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.
NONE OF THE ONES IN THE TESTING ROOM HAVE THOSE BIG, FLAT RED ONES.
YOU WANT THOSE SPONGIER, SMALL ONES.
AND CUT TO THOSE AND THEY'LL FIT ALL THE MANNEQUINS. OKAY.
WHEN ARE THE TESTS DUE?
NEXT WEEK, WHAT I WILL DO
THIS IS YOUR LAST LECTURE FOR SKILLS THAT YOU'LL BE GRADED ON.
NEXT WEEK, WHAT I'LL DO, IS I'LL GO OVER CAST CARE
AND THINGS THAT WILL BE COVERED ON THE WRITTEN EXAM.
AND THEN I'LL GIVE YOU A SAMPLE CRITICAL THINKING DEMONSTRATION.
IT'S SIMILAR TO WHAT YOU DID LAST SEMESTER.
JUST A LITTLE MORE INVOLVED.
SO I'LL GIVE YOU THE RUNDOWN AND REVIEW OF WHAT A CRITICAL THINK IS.
AND THAT'S IT.
AND YOU'LL DO YOUR CRITICAL THINKING FOLLOWING WEEK AND WE'LL BE DONE.
- WOW. - AMAZING. TWO MORE WEEKS.
YOU'VE DONE GREAT. YOU DO A FEW, THEY DO SOME FRONT LOADING AND OB,
THEY COME IN HERE AND DO SOME STUFF ON DELIVERING A BABY.
AND SOME OF THAT TYPE OF STUFF. AND I THINK TRIA DOES SOME SKILLS,
FRONT LOADING, FOR PEDIATRICS.
BUT OTHER THAN THAT, THAT'S IT.
SO, THIRD SEMESTER, BOY,
GRAB EVERYTHING YOU POSSIBLY CAN GRAB WITH AN INSTRUCTOR,
BECAUSE THAT'S YOUR LAST, BIG MED-SURG.
AND THEN YOU DO SOME LEADERSHIP AND STUFF IN SIXTH
AND SOMETIMES YOU CAN GET SOME MORE EXPOSURE. BUT, THAT'S IT.
THEY WANT YOU TO DO IT ALL.