WE ARE GOING TO DO A FEW
MISCELLANEOUS THINGS

THAT I FORGOT TO DO OVER
THE LAST FEW WEEKS.

YOU KNOW, A LITTLE OF THIS,
"WE RAN OUT OF TIME",

A LITTLE OF THAT
"I FORGOT TO MENTION"
AND THAT KIND OF STUFF.

THEN WE'RE GOING
TO DO OSTOMY CARE.

IT'S ACTUALLY YOUR LAST TESTED
SKILL BEFORE CRITICAL THINKING.

- IT IS?
- CAN YOU ALL BELIEVE THAT?

- I KNOW. SOME OF YOU
ARE EXCITED.

I'LL TALK TO YOU A LITTLE BIT
ABOUT END OF SEMESTER STUFF
AND WE'LL BE DONE.

SO IT'S VERY EASY. YOU ONLY HAVE
ONE GRADED SKILL NEXT WEEK.

- OH, MY GOODNESS.

- I TOLD YOU I WOULD GET NICER
TO YOU ON THE END.

YOU KNOW, I PROMISED IT WAS
COMING. SO, HERE WE GO.

ALRIGHT, CPT. I NEVER DID
GET AROUND TO DOING THAT.

CHEST PHYSIO THERAPY. SO IF YOU
HAVE THAT LITTLE CHECKLIST,

I AM GOING TO HAVE YOU DO THAT
SINCE WE'RE ONLY BEING
GRADED ON ONE.

I'M GOING TO HAVE YOU DEMO
THIS JUST SO YOU CAN MESS

WITH THE BED A LITTLE BIT AND
GET THE IDEA OF HOW IT WORKS.

IT'S PASS/FAIL SO, AND AGAIN
IT'S NOT A GRADED ONE

BUT JUST, KIND OF, A ON A
NEED TO KNOW BASIS.

CHEST PHYSIO THERAPY
IS PURPOSED TO DO THE
TWO THINGS.

IT'S TO DRAIN FLUID
OUT AND TO HELP THEM

GET, LIKE, SPUTUM OUT.

SOMETIMES IT'S JUST STRAINING
FROM ONE LUNG FIELD TO ANOTHER,

BUT OFTEN WE'RE TRYING TO GET
IT OUT OF THEM AS WELL.

SO WE'RE GOING TO TRY
TO ACCOMPLISH TWO THINGS.

BEFORE YOU DO CHEST PHYSIO
THERAPY ON ANYONE,

YOU WANT TO MAKE SURE
THERE'S NO CONTRAINDICATIONS

AND THAT'S PROBABLY AS IMPORTANT
AS THE WHOLE PROCEDURE.

NOT EVERYONE CAN HAVE THEIR HEAD
UPSIDE DOWN TO BE DRAINED

AND NOT EVERYONE CAN BE POUNDED
ON TO GET SPUTUM OUT.

SO, A COUPLE OF THINGS YOU
WANT TO KEEP IN MIND,

WHEN WAS THE LAST TIME THEY ATE?

THIS IS GOOD TO KNOW. YOU WANT
TO WAIT AT LEAST TWO HOURS

FROM THEIR LAST MEAL BEFORE
YOU TURN THEM UPSIDE DOWN

AND START, KIND OF,
POUNDING ON THEM.

SO, FIND OUT LAST MEAL TO
PREVENT REGURGITATION

AND THEN THERE'S SOME
COMPLICATING CONDITIONS

THAT WOULD KEEP YOU
FROM DOING IT.

SOME ARE JUST LOGICAL. IF YOU
THINK ABOUT BEING UPSIDE DOWN,

WHO COULDN'T BE UPSIDE DOWN?

- ELDERLY?
- HEAD INJURIES?

I MEAN HEADS, PRESSURE. SO
THINK OF PRESSURE THINGS.

- HYPERTENSION.
- HYPERTENSION.

I MEAN PEOPLE WITH ALREADY
HIGH BLOOD PRESSURE.

PEOPLE THAT ARE
IN RESPIRATORY DISTRESS

CAN'T GO UPSIDE DOWN, SO.

I MEAN, IT'S NOT
A FULL UPSIDE DOWN,

BUT WE'RE GOING TO PUT THEM
A GOOD 30 DEGREES DOWN.

SO WHO CAN HANDLE THAT
AND WHO CAN'T.

SO SPECIFICALLY, HYPERTENSION,

CONGESTIVE HEART FAILURE,
CEREBRAL EDEMA, HEAD TRAUMA,

ABDOMINAL DISTENSION WOULDN'T
BE A GOOD ONE EITHER.

I MEAN, AND THAT, KIND OF,
GOES ALONG WITH EATING.

ARRHYTHMIAS AND END STAGE COPD.

AGAIN WE'RE LOOKING AT THAT,
KIND OF, RESPIRATORY

VERSUS SOMEONE THAT HAS
RESPIRATORY.

LIKE CEREBRAL PALSY IS WHERE I
TENDED TO DO THIS THE MOST.

WHERE THEY HAVE A LOT OF
SPUTUM PRODUCTION

AND SO, THEY NEED TO HAVE THE
CHEST PHYSIO THERAPY FREQUENTLY.

ALRIGHT, SO ONCE YOU'VE
DECIDED THAT THEY'RE OKAY
FOR THE PROCEDURE,

YOU HAVE A DOCTOR'S ORDER,
CHECK CARE PLAN.

WHEN YOU'RE LOOKING AT THE
CHART IN THE DOCTOR'S ORDER,

YOU WANT TO FIND OUT WHICH
LUNG YOU'RE DRAINING.

THE LUNG THAT'S DRAINING IS
GOING TO BE THE UPPER MOST LUNG,

BECAUSE YOU WANT TO DRAIN
IT INTO WHAT'S GOOD.

IF YOU HAVE THE LUNG THAT
NEEDS TO BE DRAINED LOWER

THERE'S NO PLACE FOR
THE FLUID IN IT TO GO.

IF THEY'RE Bl-LATERAL, THEN
IT JUST DOESN'T MATTER.

BUT IF YOU'RE LOOKING AT
A, LIKE, A LEFT-LOWER
LOBE PNEUMONIA

FOR EXAMPLE, YOU'RE GOING TO
PUT THE LEFT LOBE UP,

SO THAT IT CAN DRAIN INTO
THE BETTER LUNGS.

THE GOOD LUNGS ARE ABLE
TO HANDLE THE SECRETIONS
AND MOVE THEM OUT

WHEREAS THE ONE THAT'S
CONGESTED CAN'T.

SO, YOU WANT TO FIND OUT THE
DIAGNOSIS AND WHAT'S GOING ON

WITH THEM AS FAR AS
THEIR CONDITION.

ONCE YOU'VE DETERMINED
THE CONDITION,

THEN YOU'RE GOING TO GATHER UP
THE EQUIPMENT WHICH IS MINIMAL.

DEPENDING ON WHAT
YOU WANT TO DO,

IF YOU NEED TO GET
A SPUTUM SPECIMEN,

YOU WANT TO GET
YOU'RE SPUTUM CUP.

IF YOU'RE GOING TO PUT A
CLOTHING LAYER ON THEM

THEN ALL YOU WANT IS, LIKE,
ONE LAYER OF TOWEL OR LEAST
ONE LAYER OF CLOTHING

SO THAT WHEN YOU'RE PERCUSSING
ON THEM, YOU'RE NOT GOING
SKIN TO SKIN.

YOU WANT A LITTLE LAYER OF
PROTECTION ON THEIR SKIN.

SO I BROUGHT A TOWEL, I COULD
USE THE GOWN AS WELL.

I LIKE TO HAVE SOMETHING
FOR THEM TO SPIT INTO.

SO AN EMESIS BASIN,
KLEENEX, SOMETHING.

THEY OFTEN REFER TO THIS
AS PULMONARY HYGIENE.

YOU'RE CLEANING OUT LUNGS,
SO, YOU'VE GOT TO CAPTURE THIS.

I'VE TOLD YOU SPUTUM IS NOT
MY VERY FAVORITE THING.

I WAS TALKING ABOUT BOWEL
EVACUATIONS THIS MORNING,

IT'S WAS LIKE, "THIS DOESN'T
BOTHER ME AT ALL."

BUT THIS IS JUST NOT
MY FAVORITE THING.

AND ONE OF THE THINGS THAT
I FIND VERY DISTASTEFUL
ABOUT SPUTUM

IS WHEN PEOPLE ARE HOCKING UP
THOSE PLUGS.

WHAT THEY TEND TO DO IS THEY
HOCK THEM ON TO THESE
EMESIS BASINS.

AND THEN YOU GOT TO CLEAN
THE BASIS AND THEY DRY
AND THEY STICK ON THERE.

IT JUST GAGS ME
TO GET THAT STUFF.

SO, I ALWAYS TRY TO PUT A
KLEENEX OR SOMETHING IN THERE

SO IT WILL JUST, KIND OF,
SLIDE OUT AND I DON'T
HAVE TO TOUCH IT.

THE OTHER THING I FIND
PARTICULARLY DISGUSTING

IS WHEN THEY HOCK INTO A KLEENEX
AND THEN THEY JUST PITCH THEM
ALL OVER THE FLOOR.

I FIND THAT TO BE DISGUSTING.

AND AS A NURSE
AND BEING PROPER,

I JUST THOUGHT MY JOB WAS
TO CLEAN UP AFTER PEOPLE,

YOU KNOW, AND BE PROPER
AND JUST GO...

..BE INTERNALLY AND
QUIETLY DISGUSTED,

UNTIL I WORKED WITH THIS
NURSE THAT WAS CONFIDENT

AND KNEW HOW TO HANDLE HERSELF.

AND I HAD A PATIENT ONE TIME
THAT WAS DOING...

HOCKING AND KLEENEX ALL OVER,
IT WAS JUST GROSS.

AND I WAS YOUNG.

AND SHE CAME IN AND SHE GOES,
"OH, MAN, MR. SMITH.

WHY ARE YOU PITCHING THOSE
KLEENEXES ALL OVER THE PLACE?

THAT'S GROSS, YOU DON'T PUT
SPUTUM ALL OVER THE FLOOR.
THAT'S A BODY FLUID.

NOW YOU NEED TO BE GETTING
THOSE INTO THIS BAG."

AND I'M GOING," YEAH!" I MEAN, I
JUST NEVER HAD THE GUTS TO --
YOU KNOW WHAT I MEAN?

I THOUGHT I WAS SUPPOSED TO BE,
LIKE, DOING IT, THAT WAS
MY JOB TO PICK UP.

IT'S NOT YOUR JOB TO PICK UP.

YOU'RE JOB IS TO TEACH THEM
HOW TO CONTAIN THEIR SPUTUM.

I THOUGHT IT WAS REAL FREEING
TO BE ABLE -- I MEAN, YOU DON'T
HAVE TO YELL AT THEM,

OR BE DISGUSTING, BUT SHE
HAD BUILT SOME RAPPORT
AND WAS ABLE TO SAY,

"HEY, YOU KNOW WHAT,
PUT THESE IN HERE."

AND I'M LIKE, "UH-HUH."

SO, TEACH YOUR CLIENTS TO
CONTAIN THEIR BODY FLUIDS

AND MAKE SURE THAT THEY
HAVE A WAY TO DO THAT.

MAKE SURE THAT YOU HAVE
BAGS ON BOTH SIDE RAILS

FOR THEM TO PUT
THEIR KLEENEXES IN.

AND THAT THEY'VE GOT
PLENTY OF KLEENEXES

SO THAT YOU'RE NOT HAVING
TO HANDLE THAT SUFF.

ALRIGHT, SO I'VE GATHERED
UP MY EQUIPMENT. IF I NEEDED
TO GET A SPUTUM SPECIMEN,

YOU'D WANT TO HAVE A CUP SO THAT
THEY COULD GET THEIR SPUTUM OUT.

ALRIGHT, I HAVE WASHED MY
HANDS AND I'M GOING TO COME
IDENTIFY MY CLIENT.

AND I HAVE HERE TODAY, CAN
YOU TELL ME YOUR NAME?

CONRAD CURRY. AND I'M
GOING TO PROVIDE PRIVACY.

MR. CURRY, YOUR LUNGS
ARE PRETTY CONGESTED

AND THE DOCTOR SAID
THAT WE SHOULD DO --

OR TRY FOR YOU SOME POSTURAL
DRAINAGE AND PERCUSSION.

WHAT THAT MEANS IS WE'RE
GOING TO PUT YOUR HEAD

BELOW YOUR CHEST A LITTLE BIT,

AND PUT -- IT'S YOUR LEFT
LOWER LUNG, WE'LL SAY.

WE'RE GOING TO PUT
YOUR LEFT LUNG UP

AND THEN I'M GOING TO PERCUSS
ON IT A LITTLE BIT

AND SEE IF WE CAN LOOSEN UP
SOME OF THOSE SECRETIONS
AND LET THEM DRAIN.

AND WHEN YOU'RE UPSIDE DOWN IT
MAKES IT EASIER FOR THEM

TO COME UP AND OUT SO YOU
CAN COUGH THOSE OUT.

AND I AM GOING TO GIVE
YOU SOME KLEENEX

TO COUGH YOUR SPUTUM INTO.
AND THAT WOULD BE GREAT.

IF YOU NEED TO GET A SPUTUM
SPECIMEN,

WHAT DO YOU NEED TO DO ABOUT
THEIR MOUTH?

- RINSE WITH WATER.
- RINSE WITH WATER,

GIVE THEM SOME ORAL HYGIENE, NOT
ANY KIND OF ANTI-BACTERIAL,

BUT, YOU KNOW, LET THEM BRUSH
THEIR TEETH, RINSE THEIR
MOUTH OUT.

AND THEN YOU'LL BE PREPARED
TO GET A SPUTUM SPECIMEN.

ALRIGHT, WELL THE FIRST
THING I WANT TO DO,

CHECK VITAL SIGNS SO, YOU
CAN JUST SAY THAT.

BECAUSE I WANT TO MAKE SURE THAT
THEY'RE OKAY. I WANT TO DO A
LUNG ASSESSMENT,

SEE IF THERE'S ANY DIFFERENCE
BEFORE OR AFTER DOING
THIS TREATMENT.

AND THEN I WANT TO LOOSEN UP ANY
CLOTHING THAT MIGHT BE TIGHT.

TIGHT BRAS, TIGHT BINDERS.

THINGS THAT ARE GOING TO MAKE
IT DIFFICULT TO BREATHE,

THINKING OF THEMSELVES
BEING UPSIDE DOWN.

ALRIGHT. ONCE I'VE GOT THEM
FAIRLY SETTLED,

THEN WHAT I WANT TO DO IS PUT
THE BED IN THE HIGH POSITION.

BECAUSE WHAT WE'RE GOING
TO TRY TO ACCOMPLISH HERE
IS A REVERSED TRENDELENBURG.

IF YOUR CLIENT CAN, ASK THEM IF
THEY CAN ROLL OVER TO THEIR --

WHAT SIDE DID I SAY THEY HAD IT?
LEFT LOWER?

- TAKE IT ROUND AND UP.

TURN THE OTHER WAY.

LET'S HAVE RIGHT, LOWER LOBE.

CAN YOU ROLL OVER? YES YOU CAN,
I JUST NEED YOU TO ROLL OVER.

OKAY, SO RIGHT NOW THEY HAVE
RIGHT LOWER LOBE PNEUMONIA.

SO, I'M GOING TO GET THE
RIGHT LUNG FIELD UP.

OKAY.

NOW TO GET YOUR BEDS
INTO A TRENDELENBURG,

YOU NEED TO COME TO
THE FOOT OF THE BED

AND FIND THE TRENDELENBURG
POSITIONS.

TRENDELENBURG
IS HEAD BELOW FEET.

AND SO WHAT YOU WANT
TO DO IS PULL ...

..THAT BUTTON OUT
TILL IT CLICKS, OKAY?

AND I SHOULD BE IN THE HIGHEST
POSITION THAT IT CLICKS.

ALRIGHT. ONCE IT'S TOTALLY
OUT, MY BUTTON IS OUT,

THEN WHAT YOU WANT TO DO
IS PUT YOUR BED DOWN.

AND SEE HOW IT GOES FLAT
FOR A WHILE?

THAT'S HOW I KNOW YOU PRACTICE
BECAUSE IF YOU LOOKED AT ME
AND GO, "IT'S NOT WORKING."

THEN, I KNOW YOU DIDN'T.

AND THEN YOU JUST KEEP PUTTING
IT DOWN UNTIL IT STOPS.

IT ACTUALLY SAYS
TO PUT HIM 30 DEGREES

IN A 30 DEGREE PLANE HERE.

YOU CAN TELL THE DEGREES
BY UNDERNEATH THE BED.

THERE'S LITTLE COMPASSES
DOWN THERE

AND IT ACTUALLY SAYS 15 DEGREES.

I THINK THAT LOOKS LIKE
A WHOLE LOT TO ME.

DOESN'T THAT LOOK LIKE ABOUT 45?

BUT IT'S NOT, IT'S ONLY 15.

I THINK IT'S MUCH CLOSER
TO 30, BUT WHATEVER.

THAT'S WHAT YOU'RE DOING. NOW,

THE POINT HERE IF YOU'RE GOING
TO DO POSTURAL DRAINAGE ALONE,

THIS IS POSTURAL DRAINAGE.

THEY'RE IN A POSTURE THAT
WOULD DRAIN THE LUNG FIELD.

SO IF THAT'S ALL
WE WERE GOING TO DO,

WE GO AHEAD AND GIVE THEM
THEIR SPUTUM CONTAINER

AND THEIR KLEENEX
AND JUST TELL THEM

THAT WE'RE GOING TO STAY WITH
THEM THIS FIRST TIME TO MAKE
SURE THEY'RE OKAY.

NEVER LEAVE ANYONE ALONE
THE FIRST TIME

YOU LEAVE THEM UPSIDE
DOWN LIKE THIS.

AND ALWAYS MAKE SURE A CALL
BELL IS WITHIN REACH.

ONCE THEY'VE DONE IT ONE OR TWO
TIMES YOU KNOW THEY'RE OKAY,

YOU CAN LEAVE THEM UPSIDE
DOWN WITH THE CALL LIGHT.

BUT THE DOCTOR ORDERED
FOR OUR CLIENT

POSTURAL DRAINAGE
AND PERCUSSION.

THE POINT OF THE TWO TOGETHER
IS THAT IF WE PERCUSS ON TO
THEIR LUNG FIELD,

AND THEN LET THEM SIT HERE
FOR 15 MINUTES,

THEN THERE'S MORE LIKELIHOOD
OF IT DRAINING.

YOU DON'T DRAIN THEM AND THEN
PERCUSS THEM AND PUT THEM UP.

IT WOULDN'T BE AS AFFECTIVE.
DOES THAT MAKE SENSE LOGICALLY?

I'VE HEARD ALL THESE WEIRD
COMBINATIONS,

"I'D DO THIS AND PUT THEM
UP AND THEN I'D DO THAT."

AND IT'S, LIKE, "NO, THAT
DOESN'T MAKE SENSE."

NOW IS WHEN WE WOULD WANT TO
POUND ON HIM A LITTLE BIT,
LOOSEN UP THOSE SECRETIONS

AND THEN LET THEM SIT THERE FOR
A WHILE SO THAT IT WILL DRAIN.

ALRIGHT, HOW ARE YOU DOING
OVER THERE? GOOD.

IT'S HARD TO SEE NOW COS HE
REALLY IS UPSIDE DOWN,

BUT JUST HOLD ON HERE.

WHAT YOU WANT TO DO IS
IDENTIFY THE LUNG FIELD

THAT YOU ARE GOING TO PERCUSS.

YOU'RE GOING TO BE
USING CUPPED HANDS

BECAUSE ACTUALLY THE PERCUSSION
ISN'T THAT'S HITTING ON THEM,

IT'S THE VIBRATION
OF AIR TO AIR.

SO THE CUPPING IS WHAT CAUSES
SOME VIBRATION ON THE LUNGS,

JUST ENOUGH TO LOOSEN IT UP.

YOU WANT TO BE SURE AND
AVOID THE SPINAL COLUMN,

THE SCAPULA, BONEY AREAS.

YOU JUST WANT TO BE ON THE LUNG
TISSUE ITSELF

AND NOT BE POUNDING ON BONES,

AND BE VERY CAREFUL ABOUT
JEWELLERY.

I WOULD TAKE IT OFF TO DO IT
BECAUSE YOU DON'T WANT
THAT SMACKING ON THEM.

YOU WANT ONE THIN LAYER
OVER THEM, NOT A PILE.

IF I PUT A THING OF THICK TOWEL
LIKE THIS WHEN I PERCUSS,

IT'S -- THE VIBRATION ISN'T
GOING TO GO THROUGH.

IT'S JUST MY POUNDING AND
THE POINT IS THE VIBRATION.

SO, EITHER A THIN LAYER...

..OR ONE LAYER OF TOWEL.

AND THEN JUST TELL YOUR CLIENT,
"I'M JUST GOING TO POUND

ON THIS LUNG FIELD HERE
FOR A LITTLE BIT."

YOU'RE CUPPING AND IT
SHOULD BE FAST SOUNDING
LIKE HORSES GALLOPING.

AND YOU'RE SUPPOSED TO DO
THIS ABOUT FIVE MINUTES.

BUT YOU POUND OVER THIS LUNG
FIELD.

IT'S VERY AEROBIC, I'M ALREADY
STARTING TO FEEL HOT.

HOW YOU DOING THERE?
"I'M, KIND OF, GOOPING UP."

OKAY. I MEAN, REALLY, IT'S, KIND
OF, EXHAUSTING THAT SAME,
KIND OF, MOVEMENT.

AND THAT'S WHAT YOU WOULD DO.

HOPEFULLY, THAT HELPS LOOSEN
UP THE SECRETIONS.

THEN YOU LET THEM CONTINUE
TO DRAIN FOR ANOTHER
10 OR 15 MINUTES.

THE THINGS YOU DON'T WANT
TO HERE IS THIS...SMACKING,

OR MY JEWELLERY HITTING.
IT'S THE CUPPING.

HOLLOW SOUND AND FAST, NOT...

..SLOW TIRED WAY.

ALRIGHT.

AS LONG AS THEY'RE DOING OKAY,
NOT HAVING ANY DIFFICULTY,

THEY'RE FINE, 15 MINUTES IS UP,
LET'S BE DONE.

SO TO GET HIM OUT OF
TRENDELENBURGS,

YOU'RE GOING TO HAVE
TO PUT THE BED UP

ALL THE WAY UNTIL
YOU HEAR A CLICK.

THE OTHER THING TO REMEMBER
IS YOU WANT TO PUT THEM

ON THEIR SIDE LYING POSITION
BEFORE YOU PUT THEM UPSIDE DOWN.

IT'S TOO HARD TO MANEUVER
YOUR CLIENTS

WHEN THEY'RE UPSIDE DOWN.

SO GET THEM ALL SITUATED
WHEN THEY'RE FLAT.

ALRIGHT, IT CLICKED. IF YOU
DON'T GET HIM ALL THE WAY TO THE
TOP BEFORE YOU START DOWN

IT JUST KEEPS GOING INTO THE
TRENDELENBURG.

SO, YOU'VE GOT TO GET IT TO
CLICK OUT

AND THEN YOU CAN
BRING HIM ON DOWN.

REVERSE TRENDELENBURG, WHICH
IS HEAD UP AND --

IT'S THAT WHOLE STRAIGHT
BOARD ANGLE, BUT HEAD
ABOVE CHEST.

IT'S JUST THE EXACT
SAME TECHNIQUE, BUT IT'S
THE OTHER BUTTON.

YOU PUT THE BED ALL THE
WAY UP AND THEN LOWER IT

AND THEN IT SWITCHES UP AND
LOWERS THE FOOT VERSUS THE HEAD.

AND THAT'S ALL THERE IS TO IT.

YOU WANT TO PUT YOUR CLIENT BACK
TO A COMFORTABLE POSITION,

PUT THEIR HEAD UP,

GIVE THEM GOOD ORAL HYGIENE,
CHECK THEIR LUNGS,

DISPOSE OF THAT FLUID OR THE
SPUTUM WITH GLOVES ON.

TAKE YOU SPECIMEN TO THE
LAB IF YOU NEEDED TO,

BUT AGAIN GOOD ORAL HYGIENE.

ANYONE THAT'S HOCKING UP STUFF,
THEY NEED ORAL HYGIENE.

WASH YOUR HANDS, DOCUMENT
HOW THEY TOLERATED IT,

HOW LONG THEY WERE IN THAT
POSITION, THE COLOR,
THE QUANTITY,

THE QUALITY OF SPUTUM.

- DURING THIS PROCESS THEY'RE
COUGHING AND SPITTING.

- SOME YEAH, UH-HUH.
- SO IT DOES THAT A LOT?

- IT DEPENDS ON THE CLIENT, BUT
USUALLY A DECENT AMOUNT. UH-HUH.

IT'S MUCH EASIER TO GET
SPUTUM OUT UPSIDE DOWN,
AMAZINGLY ENOUGH.

- DO WE STOP PERCUSSING WHILE
THEY COUGH INTO A LITTLE --

- NOT NECESSARILY, IT DEPENDS
ON HOW THEY'RE TOLERATING IT,

THAT MIGHT BE HELPING THEM.
IF THEY'RE NOT CATCHING
THEIR BREATH, I'D STOP.

WHEN PHYSICAL THERAPY DOESN'T

AND MOST OF THE TIME THE
HOSPITAL'S PHYSICAL
THERAPY DOES.

I'VE ONLY DONE IT A FEW
TIMES IN ACUTE CARE

AND THAT WAS IN THE NIGHT
SHIFT ON A PEDIATRIC FLOOR.

I HAD CLIENTS WITH CEREBRAL
PALSY AND PARENTS DIDN'T
WANT TO STAY THE NIGHT

SO I DID THEIR KIDS
A COUPLE OF TIMES,

BUT EVEN THEN PHYSICAL THERAPY
DID IT MOST OF THE TIME.

SO IT'S NOT A PROCEDURE
I'VE DONE A LOT,

IT'S JUST SOMETHING YOU NEED
TO BE FAMILIAR WITH AND
KNOW HOW TO DO IT.

I'VE WORKED WITH IT MORE
IN HOME CARE BECAUSE
THEY DO IT IN HOMES.

THEY'LL TEACH KIDS TO
DO IT OVER BEAN BAGS,

TO DRAIN THEMSELVES AND LAY
OVER BEAN BAGS AND GET
IN RIGHT POSITIONS,

HEAD LOWER THAN CHEST AND JUST
DO A POSTURAL DRAINAGE THAT WAY

OR ON YOUR KNEES, ON YOUR LAP.

SO THAT'S ALL I CAN THINK OF
REALLY ON THAT. ANY QUESTIONS?

SO WE'LL JUST HAVE YOU RUN
THROUGH THAT, WORK
WITH THE BEDS.

THE FIRST TWO BEDS,
ESPECIALLY BED ONE,

THE BUTTON IS REALLY HARD
TO PULL, BUT IT WILL WORK.

THEY'LL ALL WORK, YOU MIGHT
WANT TO GIVE THEM A CHECK OUT

IN THAT OTHER ROOM AND MAKE
SURE YOU KNOW HOW TO
WORK THE BEDS.

AND THAT'S THAT.

OKAY.

A COUPLE OF OTHER THINGS
THAT I FORGOT TO MENTION.

DID I MENTION WHAT TO DO IF
THE NG TUBE WOULDN'T GO IN?

I CAN'T REMEMBER DOING THAT.
I GET HOME AT NIGHT AND GO...

- YEAH, YOU TURN.

NO, THAT ONE WASN'T IT. WHAT IF
YOU GO TO PUT THE NG TUNE IN

AND YOU THINK YOU HAD
A PATENT NOSTRIL, RIGHT?

COS YOU CHECKED IT AND YOU
CHECKED IT, BUT IT WON'T GO IN.

WHAT SHOULD YOU DO?

- TRY THE OTHER ONE?
- TRY THE OTHER NOSTRIL.

I MEAN, YOU KNOW, HOW --
WHO IS TO KNOW?

IF YOU CAN'T SEE, UNLESS
YOU KNOW ABSOLUTELY
IT WON'T WORK.

AND IF YOU KNOW ABSOLUTELY
IT WON'T WORK,

YOU'VE TRIED BOTH NOSTRILS, THEN
GO TO A SMALLER SIZE AND TRY
ONE MORE TIME.

AND THEN IF YOU CAN'T PASS IT,
THEN I'D CALL THE DOCTOR.

DEPENDING OF COURSE ON WHAT SIZE
OR WHAT FEEDING TUBE YOU'RE
TRYING TO DO.

BUT YOU CAN ALWAYS
GO TO A LOWER SIZE,

BUT FIRST THING JUST TRY
THE OTHER NOSTRIL AND
SEE HOW IT WORKS.

ALRIGHT, I FORGOT TO MENTION
A COUPLE OF THINGS

ALSO ABOUT LAVAGING AND GAVAGING
AND REMOVING TUBES.

IF THE CLIENT HAS HAD SURGERY
AND THE PHYSICIAN

HAS PLACED THE TUBE AFTER
A GASTRIC SURGERY,

YOU'RE NOT ALLOWED
TO MOVE IT AT ALL.

SO YOU HAVE TO CALL HIM IF
THERE'S BEEN ANY PROBLEM
OR DISLODGEMENT.

AND THE SAME WITH LAVAGING, YOU
CAN'T IRRIGATE AND LAVAGE TUBES,

UNLESS THE DOCTOR HAS GIVEN YOU
AN ORDER ESPECIALLY AFTER SOME
KIND OF GASTRIC SURGERY.

OKAY, SO MAKE SURE THAT YOU
DON'T JUST, "OH, WE CAN
IRRIGATE ALL THESE."

YOU CAN'T 'F' WITH THE
GASTRIC SURGERY.

THE TUBES THAT WE PUT WE CAN
WHEN WE'RE DONE DOING THEM FOR
DECOMPRESSION

AND SO FORTH TO KEEP OKAY.

ALRIGHT, THE LAST THING
I WANTED TO MENTION

WAS -- I'VE TALKED TO YOU ABOUT
A CATH UA.

BUT WHEN I SAW YOUR
CATHETERS YESTERDAY,

I WENT, "I HOPE THEY NOTICED
HOW THESE WORK."

SO, I THOUGHT I'D SET YOU
UP ONE JUST TO BE SURE.

WE'RE NOT USING THIS SO I
CAN RETURN IT BACK HERE.

IF YOU NEEDED TO GET
A CATH SPECIMEN,

THIS IS THE KIND THAT I'VE
WORKED WITH ALL MY LIFE.

THE CATHETERS END AND THEN
YOU HAVE THIS PORT.

REMEMBER, I SHOWED YOU THAT
FIRST SEMESTER WHEN YOU
GET A CATH SPECIMEN.

AND SO YOU'D DRAIN ALL
OF THE URINE OUT OF THE TUBING,

THEN YOU CLAMP IT OFF, WRAP
IT WITH THE RUBBERBAND,

THEN YOU'D CLEAN YOUR PORT,

WITHDRAW, GET A 10 CC SYRINGE
OR 20, WHATEVER THEY NEED.

DRAW OFF YOUR 10 CC'S OF URINE,

SQUIRT IT INTO THE CUP, NEVER
SEND THE SYRINGE TO THE LAB.

AND THEN TAKE THE RUBBERBAND OFF
AND THEN LET IT DRAIN OUT.

OKAY, SO IT'S THIS.
THIS IS THE PORT.

THIS IS WHAT YOUR GUYS'
PORTS LOOK LIKE.

AND I THOUGHT THEY
WERE FUNNY LOOKING.

AND I DIDN'T WANT
YOU TO MISS THEM.

CAN YOU SEE THEM FROM YOUR KITS?

AND THAT'S
THE INJECTION PORT.

SO, THIS IS WHAT IT LOOKS LIKE,

YOU PUT YOUR RUBBERBAND AROUND
AND YOU HAVE TO PUT
IT FAIRLY TIGHT.

YOU'D ALSO WANT TO CLAMP IT
FAIRLY CLOSE TO THE PORT.

YOU WOULDN'T WANT TO
COME WAY DOWN HERE.

BECAUSE IF YOU JUST TRAP A
LITTLE,

YOU'RE NOT GOING TO BE ABLE
TO GET IT OUT OF THERE.

SO CLAMP IT FAIRLY CLOSE TO THE
PORT, THEN YOU CLEAN IT
WITH ALCOHOL.

GLOVE SUPPORT.

AND THEN YOUR NEEDLE GOES
ANYWHERE INTO THIS THING.

IT'S THE WHOLE CIRCULAR CARD.

BUT IT, KIND OF, BLENDED IN
AND I DIDN'T KNOW IF YOU
CAPTURED

THAT THAT'S WHAT IT WAS,
THAT WHOLE RING WAS THE PORT.

SO THEN ONCE YOUR NEEDLE'S IN,

THEN YOU ASPIRATE YOUR
URINE OUT OF THERE.

YOU NEVER KNOW ABOUT THAT.]

IT'S SO FUNNY. WE HAVE OUR JUG
OF URINE WE KEEP UNDER THE SINK

AND OUR JUG OF BLOOD, YOU KNOW.

PUT IT IN YOUR STERILE
CUP, CLOSE IT, LABEL IT
AND SEND IT TO THE LAB.

- CAN IT GO THROUGH ALL THE
WAY, THOUGH? COULD YOU --

- IT DOESN'T. AND YOU CAN
FEEL IT. YOU CAN FEEL IT.

WHEN IT POKES THROUGH, YOU GET
A LITTLE RESISTANCE AND THEN
IT JUST, KIND OF, STOPS.

THIS WOULD GOING STRAIGHT
TO THE CONTAINER,

BUT IF YOU GET A CC SYRINGE,
THOSE ARE KIND OF PRECIOUS
AROUND HERE.

THEN MAKE SURE THAT YOU GET
RID OF THAT RUBBERBAND.

AND LET THE REST DRAIN OUT.

OKAY?

- REMIND ME WHY WE'RE NOT TAKING
THE SAMPLE FROM THE BAG?

- IT'S DISGUSTING.

[LAUGHTER]

BECAUSE THE BAGS ARE KEPT --
WE CHANGE THESE ONCE A WEEK.

AND SO THE URINE'S IN THERE
AND WE EMPTY IT EVERY EIGHT
HOURS.

SO, IT'S DIRTY AND CONTAMINATED
SO IF WE WANT TO GET
A FRESH SPECIMEN,

WE WANT TO GET IT FROM THE
TUBE VERSUS THE BAG.

YEAH, SO NEVER GET A URINE
SPECIMEN FROM THE BAG.

EVEN IF THAT'S WHAT YOU'RE
GETTING,

YOU'RE THE FIRST ONE TO
PUT IN THE CATHETER.

WHAT YOU DO IF YOU NEED A
SPECIMEN

AND YOU'RE PUTTING
IN THE CATHETER

IS IT'S REALLY BETTER IF
YOU SEPARATE THESE TWO.

AND PUT THIS -- THIS
WOULD BE SITTING ON YOUR
CLEAN STERILE DRAPE.

YOU PUT IT IN AND THEN THE
URINE JUST STARTS FLOWING

AND YOU CAN CAPTURE IT IN
YOUR LITTLE CUP

AND THEN CRIMP IT AND THEN
RECONNECT AND GET IT
DIRECTLY FROM HERE.

BUT LET SOME
OF THE URINE PASS THROUGH,

SO YOU'RE NOT GETTING THAT FIRST
CONTAMINATED PART OF URINE.

OKAY, I THINK THOSE ARE ALL
THE ODDS AND ENDS I WANTED
TO CATCH UP ON.

LET ME MAKE SURE.

OH, NO! BLADDER TRAINING AND
CREDE.

I WAS SIGNING OFF ONE
OF THE -- YOUR SKILLS BOOKS

WHICH BY THE WAY, STILL
NEED YOUR SKILLS BOOKS.

SKILLS BOOKS. SKILLS BOOKS.
COMPLETE.

I WANT THEM BEFORE
YOUR LAST TEST.

- THE ONES THAT ARE
IN THE TRAY --

- THAT HELPS DAN AND THEY'RE
SIGNED OFF.

- FOR THE SEMESTER?
- YEAH, SIGNED OFF EVERYTHING

EVEN IF YOU HAVEN'T DONE
IT TILL NEXT WEEK.

ON IT WAS BLADDER TRAINING AND
CREDEA

AND I DID MENTION THAT,
I DON'T BELIEVE.

IT MIGHT HAVE BEEN ON
THE VIDEO, ON THE TV.

BUT I DIDN'T MENTION IT LAST
WEEK.

BLADDER TRAINING. SOME OF US HAD
A CATHETER FOR A LONG TIME

AND THEY'RE TRYING TO TRAIN
THE BLADDER.

THERE'S A COUPLE OF THINGS
THAT WE TRY TO DO.

ONE IS YOU CAN CLAMP THE
CATHETER OFF AND LET IT FILL

AND JUST START TRYING
TO BUILD TONE IN THE BLADDER.

SO IF YOU MIGHT CLAMP IT
FOR A COUPLE OF HOURS

AND SEE IF THEY HAVE ANY
SENSATION, THEN RELEASE IT,
CLAMP IT, RELEASE IT.

YOU WANT TO BE CHECKING
WITH THEM FREQUENTLY

BECAUSE SOMETIMES PEOPLE CAN'T
LAST MORE THAN A FEW MINUTES.

AND NOT EVEN AN HOUR BECAUSE
THEY DON'T HAVE ANY TONE

AND THEY'RE FEELING
UNCOMFORTABLE.

SO, IF THEY'RE UNCOMFORTABLE
THEN YOU RELEASE IT,

SEE HOW MUCH URINE YOU GOT,

AND THEN CLAMP IT AGAIN AND SEE
IF YOU CAN START STRETCHING

AND BUILDING SOME TONE
WITH THEIR BLADDER.

ANOTHER THING THAT WE DO IS JUST
TRYING TO TRAIN PEOPLE TO GO.

PEOPLE ARE HAVING TROUBLE
WITH INCONTINENCE

AND FREQUENCY OR URGENCY,

THEN OFFERING THEM THE REST ROOM
OR GETTING THEM UP TO
THE REST ROOM,

EVERY HOUR OR TWO HOURS

TO JUST TRY TO GET THEM INTO
SOME KIND OF ROUTINE.

AND THEN -- ESPECIALLY PEOPLE
THAT ARE INCONTINENT AT NIGHT.

LIKE NO FLUIDS AFTER EIGHT
8 O'CLOCK OR SOMETHING,

SO THAT YOU'RE GOING TO
THE BATHROOM BEFORE

SO THEY CAN GET A LONGER PERIOD
OF SLEEP AT NIGHT.

BUT THEN DURING THE DAY TRYING
TO GO EVERY COUPLE OF HOURS
TO DRAIN THEM.

CREDE.

PEOPLE THAT HAVE HAD
STROKES, PARAPLEGICS,

EVEN SOME POST-OP,
KIND OF, CLIENTS

SOMETIMES HAVE SOME NEURO DAMAGE

AND THEY CAN'T REALLY FEEL
TO EMPTY THEIR BLADDER WELL.

AND THEY MAY ASK US TO
CATH FOR RESIDUALS,

YOU'VE HEARD THAT TERM YET
WHEN YOU'VE BEEN OUT THERE?

THEY GO TO THE BATHROOM,
BUT THEY'RE NOT EMPTYING

THEIR BLADDER COMPLETELY SO WE
MAY PUT A STRAIGHT CATHETER IN,

A RED CATHETER OR A CATHETER
THAT DOESN'T HAVE THE BALLOON.

IT'S JUST A STRAIGHT CATHETER,
IT GOES IN.

AND THE WHOLE PURPOSE
IS JUST TO DRAIN OFF URINE

AND SEE HOW MUCH IS LEFT
IN THE BLADDER,

AND THEN YOU JUST TAKE
THE CATHETER OUT.

THE PROCEDURE IS EXACTLY
THE SAME AS WHAT WE DID,

EXCEPT YOU DON'T HAVE TO TEST
A BALLOON BECAUSE THERE IS NONE.

IT'S JUST A STRAIGHT CATH.

SO, STRAIGHT CATH FOR RESIDUAL
IS WHAT THEY USUALLY WILL SAY.

SO WE'RE TRYING TO SEE HOW MUCH
IS LEFT IN THE BLADDER.

SOMETIMES WHAT THEY'LL DO IS
THEY'LL TEACH PEOPLE TO CREDE
THEIR BLADDER.

AND WHAT THAT MEANS IS
THAT YOU PUT PRESSURE

AND ROLL AND TRY TO EMPTY THE
BLADDER TO TRAIN IT

AND TO GET THE URINE TO
COMPLETELY COME OUT
OF THE BLADDER.

SO IT'S A MASSAGING TECHNIQUE,

IT'S A PRESSURE TECHNIQUE
TO HELP EMPTY BLADDERS.

SO COMING DOWN, IN FROM THE TOP

AND PUSHING AND RUBBING AND
THAT'S CALLED CREDEING.

TO HELP ALSO TRAIN TO COMPLETELY
EMPTY THE BLADDER.

USED A LOT IN REHAB UNITS.

AND SO I JUST WANTED YOU TO
BE SURE AND KNOW THAT TERM

IF YOU COME ACROSS
IT IN YOUR READING.

OKAY. MOVING ALONG, OSTEMIES.

HAS ANYBODY BEEN WITH THE OSTOMY
NURSE YET? A FEW OF YOU?

EXCELLENT. SO YOU WON'T
BE OVERWHELMED.

WHEN I FIRST DID OSTOMY CARE,

I TOLD YOU I WANTED TO
BE A NUSRE BECAUSE I
LIKED TO DISSECT FROGS

AND SO EVERYTIME THAT WE
WOULD DO SOMETHING,

I WOULD SIT IN CLASS WITH MY
EYES, I'D JUST GO, LIKE

"OH, MY GOD.
YOU DO THAT TO PEOPLE?"

AND WHEN THEY FINALLY
GOT TO OSTOMIES

THAT WAS WHEN I ALMOST THREW IN
THE TOWEL. I JUST WAS SHOCKED.

I JUST DIDN'T KNOW THAT YOU
COULD DO SO MANY THINGS TO A
HUMAN BODY

AND IT WAS A LITTLE
OVERWHELMING TO ME.

SO IF YOU NEVER HEARD OF
AN OSTOMY, YOU CAN JUST
BE SHOCKED AS WELL.

CAN YOU IMAGINE
AS SHOCKED AS I WAS,

HOW SHOCKING IT MUST
BE TO HAVE AN OSTOMY?

AND THERE IS A LOT
OF EMOTIONAL TRAUMA

THAT IS ASSOCIATED
WITH OSTOMY CARE.

AND SO IT ALMOST GETS
PUT AS A PRIORITY CARE ITEM

WHEN DEALING WITH
PEOPLE WITH OSTEMIES.

AND I CAN APPRECIATE
THAT VERY MUCH, SO.

I FOUND THIS CUTE LITTLE...

..FOLDER THAT YOU CAN BUY FOR
JUST LIKE A COUPLE OF BUCKS.

THAT I FOUND IN A LITTLE
CATALOGUE. AND I THOUGHT
IT WAS REALLY HELPFUL

SO YOU MIGHT KEEP YOUR EYE OUT
FOR SOMETHING LIKE THIS.

SOME OF THESE THINGS ARE REALLY
HELPFUL AND THIS JUST HAD REALLY
GOOD SUCCINCT INFORMATION ON IT.

IF YOU'RE INTERESTED I CAN
GIVE YOU MY SOURCE HERE
FROM QUICK-STUDY.

HAVE YOU EVER HEARD OF
THE QUICK-STUDY GUIDES?

IT'S EXCELLENT.
- YES.

YOU MIGHT LOOK FOR THIS AND I
THOUGHT IT WAS REALLY HELPFUL.

AND IT GIVES YOU SOME GOOD
PICTURES

ON THE INSIDES OF DIFFERENT
STOMAS AND WHAT THEY LOOK LIKE.

THEY'RE REALLY HARD TO SEE
FROM HERE.

I'M GOING TO SHOW YOU ON
A LITTLE QUICK SHOT HERE
ON A VIDEO.

WHICH ALSO LEADS ME TO SAY

THAT I DON'T KNOW HOW MUCH YOU
WATCHED THE MANUFACTURED VIDEOS.

BUT THIS IS A GOOD ONE TO WATCH,

JUST BECAUSE YOU CAN
SEE REAL OSTOMIES

IN THEIR DIFFERENT SHAPES AND
FORMS.

IF YOU HAVEN'T EVER SEEN
IT BEFORE AND YOU'RE LIKE,

"OH, MY GOODNESS. WHAT ARE YOU
TALKING ABOUT? WHAT DO I DO?
HOW DO YOU TOUCH HIM?"

THAT KIND OF THING. IT'S REALLY
-- IT, KIND OF, DESENSITIZES
YOU A LITTLE BIT.

IT HELPS YOU, KIND OF,
CAPTURE ON,

"OH," WHAT IT IS AND YOU CAN
SEE PEOPLE HANDLING SKIN
AND THE STOMAS.

AND IT'S NOT SO OVERWHELMING
THEN THE FIRST TIME.

SO IT'S REALLY GOOD,
THEY DO REAL CARE

AND THEN THEY DO A REAL
IRRIGATION.

AND THEN YOU CAN SEE THE
EFFLUATE COME OUT AND SO FORTH.

SO I WOULD JUST
RECOMMEND IT, JUST
FOR THE VISUAL COMPONENT,

YOU'RE NOT GOING TO GET ANY
PARTICULAR NEW INFORMATION,

BUT IT'S A GOOD VISUAL FOR
REALITY. WHAT IS AN OSTOMY?

IT'S A SURGICAL OPENING IN THE
ABDOMEN WHERE THE INTESTINE IS

BROUGHT UP THROUGH THE ABDOMINAL
WALL AND A STOMA IS CREATED.

IT TAKES ABOUT SIX TO EIGHT
WEEKS FOR THAT STOMA TO HEAL

AND TO SHRINK TO ITS NORMAL SIZE
OR WHAT THE SIZE WILL BE
FOR THAT CLIENT.

THERE'S ACTUALLY NO NERVE
ENDINGS IN A STOMA SO THEY'RE
RELATIVELY PAINLESS,

EVEN THOUGH TO US THEY SEEM --
THEY LOOK LIKE THEY SHOULD BE.

BUT THERE ISN'T ANY PAIN
ASSOCIATED WITH IT.

AND SO THAT WILL BE HELPFUL AS
WE'RE CARING FOR IT AND PROBING
IN THEM SOMETIMES

TRYING TO FIND DIRECTION
OF STOMA IMBALANCE, SO FORTH.

THERE'S A LOT OF DIFFERENT
KINDS OF OSTOMIES,

AND THEY'RE DETERMINED
BY THEIR LOCATION.

SO LET'S TALK ABOUT BOWEL
A LITTLE BIT.

WE KNOW RECTUM COMES UP, RIGHT?

AND SO YOU HAVE THAT FIRST
OPENING AND IT COMES OVER
HERE. WHAT'S THIS?

- SIGMOID?
- I STARTED TO HEAR
SOME S-S-SIGMOID.

SIGMOID. OKAY. THEN WHAT'S THIS?

- ASCENDING?

- IT WOULD BE DESCENDING. IT
DEPENDS ON HOW I DO IT, HUH?
BUT IT'S DESCENDING, RIGHT?

BECAUSE ALL OF THIS IS COMING
AROUND AND IT'S GOING TO COME
DOWN TO COME OUT.

SO THIS IS DECENDING. THIS IS --

- TRANSVERSE.
- TRANSVERSE, THEREFORE
THIS WOULD BE?

UH-HUH, OKAY. SO THIS
IS THE ASCENDING COLON.

DEPENDING UPON WHERE IT
IS PLACED ON THE COLON,

IT DEPENDS ON WHAT KIND OF
EFFLUENT --

ARE YOU CATCHING THAT WORD,
EFFLUENT. WHAT IS THAT?

- THE STUFF THAT COMES OUT.
- THE STUFF THAT COMES OUT.

THE STOOL COMES OUT.
WHERE IT IS ON THE BOWEL

DETERMINES IT'S CONSISTANCY AND
SOME OF THE CARE THAT
WE WILL GIVE TO IT.

LET'S TALK A LITTLE BIT ABOUT A
COLOSTOMY IN THIS COLON AREA,

WHICH IS USUALLY THE DECENDING
SIGMOID PART OF THE COLON.

WHAT KIND OF STOOL MIGHT
YOU EXPECT HERE?

- MORE FORMED.
- MORE FORMED. IT STILL CAN BE
PASTY,

BUT LESS WATERY, OKAY.

SO, THE COLOSTOMIES,

WE CAN TRY TO REGULATE
AND WE CAN IRRIGATE THEM

SO THEY HAVE A REGULAR
TYPE BOWEL MOVEMENT.

THEY'RE THE ONLY KIND
THAT WE CAN REGULATE

AND IT DEPENDS AGAIN ON
WHERE UPON THE BOWL IT IS.

IF IT'S ON THE UPPER PART, IT
STILL MAYBE A LITTLE TOO
PASTY TO REGULATE,

BUT THIS IS OUR BEST
CHANCE OF FORMED.

WHAT KIND OF CLIENT
HAS A COLOSTOMY?

WHAT DIAGNOSIS GETS THIS?

- MAYBE LIKE COLON CANCER?

- CANCER.

COLORECTAL CANCER PROBABLY A
LITTLE CLOSER DOWN, TRAUMA.

- DOES LEVEL OF CONSCIOUSNESS
HAVE ANYTHING TO DO WITH IT?

- UNLESS YOUR SORE,
BUT I DON'T KNOW.

- MY CLIENT HAD PRESSURE SORES
AROUND HIS RECTUM.

SO IN ORDER TO KEEP IT CLEAN,
THEY GAVE HIM A COLOSTOMY.
- INTERESTING.

BUT HE JUST HAD IT
FOR 10 YEARS, WAS SORE

AND IT WAS JUST REALLY NASTY.

SO THEY JUST DIVERTED
IT FOR HEALTH REASONS.

THEY TRIED TO KEEP IT, YEAH.
- INTERESTING.

ALRIGHT, TRANSFERS COLON.

WHAT KIND OF STOOL?

- REAL WATERY.
- WATERY.

- YEAH. MUSHY.
- MUCH MORE BILE?

- YEAH, KIND OF, MUSHY.

AND THEN ASCENDING COLON?

- WATERY.
- WATERY, USUALLY.

- MAYBE AT RISK MORE FOR
DEHYDRATION.

- NOT NECESSARILY, BUT MORE
ODOROUS.

IT'S -- YEAH. I MEAN, THERE'S --
IT'S STILL PRODUCING AT
THE SAME RATE.

ANYONE IS AT RISK FOR
DEHYDRATION

DEPENDING ON HOW MUCH
COMES OUT OF THEM.

BUT IT'S JUST BECAUSE
WE'RE CATCHING IT AT A
DIFFERENT PLACE.

IT'S NOT HAVING THE STOP PLACE
AND GETTING THE BACTERIA

THAT FORMS THE STOOL LOWER
ON IN THE COLON.

ALRIGHT, SO OUR JOB IS --

WELL, LET ME JUST MENTION
A COUPLE OF OTHER THINGS.

OUR JOB IS TO CARE FOR THE STOOL
AND TO PROTECT THE SKIN.

WE WANT TO CAPTURE STOOL,
KEEP IT OFF SKIN,

KEEP SKIN INTACT
AS BEST AS WE CAN.

AND THE CLIENT IS USUALLY
GREATLY CONCERNED ABOUT ODOR.

SO WE WANT TO CONSIDER SOME
ISSUES RELATED TO ODOR.

GAS IS USUALLY
A BIG ISSUE FOR THEM.

I JUST WANTED TO MENTION A FEW
FOODS THAT THEY SUGGESTED
ON HERE THAT CAUSE GAS.

AND THAT'S BROCCOLI,
CABBAGE OR BEANS.

THE PROBLEM WITH GAS IS THAT
IT COMES INTO THE BAGS THAT'S
CATCHING THE STOOL

AND THEY JUST GET FULLER
AND FULLER

AND THEY CAN EXPLODE IF
YOU WILL AND POP OFF.

- UNLESS THEY HAVE THE
GAS IMPLODED.

- UH-HUH.
- BURPING?

- OH, YEAH THE TWO PIECE

AND WE'RE GOING TO
TALK ABOUT BURPING.

BUT THEN YOU BURP THEM OUT
LIKE YOUR TUPPERWARE

AND THE GAS COMES OUT.

OH, MAN. IT'S REALLY POTENT AND
SO THAT CAN BE PRETTY --

IT'S DEPENDING ON WHERE IT IS.
IT'S ONE OF THE MOST
PUNGENT ODORS

I HAVE EVER ENCOUNTERED
IN MY ENTIRE LIFE.

AND I WASN'T PREPARED
FOR THAT EITHER.

SO I'M JUST GIVING YOU A LITTLE
HEADS UP SO YOU CAN LOOK COOL

EVEN THOUGH YOUR INSIDES
ARE GOING, "AH!"

YOU KNOW, IT'S POTENT
AND I'M TELLING YOU.

ALRIGHT.

FOODS THAT CAN BLOCK UP THE
OSTOMY.

NOW, THIS IS INTERESTING ONES.
WHAT ARE SOME FOODS
YOU MIGHT GUESS?

- NUTS?
- NUTS.

- SEEDS.
- SEEDS...

CORN. UH-HUH, COS THAT CAN
FALL INTO THAT.

YOU KNOW, YOU'VE LOOKED AT
YOUR STOOL, IT COMES OUT WHOLE.

YOU KNOW, AND SO
IT CAN BLOCK IT UP.

DON'T YOU, "HOW COME
THAT DIDN'T GET DIGESTED?"

AND THEN MUSHROOMS
IS ANOTHER ONE.

I DIDN'T KNOW THAT. THAT WAS THE
NEW ONE TO ME AND I WENT,

"I JUST HAVE TO SHARE THIS."

SO MUSHROOMS CAN BLOCK IT UP,
I SUPPOSE COS THEY
EXPAND OR BULK UP,

AND THEY DON'T BREAK DOWN
AS WELL EITHER.

I DON'T KNOW, I'VE NEVER
INSPECTED MY STOOL REALLY
AFTER MUSHROOMS.

MAYBE YOU'LL LOOK AND SEE.

OTHER THINGS THAT CAUSE ODORS,
ASPARAGUS, DON'T YOU KNOW?

I MEAN, OH, MAN, ASPARAGUS

DOESN'T EVEN NEED AN HOUR
BEFORE IT'S JUST POTENT.

EGGS, FISH, GARLIC AND ONIONS,
BEANS AS WELL.

AND FOR SOME PEOPLE THAT'S
A PART OF THEIR DIET.

I MEAN, THAT'S JUST THE MAIN
STAY OF THEIR DIET

AND SO THEY WILL JUST TAKE ODOR
TO GIVE A FLAVOUR.

I MEAN, THAT'S -- IT'S JUST NOT
WORTH IT TO THEM.

AND OTHER BODIES, KIND OF,
ACCOMODATE FOR THAT AND
DON'T SMELL QUITE AS BAD

BECAUSE THEIR SYSTEMS ARE USED
TO IT AND THEY CAN EAT BEANS.

FOR EXAMPLE THEY'VE EATEN BEANS
ALL THEIR LIFE AND THEY
DON'T GET GASSY.

SO IT JUST DEPENDS ON THE CLIENT
AND WHAT THEY'RE USED TO

COS IT DOESN'T MEAN
THAT THEY CAN'T EAT IT.

IT'S JUST THAT THESE
ARE SOME SUGGESTIONS

YOU MIGHT WANT TO GIVE YOUR
CLIENT
IF THEY'RE COMPLAINING ABOUT

THESE PARTICULAR PROBLEMS.

BULK CAUSING FOODS AND I THOUGHT
THIS WAS INTERESTING,

CHINESE FOOD, POPCORN, WHOLE
GRAINS AND VEGETABLES.

AND THEN FOODS THAT
MIGHT CAUSE DIARRHEA,

FRESH FOOD -- FRUIT, RAW
VEGETABLES, SPINACH.

DID YOU KNOW THAT ONE? ME
EITHER.

THAT WAS A NEW ONE TO ME. HIGHLY
SEASONED FOODS. ALL THE
REST SEEM FAMILIAR,

BUT I JUST THOUGHT A COUPLE OF
THOSE WERE, KIND OF,
INTERESTING.

SO, JUST SOME IDEAS FOR YOU
CLIENTS.

- A LOT OF FIBRE.

- A LOT OF FIBRE
TO HELP BULK UP.

I WANTED TO SHOW
YOU SOME PRODUCTS

AND THIS CERTAINLY ISN'T ALL
OF THEM, BUT IT'S A FEW.

AND MOSTLY I JUST WANT TO
CAPTURE YOUR VISUAL MIND,

SO THAT YOU KNOW THERE'S
A LOT OF THINGS OUT THERE.

AND IF YOU CAN'T THINK OF
ANYTHING, THERE'S PROBABLY
SOMETHING ELSE.

SO MAYBE THE OSTOMY NURSE IS WHO
YOU WANT TO CONSULT WITH

TO SEE WHAT ELSE IT OUT THERE.

WHAT'S AVAILABLE.
WE HAVE A PROBLEM HERE.

ANYBODY THAT HAS AN OSTOMY,
SHOULD HAVE AN OSTOMY NURSE,

AN ET NURSE, AN ENTEROSTOMAL
THERAPIST NURSE THAT HAS
CONSULTED WITH HIM.

AND MOST OF YOUR HOSPITALS,
THAT'S POLICY.

THEY CONTRACT WITH THREE
OR FOUR NURSES IN THE
AREA TO WORK HERE

WHICH IS REALLY, REALLY
NICE AND I HOPE EVERYONE --

YOU SHOULD GET A -- TRY TO SPEND
A DAY WITH AN OSTOMY NURSE.

THEY ARE WOUND CARE SPECIALISTS
IN ALL AREAS, WOUNDS
AND OSTOMIES

AND I THINK THEY'RE FASCINATING
PEOPLE TO HANG WITH.

ALRIGHT, OUR GOAL BEING TO
CAPTURE STOOL AND KEEP
IT OFF THE SKIN.

SO, HOW DO WE DO THAT?
WELL, THERE'S A LOT OF
DIFFERENT APPLIANCES.

THIS IS A ONE-PIECE
APPLIANCE AND ON THIS
APPLIANCE WHAT IT IS,

IT HAS A PRE-CUT HOLE,
MOST OF THEM DO.

THEN IT HAS LIKE A CORIA BASE
THAT'S GOING TO STICK
TO THE SKIN.

IT'S VERY MUCH LIKE THE
HYDROCOLLOIDS, THE DUODERM
TYPE OF MATERIAL.

THAT'S GOING TO STICK TO THE
SKIN AND PROTECT THE SKIN

AND THEN THE NEWER ONES HAVE
TAPE ALREADY ON THEM

SO THAT THAT HELPS SECURE THEM
JUST LIKE WE DID WITH THE
HYDROCOLLOIDS.

YOU WANT IT TO STICK TO THE
SKIN, PROTECT THE SKIN,

BUT YOU WANT IT TO STAY ON FOR
THREE, FIVE DAYS IF POSSIBLE.

AND SO THE TAPES GOING
TO HELP STABILIZE THAT.

WHEN YOU HAVE AN APPLIANCE
LIKE THIS,

YOU NEED TO MAKE SURE
THAT IT FITS THE STOMA.

SO YOU'RE GOING TO HAVE
TO MEASURE THE STOMA.

IF IT'S A NEW STOMA, APPRECIATE
AND TELL THE CLIENT TO
APPRECIATE

THAT IT'S GOING
TO SHRINK AND GET SMALLER.

SO YOU'RE GOING TO HAVE
TO KEEP ADJUSTING.

BUT YOU WANT TO MAKE SURE THAT
THE STOMA IS AT LEAST 1/16TH
TO 1/8TH OF AN INCH

LARGER THAN THE STOMA ITSELF,
THE APPLIANCE PIECE,

BECAUSE YOU DON'T WANT IT
RUBBING OR PUNCTURING
INTO THE STOMA.

BECAUSE THAT CAN CAUSE
ULCERATION AND SKIN BREAK DOWN.

BUT WE WANT IT TO BE
AS CLOSE AS POSSIBLE

TO THE STOMA SO THAT
THE EFFLUENTS,

ESPECIALLY IF IT'S LIQUIDY,
DOESN'T GET DOWN INTO THE SKIN

AND DOESN'T BREAK DOWN THE SKIN.

- SMALLER, 1/16 TO 1/8...

- LARGER. DID I SAY SMALLER?
- NO, YOU DIDN'T SAY SMALLER.

- LARGER. IF IT'S SMALLER, IT'S
GOING TO SQUISH IT UP.

AND YOU'RE GOING TO APPRECIATE
THIS WHEN WE DO IT HERE
IN A MINUTE.

I'M GOING TO GIVE YOU
A GOOD VISUAL.

SO IT NEEDS TO BE
A LITTLE BIT BIGGER.

WE'RE GOING TO PUT SOME
PASTE AND FILLERS IN HERE.

ALSO, KIND OF LIKE,
CORK, IF YOU WILL.

CORK UP THE TILE AND KEEP IT
FROM LEAKING ON TO THE SKIN.

BUT IF THE FLUID GETS DOWN INTO
HERE, IT CAN GET UNDERNEATH

AND CAUSE THIS TO LIFT
OFF THE SKIN.

AND THEN YOU DON'T GET THAT
THREE TO FIVE DAYS OF STICK,

AND YOU ALSO ARE CHANGING
YOUR APPLIANCES FREQUENTLY.

THEY CAN LEAK AND FALL OFF IN
PUBLIC AND THAT'S JUST
NOT A HAPPY DAY.

ALRIGHT, THIS PARTICULAR
ONE-PIECE POUCH

HAS AN OPENING THAT'S
MAINTAINED WITH A CLIP.

THIS IS MY LEAST FAVORITE
KIND OF POUCH

AND YOU'LL JUST KNOW WHY
HERE IN JUST A MINUTE.

WHEN THIS IS PUT ON AND
STOOL IS COMING OUT

IF YOU HAVE A ONE-PIECE
POUCH LIKE THIS...

..STOOL COMES OUT AND THEN
YOU HAVE THIS LITTLE CLIPPY

THAT KEEPS THE STOOL FROM
COMING OUT OF THE BAG.

TO WORK THE CLIP,
IT'S LIKE A BURETTE.

AND YOU'RE JUST GOING TO HAVE TO
WORK IT YOURSELF TO
GET THE IDEA.

BUT YOU TAKE THE INSIDE PIECE
OF THE BURRETTE,

SEE HOW THERE'S THIS -- TWO
AND ONE GOES INSIDE.

YOU TAKE THE INSIDE
PIECE AND FOLD ONCE,

ONLY ONCE AND THEN CLIP
IT LIKE THIS

TO KEEP THE STUFF
FROM COMING OUT.

THOUGH, SOME OF YOU MIGHT SAY,
"WHY DON'T YOU WRAP IT UP?

THAT'LL REALLY BE SAFER." RIGHT?

I MEAN, WHO WANTS IT TO LEAK?

BUT IF YOU WRAP IT LIKE
THIS MORE AND MORE,

THEN WHAT HAPPENS IS
IT GETS TOO THICK

AND THE BURRETTE WON'T CLIP WELL
AND IT WILL FALL OFF.

SO, ONCE IS ALL THAT YOU DO.

JUST FOLD IT AND STICK IT.

THEN WHEN IT FILLS WITH
STOOL AND BY THE WAY,

YOU ONLY WANT IT TO FILL ABOUT A
THIRD FULL, NO MORE THAN A HALF.

BECAUSE THE MORE WEIGHT THAT
GETS ON THERE FROM THE STOOL,

THE MORE IT MIGHT PULL OFF.

SO A THIRD IS REALLY ALL YOU
WANT. SO NOT THAT MUCH.

ONCE IT STARTS TO FILL, THEN
WITH GLOVES OF COURSE,

YOU GET TO TAKE THIS TO THE
TOILET OR SOMETHING

AND SQUISH IT ALL OUT,
COS, RIGHT, IT'S PUDDINGY LIKE

OR WATERY AND YOU
SQUISH IT ALL OUT.

AND THEN YOU, KIND OF,
WIPE UP THE END

COS YOU DON'T WANT STOOL
ALL OVER THE PLACE.

AND THEN YOU CLIP IT UP

AND THEN YOU GET TO
DO THIS ALL THE TIME.

- OH, THEY KEEP IT?
- OH YEAH.

THAT'S WHY I DON'T LIKE IT COS
I DON'T LIKE CLEANING IT.

VERY ODOROUS AND JUST NOT
FUN, BUT CHEAP, RIGHT?

AND, YOU KNOW, SOME OF THESE
CHRONIC CONDITIONS -- CAN
YOU IMAGINE?

OKAY, LET'S ADD UP, DIABETES,
OSTOMY, YOU CAN SEE

THAT JUST WITH THOSE TWO
CONDITIONS RIGHT THERE HOW MUCH
MONEY THAT IS?

AND IF YOU'RE MEDICAID AND
THEY'RE NOT PAYING FOR EVERY --

OH, MY GOODNESS. IT JUST GETS
TO BE A LITTLE UNRULY.

SO YOU CAN SEE WHY THEY'D WANT
TO KEEP THEIR COST DOWN.

ALRIGHT. WELL, THAT'S
ONE THING THAT WE DO,

BUT MY PREFERENCE WOULD BE AND
WHAT WE'RE GOING TO BE DOING

IS A TWO-PIECE APPLIANCE.

NOW A TWO-PIECE APPLIANCE

IS A WAFER WITH A PHALANGE

THAT'S GOING TO GO
OVER THE STOMA.

NOW YOU CAN SEE THIS
IS A VERY TINY HOLE,

AND SO THE GOAL IS THAT WE
WOULD MEASURE THE STOMA

AND THEN CUT OUT THE SIZE
THAT WE WOULD NEED

TO FIT AROUND THE STOMA
OUT OF OUR WAFER HERE.

YOU NEED TO MAKE SURE
THAT YOU'RE PHALANGE

IS AT LEAST A QUARTER OF AN INCH
OF SPACE AROUND THE STOMA

COS YOU DON'T WANT YOU PHALANGE,
THIS HARD PIECE PUSHING
AGAINST THE STOMA.

AND YOU'VE GOT TO HAVE ENOUGH
WAFER TO STICK ON THE SKIN.

SO IT'S REAL IMPORTANT TO
HAVE THE RIGHT SIZE PHALANGE.

SO WHEN YOU LOOK AT YOURS
THERE'S PROBABLY NOTHING,
I TOOK THEM OUT OF A BOX.

SO WHAT YOU HAVE IS
A TWO AND A QUARTER PHALANGE
ON A FOUR BY FOUR WAFER.

OKAY. THE IMPORTANT THING
ABOUT THAT IS TO MAKE SURE
THAT YOU'VE GOT A BAG

THAT'S GOT A TWO AND A
QUARTER INCH PHALANGE,

SO THAT YOUR PIECES MATCH
BECAUSE THEY COME IN
ALL SORTS OF SIZES.

FOR EXAMPLE, HERE IS A ONE
AND A HALF INCH.

WELL, IT'S A NO FIT.

YOU HAVE TO HAVE THE RIGHT
SIZE WITH THE APPLIANCE.

WHEN YOU'RE WORKING WITH AN
OSTOMY CLIENT YOU WANT
TO MAKE SURE THAT

THEY HAVE ORDERED ENOUGH
SUPPLIES SO THAT THEY
DON'T RUN OUT

AND THAT NEEDS TO BE BAGS
AND WAFERS AND PASTES AS WELL.

OKAY,

SO THIS PARTICULAR PHALANGE

AND BAG WOULD FIT TOGETHER
AND AGAIN YOU CAN RE-USE
THIS BAG OVER

AND OVER UNTIL IT'S JUST
DISGUSTING AND MORE OKAY.

BUT BETTER THAN THAT ARE
THE SINGLE USE BAGS, WHICH IS
WHAT WE'RE GOING TO USE HERE.

THE BAG FILLS UP YOU TAKE IT OFF
YOU THROW IT AWAY AND
YOU PUT ON A NEW ONE.

OH, MUCH BETTER.

THIS ONE IF YOU CAN SEE UP HERE,
I CAN PASS IT AROUND.

IT HAS A LITTLE CHARCOAL PIECE
IN IT AND THAT HELPS WITH ODOR.

SO THEY LIKE THAT.

ANOTHER THING THAT PEOPLE LIKE
TO DO AS FAR AS ODOR
IS SOMETIMES

THEY'LL PUT LIKE A VANILLA
EXTRACT OR SOMETHING IN THE BAG

AND THAT WILL ALSO
TAKE AWAY ODOR.

WHAT YOU WANT TO BE CAREFUL
ABOUT IS THAT THEY
DON'T USE ASPIRIN.

IT USED TO BE THOUGHT YEARS
AGO THAT THE ASPIRIN ABSORBED

BUT WHAT ELSE DOES ASPIRIN DO?

IT'S VERY CAUSTIC AND SO IT
CAN BREAK DOWN THE SKIN

AND CAUSE EROSION OF THE SKIN.

SO JUST LIKE YOU CAN GET
ULCERS IN YOUR STOMACH

FROM TAKING A LOT OF ASPIRIN.

SO YOU WANT TO MAKE SURE
AND ASK THEM, HOW ARE THEY
MANAGING THEIR ODOR

AND WHAT THEY DO FOR THAT.

ALRIGHT, SO THIS IS NICE ENOUGH.
THAT'S WHAT WE'RE GOING
TO USE TODAY.

MY FAVORITE APPLIANCE AND IF
YOU HAVE TO TAKE CARE OF ME

AND I HAVE TO HAVE AN OSTOMY,
THIS IS WHAT I WANT.

THIS IS CALLED.. OH DEAR,
SURE GRIP I THINK,

AUTO LOCK,

AND IT'S HARD TO SEE, BUT
WE'LL TRY TO GET CLOSER.

SEE THESE LITTLE
TEETH RIGHT HERE,

RIGHT HERE AND RIGHT HERE.

THERE IS A LITTLE LEVER
AND SEE WHEN I PUSH IT

THE LITTLE TEETH GO AWAY AND YOU
SNAP IN YOUR LITTLE BAG, OKAY.

THEN WHEN YOU RELEASE IT,
THE LITTLE GRIPPERS,

GRIP THE BAG, SO THAT
IT DOESN'T FALL OFF.

SO YOU'RE NOT AT RISK OF
THIS POPPING AWAY COS WHO
WANTS TO LOSE THEIR BAG?

I WANT SURE FIT,
THAT WOULD BE ME. OKAY?

LOTS OF TAPE TO MAKE SURE
IT DOESN'T FALL OFF.

SO THESE ARE KIND OF COOL.
I'LL PASS THEM AROUND.

SEE IF YOU CAN KIND OF WORK THE
LEVER AND GET IT IN
AND CHECK THE FIT.

THESE ARE KIND OF NEW APPLIANCES
SOMEONE BROUGHT ME.

THEY'VE BEEN TO THE OSTOMY NURSE
AND I'VE SEEN THESE LITTLE
ATTACHMENTS

AND HOW THEY ACTUALLY WORK IS --

I'VE BEEN ALLUDING TILL
WE PUT PASTE ON, RIGHT.

YOU CUT AWAY THIS WAFER
TO FIT AROUND THE STOMA,

BUT IF YOU CAN'T GET A GOOD
FIT OR YOU GOT A PRE-CUT,

YOU CAN SLIDE THESE PIECES
IN AND THEN THEY FIT AROUND

AND GIVE YOU ADHESION SO THAT
THERE'S NOT LEAKAGE.

YOU ALSO CAN WRAP THIS STUFF
AROUND CALLED ADAPT

AND FILL IN THE GAPS WITH THIS.

AND I'M JUST GOING TO --
IT'S HARD TO EXPLAIN TILL

I'VE ACTUALLY SHOWN
YOU WHAT WE'RE DOING.

BUT I'M GOING TO PASS THIS
AROUND SO THAT YOU CAN
LOOK AT WHAT

THIS IS TRYING TO ACCOMPLISH
WITH THESE TWO PRODUCTS.

AND THEN I'LL SHOW YOU
WHAT WE'RE GOING TO BE DOING
TO ACCOMPLISH THE SAME THINGS.

LET'S SEE, WE'VE BEEN
THROUGH ALL OF THESE.

NO, NOT THIS ONE.

OS -- OSTOMY BAGS AND WAFERS CAN
ACTUALLY BE USED AROUND WOUNDS.

THINK IF YOU HAVE A DRAIN
AND A DRAINING WOUND,

THESE ARE WONDERFUL,

BECAUSE YOU CAN JUST
PUT A WAFER AROUND.

FOR EXAMPLE, YOU HAVE AN
INCISION AND THERE'S
JUST A DRAIN AT THE END.

WHY NOT PUT A WAFER
STOMA AROUND IT,

CONTAIN ALL THAT RATHER
THAN DOING ALL THAT
DRESSING STUFF,

AND GETTING THAT WETNESS
ALL AROUND THEIR SKIN

AND IT CAN JUST COME OUT HERE.

THIS IS ACTUALLY PURPOSED
FOR A UROSTOMY.

WHAT WOULD THAT BE?

URINE. I LOVE IT WHEN THE NAMES
KIND OF GO TOGETHER.

AND YOU DO THE SAME
THING, SAME CARE.

SMALLER WAFER HOLES, BUT IT
WOULD GO AROUND THAT OPENING.

WELL, BLADDER AND THEN
THE URINE COMES OUT

AND THEN YOU JUST HAVE THIS
LITTLE SWITCH AND THEN
THE URINE JUST POURS OUT.

AND YOU DO I&O JUST
LIKE YOU WOULD OUT
OF A CATHETER BAG.

SO THESE ARE KIND OF COOL,

BUT YOU CAN ALSO USE THEM
FOR DRAINAGE AS WELL.

AND THEN WE TALKED ABOUT
COLONOSTOMY A LITTLE BIT.

COLOSTOMIES CAN HAVE FIRM STOOL

AND YOU CAN ACTUALLY REGULATE
THE BOWEL BY DOING LIKE
AN ENEMA EVERYDAY

TO CLEAR OUT THE COLON AND TRAIN
THE BOWEL TO GET RID
OF THE STOOL.

AND SO PEOPLE THAT CAN IRRIGATE
THEIR BOWEL ONCE A DAY

AND TRAIN THEIR BOWEL REALLY
DON'T NEED A FULL ON POUCH

AND ALL OF THIS WEIGHT
AND SO FORTH.

THEY CAN USE JUST A LITTLE COVER
OR SOME EVEN USE JUST A 4X4.

AND THAT WAY IT JUST KIND
OF CAPTURES GAS.

IF THERE WAS ANY FLUID THAT
HAPPENED TO LEAK OUT,

IT WOULD KEEP THEM PROTECTED
WHEN THEY'RE OUT IN PUBLIC,

BUT THESE ARE NICE AND THEY'RE
CHARCOAL CONTAINED AND SO FORTH.

THE THING YOU NEED
TO REMEMBER ABOUT

THE OSTOMIES ARE THERE'S
NO SPHINCTER, RIGHT.

YOU CAN CONTROL YOUR GAS,

YOU CAN CONTROL YOUR STOOL,
BUT THERE IS NO CONTROL HERE.

AND SO THEY WANT TO HAVE
SOME PROTECTION AS WELL.

AND THIS USUALLY GIVES IT TO
THEM, SO AGAIN THEY HAVE
TO WATCH FOR IT

AND THEY MAY NEED TO BURP THEM
IF THEY'RE GETTING FULL OF GAS,

BUT IT WILL HELP MAINTAIN
THE ODOR TO BE OUT IN PUBLIC.

SO HERE'S THREE SMALL ONES.

THERE WAS A NURSE THAT I VISITED
SHE CALLED THOSE SEX POUCHES

BECAUSE SHE SAID THEY WEAR
THEM WHEN THEY HAVE SEX.

YES, AND I AM GOING
TO GET TO THAT TOO.

THINK ABOUT THAT.

TALK ABOUT BODY IMAGE
DISTURBANCE, RIGHT.

I THINK GOD PUT OUR RECTUMS
BEHIND US FOR A REASON.

YOU KNOW, I MEAN THINK ABOUT IT.

GOD WAS THINKING ABOUT
SOME OF THIS STUFF BEFORE

AND NOW ALL OF THE SUDDEN
IT'S COMING OUT FRONT. OH, WOW.

THIS ISN'T DOING A LOT FOR
MY SEX LIFE, YOU KNOW
WHAT I'M SAYING?

AND IT'S A HUGE BODY
IMAGE DISTURBANCE.

IN THE VALLEY, I DON'T
HAVE THE STATS WITH ME,

BUT WE HAD A HUGE INCREASE
WITH GANG ACTIVITY OF TRAUMA

AND COLOSTOMIES
RELATED TO TRAUMA.

THIS WAS A YOUNG
CLIENTELE, RIGHT.

WELL, JUST COS YOU'RE...

HERE IN THE -- UH-HUH.
HERE IN THE CENTRAL VALLEY.

SO A HUGE ISSUE THEN,
BODY IMAGE DISTURBANCE,

EMOTIONAL ISSUES AND OF
COURSE SEX BEING A PART
OF THAT PACKAGE.

AND SO WHO TALKS TO THE CLIENT
ABOUT IT AND WHAT DO YOU DO?

WELL, OSTOMY NURSES ARE
PRETTY VERSATILE,

BUT WE SHOULDN'T BE SO SHY
THAT WE SAY, YOU KNOW,

HAVE YOU TALKED TO ANYONE ABOUT
YOUR SEXUAL ACTIVITY
AND YOU KNOW,

DO YOU HAVE A PLAN AND SO
FORTH BECAUSE YOU CAN BE
SEXUALLY ACTIVE

AND HAVE A WAFER.

SO, THE LITTLE SMALL POUCHES
ARE LESS INTRUSIVE
AND OFFENSIVE.

SOME PEOPLE IF THEY HAVE A
COLOSTOMY LIKE TO IRRIGATE PRIOR

TO SEXUAL ACTIVITY AND SO FORTH.

TO BE PROTECTED,
BUT IT'S A HUGE ISSUE.

I DID WANT TO POINT OUT THAT
WHAT WE'RE USING IN OUR

MANEQUINNS ARE THESE LITTLE
STOMAS AND THEY'RE NICE.

THEY FEEL SOFT,

PRETTY SIMILAR, NOT PERFECT,
BUT FAIRLY SIMILAR TO AN OSTOMY.

WHAT IS FLAWED IS THE COLOR.

RIGHT, WHAT'S WRONG
WITH THIS COLOR?

- IT SHOULD BE BRIGHT RED.
- IT SHOULD BE BRIGHT,
BEEFY RED.

AND WHY THEY DIDN'T DO THAT IS
BEYOND ME COS THESE
ARE, LIKE, BRAND NEW

AND THEY'VE ONLY BEEN OUT LIKE
A COUPLE OF YEARS AND EVERYBODY
KNOWS THEY'RE BEEFY RED.

SO OURS ARE A LITTLE ANEMIC.

AND THIS ONE IS SUPPOSED TO
REPRESENT AN INFECTION.

SO, I DON'T KNOW WHAT
YOU'LL HAVE WHEN YOU
GET TO YOUR CLIENT,

BUT BE NOTICING COLOR
AND SIGNS OF INFECTION

WHEN YOU'RE LOOKING
AT YOUR OSTOMY TO SEE

WHAT THE STATE
OF YOUR OSTOMY IS.

ALRIGHT, A COUPLE OF OTHER
THINGS I WANT TO MENTION

AND THEN WE'LL JUST DO SOME
OSTOMY CARE IS WE WANT
TO PROTECT THE SKIN.

THIS IS A PRODUCT BY HOLLISTER.

HOLLISTER BEING ONE OF THE
MAJOR MANUFACTURIES,

MAIN MANUFACTURERS OF
OSTOMY APPLIANCES.

AND THIS IS THEIR SKIN BARRIER,

SKIN PREP PRODUCT SIMILAR TO
WHAT WE USE WITH THE
NO STAIN BARRIER.

EITHER ONE WOULD BE PERFECTLY
FINE, BUT IT'S GOOD TO
PUT A SKIN BARRIER

THERE THAT WILL ALSO PROTECT
THE SKIN AND HELP IT TO
HAVE GOOD ADHESION.

AND ANOTHER PRODUCT THAT THEY
USE A LOT IS CALLED
STOMA ADHESIVE.

IF THE SKIN HAS STARTED
TO GET EXCORIATED

AND STARTING TO BREAK
DOWN A LITTLE DENUDED

THEN WHAT WE DO IS SPRINKLE
THIS POWDER ON AND YOU THINK,

OH MY GOODNESS HOW CAN IT STICK?

BUT WITH THE MOISTURE OF THAT
DENUDED SKIN COMBINED

WITH THIS IT FORMS LIKE A PASTE
AND THEN IT ADHERES
TO THE WAFER.

SO IT'S KIND OF LIKE WHEN YOU'RE
THINKING OF YOUR KARAYA PASTE,

IT'S KIND OF LIKE A STOMAHESIVE
CONCOCTION THAT WORKS WITH

THE STOMAHESIVE WAFER. AND THAT
HELPS HEAL UP THE SKIN.

SO THERE'S A LOT OF STUFF
OUT THERE TO USE.

THESE ARE JUST A FEW PRODUCTS
THAT ARE OUT THERE FOR US.

ALRIGHT.

SO...

..I HAVE EVERYTHING HERE.

WHAT WE'RE GOING TO DO IS,
IT'S APPLIANCE CHANGE DAY
FOR OUR CLIENT.

OUR CLIENT HAS AN OSTOMY.

ANY KIND YOU WANT IT TO BE.
IT'S KIND OF MUSHY

SO IT'S PROBABLY AN ILEOSTOMY.

AND WHAT WE'RE GOING TO DO IS
CHANGE THE APPLIANCE AND
PUT A NEW ONE ON.

YOU GUYS SHOULD BE DOWN TO
ONE LAST ITEM IN YOUR KIT.
THIS SHOULD BE IT.

SO, BRING YOUR WAFER. EVERYTHING
ELSE WE'LL PROVIDE FOR YOU.

BUT I WANTED EVERYONE
TO HAVE THEIR OWN WAFER.

THEY'RE LIKE $5 EACH AND SO IT'S
A LITTLE MUCH TO SUPPLY
ALL THIS.

SO, I'VE CHECKED
MY DOCTOR'S ORDERS.

THE DOCTOR ISN'T GOING TO SAY,
CHANGE THE APPLIANCE

EVERYDAY OR WHATEVER.

IT'S JUST GOING
TO BE OSTOMY CARE,

ET CONSOLE AND DO WHATEVER IS
APPROPRIATE FOR THAT CLIENT.

SO, WE'RE GOING TO CHECK
OUR DOCTOR'S ORDERS

AND THEN WE'RE GOING TO DO
SOME ASSESSMENT ABOUT
SOME THINGS

ABOUT OUR CLIENT
PRIOR TO GOING IN THERE.

IT'D BE GOOD TO HAVE
A SET OF VITAL SIGNS.

IT WOULD BE GOOD TO KNOW ABOUT
THEIR BOWEL HABITS
BEFORE SURGERY

AND AFTER SURGERY.

WHEN WAS THEIR LAST BOWEL
MOVEMENT AND HOW WERE
THEY DOING WITH THAT?

THE OTHER ISSUES I PUT
AT THE TOP OF YOUR SHEET

ARE MOSTLY PSYCHOLOGICAL ISSUES.

YOU WANT TO BE NOTING
THEIR AGE AND THEIR ABILITY

TO TAKE CARE OF
THE OSTOMY THEMSELVES.

ALWAYS PART OF WHAT WE'RE TRYING
TO ACCOMPLISH AS NURSES

IS TO HAVE PEOPLE BE
INDEPENDENT.

CAN THEY TAKE CARE OF IT
THEMSELVES OR IS IT GOING
TO BE A FAMILY MEMBER?

SO YOU'RE GOING TO BE LOOKING AT
AGE AND THEIR ABILITY TO LEARN.

THEIR WILLINGNESS TO LEARN.

THEY MAY BE PERFECTLY
CAPABLE OF DOING IT,

BUT THEY'RE NOT
WILLING TO DO IT YET.

THEY WON'T LOOK AT IT, THEY
WON'T HAVE ANYTHING
TO DO WITH IT.

AND THAT VARIES RELATED TO AGE.

IT ALSO VARIES RELATED TO
THE STATUS OF THE STOMA.

IS IT TEMPORARY OR
IS IT PERMANENT?

OSTOMIES AREN'T ALL PERMANENT.

SOME ARE JUST SHORT-TERM
WHILE THE BOWEL IS HEALING,

MAYBE RELATED TO TRAUMA.
AND SOMETIMES THEY'RE PERMANENT.

SO, IF IT'S TEMPORARY,
THEY MAY SAY, NO WAY.

I'M NOT TOUCHING THIS,
THIS WILL BE OVER
WITHIN A MONTH.

AND I WILL HAVE NOTHING
TO DO WITH IT.

WHEREAS IF IT'S PERMANENT,

I MEAN THESE ARE ISSUES YOU'RE
GOING TO HAVE TO FACE
AT SOME POINT,

HOW AM I GOING TO HANDLE THIS?
SO, SOMETIMES THAT VARIES.

AGAIN, EMOTIONAL STATUS,
HOW ARE THEY HANDLING IT?

AND YOU JUST KIND
OF HAVE TO PROBE.

YOU EARN THE RIGHT BY
BEING A NURSE TO ASK
STRAIGHTFORWARD QUESTIONS.

SO BE THERAPEUTIC, BUT YOU ALSO
HAVE TO BE STRAIGHTFORWARD.

HOW'RE YOU DOING?
HAVE YOU CARED FOR THIS?

HAVE YOU SEEN IT YET? HOW ARE
YOU FEELING ABOUT YOUR OSTOMY?

OPEN-ENDED QUESTIONS THAT WILL
ELICIT SOME CONVERSATION
FOR YOU.

AND THEN OFF WE GO.

SO, I'M GOING TO GATHER
UP MY EQUIPMENT,

AND THE EQUIPMENT IS GOING
TO BE YOUR OSTOMY WAFER.

MAKE SURE YOU HAVE
THE RIGHT SIZE PHALANGE,

AND THE RIGHT SIZE WAFER THAT
WILL FIT AROUND YOUR STOMA,

MAKE SURE THAT YOU HAVE A CLEAN
BAG TO FIT ONTO YOUR WAFER.

I'M GOING TO BE
USING KARAYA PASTE.

THE PASTE IN THE BROCHURE
THAT THEY ARE PASSING
AROUND IS CALLED ADAPT.

BUT WE'RE JUST GOING
TO USE PRETEND.

THIS IS ONE OF MY FAVORITE
SIMULATIONS I CREATED.

AND, WHAT THIS REALLY IS,
IS DENTURE CREAM,

BECAUSE IT'S CHEAP. KARAYA
PASTE IS VERY EXPENSIVE.

IT COMES IN A LITTLE SHORT TUBE.
IT'S A THICK, TACKY PASTE

AND IT COSTS ABOUT $15 A TUBE.

THIS COSTS $3. SO BIG
DIFFERENCE, I CAN GET
A LOT MORE OUT OF IT.

BUT I DIDN'T NOT WANT YOU TO
ASSUME THAT YOU COULD EVER USE

DENTURE CREAM FOR
KARAYA PASTE, OKAY?

THIS IS PRETEND. BUT IT KIND OF
KILLS TWO BIRDS WITH ONE STONE.

IF YOU'VE NEVER SEEN DENTURE
CREAM, YOU CAN SEE WHAT THAT
LOOKS LIKE TOO.

SO, IT'S A VERY CLEAN PRODUCT.

BUT WE HAVE OUR PRETEND KARAYA
PASTE OR OSTOMY PAST.

WE'RE GOING TO NEED TO MEASURE
THE STOMA AND THEN MEASURE
OUR HOLE ON OUR WAFER.

SO, I HAVE A MEASURING GUIDE.

SOMETIMES YOUR CLIENTS WILL HAVE
CREATED THEIR OWN PATTERN,

BECAUSE THE OSTOMY
ISN'T WELL-SHAPED.

OURS ARE PERFECTLY ROUND,
AND SOME ARE.

BUT MANY ARE KIND OF
KIDNEY-SHAPED OR OBLONG
OR IF YOU HAVE A DUAL

OR A LOOP OSTOMY, THEN THEY'RE
NOT A PERFECT ROUND.

SO THEY WILL BE CREATING THEIR
OWN PATTERN AND YOU
CAN JUST ASK,

DO YOU HAVE IT IN A DRAWER? OR
YOU CAN START THE FIRST
PATTERN FOR THEM.

I HAVE TOWELS, WASHCLOTHS,
BATH BLANKETS.

I HAVE A 4X4, WHICH IS WHAT I
WOULD USE IN THE HOSPITAL,
PROBABLY.

BUT IF I'M IN A HOME,
I MIGHT USE A PAPER TOWEL

BECAUSE WE JUST NEED SOMETHING
TO PLUG UP THIS STOMA

IN CASE IT OOZES THE EFFLUENT.

WE NEED A BAG OR SOMETHING
TO CONTAIN OUR OLD OSTOMY WAFER.

SCISSORS TO CUT, TAPE.

WE NEED SOMETHING TO
CLEAN THE SKIN WITH.

SO I HAVE WATER.
AND THEY'RE REALLY SOILED

AND YOU'RE CLEANING
PASTE AND STOOL.

FAKE STOOL, BUT YOU'LL SEE HERE
IN A MINUTE. SO YOU
NEED REAL WATER.

AND THE SOAP THAT YOU WOULD USE
HAS TO BE A MILD SOAP
WITH NO LOTIONS

AND NO PERFUMES.

SO WHAT THEY RECOMMEND
IS IVORY OR NEUTROGENA.

AS FAR AS SOAPS GO,

IF THERE'S SOME OTHER NEW BRAND,
THAT'S FINE TOO.

THERE'S FREE STUFF IN THE
HOSPITALS.

USUALLY JUST DOUBLE CHECK
IT FOR PERFUMES.

BECAUSE THERE ARE SO MANY
DIFFERENT BRANDS.

BUT THE PERFUMES CAN
BREAK DOWN THE SKIN.

MOST OF THOSE
DON'T HAVE PERFUMES, SO.

- DO YOU HAVE THAT DOUBLE?
- HUH?

- DO YOU HAVE THAT DOUBLE?

- NO. ONE BAG WITH
A BIGGER PHALANGE.

IT'S BIGGER AND SO BOTH
WOULD FIT IN THERE.

THEY'RE JUST TRICKIER TO
CUT A PATTERN TO FIT.

THEY HAVE TWO?

IT'S A LOOP. AND YOU CAN
HAVE A DOUBLE BARREL.

ONE IS THE --

I'M NOT GOING TO SAY THIS RIGHT,
HAVEN'T LOOKED AT THE
WORDS RECENTLY.

THE RECTUM COMES OUT
AND IT'S THE EXIT.

SO, NOTHING'S REALLY COMING OUT,
BUT IT DOES MAKE A LITTLE MUCUS.

SO JUST BECAUSE YOUR CLIENT HAS
AN OSTOMY DOESN'T MEAN THAT

YOU SHOULDN'T EVER WIPE
THEIR RECTUM,

BECAUSE THEY DO HAVE A LITTLE
DISCHARGE THAT CAN COME
OUT OF THERE.

BUT THEY SHOULDN'T HAVE STOOL.

BUT THEN YOU CAN HAVE
ANOTHER OPENING

THAT IS FOR THE STOOL OPENING,
WHEN IT'S TEMPORARY. YOU
CAN ALSO HAVE A LOOP,

AND THEY PUT A LITTLE STENT
UNDERNEATH IT AND LOOP
THE COLON.

SO YOU'LL SEE THIS FUNNY
LOOP COMING OUT.

AND THOSE ARE REALLY TRICKY
TO GET A FIT AROUND.

BUT ALL OF THEM
JUST HAVE ONE BAG.

AND YOU JUST, LIKE, HAVE TO
ADJUST YOUR PHALANGE SIZE.

IT'S FUN FOR THE ET NURSE
TO BE EXPERT REALLY IN ALL
OF THESE APPLIANCES

AND GETTING GOOD FITS
FOR YOUR CLIENT.

I PUT A REALLY GOOD ARTICLE
IN YOUR SYLLABUS.

AND THEN I DIDN'T INTEND FOR YOU
TO READ THE WHOLE ARTICLE,

I'LL TELL YOU THAT RIGHT NOW.
BUT I DID INTEND FOR YOU TO READ

THE FIRST, LIKE,
PAGE AND A HALF OF IT.

AND WHAT IT TALKS ABOUT IS
A NURSE THAT IS

HER JOB IS TO FIND THE RIGHT
PLACEMENT FOR THE STOMA
PRIOR TO SURGERY.

SO, IF THE CLIENT DIDN'T
COME IN WITH TRAUMA,

THERE WAS TIME, IF THEY'RE A
CANCER CLIENT, THEY'RE GOING
TO HAVE A STOMA,

THEN YOU HAVE NURSES THAT GO IN
AND FIND THE CORRECT PLACEMENT

AND PRE-MARK IT.

SO THAT THEY'LL GET ADHESION
OF THEIR WAFER.

IT'S A VERY INTERESTING ARTICLE.

AND THE SUCCESS RATE
OF THE CLIENTS WHO GET
PRE-MEASURED VERSUS

THE ONES THAT DON'T IS
SIGNIFICANT.

SOMEONE THAT TAKES THE THOUGHT
TO AVOID CREASES IN THE ABDOMEN,

GET AWAY FROM UMBILICUS,
GET AWAY FROM SCARS,

ON FLAT SURFACE, MAKE SURE
THEY'VE GONE THROUGH THE
RECTUS ABDOMINIS MUSCLE,

SO THAT YOU GET A GOOD OSTOMY.

SO ANYWAYS, INTERESTING AND IT'S
A QUICK AND EASY READ FOR YOU.

ALRIGHT, I THINK I
HAVE ALL MY SUPPLIES

AND I AM READY TO GO.

GOOD MORNING, MR CURRY,
IDENTIFY MY CLIENT.

WASH MY HANDS, PROVIDE PRIVACY.

IT'S TIME TO CHANGE
YOUR WAFER BAG.

IT'S BEEN ON THERE A FEW
DAYS AND IT WAS STARTING

TO PULL UP THERE A LITTLE
ON THE EDGES.

AND SO, I THOUGHT WE'D GO AHEAD
AND GET A NEW ONE ON THERE.

HOW ARE YOU DOING WITH
YOUR OSTOMY BAG?

ARE YOU ABLE TO DO IT YOURSELF?

ONE OF THE THINGS I DIDN'T
MENTION ON YOUR LIST WAS,
CAN YOU SEE IT?

THEY MAY HAVE THE WILLINGNESS.

BUT THEY MAY NOT BE CAPABLE OF
DOING IT, THEY MAY NOT
HAVE THE ABILITY.

THEIR HANDS MAY BE CONTRACTED
FOR SOME REASON.

I WENT AND CHANGED, ONCE A WEEK,
I GO TO A LADY'S HOUSE

AND CHANGE HER WAFER BECAUSE
SHE COULDN'T PHYSICALLY DO IT.

SHE COULD EMPTY THE BAG,
AND SQUISH THE STUFF OUT,

BUT SHE COULDN'T CONNECT
HER BAG TO HERSELF.

SO YOU'RE LOOKING AT THEIR
MANUAL DEXTERITY AND
THEIR VISUAL ACUITY.

CAN THEY SEE IT? PHYSICALLY,
DO THEY HAVE THE EYESIGHT?

OR CAN THEY SEE IT?

I HAD AN OBESE CLIENT AT
ONE TIME, HUGELY OBESE.

AND THE STOMA WAS UNDER
THE ROLL OF ABDOMEN.

AND THEY PHYSICALLY COULDN'T
SEE IT STRAIGHT ON.

AND SO WE HAD TO RIG
THEM UP WITH A MIRROR

SO THAT THEY COULD SEE WHAT THEY
WERE DOING ACCORDING
TO THEIR ANATOMY.

SO, IT'S A OFTEN A LITTLE
MORE COMPLICATED THAN
THE STRAIGHT BOARD

LIKE WE'RE GOING TO DO,
JUST, KIND OF, PUT IT
ONTO A MANNEQUIN.

THEY TALK ABOUT EVEN
WITH THE CHARCOAL PUTTING
PINPRICKS IN THE TOP OF IT,

SO THAT THE GAS CAN ESCAPE, BUT
IT WILL PASS THROUGH
THE CHARCOAL.

I HAVE ALSO READ IN SOME
THAT THEY DON'T THINK

THAT YOU SHOULD EVER PUT HOLES
IN BECAUSE OF THE SMELL.

AND SO, YOU KNOW, I DON'T
HAVE AN ABSOLUTE ANSWER.

I GUESS IT'S WHATEVER WORKS
FOR YOUR CLIENT, AS FAR AS
THIS CLIENT.

IT'S THE GAS.

YEAH.

ONCE THAT CHARCOAL GETS
WET AND SOILED,

AND THAT'S WHAT YOU HAVE
TO BE CAREFUL ABOUT,
IT'S NO LONGER EFFECTIVE.

THE CHARCOAL HAS
TO BE DRY TO WORK.

SO WE WANT TO PROTECT THAT.
THEY CAN BE A LITTLE TRICKY.

- SO IT ABSORBS,
THE CHARCOAL DOES.
- UH-HUH.

OKAY, I DON'T KNOW HOW GOOD --
I SHOULD TRY TRENDELENBURG
IN THIS THING, I THINK.

YOU MAY HAVE TO STAND UP.

SORRY. OKAY, HOW'S THAT?

- MUCH BETTER.
- YEAH.

BETTER?

YOU'RE GOING TO ASSESS
THE VALVE AT THIS ABDOMEN,

LOOKING FOR INSPECTION
AS FAR AS SIZE, SHAPE,

CONTOUR, COLOR, SCAR, CREASES,
THAT KIND OF THING.

WE CAN SEE LITTLE BETTER ONES,
THE WAFERS OFF, AS FAR AS
GETTING A GOOD FIT.

AND THIS MIGHT BE AN APPROPRIATE
TIME TO LISTEN TO BOWEL SOUNDS

BEFORE WE JUST --
WE TAKE ALL THIS OFF.

I DON'T THINK IT'S EXACTLY
IN THAT ORDER ON YOUR SHEET.

BUT LISTEN FOR BOWEL SOUNDS.

AND THEN MAYBE GENTLY PALPATE.

BUT I WOULDN'T WANT TO STIMULATE
A LOT OF BOWEL ACTIVITY HERE.

BECAUSE ONCE THIS IS OFF,
REMEMBER, NO SPHINCTER.

SO IT OOZES A LOT AND IT CAN.

SOMETIMES, THEY DON'T.
BUT THEY CAN.

ALRIGHT, WE'RE GOING TO GET
A BAG UP HERE WITH STUFF IN.

AND THE FIRST THING WE WANT TO
DO IS JUST TAKE THIS OFF
EVER SO CAREFULLY.

WHEN YOU'RE JUST CHANGING
THE BAG ITSELF,

MAKE SURE THAT YOU PUT
PRESSURE ON THE WAFER

AND KEEP IT DOWN BECAUSE YOU
DON'T WANT TO BE YANKING

IT ALL OFF OR YOU'RE GOING TO BE
DOING THE WHOLE WAFER CHANGE.

AND SO, STABILIZE THAT
AND THEN PEEL IT UP.

AND THEN LOOK AT THE STOOL.

STOOLS -- I DON'T WANT
TO LOOK.

OKAY, I HAVE TO TELL YOU
ABOUT ONE OFF MY BIGGEST
SNAFUS I EVER DID.

IT WAS JUST BAD.

YOU KNOW, I PUT EVERYTHING
IN A GLOVE.

IT JUST WORKS GOOD, YOU HAVE
THIS AUTOMATIC TRASH CAN
IN YOUR HAND.

SO I WAS IN THIS CLIENT'S
HOME ONE TIME AND I WAS
CHANGING THE WAFER

AND I THOUGHT, IT WAS JUST LIKE
THIS, ABOUT A THIRD FULL.

AND I THOUGHT, THAT'LL JUST FIT
IN MY BAG, IN MY GLOVE.

SO I TOOK IT LIKE THIS
AND I WENT LIKE THIS.

AND THE WHOLE THING
WENT LIKE, PHSST.

ALL THE STOOL CAME OUT.
I HAD THE BAG IN MY HAND,

BUT I HAD THE STOOL, PHSST.

WELL, I HAD JUST WALKED INTO
HER BATHROOM AND IT WENT PLOP

ON HER BATHROOM RUG,
SMACK IN THE MIDDLE OF IT.

I WAS LIKE, OH, I CAN'T
BELIEVE I JUST DID THAT.

SO I WALKED IN AND SAID,
I AM SO SORRY,

BUT I JUST DROPPED YOUR OSTOMY
BAG ONTO YOUR BATHROOM FLOOR.

OH, SHE WAS SO MAD.

SHE GOT UP AND SHE STARTED
SCREAMING, I CAN'T BELIEVE
YOU DID THAT.

THIS IS THE BIGGEST MESS
I EVER SAW.

I KNOW, I'M SO SORRY.

AND IT WAS, I MEAN, YOU KNOW,
IT WAS THIS MUCH. PLOP.

SO ANYWAY, WE GOT IT CLEANED UP.
AND I WOULD JUST LIKE TO SAY,

DON'T DO THAT.

THESE DO NOT FIT IN YOUR GLOVES.

MAKE SURE THAT YOU PUT
THEM IN A BAG.

WE'RE GOING TO REUSE
THESE OVER AND OVER

SO EVERYONE GETS THE GRAND
EXPERIENCE OF CLEANING UP
STOOLS.

SO JUST LAY THEM NICELY, SO WE
CAN GET YOU TO PULL THEM ON.

ALRIGHT.

YOU NEED TO CLEAN OFF THE STOOL.

AND SO WHEN YOU DO,
DO IT WITH TOILET PAPER,

DON'T GET THE LINEN
ALL SOILED UP FIRST.

BUT I LIKE TO GET AS MUCH
OF IT OFF AS I CAN.

ACTUALLY, I'M GOING TO THROW
THIS TO THE SIDE HERE SO
IT DOESN'T DO THIS.

SO.

JUST LIKE REAL.

AND LET'S GET THE BULK
OF IT OFF.

ALL THE WHILE CHECK IN
WITH YOUR CLIENT,

AND SEE HOW THE STOMA LOOKS.

OKAY. I'M FAIRLY SOILED HERE.

I'M GOING TO GO AHEAD
AND TAKE THE WAFER OFF,

PEELING TOWARDS THE OSTOMY.

DO THAT.

AND THEN CLEAN THE REST
OFF WITH TOILET PAPER.

AND THEN I'LL CLEAN THE SKIN UP,
WITH SOAP AND WATER.

IT'S HERE THAT YOU WANT
TO LOOK AT YOUR STOMA

AND SEE WHAT THE COLOR IS.

LOOKING FOR ANY KIND OF
SIGNS OF SKIN BREAKDOWN.

LOOKING AT PERISTOMAL SKIN.

MAKING SURE THAT THAT STOMA
IS NICE, BEEFY RED.

WHAT IF IT WAS BLUISH?

- CYANOSIS.
- CYANOTIC.

CYANOSIS, SO CIRCULATION
IS CUT OFF SOMEWHERE.

IS IT BECAUSE OF THE WAFERS,
BECAUSE OF THE STOMA ITSELF,

SOMETHING AMISS.

BLACK CERTAINLY ISN'T GOOD.

THIS WOULD OBVIOUSLY
BE A LITTLE ANEMIC.

SO, I'D NOTIFY THE DOCTOR
ABOUT THAT AS WELL.

- ALRIGHT.
- THAT'S DOESN'T HURT, WHEN
YOU'RE...

NO. HUH-UH.

NO NERVE ENDINGS. AND THERE'S
JUST HARDLY ANY PAIN AT ALL.

UNLESS IT'S NEW. IN
THE BEGINNING, THE
SURGERY ATTACHMENTS

CAN BE A LITTLE SORE ON THE
SKIN. THERE'S A LITTLE
BIT OF SWELLING.

BUT FOR THE MOST PART,
THERE'S NOT MUCH PAIN.

BUT ASK THEM HOW THEY'RE
FEELING.

BUT THIS PART ITSELF IS NOT
PAINFUL. IT'S, KIND OF,
A SLICK, MUSCLEY.

OBVIOUSLY, SOAP IF YOU NEED IT.

AND THEN MAKE SURE
YOU GET IT NICE AND DRY.

NOT TOO MUCH PRESSURE
AND STIMULATION ON THAT BOWEL.

ALRIGHT. I'M GOING TO GO
AHEAD AND PUT SOMETHING.

MY CLIENTS AT HOME CARE
LIKE TO PUT PAPER TOWELS.

AND THEY LIKE BOUNTY OR ONE OF
THOSE STURDIER KINDS OF
PAPER TOWELS,

AND THEY WOULD JUST KIND
OF PUT A LITTLE IN THERE.

AND THAT WOULD KEEP
IT FROM OOZING OUT.

ALRIGHT. YOU MAY NEED
TO CHANGE GLOVES DEPENDING
ON HOW SOILED YOU ARE.

AND DETERMINE THAT YOURSELF.

I HAVE MY MEASURING GUIDE HERE,
AND I'M GOING TO PUT IT OVER.

THIS IS GREAT. BUT THIS
SHOULDN'T GIVE ME THE
RIGHT SIZE. OH, WELL.

MY SETUP PEOPLE.

I REALLY NEED ABOUT ONE
AND A HALF INCHES.

SO I'M GOING TO CUT IT A LITTLE
BIT SMALLER THAN WHAT
THIS ONE IS.

THIS ACTUALLY COSTS $5.26.
PRETTY PRICEY, DON'T YOU THINK?

OKAY. SO WHAT YOU WANT TO DO
IS TAKE YOUR GUIDE HERE,

AND ON THE BACK SIDE, CENTER IT.

AND THEN I LIKE THESE LITTLE,
ROUNDED, CURVED SCISSORS
A LITTLE BIT BETTER

THAN YOUR BANDAGE SCISSORS. YOUR
BANDAGE SCISSORS ARE GOING
TO CHEW THEM UP PRETTY GOOD.

SO WE'LL LEAVE A COUPLE
OF THESE OUT FOR YOU.

AND THEN YOU'RE GOING
TO CUT INSIDE

AND I'M GOING TO CUT THIS LITTLE
SMALLER THAN THAT. YES.

THEN BEFORE I DO ANYTHING --
GOT REALLY CLOSE HERE

AND I DON'T WANT TO GET
ANY CLOSER ON THIS SIDE,

BECAUSE I WANT TO HAVE ABOUT A
FOURTH OF AN INCH AWAY
FROM MY PHALANGE.

I CUT THAT WAY TOO SMALL.

TURN IT UP AND I'M AIMING TO
HAVE ABOUT 16TH OF AN INCH

TO AN EIGHTH OF
AN INCH AROUND THIS.

ALWAYS CHECK IT BEFORE.
STILL NOT GOOD.

BETTER TOO SMALL THAN TOO BIG.
BECAUSE IF YOU GET IT TOO BIG,

YOU HAVE ONLY A COUPLE OF
CHOICES, AND THAT'S ONE
TO PUT IN THAT TAPE STUFF

THAT I SHOWED YOU
AND FILL IN THE GAPS.

OR MAYBE THAT
OTHER PRECUT ROUND.

CAN YOU GUYS SEE IT?

WELL, THIS IS IMPORTANT.

IF YOU CAN'T SEE IT,
COME CLOSER AROUND HERE.

NOW SAY YOU SCREWED UP
AND YOU ONLY HAD ONE

WAFER OR WHATEVER. I MEAN,
YOU MIGHT SEE THE TEGADERM...

- ..WOULD YOU PUT TEGADERM
ON THERE?
- OOH.

YOU CAN FILL IN WITH PASTE.
I'LL SHOW YOU HOW TO DO THE
PASTE.

DON'T WRECK IT IF
IT'S YOUR LAST ONE.

CUT IT SMALLER VERSUS LARGER,
THAT'S YOUR BEST BET.

BECAUSE THE THING IS, YOU JUST
GOT TO KEEP IT OFF THE SKIN,
THE EFFLUENT.

OKAY. ONCE THIS IS SET,
THE SKIN IS DRY...

- ..WE'LL DRESS THEM.
- DOES IT MORE, BECAUSE...?

I KNOW, BUT IT MAKES ME FEEL
BETTER. TO THINK I HAVE
DONE ALL I CAN DO.

WHAT YOU WANT TO DO NOW
IS SMOOTH THE EDGES

SO THAT THOSE ROUGH EDGES
AREN'T GOING TO BE PRESSING,

AND THIS STRETCHES
IT A LITTLE BIT.

TRY NOT TO TOUCH
THIS SURFACE AT ALL.

THEN YOU'RE GOING TO TAKE
YOUR KARAYA PASTE,

AND IT'S ACTUALLY A FATTER BEAD
THAN WHAT I'M GOING TO GET.

BUT WHAT YOU WANT IS
A FULL BEAD ON THIS INNER EDGE.

FULL FAT, LIKE THIS.

THEN YOU WANT IT TO SIT
UP FOR ABOUT ONE MINUTE.

IT'S IN THAT TIME THAT IT
WON'T BE QUITE SO TACKY

AND YOU'LL GET BETTER ADHESION.

I'VE BEEN WITH QUITE
A FEW OSTOMY NURSES,

AND THE OPINION PRETTY MUCH
OF THE ONES I WENT WITH

AND I'VE TALKED TO
IS ONE BEAD IS ENOUGH.

SOME PUT A BEAD ON THE SKIN
AND A BEAD ON HERE.

BUT IT'S ACTUALLY JUST TOO MUCH
AND YOU DON'T GET AS MUCH
ADHESION.

IT'S JUST GOOFY, AND YOU
DON'T WANT THAT MUCH.

AFTER IT'S SET UP FOR A MINUTE

THIS IS WHERE IF YOU CAN'T
SEE YOU MUST SEE,

COME, DON'T BLOCK THE CAMERA,
BUT COME IN CLOSER, YOU
CAN SEE IT.

ALRIGHT. WHEN YOU PUT THIS ON,

SEE HOW I HAVE THESE
SPACES RIGHT HERE.

IT'S MY FULL EIGHTH OF AN INCH.

WHAT I WANT TO DO IS PRESS DOWN.

BUT THEN I'M GOING TO TOUCH
ONTO HERE AND SQUISH IT OUT.

I'M NOT TOUCHING THE PASTE,

I'M JUST SQUISHING
IT FROM THE BACK

OF THE WAFER SO THAT
I GET A GOOD FILL.

NOW, WHEN THE EFFLUENT
COMES OUT,

IT'S NOT GOING TO GET
ON SKIN AT ALL.

I'VE CAULKED IT, I FILLED
IT IN. IT'S LIKE THE TILE
OF YOUR BATHROOM.

THERE'S NO GAPS, AND THAT'S WHAT
YOU ARE TRYING TO CREATE.

NOW, IF YOU WANT, YOU CAN TAKE
YOUR FINGERS, AND THAT'S
PRETTY TACKY.

AND YOU CAN GET IT WET AND THEN
YOU CAN JUST DAB IT DOWN.

I'M NOT TRYING TO WIPE IT AWAY.
THAT IS NOT THE GOAL.

I'M JUST PATTING IT DOWN
SO THAT IT FILLS IN ALL
OF THE GAPS IN THERE.

AND IT'S JUST BEAUTIFUL.

OKAY. AND THAT'S WHAT YOU'RE
TRYING TO ACCOMPLISH.

NOW, IT IS MY PREFERENCE,

PEOPLE CAN DO IT THEIR WAY,
BUT I LIKE TO PUT
MY BAG ON ASAP,

BECAUSE THEN I DON'T HAVE TO
WORRY ABOUT THINGS OOZING.

SO, IF YOU COULD PUSH OUT
YOUR STOMACH A LITTLE,

AND WHAT I MEAN IS, KIND OF,
BEAR DOWN AND GIVE ME
A LITTLE TENSION,

SO THAT I CAN PRESS DOWN.
SOMETIMES, IT FEELS LIKE I'M
PRESSING INTO THEIR SPINE

TO GET SOMETHING TO PRESS
AGAINST.

BUT TO GET ALL THOSE
LAYERS DOWN.

AND THEN, JUST LIKE YOU DID
WITH THE HYDROCOLLOID,

IF YOU CAN HOLD IT FOR ABOUT
A MINUTE TO GET A GOOD SEAL

ON HERE AND GET IT STUCK.
MAKE SURE YOUR BAG IS ON.

NOTHING WORSE THAN A BAG
THAT DOESN'T STICK.

AND THEN YOU CAN GO AHEAD
AND PUT YOUR PASTE.

THAT WOULD'VE BEEN REALLY
GREAT OF ME IF I HAD PUT
A SKIN PREP ON.

AND SINCE I FORGOT, I WOULD GO
AHEAD AND AT LEAST PUT IT
ON THIS MUCH OF THE SKIN

SO THAT MY TAPE WOULD
STICK GOOD.

AND THEN PICTURE FRAME,

IF THE TAPE ISN'T INCLUDED
ON YOUR OSTOMY WAFER,

SO THAT IT STAYS ON.

AND THEN MAKE SURE ALL THESE
PIECES OF TAPE HAS DATE,

TIME AND INITIALS ON IT.

ON YOUR BAGS, IF YOUR CLIENT
IS UP AND AMBULATORY,

THEN THE BAG NEEDS TO FACE DOWN.

BUT IF YOUR CLIENT IS BEDRIDDEN,
AND THEY'RE IN BED ALL THE TIME,

IT DOESN'T MATTER IF THE
BAG GOES OFF TO THE SIDE.

ALRIGHT.

CLEAN UP THE AREA.

FILL THIS UP.

COME BACK, CHECK ON THE CLIENT,

MAKE SURE EVERYTHING IS STICKING
AND STAYING ON OKAY.

AND OBVIOUSLY THE BED LIGHT.

OKAY. WASH YOUR HANDS, DOCUMENT
THE CHANGE AND DOCUMENT
THE STOOL.

AND HOW THEY TOLERATED
EVERYTHING.

alright. I WANT TO
SHOW YOU QUICKLY,

SOMEONE CHANGING
THEIR OSTOMY BAG.

A REAL PERSON ON HERE. AND IT'S
JUST A QUICK, LITTLE VIDEO.

NO, IT'S A SHAME, ISN'T IT?
BUT I THINK I FOUND A NEW SET
THAT'S EVEN BETTER.

A NEW WHAT?

A NEW SET OF VIDEOS,
SKILLS VIDEOS, UH-HUH,

MADE BY SOME OTHER MANUFACTURERS
THAT TOM AND I WERE LOOKING
AT, A COUPLE OF SETS.

THEY HAVE INTERVIEWS OF CLIENTS
AND CAREGIVERS THAT DO THE CARE.

THEY SHOW YOU THE SKILL
SET, MOST OF THE TIME
ON REAL CLIENTS,

BUT SOMETIMES ON MANNEQUINS.

AND THEN THEY SHOW YOU A
REAL CLINICAL SITUATION
OF THE SAME SKILL.

SO YOU GET TO SEE IT IN SOME
DIFFERENT ENVIRONMENTS,

SO YOU CAN GET THAT HOSPITAL
SOUND AND FEELING
OR CLINIC SOUND,

REAL CLIENT SOUND, AND WHO MIGHT
GET THIS PARTICULAR TREATMENT,

AND YOU'VE SEEN
THE TEACHING OF IT,

WHETHER IT'S MANNEQUIN
OR REAL BED. ANYWAY, THEY
LOOK PRETTY GOOD.

DOESN'T SEEM TOO MUCH. YOU
PRICED THEM, WHAT
WERE THEY, $60?

$60-$65. THAT'S A LOT
CHEAPER THAN WHAT...

AND ONE HAD 300 SKILLS,
AND ONE HAD 95.

AND SO I'M COMPARING WHAT SKILLS
THEY HAVE ON THEM RIGHT NOW.

BUT THEY'RE BRAND NEW, AND I
THOUGHT, THEY WERE REALLY,
REALLY NICE.

ALRIGHT. SO, THAT WAS THE LAST
ONE. AND AS HE WAS SAYING,

HIS LAST LITTLE STEP TO
ORDER ME SUPPLIES -- GOSH,
YOU LOST A POINT.

MAKE SURE YOU'VE
ORDERED SUPPLIES.

REMEMBER WE TALKED ABOUT YOU
BEING THE ONE USING
UP THE LAST WAFER,

THE LAST BAG. NO GOOD.

ALRIGHT.

YOUR LAST AND FINAL GROUP SKILL,

EVER PASS-FAIL IS YOUR GOING
TO IRRIGATE AN OSTOMY.

AND I'M THINKING THAT
IS A FULL OSTOMY.

SO, SHE GETS HER OSTOMY
IRRIGATED TO REGULATE BOWELS.

YOU CAN BE THINKING OF THAT
AS THE CRITERIA HERE.

AND AGAIN, YOU WOULD DO QUITE
A FEW PRE-ASSESSMENTS,

YOU HAVE A PRETTY LENGTHY LIST,
MOST OF WHICH WE'VE
ALL TALKED OVER.

SO YOU CAN LOOK AT
IT BRIEFLY AGAIN.

YOU'RE LOOKING AT
EMOTIONAL ISSUES.

WILLINGNESS, VISUAL ACUITY,
ABILITIES, LEARNING, AGE.

YOU WANT TO KNOW ABOUT THE
STOMA,

YOU WANT TO KNOW WHAT
KIND OF STOMA IT IS,

IF IT'S PERMANENT,
IF IT'S TEMPORARY.

DOUBLE BARREL, SINGLE.
WHAT HAVE I GOT GOING HERE?

YOU WANT TO KNOW ABOUT
THEIR DIET HABITS,

THEIR DIET REGIMEN, THEIR
ACTIVITY. ARE THEY UP AND ABOUT?

CAN THEY GET UP TO THE
BATHROOM TO DO THIS?

IT'S MUCH EASIER TO DO IT IN THE
BATHROOM THAN IT IS ON THE BED,

ALTHOUGH YOU CAN DO IT IN BED.

VITAL SIGNS, IN THE HOSPITAL.
NOT NECESSARILY IN THE
HOME ENVIRONMENT.

AND HOW OFTEN THEY DO IT,

HOW WELL THEY TOLERATE THE
ENEMA.

BECAUSE BASICALLY THAT'S JUST
WHAT IT IS, AN ENEMA.

SO, WHAT KIND OF VOLUME OF FLUID
THEY USE AND SO FORTH.

SO, DO YOUR ASSESSMENTS AND THEN
WE'RE GOING TO GATHER UP
OUR EQUIPMENT.

WE'VE CHECKED OUT ORDERS
AND SO FORTH.

SO, IN OUR EQUIPMENT, WE'VE GOT
SOME EXTRA LITTLE GOODIES HERE.

WHAT I HAVE GATHERED IS,

AN ENEMA BAG WITH A CONE TIP.

AND IT LOOKS LIKE THIS.
AND THIS IS LIKE AN ENEMA BAG,

WE'RE STILL GOING TO
PUT SOLUTION IN IT.

AND IT'S THE SAME AS DOING
AN ENEMA ON AN ADULT.

WE CAN PUT AROUND 750 TO A
1000 IN AN ADULT CLIENT
AS THEY TOLERATE IT.

THE DIFFERENCE IS WE'RE GOING
TO HAVE A CONE TIP END.

THE REASON FOR THE CONE TIP IS,
REMEMBER, NO SPHINCTER.

SO, WHEN WE GO TO PUT FLUID IN,
WHERE WOULD THE FLUID GO

IF WE DIDN'T HAVE THE ABILITY
TO STRETCH IT AND SEAL IT OFF?

IT WOULD ALL COME SQUIRTING
BACK.

SO, THIS GOES IN AND KIND OF
STRETCHES AND THEN FILLS
IN THE GAPS

AND KIND OF IS THE
STOPPING AGENT

SO THAT THE FLUID DOESN'T
ALL COME SQUIRTING BACK.

SO YOU HAVE A CONE TIP.

YOU DON'T HAVE TO REALLY PUT
WATER IN, JUST TALK THROUGH IT.

I WOULD PUT MY 720 CC'S LUKEWARM
WATER, 105, 110 DEGREE WATER,

HANG IT ON A BAG AND I WANT MY
BAG TO BE ABOUT 12 TO 18 INCHES,

THE BOTTOM FROM WHEREVER
THEIR STOMA IS. SO ADJUST
ACCORDINGLY.

IF THEY'RE DOING IT
THEMSELVES AT HOME,

THEY COULD HOOK IT UP TO
THE BACK OF THEIR BATHROOM DOOR,

PUT A HANGER ON THE SHOWER ROD
OR SOMETHING,

RIG UP SOMETHING SO THAT
THEY GET SOME KIND OF A
POLE SETUP GOING.

I WANT TO SHOW YOU THIS ONE.
I FOUND THIS ONE.

THIS IS A REAL OSTOMY ENEMA BAG.

THIS IS WHAT THEY USED
IN THE OLDEN DAYS.

ISN'T THAT INTERESTING?

ISN'T THAT SOMETHING YOUR
GRANDMOTHER WOULD HAVE?

NOT COVERED OR SOMETHING.

- CHECK OUT THIS CONE TIP.
- IT'S NOT REUSABLE?

HUH-UH. NO. THESE AREN'T EITHER.

THESE GET RINSED AFTER
THEY'RE USED. BUT NO.

METAL CLASP, GREAT.

I LOVE MY LITTLE ANTIQUE.

ALRIGHT. TRASH BAG TO PUT
THE OLD BAG ON IN HERE.

MOST OF THEIR SUPPLIES ARE KEPT
IN A LITTLE BAG LIKE THIS.

SO, ONCE THEY'VE BEEN USED,
YOU WANT TO MAKE SURE

YOU HANDLE EVERYTHING WITH
GLOVES.

AND DON'T JUST THINK, OH,
IT'S BEEN CLEANED.

MINUS THE FIRST TIME IT'S BEEN
USED.

SO, YOU WANT TO MAKE SURE AND
GET A SLEEVE TO FIT
OVER THE WAFER.

SO YOU'VE GOTTA MAKE SURE
YOU HAVE A PHALANGE

THAT FITS THE SAME PHALANGE SIZE
AS YOU'VE GOT ON HERE.

AND THAT'S A LITTLE TRICKY. IN
FACT, WE'VE GOT ALL DIFFERENT
KINDS OF PHALANGES.

AND THEN THEY HAVE CLIPS
AT THE BOTTOM.

AND THAT WILL GIVE EVERYONE A
CHANCE TO PRACTICE WITH
A CLIP FOR REAL.

WE NEED A CLEAN BAG TO PUT ON
AFTER WE'RE DONE.

AND YOU'RE GOING TO NEED
YOUR WATER TO RINSE OUT.

OF COURSE WE PUT IT IN HERE,
BUT WE'RE GOING TO BE RINSING
OUT THE BAG,

WHEN WE'RE DONE WITH IT.

ALRIGHT. SO I'VE GATHERED
MY EQUIPMENT,

I'VE IDENTIFIED MY CLIENT,
WASHED MY HANDS, PROVIDE
PRIVACY.

ALRIGHT. MRS SMITH, YOU ARE UP
AND READY TO IRRIGATE

THAT OSTOMY AND GET ON
WITH YOUR CARE.

THIS PROCEDURE TAKES
ABOUT AN HOUR.

SO, MOST CLIENTS LIKE TO
START THE PROCEDURE,

FINISH UP THEIR MORNING
ACTIVITIES AND THEN FINISH THIS

AND YOU'LL SEE WHAT I MEAN
HERE IN A MINUTE.

ALRIGHT. LET'S SEE WHAT
WE HAVE GOT GOING HERE.

WE'LL BRING THAT UP HERE.

OKAY. WELL, YOUR WAFER LOOKS
LIKE IT'S NICE AND SECURE.

SO, WE DON'T NEED
TO CHANGE THAT.

I'M INSPECTING THE ABDOMEN
AS I ALWAYS DO FOR

CONTRA, COLOR, CREASES,
THE INTEGRITY OF THIS WAFER.

AND I'M GOING TO GO AHEAD
AND TAKE THE BAG OFF.

IF THE BAG'S CLEAN, YOU CAN SAVE
IT. IF NOT, DISPOSE OF IT.

THEN WHAT I WANT TO DO,
IS I WANT TO CLIP THIS ON.

CAN YOU PUT OUT YOUR STOMACH FOR
ME JUST A LITTLE BIT? THANK YOU.

AND GET THAT NICE AND SNUG ON.

NOW, THE GOAL HERE IS,

WE'RE GOING TO BE WORKING
OUT OF THE TOP

AND EVERYTHING WE PUT IN IS
GOING TO LEAK OUT OF THE BOTTOM.

SO, THERE'S A COUPLE OF THINGS.

IF YOUR CLIENT IS IN THEIR
BATHROOM, THEY CAN SIT
IN FRONT OF THE COMMODE

AND DRAPE THIS INTO THE COMMODE.

YOU CAN SIT ON THE COMMODE
AND PUT IT BETWEEN YOUR LEGS.

IF YOU DO THE
BETWEEN-THE-LEGS METHOD

UPI MIGHT WANT TO
TRIM THE BOTTOM OFF

SO IT'S NOT DRAGGING
IN TOILET WATER.

AND IT'S TOTALLY TRIMABLE,
BUT JUST DEPENDING

ON WHEN YOU'RE SNIPPING IT OFF

BECAUSE YOUR LAST CLIENT
DID IT THAT WAY,

BECAUSE THIS IS ONE WAY YOU MAY
WANT TO SIT IN FRONT
OF THE COMMODE.

BY THE SAME TOKEN, IF YOU
WERE DOING IT IN A BED,

YOU COULD TURN THIS
AND PUT A BEDPAN ON A CHAIR

TO THE SIDE OF THE BED AND THEN
DRAIN OFF INTO THE BEDPAN.

SO JUST DEPENDS ON WHAT
YOU NEED TO DO.

WE'LL JUST SAY OURS IS GOING
DOWN INTO THE TOILET. OKAY.

SO WHAT WE WANT TO DO NOW IS,
PUT A LITTLE K-Y JELLY.

OH, WHERE'S MY K-Y JELLY? NO.

IMAGINARY K-Y JELLY
ON MY FINGER.

AND WHAT I WANT TO DO IS
I WANT TO TAKE MY FINGER

AND I WANT TO PROBE
INTO THE OSTOMY

SO THAT I CAN SEE WHICH
DIRECTION IT'S GOING.

IS IT GOING THIS WAY OR UP
OR HOW AM I GOING TO
POINT THE CONE?

REMEMBER, NO NERVE ENDINGS
IN HERE, THIS ISN'T PAINFUL,

BUT YOU NEED TO GET THE BEST
DIRECTION ON YOUR ENEMA HERE.

SO, LUBRICATE.

TAKE THIS GOING FROM THE TOP.

AND THEN, PUT IT IN
UNTIL IT'S SNUG.

DON'T PUSH TILL IT HURTS.
BUT YOU WANT IT TO BE
FIRM ENOUGH

THAT IT'S NOT ALL
SQUIRTING BACK.

AND THEN, FOLLOWING THE SAME
RULES AS YOU DID WITH AN ENEMA,

YOU'RE GOING TO OPEN THIS UP
AND LET IT RUN IN,

NICE AND SLOW OVER
ABOUT FIVE MINUTES.

IF THEY HAVE CRAMPING,
SLOW IT DOWN.

IF THE CRAMPING
DOESN'T STOP, STOP IT.

AND THEN LET IT
CONTINUE TO GO IN.

AND THEN ONCE IT'S IN,
CLOSE THIS DOWN.

AND THEN -- YOU'LL LOVE THIS
WHEN YOU WATCH IT ON THE VIDEO,

BUT AS SOON AS YOU TAKE THIS
OUT, PHOOSH, STARTS COMING BACK.

SO, IT'S A LITTLE
DIRTY PROBABLY.

YOU WANT TO SEAL THIS RIGHT UP

AND LET WHAT'S GOING
TO JUST IMMEDIATELY ESCAPE
OUT OF HERE, COME OUT.

THAT'S STOOL ON THE FLOOR.
OKAY. LET IT COME OUT.

NOW, ONCE THE FIRST
RUSH COMES OUT,

AND THAT TAKES LIKE ABOUT
FIVE MINUTES OR SO,

WELL, THIS IS JUST
A PROBLEM HERE,

THEN, YOU'RE GOING TO TAKE THIS.

YOU CAN KIND OF RINSE OFF
THE END A LITTLE BIT,

GET THE STUFF OUT OF THERE.
AND THEN YOU WANT TO CLIP IT.

OKAY. REMEMBER YOU'RE GOING TO
TAKE THE INSIDE OF THE CLIP,

FOLD IT ONCE
AND THEN SNAP IT SHUT.

THEN YOU'RE GOING TO COME UP
HERE, AND WITH A CLOSED
PIN OR A CHIP CLIP

OR YOU CAN SEE MY PAPERCLIP,
YOU'RE JUST GOING TO
CLIP IT LIKE THIS

AND THEN TELL YOUR CLIENT
TO GO ABOUT THEIR BUSINESS.

THIS IS WHEN THEY CAN FIX
THEIR HAIR, BRUSH THEIR TEETH,

TAKE A SHOWER, WHATEVER THEY
NEED TO DO, TO GET READY.

JUST GO ON WITH THE DAY.

THEN YOU CAN GO AHEAD
AND CLEAN UP YOUR SUPPLIES.

YOU WANT TO MAKE SURE THAT
WHEN YOU RINSE THIS,

YOU RINSE IT INTO TOILET WATER
OR USE THE SAME BASIN.

DON'T CLEAN IT IN THE KITCHEN
SINK OR ANYTHING.

OR EVEN IN THE BATHROOM SINK.
YOU'D BE SURPRISED.

BATHTUBS, NO. UNLESS THEY
NEVER USE THE BATHTUB.

BUT, BE CAREFUL ABOUT HOW
YOU'RE RINSING AND DISPOSING
OFF THESE THINGS.

RINSE IT AND THEN THEY SAVE IT.
THIS LASTS, GOODNESS,
FOR MONTHS.

IF YOU CAN, PUT
YOUR SUPPLIES BACK.

THEN FILL THIS UP WITH
SOME NICE, WARM WATER.

YOU'RE GOING TO COME BACK.

IT'S BEEN 45 MINUTES,
AN HOUR, WHATEVER.

YOU'RE GOING TO TAKE THIS OFF.
HOPEFULLY, NOW YOU'LL SEE

A STOOL IN THERE.
THAT'S THE GOAL.

PUT THIS IN THE TOILET.

OPEN THIS UP.

RINSE OUT AS BEST YOU CAN,

THE BULK OF THE STOOL.

AND THEN, TAKE THIS OFF.

THIS ALSO GETS RINSED AND SAVED.

SO, BACK INTO THAT BASIN,
TO CLEAN IT UP.

MAKE SURE YOUR WAFER
IS NICE AND INTACT.

CLEAN THE STOMA AND DRY IT.
AND MAKE SURE THAT
IT LOOKS FINE.

AND THEN REPLACE A CLEAN BAG.

CAN YOU TUCK BACK
YOUR STOMACH, PLEASE?

SNAP THAT ON. MAKE SURE
IT'S ALL CONNECTED,

AND MAKE SURE THIS
IS IN GOOD SHAPE.

THIS GETS RINSED OUT.

KEEP EVERYTHING IN ONE BASIN.

YOU KNOW, LIKE THEIR BATH BASIN,
THEY SHOULD SAVE THOSE.

AND THEN KEEP ALL
THE SUPPLIES IN THERE.

RINSE IT, DRY IT AND SO FORTH.

TAKE OFF YOUR GLOVES. WASH IT.

DOCUMENT. AND THAT
IS AN IRRIGATION.

OKAY, MAKE SURE
YOU ORDER SUPPLIES.

AGAIN, YOU DON'T WANT TO BE
OUT OF SUPPLIES WITH THIS.

SO, THAT'S A BIG ONE.

ANY QUESTIONS?

PRETTY STRAIGHTFORWARD.

ALRIGHT. YOU'LL REALLY BE
CLEANING AND REALLY
DOING YOUR STUFF.

WHAT YOU CAN DO WITH YOUR
WAFERS IS YOU CAN GO AHEAD

AND PRE-CUT THEM BEFORE
YOU COME IN FOR TESTING.

IT'S BORING TO WATCH
YOU CUT. SO.

HAVE THEM CUT. YOU JUST,
WHEN YOU COME IN TO TEST,

HAVE TO SAY, I WOULD MEASURE,
I WOULD CUT AND THEN
I WOULD LAY IT DOWN.

WE WANT TO SEE YOU LAYING IT AND
MAKING SURE THAT IT'S
THE RIGHT SIZE.

CUT THEM TOO BIG
AND THAT'S A PROBLEM.

SO, WHEN YOU'RE LOOKING
ON YOUR MANNEQUINS,

MAKE SURE THAT YOU MEASURE ONE
OF THOSE SOFT, RUBBERY ONES,

NOT THOSE -- ON THE
OLDER MANNEQUINS,

YOU'RE GOING TO SEE SOME
BIG, FLAT OSTOMIES.