIGRAMS PER MILLILITER.
THAT'S HOW IT'S ACTUALLY PACKAGED FROM THE MANUFACTURER.
SO, I PUT A LITTLE TAPE ON HERE SO I KNOW THE SOURCE OF MY DRUG.
THAT WAS THE ONE POINT I WANTED TO MAKE REAL CLEAR
YESTERDAY WITH THE DEMEROL.
FROM WHAT SOURCE DID YOU DETERMINE THIS .6?
HOW DID YOU COME UP WITH THAT? SO, THAT MATH WAS GOOD.
OKAY, SO WE GOT TWO MILLIGRAMS PER MILL,
AND I NEED TO GIVE ONE MILLIGRAM. SO WHAT AM I GOING TO GIVE?
ONE MILL.
- HALF A MILL. - HALF A MILL.
HALF A MILL.
SO, IF I'M GOING TO GIVE A HALF AND I AM GOING TO GIVE IT TO A BABY,
I'M PROBABLY JUST GOING TO GO WITH A ONE CC SYRINGE.
YOU COULD GO WITH A THREE CC.
AGAIN WE DON'T HAVE ANY HUNDREDTHS TO WORRY ABOUT,
BUT IT'S EASIER TO DROP THE DOSE.
OKAY, SO I HAVE MY MED.
I HAVE GATHERED MY SYRINGE. SO I'VE GOT A ONE CC SYRINGE.
NOW, I NEED TO CONSIDER THE NEEDLE THAT'S GOING TO GO INTO BABY THIGH.
LET'S TALK ABOUT GAUGE.
WATERY, IT'S ACTUALLY KIND OF, OILY. THE STUFF, REALLY.
BUT IT'S STILL FAIRLY A WATERY-OILY, IT'S NOT THICK, THICK STUFF.
SO IT DOESN'T NEED TO BE REAL THICK.
USUALLY ON THE BABY WE GO WITH A 25 GAUGE.
THE SOFTEST OF MUSCLE, OH MY GOODNESS,
THEY'RE SOFT AND THEY DON'T TENSE UP, YOU KNOW, SOFT.
LENGTH, BABY THIGH.
THERE'S ACTUALLY TWO RECOMMENDATIONS.
AND WHEN THEY WERE MAKING THE RECOMMENDATIONS FOR IMMUNIZATIONS,
THEY SAID ON KIDS TO GO WITH THE ONE INCH NEEDLE.
BUT YOU WILL SEE IN THE NURSERY STILL WE VISUALLY CAN'T GET OVER IT,
AND WE'RE GOING TO GO WITH FIVE EIGHTH INCH NEEDLES.
SO, WHEN I WENT TO GET MY SUPPLIES
WELL WE HAD JUST RUN OUT OF ALL OF THOSE PRE-ATTACHED NEEDLES.
SO ON THIS ONE IT'S A 27 GAUGE, HALF INCH NEEDLE.
THAT WILL DO ME NO GOOD, AND I NEED A SAFETY DEVICE.
ACTUALLY, YOU KNOW WHAT? I DIDN'T GET ONE WITH THE SAFETY DEVICE,
I'LL HAVE TO WORK ON THAT.
I DON'T EVEN HAVE A SAFETY DEVICE HERE, SO, I BETTER BE SAFE.
I'VE PICKED ANOTHER NEEDLE THAT I AM GOING TO ATTACH
WHICH IS A 25 GAUGE, FIVE EIGHTHS.
AND I THINK I HAVE A BOX OF SAFETY GLIDES
AND I'LL TRY TO PULL THOSE OUT SO WHEN YOU TEST,
YOU'LL HAVE ANOTHER SAFETY GLIDE.
BECAUSE I WANT YOU TO GET USED TO ALL THESE DIFFERENT THINGS,
BUT OBVIOUSLY I PULLED THE WRONG THING HERE TODAY.
I HAVE A 25 GAUGE, FIVE EIGHTHS INCH NEEDLE.
SO I AM GOING TO HAVE TO TAKE THIS NEEDLE OFF.
I HAVE A FILTER NEEDLE COS WHEN I BREAK THE TOP OFF THIS
GLASS AMPOULE THERE IS A CHANCE THAT GLASS COULD GET INTO THE AMPOULE.
SO I GOT TO DRAW THE MED OUT WITH A FILTER NEEDLE.
THEN I AM GOING TO ATTACH THE 25 GAUGE, FIVE EIGHTHS INCH NEEDLE.
WE ARE IN THE NEEDLE SWAP, OKAY.
THIS IS ALSO A DIFFERENT KIND OF SYRINGE.
IT DOESN'T HAVE LUER LOCK.
REMEMBER WITH THE JAR THREADS THAT SCREW ON THE NEEDLE?
IT'S JUST PLASTIC TO PLASTIC,
SO WE'RE GOING TO HAVE TO USE A LITTLE DIFFERENT TECHNIQUE
TO STABILIZE OUR NEEDLE AND I'LL GO THROUGH THAT.
SO, I HAVE ALL MY SUPPLIES, I HAVE ALCOHOL, BAND-AID,
AND A TWO BY TWO FOR MY BABY TO DRY OFF.
AND I REALLY DON'T NEED TAPE, I'M NOT GOING TO LABEL MY SYRINGE
BECAUSE I'M JUST GOING TO BE RIGHT HERE WITH THE BABY.
YOU DRAW IT UP NEXT TO THE BABY AND GIVE IT TO THE BABY,
SINCE THEY'RE IN THE ROOM SO NOT REALLY NECESSARY.
ALRIGHT, GATHER MY SUPPLIES. I HAVE WASHED MY HANDS,
AND I'LL IDENTIFY MY CLIENT WHEN I GET IN THERE, AND SO FORTH.
OKAY, I GAVE YOU A PRESENT.
AND THE REASON FOR THE PRESENT IS THAT
IT'S WHAT YOU'RE GOING TO SNAP THIS OFF WITH.
IT'S YOUR GRIPPER SO THAT YOU DON'T CUT YOUR HANDS.
WHEN YOU'RE READING IN YOUR BOOK, I THINK SOMEONE MENTIONED IT EARLIER,
THEY SUGGEST THAT YOU USE AN ALCOHOL SWAB
OR TWO BY TWO'S, AND THAT'S NICE.
LET ME EXPLAIN A FEW THINGS ABOUT THESE.
THE ONES THAT THE MANUFACTURERS MAKE, THE AQUAMEPHYTON,
REALLY COMES IN AN AMPOULE.
THEY'RE A LITTLE STURDIER THAN THE GLASS
THAT THEY DO THESE FOR THE PRACTA-AMPS
AND I HAVE HAD A LOT OF THEM SHATTER IN STUDENT'S
TWO BY TWO'S AND SO FORTH. AND IT CUT A COUPLE OF TIMES.
WE HAD TO COME UP WITH SOMETHING A LITTLE SAFER FOR THESE
BECAUSE THEY'RE JUST A LITTLE LESS STURDY.
IF IN THE WORKFORCE,
YOU DIDN'T HAVE A LITTLE SNAPPER LIKE THESE
AND THEY'RE GETTING MORE OF THEM. IT'S A NEW PRODUCT
AND IT JUST CAME OUT IN THE LAST YEAR,
I WOULD USE MY ALCOHOL SWAB WITH THE PACKAGE OVER IT.
NOT JUST TAKE THE ALCOHOL SWAB,
BECAUSE YOU'RE GOING TO GET MORE PROTECTION FOR YOUR HANDS
IF IT WERE TO SHATTER OR BREAK.
AND THAT'S THE WHOLE THING, IS TO PROTECT YOU.
MOST OF THE TIME, THEY DON'T.
I WANT YOU TO PRACTICE WITH YOUR AMP, I'LL GIVE YOU ANOTHER ONE.
THIS IS CLUMSY MORE THAN IT IS HARD,
JUST CLUMSY WORKING WITH THESE THINGS.
ALRIGHT, I NEED TO DRAW UP MY DOSE.
SO, WHAT YOU WANT TO DO IS JUST KIND OF TAP THIS.
DON'T HIT IT REAL HARD OR SOMETIMES WHEN YOU HIT IT
YOU WILL FLICK IT RIGHT OFF.
AND YOU WANT TO MAKE SURE
THAT WHEN YOU'RE DOING IT, YOU'RE NOT FACING ANYBODY.
YOU WOULDN'T DO THIS OVER THE BABY'S HEAD,
I WOULDN'T SHOOT TOWARDS YOU.
YOU'RE ALWAYS GOING TO SHOOT AWAY OR TOWARDS THE WALL,
SO THAT NO ONE GETS INADVERTENTLY SHOT AT.
GRAB HERE AND FLICK, BUT WE'RE GOING TO DO THIS BECAUSE IT WORKS BETTER.
WHEN YOU GRAB IT IT'S REAL SIMPLE.
YOU CAN SEE THE DEMARCATION LINE HERE.
I PUT MY THUMB HERE AND PUSH AND MY FINGER UP ABOVE IT
AND PULL WHILE I AM HOLDING THE BOTTOM, AND YOU JUST SNAP.
AND I JUST DROPPED IT THIS MORNING AS WELL,
SO THERE'S ANOTHER LITTLE PIECE OF GLASS SOMEWHERE IN HERE.
THESE REALLY, VERY OFTEN THEY WILL HOLD ON TO THAT
TOP PIECE AND IT WOULD ALL GO INTO THE SHARPS CONTAINER.
SO FOR NOW, YOU CAN JUST DUMP IT IN AND THEN SAVE THIS
AND BRING IT FOR TESTING SO, YOU WILL HAVE YOUR LITTLE SNAPPER.
OKAY, SO NOW I'VE GOT AN OPEN-ENDED VIAL
AND I NEED TO GET MY MED OUT OF IT.
- SO. - WHY DOES IT COME OFF THAT?
I DON'T KNOW. I DON'T KNOW IF IT HAS SOMETHING TO DO WITH THE METAL.
WHY THEY DON'T JUST PUT IT IN A VIAL? I JUST DON'T KNOW.
THERE'S TWO OR THREE MEDS THAT ARE ALSO IN YOUR CRASH CARTS
THAT ARE DONE IN VIALS, AND I DON'T HONESTLY KNOW WHY.
- THAT'S GOT TO BE HARDER.
- IT'S NOT REALLY. - I MEAN THE PACKAGE. - IT'S CLUMSY.
I WOULD THINK. HOW DO YOU MAKE A -- I DON'T KNOW.
I JUST KNOW IT'S TRUE.
SOME THINGS ARE JUST NOT TO KNOW.
YOU GET TO HEAVEN AND YOU CAN ASK ALL THOSE QUESTIONS.
ALRIGHT, I AM GOING TO GO AHEAD AND TAKE MY NEEDLE OFF HERE.
AND I AM GOING TO PEEL BACK AND PUT THE FILTER NEEDLE ON.
NOW, NO THREADS. IT'S PLASTIC TO PLASTIC.
SO, YOU GOT TO TWIST ON, PULL CAP OFF.
TWIST THE NEEDLE ON, PULL.
TWIST-PULL.
IF YOU TWIST-TWIST, IT WILL KEEP PULLING YOUR NEEDLE OFF
BECAUSE IT'S THE PLASTIC KIND OF CATCHING ON ITSELF THAT MAKES IT STICK.
ALRIGHT, HERE'S WHERE CLUMSY HAPPENS.
BECAUSE I HAVE SHAKY HANDS,
YOU DON'T PUT AIR INTO THESE OR IT WILL JUST BUBBLE ALL OUT
BECAUSE IT'S NOT A SEALED TAUT.
SO, YOU GOT TO PUT YOUR NEEDLE IN HERE
AND SUCK OUT WHAT YOU NEED, AND SUCK OUT A LOT.
AND NOW, FOR THE STEADIER HAND,
I JUST NEED YOU TO APPRECIATE,
THAT YOU CAN HOLD THESE UPSIDE DOWN AND NOTHING WILL COME OUT.
AND THEN YOU CAN PUT YOUR NEEDLE IN,
AND NOT ALL THE WAY AND THEN YOU CAN SUCK IT OUT.
IT'S HARD TO SEE HERE AND IT JUST KIND OF COMES OUT.
I DON'T KNOW, BUT IT DOES IT.
I DIDN'T KNOW THAT FOR THE LONGEST TIME AND I WAS IN A CODE ONE DAY
AND THEY WERE PULLING THE CODE MEDS OUT, AND THIS NURSE WAS WITH THIS DOCTOR,
I DON'T KNOW AND THERE WAS SOMEBODY FLIPPING THEM OVER, AND I WAS LIKE...
HERE THIS POOR GUY'S DYING AND I'M GOING,
"HOW DOES THIS COME OUT?"
SO I DON'T THINK THAT'S THE TIME
THAT YOU'RE SUPPOSED TO BE GAWKING AT DUMB STUFF LIKE THAT
WHEN THERE IS THEM, YOU KNOW. OKAY, WELL THAT SORT OF THING.
SO YOU'RE GOING TO HAVE TO REALLY FLICK IT HARD.
AND GET YOUR AIR OUT.
AND THEN REMEMBER, AND I'M MAKING SURE MY AIR PASSES THROUGH MY HUB.
REMEMBER THAT THIS IS, KIND OF, AN OILY, SLIPPERY STUFF.
AND THEN YOU WOULD GO TO YOUR TRASH CAN AND SET YOUR DOSE.
2.5, OH WELL, THERE'S THOSE NUMBERS.
ALRIGHT, TO GET THIS NEEDLE OFF, IT'S SLIPPERY.
SO IF YOU'VE GOT ANY OF IT ON YOUR HANDS, YOU WANT TO DRY.
MAKE SURE YOU PUT THE CAP ON,
HOLD THE FLANGE BEING CAREFUL NOT TO PLUNGE OUT YOUR DOSE.
HOLD THE FLANGE AND THEN TWIST OFF, THE OPPOSITE WAY.
TWIST IT AND IT WILL RELEASE THAT SEAL YOU CREATED WITH THE PLASTIC.
ALRIGHT, THROW THESE AWAY AND THEN NOW YOU'RE GOING TO PUT ON...
I DON'T THROW MY AMPOULE AWAY UNTIL I'VE TOTALLY GOTTEN,
GIVEN MY DOSE, IN CASE I INADVERTENTLY HIT THIS AND SQUIRT SOME DOSE OUT.
I'M GOING TO PUT ON MY 25 GAUGE.
MY HANDS ARE SHAKY TODAY, 25 GAUGE, FIVE EIGHTHS INCH NEEDLE,
TWIST AND IT SHOULD BE ON NICE AND STURDY.
ALRIGHT, I'M GOING TO GET RID OF ALL MY TRASH. SAVE THESE NEEDLES.
CONNIE AND I'LL PUT A LITTLE BOX OUT SO THAT YOU CAN SAVE THEM.
SOME OF THEM HAVEN'T EVEN BEEN USED. SO WHO KNOWS WE USE THEM FOR SOMETHING.
CLEAN UP YOUR AREA, AND THEN...
DOUBLE CHECK.
ONE MILLIGRAM, HALF CC, AND I'M HAPPY.
I'M GOING TO GIVE MY SHOT TO MY BABY. ALRIGHT.
BABY. YOU'RE GOING TO COME IN AND DO YOUR BABY.
NOW, YOU NEED TO APPRECIATE
THAT YOU'RE NOT GOING TO HANDLE A BABY THAT'S ONE HOUR OLD WITHOUT GLOVES.
BECAUSE THAT BABY PROBABLY HASN'T HAD A BATH YET.
THE BABY HAS GONE THROUGH THE BIRTH CANAL,
THE BABY'S BEEN EXPOSED TO MOM'S AMNIOTIC FLUID, MOM'S BLOOD,
MAYBE EVEN MOM'S STOOL OR URINE, DEPENDING ON THE SCENARIO.
SO THERE'S A LOT OF BODY FLUIDS ON THIS BABY.
EVERYTHING DONE BEFORE BATH IS WITH GLOVES.
EVEN TO UNWRAP THEM BECAUSE OF BODY FLUIDS.
SO, I CAN'T REALLY CHECK THE MAR TO THE NAME BAND
UNTIL I UNWRAP, AND SO YOU'RE GOING TO UNWRAP AND GET DOWN AND...
OH BOY, WE HAVE THIS ONE REALLY PACKAGED UP NICELY.
THAT'S IT. I SHOULD HAVE CHECKED.
I NEED TO GET DOWN TO DIAPERS.
THEY'RE JUST GOING TO BE IN A DIAPER AND A T-SHIRT,
NOT A CUTE LITTLE OUTFIT ALREADY.
I NEED TO GET DOWN
TO NAME BAND AND TO THIGH.
OKAY.
I'M GOING TO CHANGE THE NAME BAND.
THEY USUALLY HAVE A BAND ON THE HAND AND THE FEET.
SO MAR, I HAVE INFANT BABY,
OH IT'S AN RN'S BABY, AND IT'S BABY BENEFIEL. OH HOW SWEET.
OKAY, IT'S MY BABY. TAKE GOOD CARE OF HIM.
OKAY, I HAVE MY BABY.
AND NOW I WANT TO CHECK, AND WHAT WE TYPICALLY DO,
I'M GOING TO JUST TILT HIM UP A LITTLE BIT FOR YOU SO YOU CAN SEE...
IS WE USUALLY GIVE THE AQUAMEPHYTON IN THE LEFT THIGH
FOR RIGHT-HANDERS ESPECIALLY.
AND THIS IS THE REASON THAT WHEN I GO TO DO THE THIGH,
IF I COME IN FROM THIS DIRECTION,
ALL THESE OTHER EXTREMITIES ARE GOING TO BE INADVERTENTLY SWATTING AT ME.
BUT I DO WANT TO TEACH YOU HOW TO PAPUSE THIS BABY
SO THAT THEY DON'T WIGGLE ON YOU.
THEY DON'T BITE TOO MUCH AND I DON'T USUALLY WRAP THEM,
BUT ON KIDS THEY'RE A LITTLE MORE BIGGER, SO I DO.
OKAY, WHAT YOU WANT TO DO.
GET YOUR BABY SWADDLE
AND EXCUSE ME THERE, BABY.
I NEED TO GET THIS BLANKET SO I CAN SHOW THEM.
OKAY, ON YOUR BLANKET, THIS ONE IS KIND OF SQUARE.
OFTEN TIMES THEY'RE A LITTLE RECTANGLE.
YOU'RE GOING TO TAKE AND FOLD DOWN A PIECE LIKE THIS FOR THEIR HEAD
BECAUSE YOU DON'T WANT THEIR HEAD PARTICULARLY WRAPPED UP.
SO GET YOUR BABY, PUT HIM THERE, SUPPORT THOSE HEADS COS THEY FLOP.
ALRIGHT, THEN YOU'RE GOING TO TAKE -- I WANT THIS LEG TO STAY EXPOSED.
SO YOU'RE GOING TO TAKE THIS FIRST WRAP HERE,
AND WRAP IT NICE AND SNUG, KEEPING THIS LEG OUT.
THEN YOU'RE GOING TO PULL THIS UP THROUGH, KEEPING THAT NICE AND SNUG,
AND THIS IS A PITIFULLY SMALL BLANKET.
OH IT'S TERRIBLE, I NEED A BIGGER BLANKET.
AND THEN TAKE THIS EDGE AND WRAP IT TIGHT, TIGHT, TIGHT, AROUND.
SO THAT ALL THAT'S STICKING OUT IS A BABY LEG.
OKAY, SO PRACTICE SWADDLING.
I LIKE THE RECTANGLE ONES THAT ARE LONG ON ONE SIDE BECAUSE I
AND GET THEM REALLY TIGHT IN THERE.
OKAY, I WANT TO IDENTIFY MY LANDMARKS WHICH IS BASICALLY A FINGER AT THE...
BELOW THE GROIN HERE AND A FINGER ABOVE THE KNEE.
HERE'S THE MEDIAN LINE, AND HERE TO THE SIDE IS THE VASTUS LATERALIS.
MY GRIP FOR THE BABY IS TO PUT THE KNEE IN THE WEBBING
OF MY HAND TO STABILIZE IT.
AND I PUT MY THUMB ON ONE SIDE OF THE MUSCLE AND MY FINGER HERE,
AND THEN I SQUEEZE MY THUMB AND FINGER TOGETHER, LIKE THIS.
AND IT POPS THAT LITTLE MUSCLE UP, AND IT'S AS PRETTY AS CAN BE.
AND THAT'S WHAT YOU WANT RIGHT HERE.
SO THAT'S MY GRIP. THAT WAY THAT LEG'S GOING NOWHERE, THE BABY IS WRAPPED,
IT'S JUST ME THAT'S GOING TO BE HOLDING ON.
OKAY, ONCE YOU SHOW US THE GRIP, IT NEEDS A RUBBER PAD HERE.
YOU'RE ACTUALLY GOING TO GIVE THE SHOT IN THAT.
PULL AWAY. PULL IT STRAIGHT, NO TWIST.
GOT TO CLEAN THAT LITTLE THIGH, AND YOU CAN LEAVE IT THERE IF YOU WANT.
USUALLY WHEN YOU CLEAN THERE'S BLOOD AND YOU CAN SEE THE STUFF.
I'M SQUEEZING UP BETWEEN MY THUMB AND FOREFINGER
AND PINCHING THAT LITTLE MUSCLE UP AND THEN YOU CAN JUST PUSH THIS IN.
OH! BABY, I'M SO SORRY.
ASPERATE, PUT IT IN. PUT IT IN FAIRLY SLOW,
AND THEN IF YOU HAVE ONE OF THOSE SAFETY GLIDES,
YOU'RE GOING TO SAFETY GLIDE OUT,
BUT I DON'T HAPPEN TO HAVE A NEEDLE SAFETY DEVICE TODAY.
SO NEEDLE OUT,
YOU'RE GOING TO JUST STAND HERE A MINUTE AND HOLD
BECAUSE WHAT AM I AT RISK FOR HERE?
THEY'RE GOING TO BLEED. THAT'S THE WHOLE POINT OF THIS SHOT.
SO THEY USUALLY GIVE YOU A TRICKLE DOWN THEIR LEGS.
SO, I LIKE TO KEEP SOME PRESSURE ON.
YOU MIGHT WANT TO TRY A DRY TWO BY TWO.
HOLD, BABY'S GOOD. I KNOW THEY'RE WRAPPED.
I NEED TO GET RID OF THIS IN MY SHARP AND IT'S NOT FAR.
AND MAYBE DRY.
I ALWAYS PUT A BAND-AID ON BABIES BECAUSE THEY DO OOZE MOST OF THE TIME.
YOU DON'T HAVE TO ON MY MANNEQUINS, PLEASE. IT'S NOT NECESSARY.
AND THEN YOU WANT TO REPOSITION THE BABY,
AND THIS IS HOW YOU WRAP HIM NOW THAT ONE SIDE STILL GOOD.
BRING THIS ONE UP AND TAKE THIS ONE ALL THE WAY AROUND, NICE AND SNUG
AND THEN THEY EITHER LAY ON THEIR SIDE
OR ON THEIR BACK WITH THEIR HEAD TURNED.
- SO IT'S NOT REALLY A MASSAGE, JUST PRESSURE?
- JUST PRESSURE. YEAH, THERE'S NO NEED FOR A MASSAGE.
IT MIGHT CAUSE BRUISING, I WOULD THINK.
- IF YOU'RE LEFT-HANDED DO YOU DO IT THE OTHER WAY?
- YOU CAN. IT DEPENDS ON THEIR HOSPITAL POLICIES.
SOMETIMES THEY STARTED THE HEPATITIS B SERIES ON BABIES
AND SO THEY MAY DO THE HEPATITIS -- IT'S WHAT WE DO IN OUR HOSPITAL.
HEPATITIS WAS RIGHT LEG, AND AQUAMEPHYTON WAS LEFT
JUST SO IN CASE THEY HAD A LITTLE SWELLING
OR IRRITATION, WE KNEW WHICH SHOT DID WHAT.
SO STAY WITH YOUR HOSPITAL POLICIES
AND THEN BECAUSE OF MONEY THEY QUIT DOING THE HEPATITIS B
AND THEY STARTED DOING IT IN THE DOCTOR'S OFFICES.
AND I DON'T KNOW WHAT THEY'RE DOING RIGHT NOW WITH THAT.
SO, TAKE YOUR GLOVES OFF, WASH YOUR HANDS, DISPOSE OFF.
NOW YOU CAN GET RID OF YOUR AQUAMEPHYTON
IN THE SHARPS CONTAINER BECAUSE IT IS GLASS.
ALL THESE OTHER NEEDLES WOULD GO IN SHARPS.
WASH YOUR HANDS AND DOCUMENT.
AND WE'RE GOING TO DOCUMENT THAT OUR SHOT WAS GIVEN AT TWO O'CLOCK.
AND IT WAS GIVEN IN THE LT.
LEFT THIGH.
BY ME, DB, WHO IS DIANE BENEFIEL RN.
AND YOU ARE SN CSUF, OKAY.
AND THAT IS IT.
THEY'RE NOT REALLY HARD. JUST THIS ONE IS CLUMSY.
AND THE OTHER IS HIGH ANXIETY, BUT PAST THAT,
IT'S REALLY NOT, THEY'RE NOT BASICALLY HARD SKILLS.
SO PRACTICE WITH THAT STUFF AND GET COMFORTABLE.