Fundamental Concepts | Picmonic Nursing Webinar

process the big thing most people most students get confused on its just not following ad pi make sure you assess assess assess assess before anything else unless that patients going to die in the next two minutes you must assess and this is actually an example from our pic Manik learning system so if you're not preparing for the NCLEX right now and you're still in school this is just an example of how we take an assessment here's for number two and we turn it into the assess man so you can always remember to assess first so remember add PI we're actually going to show you an ad plus sign with a PI so you can always remember that along with this RN Assessor said you remember assessment diagnosis planning now everything when you do planning this is more for your clinical evaluations you know all those plans all those all those goals yep right on this disastrous care plans which I hate and I'm sure you do too that they got to be realistic individualized and timed he doesn't have each of those three pieces you're a clinical instructor especially if you had some really evil ones like mine they're gonna throw it back at you and tell you to do it again and you're just gonna hate your life and I don't want that for you today and you don't want it either and that's no fun so the last thing is implementation in evaluation for the nursing process and that's really important to make sure you evaluate all of your interventions to make sure that they're actually actually work now the next thing is Maslow's hierarchy of needs now before I say anything we do have lots and lots of high your questions that I like to ask and you can always type in the answers into your little question box today because I have so many things I want to go over I'm definitely not going to hit on all of my questions like I would normally do but you know I'm gonna go over a lot of them for sure but the big thing is Maslow's so I don't think I have my Maslow's pick monic here in my know I don't I don't want my Maslow's peg monic in our system here but what you need to know is ABCs right ABCs airway breathing circulation always always always always if there's a question and you see Payton airway the answer is something to do with airway right and if there's no airway and there's no breathing and there's no circulation there's no excessive bleeding then you worry about kind of Maslow's hierarchy of needs and it's a way of thinking so if you've not if you're planning right now for them Frank Lex and you really not mastered the really comes down answering questions and knowing what's going to kill the patient first that's really what we worry about now the next thing is normal vital signs so we just want to talk on some normal vital signs you know these are pretty by this point everyone should know all of them are more vital signs so what's a normal pulse sixty to a hundred right so if the pulse is high then we need to speed it up if it's look I mean sorry if it's it's high when you slow it down if it's low we need to speed it up now what kind of a patient normally is gonna have a low pulse rate below sixty and that it's normal for them what kind of patient does anybody know anybody know that's right so we have athletes athletes that's a big one so somebody's a big athlete or you know a trainer long-term trainer they often have really low pulse rates and that's really important very high yield thing that you need to know that's probably likely to show up on the in clicks to try to confuse you and that's really really important make sure you know that and Maria says another patient is a pacemaker and that's possible but um you know that shouldn't be your first thing the first thing you should think about somebody who is very physically fit a very very physically fit and you know very good shape works out maybe like a distance runner it's usually an athlete type person I have a low pulse rate another thing I want to talk about aside from just your assessment of your normal vital signs is to really talk about your you know the neurovascular assessment so the six piece now you're not going to get questioned on the six piece but it's really important that you understand each one um so we you know we worry about neurovascular assessments so maybe a patient who is unable maybe they have a your assessing their their limb after a hip surgery or if they're in a cast right this is going to involve a neurovascular assessment so if I'm here in a in a hand cast I want assess everything about this hand so I'm going for pain we've got our PE pain bolts here I'm gonna worry about paresthesias so paresthesia is and we show everything here as our pins and needles character but we actually remember it by this P Parrish t-shirt or paresthesias and that should the pins and needles type feeling another P and neurovascular system its pulse so make sure you feel the pulse in my cast at the hand and you can feel good pulse also is power so you want to feel you know look at and assess the the limb and see if it's gray if it's red if it's pink if it's gone you know those kind of type of things are really really important another one is pressure to see what the the pressure of the actual skin is like is there increased pressure inside the tissue like edema and also is paralysis so if i mimic cast up to my hand here and i say oh i'm you know do you feel any pain in your fingers can you wiggle your fingers and they're well they're not paralyzed i'm gonna assess a pulse all those things are really really important and those are assessment findings that are absolutely important for you to know now another just i kind of feel like we're going out of order but it's definitely a logical progression to go through assessment type things as always and you know everything you think you always should think assess first but another assessment type thing is really just being able to assess pain so remember that pain pain isn't going to kill you contrary to popular belief but pain is a subjective thing so you must always ask the patient to rate their pain on a scale so that way you know you can never say well the pain is bad everyone's definition of bad is different so you need to make sure you haven't you know a scale zero one to ten and I actually like to use the example I always use this example when I worked in the network TMS as a paramedic I would ask well let's say zero is no pain and let's say ten is being burned alive so what would you say your pain is and you know I'd always get a ten and I would ask him it'd be like really you feel like you're being burned alive right now and usually if it was true they'd be yes I really feel like and then you know that it's a really severe pain so that way you kind of always know now what other things important and is a fundamental concept but also a little bit of psycho or not but you know child and elder abuse so what are some signs and symptoms of child or elder abuse does anybody know how many examples of those child and elder abuse these are really high yo things to look for and everyone says bruises and I can tell you right now that you know elderly people very often they bruise very easily they're very thin-skinned and they're often on things like put a clip in a grill like plavix so they bruise very easy and that's what we you know that's normal I can tell you that you know I grew up in southern Ohio is born in West Virginia so we ran around like you know crazy people outside all the time and we would always get bruised as kids so you know what kind of things oh now I see some better answers so the big thing is bruises of different stages that's really important there's several bruises of different stages and especially in children or an adult that's the same and we have broken bones but broken bones are okay but again multiple stages of broken bones again very very bad so we see a new broken bone but we also see previous or a history of several broken bones that's not a good sign Virginia actually states some really good one especially with especially with elderly and it's fear of the caregiver that's actually probably one of the biggest ones is you're going to get some type of scenario where your patient you go to interview the patient and the patient's you know not doesn't make good eye contact they don't look at you and they don't really say anything and the caregiver speaks for them so what do you do there well what you want to do is try to speak to that patient alone that's a really a really big thing right away mal nourishments another good one that I see it's it's possible but definitely not by itself alone you want to correlate along and another one is let's see just reading a couple of these Oh so being being fearful of talking around your caregiver or you know whoever's taking care of you that's for sure and looks like that's you guys I'm just reading all your answers here to make sure that I've got them yeah and then really the other one is just inconsistencies in the story so you know they tell you that they fell down and then you know really they're just covered in bruises all over so the story just doesn't match up with what they're saying and that's another clue just remember that any kind of child abuse or elder abuse is report is a reportable incident it must be reported to the authorities and that's really important to do that so we have pic monix on each one of these individuals their individual topics and as well so just so you know so oxygen the oxygen delivery their oxygen delivery methods which is actually really really important but I don't need to go over it because I think it really is just kind of understood and you're not going to get any specific type questions that are really going to throw you off with this but the one thing that is is true is about the venturi the venturi mask what's really important about the venturi mask versus every other oxygen delivery device and that's the one thing that is really really important that you absolutely must know why it's difference what is different about the venturi mask no Liz got it right away before anybody else I feel like how to even a question a chance to get an answer I'm not gonna give the answer yet Liz that's right oh so um so the big thing is it's the only device that can deliver an accurate amount of oxygen at at the mouth at the action you know are at the the nose so it's the only one can deliver the most accurate percentage right at the device all the rest of them keep in mind if I put you on two liters via nays canula and I put you on a hundred feet of nasal cannula tubing are you getting two leaders at your little nostrils you're not because that decreases and that's really really important because the control valve is right there on the venturi mask and that's really really important so make sure you know that that that's the only device that can really give you actual you know precise percentage measurements now the next thing is a really more of a concept rather than a basic and it's hypoxia so this is really important hypoxia that you really be able to just identify what's kind of signs and symptoms are hypoxia well what's hypoxia well it's decreased oxygenation right you know its inability for oxygen to be delivered to the tissues either because you're not oxygenating well you know usually type of a thing so early signs you know cyanosis peripheral cyanosis everything tries to shunt to the center of the body so I can have finger cyanosis or if you're somebody like me and you every nadh's phenomenon you know you get cyanosis of your fingers all the time but there's you know the early signs so that's it you know early cyanosis shunting the blood to the systemic circulation but late signs late signs and symptoms are really important to know and that's really knowing that you have a central cyanosis and Liz really point out a good point also is early on early sign is gonna see tachycardia and that's a compensation mechanism now what's another compensation mechanism where you see tachycardia well that's shock any type of shock maybe you had a hypovolemia well the first thing is going to compensate is tech cardia because we increase the beats the heart rate increases to increase the heart rate so that you can keep cardiac output up and that's exactly where you why we see a hypoxia because it's exactly the same thing and it's all goes along with it and lots you guys are typing lots of things and confusion and disorientation and restlessness are all definite signs of hypoxia that's really important one we have really really really great them really great pic monix you can go in and see each of these details in their way but the big thing is to remember it starts in the peripheral when it moves to the internal you know the the central trunk you know trunk cyanosis now another thing that's a really basic fundamental thing is just to really understand some basics on diet and diet and really being able to progress diets for patients so a patient has dysphasia what kind of diet do they immediately go on anybody know the patient has dysphasia what kind of diet they immediately go on I don't know I think they go on the marshmallow and cheese diet I think that one sounds good I just made it up sounds good to me right I would like to have a diet of marshmallow and cheese sure so the big thing is to really understand yeah so I see lots and lots and lots of different different answers here and the big one what's important anytime somebody has dysphasia difficulty swallowing immediately you're not going to feed them anymore you can't just immediately put them on thickened liquids which is what everyone picked or puree everyone picked that right but you are not the person who is able to assess their level of swallowing and that's what's really important here who is what type of patient is available or what kind of provider is going to do that well that's a speech therapist that's what's really important a speech therapist so the patient is NPO until speech therapy can I can't assess them and what kind of diet are they likely to be put on well they're likely to put put on a thickened liquid diet and that's really really a really the second step there is a thickened liquid diet that's what you have to know for it's really important so types of diets you know you can be on a liquid diet you can be on a puree diet thickened liquids here we have we can be a mechanical soft I low fiber diet and then a regular diet so really we just have kind of a progression here we have each one of these inside of our pic monic so you can really understand each one and all the details that go along with it if you're not 100% up to speed on that as well so section two really quick I just want to talk about some skills we're going to talk about some skill things that are definitely definitely definitely definitely important for fundamental type concepts we're gonna talk about tracheostomy care now and tracheostomy ileostomy colostomy really quick so tracheostomy care what's really important here well the important thing there's just a couple of really important points if you have a tracheostomy it is really really important to know what what's really important with a tracheostomy care patient has a trach they come back they've got they're probably the biggest thing you know there's there's a lot of several little things but number one if they just had a placed well you can't replace it but what is important well you can't change it what is important if it gets dislodged you must always have a two but nearby you need to have a replacement tube nearby now if it's new what's really important about well if you just have this whole placed what's important of course is the fact that you need to have a a new one put in but that new one's not gonna fit in that same place because of all of what well because of swelling that's why so you need to have a smaller size right a smaller size available and you can put that smaller size in you can replace that smaller size if it comes to slosh right away now the if the patient has an old colostomy what's really important is you would always tracheostomy care you're gonna clean around the stoma every eight hours and also every time you put that you know that tie on what's really important with any kind of tie well we don't want to make sure it's too tight but most importantly want to make sure we get two fingers underneath that Tyga's and make sure when I choke and there's poor patients to death and that's really important now ileostomy so we have ileostomy and colostomy well these are you know we have our ill star mouth in our colon star mouth here and we have pic monix for each individual one of these but what's important to know well the big thing here is to understand digestion and elimination concepts and the fact that when it le asked me is a stoma in the ileum and a colostomy is a stoma and then colon so we know that if we have our little question mark I went too far here so we have our little question mark of a Cole you know : and we have a ileum in the middle there we know that our ileum is more likely to be liquefied stool because as it progresses from the duodenum our duodenum down to the ileum terminal ileum and to the colon it becomes liquid then it becomes you know it's this liquid kind then it becomes a little more solid little more solid little more salt so go to the colon its : systole just draws fluid our which makes this wonderful beautiful little stool puplic they are just gonna poop out right but if you ever know ileostomy what kind of output are you gonna expect from that we can expect some liquid liquidy gross sickness coming out of that but a colostomy well you're going to expect probably very similar to form to stool coming out of a colostomy now well it's important for diet for these well the big thing is a ileostomy is you want to make sure they're on a low fiber diet low fiber diet because you don't want to create a bunch of bulk for them and a colostomy you want to put them on a high fiber diet those are really important points to make sure you know and they're inside of both of these pic monix if you want to go back and review them but they're really really important for you to know so moving on to lung sounds now lung sounds are something that it just crazy crazy crazy difficult for so many students to memorize you're probably gonna hear a lung sounds you know there's a high likelihood you were gonna hear lung sounds on your exam my mouth's getting dry here today but it's highly likely you're actually gonna get some lung sounds on your exam they may have to listen to an auscultate and hear the lung sounds now a couple of them are pretty easy right away now if you're getting described lung sounds those are pretty difficult I think harder in my opinion but what I want you to remember is crack boss so there's coarse and fine crackles so here's actually these are actually our pick monix for lung sounds so we have on the left-hand side of your screen here we have our our fine crackles and I want you to just take some of your hair right here near your beautiful little ears I'm sure all the way you guys have beautiful I just went you rabbit back avoid and screw yeah feels low weird that's right beside you and you here right that's what fine crackles sound like so somebody takes a big deep breath and you can hear this you know rubbing sound kind of like ears then you know that's a fine crackle now take some velcro and tear velcro apart here on the right hand side that's a coarse crackle that's definitely more of a severe crackle but how do I keep that separate from rhonchi now rhonchi I always explain this the same way and I don't know if I could do it cuz my my water sit really full but I can pretty much explain it as it's pretty much when you hear fluid coming through a straw that's almost of an empty empty container I got a lot of air with that but that's wrong so what happens is that's air moving through mucus just pouring through mucus and we got it all described here in our pic monic it's just low rumbling like some and it sounds a lot like sucking air through a straw from an very empty Cup because it's as fluid moving through this pockets and pockets of mucus wheezing one of my favorite big Mana characters are wheezing weasel and that's really this high-pitched sound high-pitched them which is very classic especially on expiration expert ory wheezes I really just kind of the other one of these two now the last one I'm not able to really explain but it's definitely a hundred percent different than anything else is a pleural friction rub now a pleural friction rub now we've got it right here in our pick Manik so you can remember here our pleural friction rub you can remember it right here see this little balloon it's almost exactly like you took this beautiful balloon and you just rub their fingers across it you know you rubbed your fingers across the dry balloon what happens is the lungs are trying to expand and inside the pleural cavity there's usually some nice beautiful fluid in there that allows those two to glide along each other well what happens is it gets either it's gone maybe they have you know some kind of fibrotic lung pulmonary fibrosis whatnot maybe they have a other issues but it causes the lung to actually rub across that pleura and you actually feels just like that very very coarse balloon type sound and that's a plural friction rub you can always always always get that one so simple but you're likely to get probably probably probably likely to get rhonchi wheezes crackles they're pretty easy just listen to them a couple of times you can always go on google and get them and you'll see to be able to compare to them to the examples that I've given you now animus anima Emma here we have our enema Emma character and if you listen to this pick monic it's definitely one of my favorites because you can always have fun with enema Emma because we have an enema enema Emma pick monic it's wonderful doll character that everyone can have fun with learning about enemas it's a lot of fun now what's really really really high yield about some types of minimus now there's types of enemas all inside of mine but the big thing is we want to worry about what kind of which nerve stimulation if we're giving somebody an enema which is that it's right guys you all hid and that's right vagal nerve so if I stimulate the vagal nerve it's very out I'm gonna drop that patience hurry now what are the kind of things stimulate the vagus nerve well carotid massage let me just go ahead and you know I always think about if you choke somebody out one Chuck myself all right here I choke myself out and I turn my face red I'm actually putting pressure and I'm stimulating the vagus nerve and that's gonna make me pass out because it's gonna drop my heart rate I mean that's really really important to know so in a man Emma here you can get some stimulating of the vagus nerve which could lower the hurry but what's really important I'm probably the most common question I see personally with enemas is that a patient experience is paying with their enema during administration what does the nurse do first I was a nurse to first what's a very first thing you you have if there's discomfort or pain while you're giving someone their lovely lovely lovely enema well if there's discomfort the first thing you're gonna do is you're gonna slow the flow slow the flow well how do you slow the flow you price its ministering it to fast and then stop the enema second first slow the flow and how do we slow the phone well I mean how old are we how high we hold the bag depends on how fast it goes in so if you know you want to give an enema some you don't really like and you get my you know 500cc retention you just hold that thing really high so that all the Animus all that intimate juice mmm juice goes in really fast right but the big thing is you want to slow it down first by lowering it down I mean it's usually about 12 to 18 inches where you want to hold it but you want to hold it above if you're holding above 18 inches is awfully you're gonna give it too fast and the patient's gonna have a lot of discomfort first thing you do slow it down then if they still experience discomfort then you stop everyone always goes with stop and you're always gonna get that question wrong look for slow the flow look for lowering the bag um and then and then and then stop the enema nobody likes getting an enema if there's anybody out there likes getting in there weird okay so any of you guys listening they like to get enemas you're weird okay and that's all right now I do have a patient story but this little patient guy who used to come in the ER years ago fortunately he passed away maybe he was lonely I don't know but he would always come to the ER with constipation what did he need to get an enema I think he enjoyed it but one of the big things was just remember that if you could have a nice slow flow in a mile that it's nice and comfortable high fast and meter slowed it down before you stop it that's a really really high yield point because everyone misses that question don't miss that question next thing is some testing procedures and I'm not gonna go over each one of these individual I'm just gonna hit some really high yield points on each one of these for sure but the big thing is you know we ever MRI now the very first thing about an MRI you should immediately be screaming out what what what what what what are we screaming out soon as I say MRI before I even ask any question about MRI what do you should you be saying I mean guys this is this is this is an easy one you guys aren't getting I'm really I'm really disappointed okay there we go so the big thing is making sure that what is an MRI will an MRI is a magnetic resonance imaging so do you have any metal is there any metal in your body do you have a pacemaker you as a have a pacemaker is it is it MRI safe if they don't know it's not MRI safe that is the answer so that is really really important making sure that they don't don't have any type of metal you know body piercings as Tracy says and that's really really important though that's the biggest thing with an MRI and then course lay still all that stuff I think is common sense same with CT lay still may you know ministering anxiety medication if they're really nervous that stuff's not usually important you're gonna get that middle question for sure and they're always going to contrast MRI versus CT just remember the name of it magnetic resonance imaging and you're going to remember magnet metal that's how I remember it CT different cat scan so TB test what's important about a TB test so TB test is really really important ELISA points out an MRI as some medicine patches some medicine patches contain some types of metallic materials and that's really important sometimes to make sure those are taken off that's not a high-yield question usually not not as far as I know yet maybe it's got been coming I'm not sure so TB test what's really important about a TB test what is it what any cakes a positive TB test let's put it that way well let me just go ahead and say this just for the sake of time the TB test is it is an intradermal injection so it's intradermal into the dermis and it creates an in duration and in duration is a little bump that you inject and you go to read 48 to 72 hours later and your feeling for that in duration what's really really important is you have to have an in duration of 10 millimeters in a normal healthy patient in a patient who's immunocompromised or maybe a patient is at high risk you would accept 5 millimeters because they have a less of immune response what you're doing is you're creating a type 4 or sensitivity reaction in their body which is a mounting response which is creating these th t-cells to react to that and create this big giant in duration you've seen a positive TB test before they're really really large I'm just another kind of a low yield point far as what I'm concerned but is if they've ever had the BCG vaccine the TB vaccine if they're not from the United States maybe they come from India or a third world country they probably have the BCG vaccine and you're always gonna test positive for a TB test which means you mean what kind of tests to rule it out chest x-ray and that's right lumbar puncture we're always going to talk about that's between the fourth and fifth vertebral space lie on your side lay on your back for an hour after the procedure one to four hours of the procedure are also important I'm not gonna talk about pyelogram or liver biopsy but anytime we're giving IV contrast dye just really quick the only thing giving IV contrast is a couple important points with IV contrast either fundamental concepts you must must must must know and what are they what do we need to know about IV contrast dye what is that Oh think think think think think yeah everyone always says the iodine shellfish thing okay let me tell you what the likelihood you're gonna get that question not very likely everyone has that yes yes yes yes yes but what's actually more important that you're probably going to get is the big thing is a patient with making sure that they drink drink drink lots of fluids at after they've received contrast dye because it's at a high risk to cause renal failure and that's right Clarice got it is the kidneys we always worry about the kidneys we need to get that contrast dye out of the system because it can cause severe kidney problems so we want to also screen those patients for kidney types of issues any time we have a IV contrast dye yes allergy the surface iodine yes it's true is it likely or any other question I don't think so it's so high yield are so common that everyone just burned that in the brain I don't know but um that's likely what you're not going to get you're likely to get something else about it like making sure you hydrate efficiently afterwards to make sure you know that for sure so I just want to talk about a couple of lovely lovely lovely assistive devices because these are really important so we have our cane we got a little minor with our cane here and we have our walker character so it's really important how do we measure a cane for a patient this is important how do we measure a king look through I met make sure I didn't miss a important point for you guys I had a couple of notes of things I wanted to make sure I said in the right order and I got all these lovely papers and I had completely out of order I like to blame Steve Oh so how do we measure oh wow Sarah got it right away on the big thing is so Akane needs to come up to about the greater trochanter of the femur so even our image right here is a little bit high and that's really important because you don't want them to be thrown off balance you don't want them to be walking with their cane like this on this side right you don't want them to be throwing their hips out of alignment that's really important and of course the Walker what's important with the Walker what's really important with walking with a walker well the important thing here is to walk with the affected leg first so you can see our Walker here and you could see he's walking with his little crooked leg walking with his affected leg and that's about the biggest biggest biggest thing right there for sure sizing crutches another really really important one you're likely to see how do we size crutches how do we size those lovely crutches it's really easy to remember from under the arm that's right but how into the arm and that's right let's you guys are typing in it now and that's right Mike two inches all right to just try to remember about three fingers two to three fingers which is about two inches below the armpit so you're going to stick these lovely three fingers of yours I'm going to stick them in that patient's armpit you can make sure those crutches are below that lovely two inches two inches below the armpit that's really really really important these are things you're going to see as far as communication very likely you're gonna get some questions on this hearing impaired and visually impaired the big thing is especially the hearing impaired is that you don't yell at your patients just because your patient is hearing impaired number one I mean back up a second just because your patient is old please don't yell at those old people some of those old people are not deaf I'm getting old please don't yell at me I have a baby face but in the next five years if I keep living my life like it is getting I look this beautiful do not yell at me I'm gonna yell back and that's something you just don't want to do what do you want to do the biggest thing is I want to look you I want to be I - I face the level with you so here I am look here hey hey hey hi friend here we are here we are right face level we're at eye level and we're going I'm gonna face you when I speak and I actually try to enunciate my words personally I have a very expressive face which I'm not sure is a good thing all the time but I'm gonna talk to you and then I'm gonna wait and as Tracy said skin I'm gonna weigh for you to respond that's absolutely right so we want to be patients when I talk to them and wait for them to respond now what we can do if we want to make sure somebody doesn't hear us we want to make sure that they hear us is by asking them you know to repeat the redirections back or repeat the teaching back and that's really really important to make sure that we have them visually impaired what's really really important probably the most important thing I think personally I think for somebody who is blind on and only give away the answer here what what's the immediately when I say taking care of somebody who's visually impaired what should what should your responses what are the important things to know about taking care of somebody's visually impaired there's a couple big ones judgers has safety well safety is I'm always important because we never want anybody to get hurt so I agree with you there but I want to get a little bit more specific um announce yourself lots of you guys say that and that's a very very very very important don't surprise them always a good point that's these are all really in points also for the deaf or you know somebody's hard-of-hearing that's also important understanding they're not deaf that's important but the big one I was wanting to go for it looks like Christy says it here the big one is feeding because this is what I actually see a lot on questions I see a lot of questions on this so you're likely to see questions about the or your like to you know understand or already know about the cane with a red white cane with the red tip visually impaired make sure that they understand and know or familiar with the surroundings yes all those things are very true and I personally believe very understood but what is really important is may ensure that you are feeding them in a very specific way because you need to lay out their food and how do you lay out their food you're gonna lay out their food via the clock method this is very very very very very important and personally I think it's just cruel if you don't know this so if you're going to be a nurse and you plan on being a nurse this is something you must must must know because I think it's just cruel because these people expect it especially for medical providers and you know it's kind of I personally believe cruel if you don't know it because they don't know to tell you that but you want to feed it in a clockwise direction what does that mean because I mean you you know move it in a clockwise direction before you stick it in their mouth No what you do is you set the food up in a 12 and a three and a six nine o'clock pattern and then you inform them what food is at every direction so you say mr. Smith I want to let you know that the mashed potatoes are at 12 o'clock I've got my West Virginia slang going on here the mashed potatoes are at the twelve twelve o'clock the green beans are at three o'clock you have some roast beef at six o'clock and you have some fruitcake or pudding or whatever the dessert is at nine o'clock make sure you and do that same clockwise thing that's really important to them because that is very very very very very important and I'm just gonna be honest with you it personally offends me if somebody doesn't know that because that's really important basic basic fact and that's really important for these patients because that's how they eat so if you're not able to do that for them I feel like you're really doing them a disservice just make sure you understand that and it's likely actually you're going to see I'm understanding that clockwise method of how to you know give them food really important so we also have next our culture so culture culture culture culture is really important and I'm going to be honest at pick monic it's something we always try to stay away from because we make images that are most definitely most definitely actually let me back up a quick how would he know the time 12 3 6 & 9 well what's actually really important is that anybody can learn and what they learn is that the orientation of anything and they learn the clock method so they learn 12 3 6 & 9 and then learn exactly what a clock looks like just because they're not blind doesn't mean they're not as smart as you are or smarter so don't take that assumption that's something that I actually find a lot that is really really really bothersome sometimes because you need to make sure that you you know you never assume that they don't know because they probably do know and if they don't know they're going to speak up and tell you but these patients have been blind for a long time unless you're dealing with a patient who is newly blind because of an acute condition I'm in that scenario that's entirely different but you're likely not to be you're going to be told that if that's so moving on here to new culture so culture again I just want to touch on a couple of these just really quick and just kind of hit on some some high yield points with some culture things but the big thing is so we have see we have here in our culture section I'm just going to touch a couple of these we've got our Native Americans Native Americans a big thing is almost all these different culture types they do not do direct eye contact so you should assume that that is normal any time any kind of culture question comes up and they don't make direct eye contact you should have immediately assume that's normal and be okay with it and the other thing is most of the cultures like Arab American mexican-american there's usually usually someone maybe somebody else making the decisions in those scenarios and it's for also perfectly okay anytime you get any kind of culture question it is very likely that the answer is accept it and move on do not draw attention do not question do not understood not dive further into why you see there's an old question but a goodie about coining think winning is you know rubbing the coins and their child's back that's not child abuse that's part of their culture and that is perfectly acceptable and that is understood that but that's also where you would look for there's other cues of bruises in multiple stages in other parts of the body you know a child who doesn't want to speak to you and doesn't want any you know answer any of your questions inconsistencies in the story and things like that those are also really important also understand lots of cultures don't like to do organ donation and lots of other little hot/cold type things as well but most of them the big thing here is that they really just avoid contact for sure so just some quick patient positions this is a really really basic fundamental concept but I just want to talk about this we got our tea Trendelenburg here what's important about the Trendelenburg position well we're gonna put the feet in the air we got our tea bird here character mr. t bird why do we put the feet up what type of patient will we put up what kind of patient do we put their feet up well that's right shock hypovolemia absolutely right any type of hypotension for sure so we have our supine we got our supine spine here that's on the back don't forget that this is you know basic things you should just know Fowler's position we've the low valores medium bowers high filers position we get our foul here just remember that that's raising the back for sure and the number one thing any patient is having difficulty breathing set those patients up number one thing you should be doing we've got the side lying position this also works for pregnant patients if you put them on the side lying position to take that pressure off the vena cava side lying position Sims position for a beautiful animal Emma patient also very important we have our prone prone position which is on the belly which is something we don't use very often but sometimes it's seen in surgeries and then we have our Sam's position here which is with that knee all the way increased up now what you're gonna see right here with all of these positions as you see right over there since position is that we've got this knee pad and that's really really important because we always pad all the brownie promises promise prominences and that's really important for sure so the next thing we're going to talk oh I got a couple questions here oh sorry just a couple statements I guess but all you guys are right on all your comments none of those are definitely wrong Wow lots of them just popped in all the ones oh so he asked if I'm seeing your questions well Samia I haven't seen a specific question but we get lots of responses so you can always type in it again or type it at the end for sure and we'll get to it now this next thing is something you're probably very most likely I could almost guarantee going to receive some type of question on types of precautions please please please please please please please understand this please understand what to do for it and see exactly what you need to do now the number one thing is standard precautions now what are standard precautions well you can see right here in our standard precaution and we kind of cut it off but you need to put on standard precautions you can put in some eyewear maybe a mask if you need maybe a gown and after the gown after the gown then those lovely Gove's gloves and this is really important also for sterile procedure because I just wrote a question about this today actually yesterday but how do I remember that I put the gloves on after the gown well if I have gloves on and let's say these gloves are clean and then I stick them through a sleeve on a gown second well now they're all dirty with all this crud on the gown so what I want to do is I'm put my gown on and this beautiful blue gown on and then I want to put my gloves on over top and they roll up over top of the glove down a dress and that's really really important another important thing is to wash in and wash out we've got it right here in our image it's super super super important to always have discard everything inside the room as well standard precautions now all from that we have contact precautions now cleanser precautions include really the big thing of keeping not touching the patient or understand that something on the patient is going to touch you and ride on to another patient that's really the important thing here is you know these aren't necessarily designed to predict the provider they're protecting you from transmitting it on to another patient and that's why we always wear a gown and gloves there gown and gloves character right here and we may assume that we have a patient may need to give them a private room and we're always going to put these gown and gloves on to keep those organisms in that room so somebody who has some c-diff lovely see there for maybe a mersa infection in a wound we're gonna put them on contact precautions they're gonna be in their private room and they're a big big thing is we're enough contact precautions you see that little card outside the rooms you're gonna put those gloves on and put the gowns on must must must do that parts of your body rub up against things in that room is infected it's really really important the next thing is droplet or airborne precautions and this is things like influenza TB big in viruses like that we have them droplet precautions and airborne precautions anything that you can pretty much just coffin aerosol eyes you want to put them in this negative pressure room so that if the air is being sucked from the outside in so that nothing other organisms going to the outside out of course they need to be in a private room but you know they're gonna have this negative pressure air for like TB measles varicella things like that it's really really important any patient oh and Marcel actress is really important is that you have an in ninety-five mask and that's really really important you're probably gonna be fitted with an n95 mask if you haven't been already for sure so Jojo asks of the patient with Marissa can go outside a private room absolutely so what we do then if they go outside of the room a patient with contact precautions even airborne precautions well what are we gonna do then does everyone in the hospital I have to put on a mask no what happens then is we cover up that patient with MRSA in a wound we cover up the wound and we put a blanket over the bed and those patients can move outside the room a patient with TB perhaps would wear and in 95 masks themselves so we would keep that mask on them at all times while we're transporting that patient and that's really really what is important it doesn't mean so the difference is if you enter the room you wear protective precaution when you take a patient out of the then the patient where's precaution but a patient doesn't there we need to wear precautions inside the wrong room and that's really really really really important Gregory asks why does it man up three legs I guess I don't oh shoot I can't remember to be honest it's a it's a part of the pic monic it's a story in this pic Monica I can't remember exactly why it says it but you can go to pick Montcalm and you can look up drop droplet air board precautions and definitely definitely definitely see that for sure but but sure but some you ask how long are the room can they go they can go as far as they want as long as they have the proper precautions they can't go outside and smoke a cigarette but that's not the kind of things we Wow but they can be transported x-ray transported to CT scan things like that for tests and procedures of surgery so another quick concept because we're we're almost done here is wound healing and this is really important definitely definitely important wound healing now we need to understand the Braden scale skin integrity and ulcers now all these types of things are important and understand the stages of wound healing and then really just understanding like surgical devices and for sure oh actually let me just go back here so the droplet precautions is the reason there are three feet is because there's three you need to be three feet from the patient three feet from the patient otherwise you may be sprayed with these beautiful droplets and that's why there's three feet in that particular question so that's your answer so I usually don't like to jump back but Steve clarified my answer there and got me kept me on speed so wound healing big thing here we're just going to go over a couple of different things on wound healing this is all really really important stuff so we have our little pressure cookers for our pressure cooker also Rock a nose for pressure ulcers everything pretty much the Braden scale impaired skin and trigger it Tegrity everything comes back to pressure ulcers pressure ulcers right so you need to know the stages of pressure ulcers and this is we have a whole pic monic just on the types and the stages pressure ulcers so just understand any type of reddening right away no we don't have it we don't the image in here but any type of reddening right away reddening on the skin is a stage one pressure ulcer and that's really really important and then I just like to always remember that a stage 4 pressure ulcer is pretty much when there's muscle and bone exposed so just reddening you know reddening skin is a stage one right you know you can push the skin it's not just red because it's red but you it's red because of pressure right that's a stage one and then a stage four is muscle bone exposed it's easily how you can tell a stage four so here we got our inside of our pick monic we actually have all the different layers of the skin all the details four types of pressure also it's definitely one you should go and review for sure another thing is just you know interventions for impaired skin integrity so a patient who has impaired skin injured what's really important for those patients what do we want to do for a patient who has a risk for impaired skin integrity or currently has impaired skin trigger what's important so they have a wound basically what's really important lots of guys immediately you know Samia says repositioning very very very important cue to our turns you must have that cue to our turns and these patients must must must stay dry now I'm talking like I'm not talking like you know Tempe Arizona Phoenix Arizona where I met located dry but it needs to be dry meaning if they have soiled linens or they have a leaky catheter or they don't have a catheter in they're urinating on themselves they must be changed and dried and cleaned at all times it's always gonna cause skin breakdown and the other thing Victoria who points out which is good it's definitely a high protein more high-calorie diet it's really really important for sure definitely the protein to increase that college and help them get this skin get the skin go back up but also it's also really important to pad bony prominences so any kind of the heels the hips sides and as you move these people in between the I mean even when I sleep I have a nice lovely little pillow in between my knees not because I have a breaks Kris person can break down because it's bony prominences I got gnarly gnarly knees my gnarly knees are ridiculous but I don't want to mine gnarly needs to rub up against each other I want to have these nice beautiful companies with this pillow in between and that's exactly what you need to think about you put a patient in the sims position you better be putting a pillow underneath that knee but also for any patient you put on their side that's really really really important now a couple of things we actually have a really great pic Monica that we recorded this lecture which we record these later on I'm gonna put this the image from our pic monic in here because it's a really great one we have the types of wound drainage devices so that you're able to actually go in and see like a Jackson Pratt drain and understanding how to empty that and that it's suck you know you just suction to keep the to pull out of the wound for sure that's really important now another thing you know types of wound hanging primary intention secondary intentions tertiary attention we got another beautiful pic monic for that you can go in and view as well and the last thing is really just using rice for treating soft tissue injuries what is rice I mean we you know did we stick it into rice did we stick their arm and rice when I dropped my phone one time I stuck it in some eyes and I waited like four days until the rice sucked all that fluid out and then I pulled it out and it was working and I was like magic I should go to nursing school right no absolutely wrong rice stands for exactly what you guys are saying the big thing is rest any type of injured limb rested and then when put ice on it for in to decrease inflammation so ice then we want to put compression on it and I'm not talking like a tourniquet style compression we're talking about a light compression and number one out of all this most important if I have a swelled up hand I absolutely must put that hand way up in the air because if their hands way up in the air that limb fat are gonna drain with gravity and it's going to decrease in dima most of the edema is leaking out from the veins into the interstitial fluid and what's going to carry that away the lymphatic system the lymphatic system works by what it works by muscles and gravity it does not work with veins so we must must must use gravity elevate elevate elevate elevate elevate elevate elevate don't forget that that's really really really important that's probably the most important to be honest but the big thing is rest ice another thing really important with wounds or like a sore muscle sometimes we teach alternating cold and hot therapy or warm therapy what's really important if we're using anytime a heating pad or warm compress is what is important with those were cold compresses as well what's it what's the important teaching point it's actually a really high yield question I should put this in here you guys know this come on I know you know it the big thing here yes it's right limit the amount of time it's on there and don't put it right on the skin if you've got it this beautiful heating pad you must put something in between that beautiful heating pad and your skin so it doesn't burn your skin off or if you have a bag of ice you're not gonna throw a giant block of ice on the skin you're gonna put that block of ice up against something to insulate it so that it can then you know thermally go through that and not actually freeze the skin so it'll freeze that intermediary device or it'll burn that intermediary device and that's really really important and of course we never want to put anything more than about 20 minutes and that's about right a lot of you guys type that in for sure and it's really really really important 20 minutes in between you want to sometimes alternate heat and cold that's often therapy that we actually prescribe but definitely definitely definitely work so what's really really important is that you understand all of these points and all of these topics we have here on the screen are all in pic monix that you can easily review inside of our picnic learning system you go to pick mana calm and signed up and get access to see these and all of our wonderful characters and a lovely voice to help you remember all it's not my voice on all of them but there's a few of them you'll see my lovely voice but you're not gonna see my wonderful face because that's where you see these are in the webinar but lots of you guys have lots of questions of course on asking about how are you gonna see these again we do recorded webinars very often and we publish him our YouTube channel you can go to youtube.com and look for Monica do I mean most importantly to get everything we went over go to pick Montcalm and just check out our pick Monica learning system go to pick Monica come sign up for account and search and see all these pick Monica topics everything we went over is times ten inside of our pick mark comm system so you just go to pick monitor comm and sign up and you'll see all of this in here if you want to see just my beautiful face on a webinar well then you're probably gonna have to go to like YouTube or YouTube and see pic monic video and you see a lot of these in here this particular webinar won't be available usually for about a week so if you're up against a particular time break I don't I'm not gonna have it but if you have any questions now now is a great time something we didn't get to and I can get to really quick you can type it into the question box right away and I will see if I can get to your questions and help you out see we have here Oh Tracy says have a great holiday can No well thanks Tracy I'm gonna go see my mother in Texas and then after that I am going to a remote location where no one will find me and pick monic land or a nursing world or anything to the like and I will be gone for five whole days and that leads into my next question of Sarah asks how long to my next webinar well what you'll realize guys is that we do tons of free webinars and we have no more scheduled well that's because I'm taking a vacation because I'm going to this remote location that no one knows about and they hope that I come back but we'll be back in January with lots more live webinars but we're also hopefully hoping to have our finalized series of a record webinars up for you so you have all of the beautiful ones recorded with my lovely face and all the weird questions and all the really corny jokes that are all there for you for sure let's see what we have Genisys thanks great webinar well you're welcome gee I'm glad you enjoyed it okay daniel has a question here really quick I've gotten a question I have done a question saying that if a false negative is good for TV test the negative versus false at a positive and TV I'm not actually sure of your question but let's talk about it so there is what makes a positive TV test well you get a t a turbulent skin test which is a intradermal injection right so you get this intradermal injection of TB tubercular and it's injected and once it's injected you have 48 to 72 hours and we're waiting on this type for sensitivity reaction your body is waiting on a type for sensitivity reaction now there's a couple scenarios are going to happen here number one you've been exposed to DB and you're going to mount a response to that hey I recognize that and I'm gonna make a response and I'm gonna kill it your body says or or you've been immunized by the BCG vaccine usually only from patients who come and they've immigrated to the United States because we don't give it in the US or maybe much older patients who receive the BCG vaccine not a common scenario in the NCLEX but they would also mount a positive response because they've the BCG vaccine is actually a live vaccine your body and me on some unit response right away it's gonna get this type for sensitivity reaction or you have no reaction you have less than a 5 or less than a 10 millimeter in duration or if you're a high-risk or you're immunocompromised your test is essentially positive at 5 millimeters now once we have those so if you're immunocompromised you're a positive of 5 millimeters you're positive we move forward if you have VCG vaccine you're positive we move forward could we need a test you further or if you just have a 10 millimeter greater than 10 million meter in duration we move forward and what happens what does it mean boy we move forward well we go to the next step and the next step is to do a chest x-ray because what we know about TB is that it's really really cheap to do with this TB test and everyone I have to get one every year it annoys me to death but you know I come back negative but if I came back positive where is TB almost always 99.999% of the time it's in the lungs so it's spread by you know it's aerosolized you know something we have to do air you know airborne precautions from so it's in the lungs remember that so when we do this checks this way it's gonna have you're gonna have these nodules in your lung or a gum complex or you know you're gonna see these Gong complexes in your lungs and it's pathognomonic TB it's like whoa this guy's a real TV eviction if not you're negative and you go on down the road so you have a false negative test and that's where you really get that so you have a you know false negative test TB tests aren't perfect and that's where we should really understand I hope that answered your question Daniel Samia asks a question the order that med should be given and I don't know what kind of meds are talking about some um Clarissa asks about when reporting abuse do we as nurses reported to authorities or charge nurses and she reports it well that really depends on your hospital policy but what I can tell you on the index is that you report it to the authorities that's going to be your answer the answer on the index is not going to be a it's going to be reported to Child Services Child Protective Services or the government authority whatever it says right there it's not going to be an internal mechanism on an english-style test but i'm your hospital policy may be to report to the charters and that's fine remember in in corrects world we have everything at our disposal in NCLEX world in the NCLEX world I've got a neurologist sitting right here I've got an a cardiologist sitting right here I've got my doctor sitting right here we know that never happens in real life I've got somebody else sitting right here infectious disease guy I've got the pharmacist sitting right here across me they're all just right here I can ask him any question they jump in in a second and that's we should think about this perfect world don't think about what we actually do in your facility because that'll always mess you up but the real answer is you report it to the to the you know government agency that's tracking in the United States for sure OCR asks hello from Texas in San Antonio come on down actually Sara next yearfor let's see where I'm gonna be in San Antonio next year for a convention I'm not sure which one I think it's the Texas Association of vocational nursing educators next year actually I think I was speaking at that convention next year I'm pretty sure it's going to be in San Antonio for sure so definitely so Marcel has another question about TV so maybe TV is a hot topic lately I don't know but um the big thing is she had a question about is five millimeters in duration negative or positive well this is really important because you got to read the stem of your question five millimeter in duration is only positive in two types of patients a patient who has high risk or a patient who has a compromised immune system so a patient was HIV a patient on chronic immunosuppressive therapy I'm a patient with a lo T so those are patients who ever that's a positive Testament level if they're if I have a five millimeter in duration I'm fine that's a negative test tell them to have a nice day you read it as negative and you follow up next year no further indications needed Liz I don't really understand your question for sure but Chrissy says Merry Christmas and Happy Holidays and all she typed in a whole bunch of stuff but I'll see you next year - Christy but good luck Sarah she's taken her Jing clicks on January 25th um let's see here I just got a couple more minutes and look like lots of questions reported oh boy Ellen as I can't even say this Ellen ace Ellen ace that's how you say it as when we in Florida well we're going to be in Florida next actually in March for the national student Nurses Association convention in Orlando Florida so if you're a student nurse you should come to the NS na in March and see us there cuz we'll be there the whole big amount of team will be there well not the whole big money team was ever late four or five of us for sure so Liz asks if you were a nerd can you amount a response and can you actually a mount a response so you mean I mean if you're a nerd that I mean Sam they would be like immunocompromised I think you're just maybe caught on some terminology here but if you're a nerd then you can't amount any type of immuno responses for sure so the answer would be no I mean any kind of anybody who's immunocompromised that's those people in TB are positive at five millimeters in duration now it is possible that a patient who has severely immunocompromised may be there but they're severely late stage IV HIV and for some reason you don't realize they're almost dead and you do it TB test on them if you did a TB test on they're not gonna mount any response but those types of scenarios you're not going to get on your NCLEX you're not going to get it for sure yeah Arlene asks if you can be allergic to TB text you know I'm sure you can but it's pretty it's just like the flu shot you could be allergic to the flu shot but keep in mind um if you're allergic to it you're going to amount immediate response a type 1 sensitivity reaction the TB test itself is only read till 48 to 72 hours and that's a type for sensitivity reaction that's a type for sensitivity that's a delayed response so that's not going to be immediate if you're allergic to it right away you're gonna get a rash immediately guys are breaking out your allergic reaction and even severe in subsequent tests but time if you know you're not allergic to it we're looking for the type for sensitivity reaction which is gonna be that delayed hypersensitivity reaction so today I was very nice and I answered everyone's questions so there shouldn't be any other questions but if you have one you can always reach out to us at feedback I pick mana calm we're here for you if you need us you can always reach out to us I know lots you guys are getting ready or for your ink Lex there's hundreds of people in here today and so many of you if you have any other questions you can reach out to us feedback a pic monic otherwise you can always check us out on youtube channel at Pig monochrome searches Pig monic video and always epic Monica com sign up for account check us out use us it's going to help you have a great night have a happy holidays and I won't see you guys until next year live because I'm taking a vacation have a good night good luck studying

Channel: PicmonicVideo

Views: 219,545

Rating: 4.8528976 out of 5

Keywords: fundamentals, nursing help, nursing videos, picmonic, visual learning, audiovisual, Nursing School (Organization), Nursing (Field Of Study), nclex, ati, hesi, mnemonics, nursing student, nursing mnemonics, Picmonic Video, Fundamental Concepts

Id: Rl1Zo7rbT6s

Length: 68min 38sec (4118 seconds)

Published: Wed Feb 24 2016