Pharmacology Basics and Math | Picmonic Nursing Webinar

so like I said without further ado let's get started try to keep these to a quick 1 hour pharmacology basics and math and the end we're going to do a question and answer session if you again my name is Kendall Wyatt if you've not been to any of these before looks usually about 40 50 percent of you guys have been to a webinar before we appreciate it I manage all the content here at pic monic and of course I just finished med school went to nursing school and and also as a paramedic before that still a paramedic can never stop being a nurse it's just kind of something that was goes on just really quick about us what is pic monic what do we do here we take everything you're going to see today all the little tippets is all a character that fits in the backend so we've got some conversion pick monix and some other things not heavy on the topics today but we've got a few but everything you see all the characters are some type of content piece that's in our tech monic system and as always I always have my little handy dandy pigment cup my mouth gets really dry because I talk a lot and so I always have string for my pig mana cup and that's of course how I make 25 cents every drink so something like herpes will become my herpes harp if you're into drugs some warfarin would be the warfare II here oxytocin would be the octopus toe so you can kind of see on how characters map and everything you need to memorize during nursing school and whatnot today we're going to talk about math which is really just application thinking it through and that's really really really what's important Eric asks how often we do webinars we do them pretty regularly we don't have them on a set schedule we do them pretty much every few weeks we have a live one and as I will say lots of times you can check out all of our videos on YouTube just look us up pick monic video you can check out the free webinars it's a tough one for every single topic pretty much a recorded version and then we do the live ones from time to time so if you're a trial member even if you're a trial member you'll get the email notifications to tell you about the webinar so sign up for a quick Monica even the free one so let's get started so what we're going to talk about today we're going to talk about a lot of stuff and I really want you guys to try to think through it we'll stop when we talk about equations and doing the actual math but we're going to talk to them sings at the end so we're going to talk about medication administration basics then we're there are some routes of administration just basic things again some high-heeled points of things you need to remember the most common things that you're going to see on an exam I like to try to point out if this is a review for you so if it's a review for you and then you know you've done all this stuff great if you're in the midst of doing your pharmacology course or pharmacology or farm math course then this is really good important and you can kind of pick up where you're at use it as practice so it and then second we're going to talk about conversions this is a good concept and it's good to review when I do this webinar some you know often people don't necessarily understand the method that I'm using for my madness but you understand the concept of breaking everything down and converting and that's what's important so we get a lot of good feedback for this webinar the last section of course is equations so we're just going to do some some practice equations to talk through all the concepts that we've talked about how to do equations so first off medication administration routes administration let's get started the basics of the easiest thing right away is the rights right I mean there are lots of rights I feel like when I was in nursing school and met you know and I was a paramedic there were literally they're like five rights and then there were six and another seven and there's lots of rights and there's so many there's the patient Bill of Rights and all these things but the important thing to remember is always checking sorry the soul is always actually making sure that you do the five minimum rights and there yes there are seven and that's important to remember if you're literally need to regurgitate a bunch of information but the five are the things that are going to keep you from making a medication error and that's really the point of them is to have those right five so you're always going to make sure you the right patient documenting checking depending on facility policy and whatnot you may need to check two modes of identification asking the patient their date of birth and what else may be identifying their argument and depending on facility policy dictates what you should be doing or not but the idea is to identify the patient through some means and you see that vary from test to test in your state or school right time the timing of the drug the dose the actual drug the drug name which drug it is and which route so one of the ones that I see all the time and I'm using as an example after we talk about the right dose so that which dose of the medication every time I do any kind of medication question because I literally mix up numbers all the time I always always always always write it down so today when I'm talking about this stuff I'm actually going to write down some numbers because I don't want to say it out loud wrong and it's a common thing you're going to do and I want you to do that I want you to really think about when you're doing these questions because every time I've done farm math questions if you gave me a test right now I would probably miss a couple because I go too fast I don't stick to the same things I use this example there you know why don't our planes crash all the time because there's not a lot of your planes in the sky no that's incorrect they run through checklists of everything that has to be checked every single time before they take off before they land once they're in the plot in the air there's a list of checklists of do all of these things right in order and that is really important and if you do that you're not going to miss anything and that's what we want to do so if I took the medication epinephrine epinephrine is the worst one for all of these things epinephrine can be given via ET tube epinephrine can be given subcutaneously epinephrine can be given IV the route of epinephrine epinephrine can be injected into sub-q right it can be can have lots of uses but epinephrine also can be confused with norepinephrine so make sure you have the right drug maybe the actual the right drug the right route and then the right dose because we know epinephrine if we're giving it for anaphylaxis versus giving it for them for a cardiac for a cardiac situation it's a lot different and that is really important that's a really common a really common medication error um Elizabeth Elizabeth said she can't you can't hear me sometimes we get this with good webinar pretty commonly on if you have any trouble you just um sometimes you can log out log back work for you if you can't hear me just check your sound what not every every webinar there's always one or two people with them have a couple issues so that's pretty normal but um you know you can yeah she says she's good now well great that's great Elizabeth so let's get forward I'm not gonna spend a lot of time on all these basic topics but really understand routes of administration with this to understand all of the routes this is a really common comment basic question when you're doing fundamentals and and when you're doing farm basics you know what are all the routes of the medications it's really important just to be aware that there are lots of routes because you can absorb medications so you can apply every single one of these types of routes has a high yield question that goes along too with it I'm not going to give you all of them but you know you make sure you understand you know beautiful you're going to put it in between the cheeks you know in between the gums there rectal you can give rectal valium right for a seasoned patient you can give rectal medications that way things can go in through tubes like et tubes over time on transdermal medications being on the skin we know there's a big one there with making sure there's a whole little pic monic on just those alone rotating the sites making sure that you don't do what if you had a transdermal patch or medication what's the difference between a transdermal patch of medication versus a cardiac electro or a cart and you know am a cardiac patch to put up a cardiac monitoring what are the two differences there there's really stark difference that you need to remember one you need to do what with one you need to not do it well if you want to put on a a so let's say you put on a highway forgotten the tag on word you want to put an electrode you want to put on cardiac monitoring pacing pads that's what I'm trying to say pacing pads that needs to be adhered close to the chest and you may shave the chest put that on right you may shave the chest to put a cardiac pacing panel but if you're putting on a medication that's a transdermal medication you would not shave the chest you would try to put in an area that's not shaved because you could cause a very serious irritation because the medication can cause a lot of irritation really important drops and sprays knowing how to put drops and sprays in there where you put the drops you know things like that are really important I'm just those tidbits if you just review all those tidbits transdermal you know eyedrops and giving things to different tubes and different routes it's not as important to memorize in the beginning but more when you come back and you're reviewing you're finally ready to take your in clicks because it's all going to make sense so if this is not you're not at the end and this is sounds like a whole lot of hodgepodge but knowing that you can give there what's a good thing with inhalers what's an important teaching point regarding inhalers that is important to know with the high-yield point there guys aren't very very question answering today so with inhalers is right is you want to make sure that Sandra says use a spacer yeah you may want to use a spacer but not required but that is one of them the other one is if it's a steroidal medication is making sure that they rinse them out the really common one that you see so that's right and that's important as well so again other routes intradermal sub-q intramuscular IV epidural winter cycle interosseous apron terms needle other picnics you can go in and see all of these routes of administration so that was just a quick little rundown just so we're saying we're complete the next section is conversions before we get to the big one and the one that everybody is literally the the stuff that we're going to run through sections the first thing we have to understand is we're viewing conversions this is the if when I when I work with a student if I tutor a student on farm math the majority of their problems 50% of the 50% of the problems are literally not doing the conversion they converted wrong they converted wrong if you get the conversions down then you can do on the map so you're kind of them I say this a lot with all of the all of the all of the equations or all of the prop or other every time you have problems in an area you're trying to learn you have to be really good about evaluating where you're on being honest with yourself so where are you you having trouble converting why'd you miss the question did you just do bad math do you not understand how to get the equations out or is it you know did you have a problem converting did you read the question wrong because they're always those all those ones and you kinda have to just do your own little evaluation and Italian so we're going to talk about conversions conversions are super important one of the ones the biggest one that I see people mix up all the time and it's yeah when you just burn this logic check in your mind is one pound or one kilogram is 2.2 pounds if you remember eyes one thing and I like to use a logic check of my own weight which of course is a very light very light weight of course but if I use my own weight it's not 250 pounds but I know that pounds are 2.2 one kilogram I just remember the pounds are more so you know I remember that I'm in America and America is maybe more of a more overweight area possibly maybe we're in denial but pounds are more so more pounds so 2.2 pounds so every time I convert any equation from kilograms to pounds I just do this logic check at the end say okay I convert it to pounce is it a bigger number yes or no if I say no then I know that I got my math mixed around I divide it instead of multiplied and I see that so many times people divided into multiply literally probably one of the easiest things you can make sure you do to not miss any questions super super super important see that so many times so if I have 250 pounds and I want to go to kilograms well then I need to go to a smaller number if I want to go to a smaller member I need to divide the big number so I divided by 2.2 to get 113 or so and of course we round accordingly most of your equations as we're doing any type of equation you want to round at the last point we're doing equations try not to round in the very beginning or do any very large rounding because you when you do math equations I see so many people round to a big number in the beginning and then there are a number that they're getting is 1 or 2 or 3 off because they've got kind of an evil nursing instructor that didn't write the question very well and that's fine but you want to make sure that if you round at the end they're more likely get the most you're going to most most close to the correct answer at the end so with that being said the next one is inches to centimeters see this all the time as well really common question and this is usually regarding you know measuring wounds or or measuring a child's height or giving a Braslow tape for you know giving a height of a patient to measure things out and that's remembering 2.54 centimeters is one inch you just have to remember and remember one inch is 2.54 centimeters literally just remember it so if you have 12 inches that's 12 12 inches is 2.5 4 times 30 so it's 30 point 48 centimeters so there are so many different ones you just have to solidly memorize which their picnics to help you memorize the things so 2.2 pounds in one kilogram one inch 2.54 centimeters and some other important ones and this is one that's really important is MLS two ounces this is the one thing every time I talk about this is I talk about picnics and all the Canadians come in and they say oh all your picnics are in US units well we of course are based in the US originally and we are adding more international units you know SI units but what's important is to know the conversion weather no matter where you're at and one ounce of course is about 30 MLS we make that easy for math you could use 29.5 570 miles that's important yes but Oh careful stitch so oh sorry we have stitch here today with the webinar he's hiding in the background so he's not done not being the most cooperative and being quiet today but yeah so Sandra says hi stitch um c'mere stitch okay here we go so anyway 1 ounces 30 MLS so when you need to give what's the one thing you're always going to see this with you're always going to see it with children's medications especially something that needs to be given for metal by mouth you're going to see that very very commonly and what I'd like to just think about with this is just attach what you don't notice something you do know and what do you know well I know bottles and when I talk about bottles in a timeout medication bottles or alcohol bottles and kind of soda bottles or water bottles and a water bottle what standard water bottle is approximately on how many MLS what's about 500 MLS and in a careful stitch it's about 500 ml so if I have 500 MLS in a water bottle then I know that that's about 16 ounces it's actually 16 ones 16.3 three or sixteen point six so I've associated something that I know so I can easily just guesstimate well how many Ounces are in an ounce so I know that that's about 500 MLS or 480 MLS is a 16-ounce bottle and you see that very commonly it's a standard size that we see all the time so attached it is something you know let's make sure you got all my questions Oh Morgan says show us the dog oh my goodness I usually don't do this to the Commission come here now he's mad on the other side pouting he'll come over Kristen so it's important to remember something you know attach something you know to something you don't know oh oh oh yeah there we go oh yeah yeah he thinks he's going to stay here the whole time now see he thinks he's winning see ya anyway so the point is attach it to something that you do know and you can do well he doesn't realize that people are watching him it can't figure it out and this is the weird fish on the screen so so let's talk about this with them here's the example of what I was talking about we've got these water bottles right here these are wintertime out and every single one I'm oh there it is 16.9 ounces so 16.9 ounces is how many MLS if you just do that conversion in your mind it's easily going to be able to to match something that you maybe can't remember to something that you know and everything we're going to do today we're going to do that exact same thing when you run through a couple of these examples now with that water bottle there's another level of what we can do to it we can attach multiple things now what I can tell you what big monic is we know more than anything about memory how to memorize things how to learn things and in our product is research proven to help you memorize things more faster longer right remember everything forever what we know is you have to create anchors and associations with things that you don't know the things you do so if we're talking about this water bottle and we know a water bottle is if we're trying to remember 30 30 miles is one ounce so it's got that and we can anchor that through the water bottle 16-ounce water bottles about 500 MLS and if we know that 500 MLS well how much is 500 ml zwey hmm oh my goodness somebody just talking about stitch oh my goodness how many how much is five emails 500 MLS way that's important to remember oh my god you guys are so awful literally like 300 messages about stitch yeah so 500 MLS is about what weight well you can remember 500 miles is about a pound so when you think about when you're learning later if you're not in this in the scenario of learning about congestive heart failure and we need to worry about how much weight do you gain in 24 hours more than 1 pound is 500 ml so that's 500 ml so fluid if we're thinking about that we can attach things we know things we don't so if you are retaining fluid or you're losing weight you can also think about your ins and outs and you can say okay put a thousand two fluid in and I only got 500 out so technically that patient should weigh one pound more or they may and there are other ways to lose weight sweating and and respiration and whatnot but you know that's a definitely a thing you can think about and of course Natalia says 500ml zazz 1/2 liter okay yes true when you're not bombed you don't win a prize for that the last one of the conversions are teaspoons tablespoons so teaspoons little baby teaspoons I will just think about a tea is a little tiny pea and that's 5 MLS I just remember the one thing the one little teaspoon is 5 MLS and I remember that a tablespoon is really big and you know I wish that I had three people at the table to other people aside me and that's three teaspoons is a tablespoon so five times three is then a tablespoon is how many MLS is 15 now you're thinking about this thing like oh my god why can't we just do some math a lot of these things though the how if your everything about math equations and you see people and they say okay how that did you figure out that so fast how did you get to the answer well I did it in my head what they're doing is they're associating something they know to something they didn't know and they've matched it and they're able to create those associations faster they're making the connections to do it faster so if you looked at this example well how many teaspoons is 45 MLS or how many tastes tablespoon sir how many tablespoons is 45 and Mel's a tablespoon is 15 MLS so 15 MLS if I need to give 45 that's three tablespoons but what if I need to use teaspoons well I wouldn't want to use teaspoons because who's going to measure nine teaspoons of something but 90 spoons is of course would be equivalent to that amount and that's what you have to think about yeah Arleen it looks like Arlene's here today we know I mean so that's right Arlene that's correct so when we think about this let's give this medication right here this is one of our questions we're going to start easy of course so we're going to administer 15 ml of medication to your patient but you only have a teaspoon so how many teaspoons do you give simple right this is very simple question we're going to get a lot harder but if you think about it so if I take what first off you have to even in the easiest of questions you have to say okay what is the question asking me every single nursing question in the world you must do this I don't care what it is and you don't do it you're going to make a lot of simple mistakes what if the question asking me well the question is asking me how many teaspoons should be given to give 15 ml of medication I said the exact same thing the question asked but I restated it and it makes sense and it's correct sometimes you can even maybe truck that down if you really want to do really well in practice right practice running through the motions remember your checklist make sure you do everything that's on the checklist so of course we take 15 but divided by three are we divided by five sorry and we end up with three teaspoons is a tablespoon I mean that's what we need to know so how much do we need to give what do we need to do we divide it by the teaspoon which is five to get three a very simple example of what we're going to talk about and that's right um let's you guys set things on you yeah I meet us amita says I want to know somebody view of fluid calculations i meter nothing gets jumped into right away just sit back calm down cut your dog that's nearby we're going to build we're building up to a lot harder questions as we go but you have to start with the basics and we can always assume everybody knows the basics because 90% fifty percent of all the problems that I see when the student comes in as trouble is the basics they're missing the basics every single time so really just talking about conversions before we get into more calculations which is the last part is converting kilograms grams milligrams and micrograms this is a very simple concept I'm not going to spend a lot of time on it but we're going to run through it just to make sure you're doing this because again same example so many of these you're going to miss the question because you forgot to do the conversion guarantee it I gave you kilograms and you should have had it in grams or he had grams you didn't use kilograms and somebody was trying to trick you and in real life this doesn't happen so often but under questions and on your exams especially if I was your instructor I would try to trick you up in the very beginning with very basic questions asking you these types of things to force you to make sure that you multiply and divide so if we're going from a small a large a large size number a kilogram number two grams to milligrams to micrograms why need a multiply because I know that there are more micrograms than their more micrograms to one kilogram but if I'm going from a small number a small amount of thing which there are lots of to a big number I need to divide so let's just talk through that basic concept very basically I'm to just make sure you think about it in this way a kilogram is a kilogram is a kilogram that's a lot right a kilo means a thousand a kilogram it kilo means thousand medical terminology so a kilo is a thousand grams grams I like to think as kind of our our staple if I can remember grams then I can remember which way to go from grams so a thousand grams well if there's a thousand grams well how many milligrams is that how many milligrams is a thousand grams thousand grams one thousand grams we need two thousand grams what we're coming down it's one gram right so one kilogram is a thousand grams which is one gram of kilograms one thousand grams but what if we have one gram one gram is how many milligrams a thousand milligrams it's a thousand every single time now when we talk about this all the way across why do we try not to go did you see how hard it was to try to go from one kilogram to a thousand grams to how many how many milligrams a thousand grams it's very very hard to do very quickly but if you take a thousand grams and you know that this one one gram is a thousand then you can know that you just need to take a thousand times a thousand to get your answer so let's even go to milligram so a milligram one milligram by itself we move to the right two micrograms how many micrograms is one milligram a thousand simple enough now let's make it a little harder one kilogram by itself Jasmine says she has mean so she had to do her headed or has any calculations three times because of because of distractors and that's right that's what this is supposed to do they're trying to trick you with the distractors that mcg versus the mg versus the G versus the cage yes I think we could make a little rap out of that and making sure you look at that we're going to talk about those examples yeah Keisha says her a farm instructor puts the types of questions throughout all of the exams and that's what you do to make sure you pay attention so you don't make a simple mistakes on your on your actual board exam you'd hate to take if you have 75 questions and you can get two right just for me easy this simple stuff oh it's so dumb it's so simple but that's very true so one kilogram what's one kilogram well we already talked about we're going to go across the way here so one kilogram of course is a thousand grams we know that but a thousand grams we know if we know this this equates right a thousand grams of is ten thousands a thousand milligrams how many is a thousand grams or a thousand grams is a thousand times a thousand which is a million a million milligrams and then we know that we have a million then we go to a billion so with lots and lots and lots of giant numbers here and that's where we have to think about this and we talk about you see people talking about moving zeros and doing those types of things if you learn that way that's great adding three zeros because it's a thousand I think it's a good way that's how I do it myself but that's not how I found in a great way to make sure I teach it every time so if that you know just think of this kilogram is a thousand so I know if if I have one of them and I need to go one gram I need to go down a level then I need to multiply by a thousand remember if we're going from over here to kilograms over to micrograms mils multiply if we're going from micrograms up to a kilogram we always divide so five kilograms of course 5 is just 5 times all the numbers that we have across here 5 kilograms is 5,000 grams 5 million milligrams five billion micrograms MCG what medications often given micrograms well there's a few of them but the big one I say pretty option is is synthroid or levothyroxine because we don't use we don't use them trade names on our exams my clicker is not working very well today so what if we have some hard ones and this is where these types of things are it's going to trick you up as we get to the dose of these calculations were going to try at the end because I didn't put the easy stuff in there so we're going to work through it and I expect you to be able to work through it at the same time so 500 Mike 500 grams 500 grams is how many kilograms well I have grams which is a small number I need to go to a big number so if I have a small number I need to go to a big number do I multiply or divide well that means I need to divide right I divide 500 grams so I've got a grams are smaller than kilograms divided to go to the bigger number if that confuses you think about pounds and kilograms you can think about pounds are more of a quantity and kilograms are smaller numbers you have to divide to get to the number so here we got five degrees 500 grams is how many kilograms 0.5 and that's absolutely right Arlene says good I have my cup I do have my cup Arlene that's why I'm making those 25 and 30 cents that's right so it's 0.5 you guys are right so we take 500 we divide by a thousand and get 0.5 and every single time I do this it doesn't matter and today is no different someone always say hey why can't we just go past this why can't we go this is the important stuff you've got to understand these basics because if you're if you already know how to do all of this mmm you probably would be you know missing questions you've got to start with the basics to make sure you get it and you got to go through it every single time so again if we had that right there and we had our 0.5 let me see if I got my L sir I'm sorry I've got it 4 grams 4 grams so how 4 grams is how many milligrams 4 grams here's our 4 grams I just figured out how to do this little laser pointer thing today and it literally has just made my day because I used to have to spin a lot to get the big cursor to show up but now they get this little laser pointer I feel like I'm just it's like a new hot toy um so 4 grams what do we need to do well 4 grams to get to a smaller number to split it up to divide it all out divide it all it's bad choice of words to make it into smaller chunks any or more chunks tiny pieces I need to multiply them right I need to break it into smaller pieces and that is multiplied so I need to multiply by what oh it's a thousand so it's then for um four thousand milligrams now an important point I forgot to mention I'm just going to go back here liquid to the slide because this is really important as you're writing numbers this is one of the basic things that I see so often and I you know if I were grading your test I would mark this wrong what one of the things because a lot say I look back through the questions what you guys put in um point five point five kilograms is a wrong answer any time you have a a number and something that's in the tenths or hundredths place you always must put a zero a 0.5 because it has a zero there then it tells you that that's a zero and there should be a point there because what's the one thing if you write a number it's really hard to see or even read on a paper it's a point tiny little thing that's why we put this leading zero zero point five and when you give the order verbally if you're reading back in order and someone tells you 0.5 kilogram then you're going to say zero point five kilograms you read back the order to make sure you are absolutely getting it correct 0.5 0.2 Jasmine says or 1/2 I it's usually better not just stay away from the fractions and those fractions literally the most confusing thing ever and it really really I always convert all of all the fractions into decimals just because it's easier on the math because trying to do the fraction lines across it it just confuses things but it's definitely 0.5 s better but if you can use fractions to it is acceptable so again let's get back to our of example 4,000 brands our fourth for grams is 4000 milligrams so here is it here's another example 0.25 grams 0.25 grams is how many milligrams 0.25 jazmyne says she sucked she agrees but her school sucks sorry Leslie a fractions are for formulas and that's correct so 0.25 grams now this was tricky because you have to think about what is that letter at the end and it's grams I want to go from grams to milligrams ignore the fact that it's 0.25 so that means I need to do what I need to multiply I need to break the big number up into smaller number which is going to be a more of a quantity so remember big numbers lots of number so you know it's going to get more quantity as you go across so if I have 0.25 here I can't have a I mean it would be unlikely that I would have a fraction on this side I would need to have more of a number on that side and lots of you guys are definitely talking about 0.25 is 250 250 milligrams and that's right so you multiply by a thousand very very very good very very that's correct so another example Kim believe I have so many examples in here is 1.25 grams again same thing 1.25 grams is how many milligrams milligrams well right away 1200 15 12 and 15 so what do we do 1.25 we multiply by a thousand very simple 1250 milligrams correct somebody asked about grains um what about grains grains I didn't include it in here because it's I don't know for a fact that they faced it out I know that a lot it's still in a several of the books it's unlikely that you're going to see I'm see it on your exams standardized exams but it may be there so one gram is how many grains just just drop drop is it dripped down yeah I was okay I was on your HESI I mean yes but if you think about what is grains how many grains is 1 gram 1 gram Cindy 260 Cindy I'm pretty sure it's 15 grains and that's that's written gr I always write out rains every time I talk about grains but one gram is 15 grains which is 60 milligrams that makes sense I don't have it in here but I always remember 1 grams 15 grains just just to make it easy you need to remember just one she's number one then you now to convert converted ring so the last one going back going again is 800 milligrams 800 milligrams is how many how many grams 800 milligrams is how many grams so we need to do what I'm a multiplication we need to divide so if we divide by a thousand then we should end up with 0.8 so I see lots of you guys typing in and you didn't put in grams the G at the end I would mark that wrong you didn't put in the zero and before the 8 I would mark that on its 0.8 grams you have to give your especially if you're in a pharmacology course make sure you include what the ending is make sure you remember the meaning zero because all those things are things you would get marked wrong for very easy stuff and that's where we're here today is to make sure we get to the easy stuff so we talked about building we're building up 1.25 grams or one point two five pounds one point two five pounds is how many kilograms whoops right one point two five pounds Kristy that's about just moving a decimal point and yeah we can move that that's what I said we don't really talk about that today but you can move it three places which would be thousands multiplying by a thousand so one point two five pounds is how many kilograms well it's two point seven five so we multiply we have pounds a small number and we need one remember kilograms so I'm sorry I think I'm yeah again I'm get my numbers mixed up I'm talking talking way too fast and reading too many things as usual which always ends up happening because I get sidetracked but if we have two point seven five kilograms two point seven five kilograms is how many grams 2750 so if we know that it's 227 two thousand seven fifty grams that we know that's two point seven five milligrams two million seven or fifty thousand milligrams so that being said that's enough yeah Maria more on the easy step let's talk about equations we're going to run through some equations and we are going to run through them and do some examples so we're done tablets real quick just a basic and then we're going to do we got it I might be drugged at the end and some weight based stuff the biggest thing with all of these again same thing make sure you don't miss the easy stuff what's the question asking me how much am I supposed to give what's quantity that I've been given in the question you should be writing these things out make sure you do all of your conversions so make sure you have pounds to kilograms you haven't in the right amount calculate to the right form and then calculate your dose we're kind of going to run through these exact same steps with every single question now we can skip a step if it's not relevant but we know that we've got to pretty much ask all the questions you got to run through the checklist otherwise you're going to make mistake and you're going to miss the easy things so those five writes pretty much and then also asking to make sure we have correct hmm let's see so the first thing here is tablet so we really got that same exact formula that we have to the conversions there Oh someone asked a question about pounds the killer okay so we'll get to that pounds nipple kilogram question p.m. because I didn't put the actual equation on the screen so we did a little bit earlier so the nurse is given an order for a zero Meissen 0.25 grams Pio to be administered each day she has 125 milligram tablets are how many tablets should she administer to the patient each day okay so first off any nursing question no matter what you really just want to say what's this question asking the coil the question is asking me how many tablets should I give the patient each day to give the patient 0.25 grams every day right so how many tablets do I need to give to reach 0.25 grams I could write that down I've rephrase the question so that I understand now the problem is I don't have very simple things to make this work that's correct what do I have I always pretty much go back and we just go back to my checklist what's the question asked me why rephrase the question what's the total dose that I'm giving what's a quantity I've been given in the question and then of course any kind of conversions and calculations to work through so if we look at this I know lots of guys are already typing in the answer and you're just so smart so first off we're going to do how many tablets how many milligram tablets daily what's a total we need to give well we need to give 0.25 grams pio pio is of course by mouth every day and we've been given 125 milligram tablets yeah every time I get one of these questions again depending on where you're at on the level of understanding Barma college math this could look like a really easy question but every single time it makes it messes people up because I need to give 0.25 grams pio 0.25 grams let's see if I got this here there it is I've got I need to give 0.25 grams grams I wrote that down and I realized if you just do enough to realize that 0.25 grams right if you just realized that is not the same as milligrams that you you have then you know you need to do some multiplication or division to get to the right ramps so let's go through it if I have 0.25 grams that I need to give right so how many 0.25 grams well 0.25 grams is 250 milligrams I multiply 0.25 times a thousand to get 250 250 milligrams right yeah oh my god you guys are killing me some of these um every now and then a couple of people throws and crazy answers so 250 milligrams now if I were given a question literally that simple 250 milligrams was pretty easy to see that I need to give 250 milligrams per day but I have what type of tablets well I only have 125 milligram tablets so how many tablets do I need to give well if I have 125 milligram tablets on hand I divide that into 250 it's going to give me what it's going to give me a total of 2 so 250 milligrams is what I need to give and I divide that but whatever have on hand what I've been given is 125 milligrams then I'm going to equal to or 2 tablets so I can give two tablets to that patient by mouth to equal the order of 0.25 grams now in real life you're going to be given 250 milligrams unless you have chlamydia and then you're going to get one gram one time pioppi now by now right am I right am i right come on that was that was a great that was a great Madison joke come on guys you guys are killing me anyway arrow is going to be given milligrams in real life but this is pharmacology math and the math questions are trying to trick you they are set up to trick you this is the one part usually I say all of everything in nursing school or med school or paramedics Corps whatever school you're in is not really designed to trick you a farm math is really designed to see if you're paying attention to trick you that's the only place you really have to just be careful you read everything single thing because this changes the question of why if you accidentally picked if you are looking at multiple choice answers you saw maybe you know four tablets or 200 tablets or 0.25 tablets because they're going to give you the wrong multiplication that you would do in trend I it correct so the next one is a very common this is one you're very likely to give and these are very very good to understand these this is very common when we give because we give it per ml so it patients to receive morphine morphine sounds like a fun time today eight milligrams IV now that's a look okay well hook me up morphine sounds like fun eight milligrams you have five milligrams in two milliliters how many milliliters should be administered so let's run through our scenario I'm going to ask myself well what do I need to give well they're asking me how many milliliters of morphine that I need to give to equal eight milligrams okay we can figure this out I think we can see we go sorry Oh somebody said reconstitution they're confused well just wait for a minute we got that too so let's talk turkey this one we know we have to run through the scenario so how many milliliters that's the question how many Malays do you need to give well what is what Oh what is the ultimate result we need to get or we need to give eight milligrams so the question is how many milliliters do we need to give to get to eight milligrams right okay milligrams no liters oh my good as it gets too confusing but if you break it down to the simplest form I love saying that over and over because it just sounds like catchy phrase and it makes me sound smart break it down to the simplest form is everything in milligrams well yes everything's in milligrams and everything's in milliliters so this is an easier question so what we're going to do is calculate how much in milligrams is in each ml if you break it down to literally the simplest form break it down the simplest form how many milligrams are in each ml hmm well how do we do that well we have five milligrams in two milliliters so if I divide everything by two then that would tell me what well my little clicker here done crazy so then it's going to tell me if I divide this by 2 that means if I have 5 milligrams in 2 milliliters of solution then I have 1 ml that's going to be 2 point 5 milligrams because there's two point five milligrams per 1 ml sometimes if you get a really complicated dopamine infusion when you get a complicated question that has a picture of the IV bag it's a really common one that they give you look at that picture look at the picture because it very often will tell you so many milligrams and 500 ml s but actually on on the bag it may actually break down how much is in per each ml and it makes it a little easier so we look at this 5 milligrams and 2 ml that's a really concentrated morphine holy crap right that's a you know concentrated morphine well that's the question they'd be given and that's what we do so I'm getting lots of answers and I love getting wild answers mm-hmm so Beverly ass right now is like when you get a question like this should you round or do we do so when the question asks well like I said earlier is it really important villages to not round until the end I'm don't round until the very end unless it's some you know really bizarre long uncommon that you can't wrap it you know if it's 3 3 3 3 4 3 3 3 3 3 3 then okay you could round because it's you know you're going to stay in the ballpark but don't round and then round again then round again if it's a complicated question because you're going to get very far away from the answer if if you have an evil nursing instructor which is possible I know everybody has an evil nursing in their past I have my own if I have to dissect number placenta in my life from nursing school or puke ok so two point five milligrams per ml now how do we get to point five milligrams per ml to get 8 milligrams so what do we need to do next well we have to then and that's right lots you guys are typing in the answer lots you guys are talking about your evil instructors I agree there's over there they're a couple out there in every school how many MLS do you need well how many ml's do I need what I need to give what how do I calculate that I'm going to take my 8 milligrams that I need to get the dose that I need to give remember from the beginning I need to gave 8 milligrams and I'm going to divide that by what I have which is 2.5 milligrams I have two point five milligrams and each one of these MLS to tell me that I need three point two amounts and that's right Lots you guys typed in the answer very very very good if you can think through it all of these are the same there are not a single one of these the change over time if you can break it down how much medicine is in every single ml then pretty much you can calculate what it's in if you can move from milligrams to grams to micro grams to kilograms whichever way you go about and you understand how to do it you're not going to mess these up because if you can break everything down with the simplest form or the same form all you have to do is multiply it and it's it really is simple if you're looking at me like man crazy right now it's because you just have to practice and make sure you're not missing any of the basis because the basics are so so so important Shantay we'll get to yours which is right here so here's an IV message this one's a difficult one your patient has a cefepime 1000 milligram ordered every six hours you're given two grams diluted in 500 ml of normal saline how many enough should be administered hmm these are the fun ones love it every single time I enjoy these questions and we're going to break down using the exact same methodology of talking about the same thing exactly like we did with all the others all those basics still apply first off what is cefepime what kind of medication is cefepime if this is a review for you you should know that cefepime Ceph is what type of medication what type of medication what type of medication mmm it's safe and if you we have a pharmacology base pharmacology overall webinar which will teach you that Saif is a prefix for cephalosporins which is cephalosporins are antibiotics that's you guys Geraldine Theresa ready right away very good and Arlene yes I see Arlene's bat she was here before so um that's right so we've got an antibiotic we're giving it pretty it's a pretty high dose of cefepime where's aria sorry we're giving 1,000 never mind so pretty standard dose of suffering that we're going to be giving today so we're going to give thousand milligrams every six hours okay we need to give cefepime every six hours now we're giving the supper beam I think maybe I even have it on the next one I feel like maybe it's not in this one we need to give it over 30 minutes and that's what the order is feel like I might have left it out here I apologize I think I added in the next slide so the first question is let's just restate what's going on the question asked is how many milliliters should be administered so the question let's restate it how many milliliters per minute do we need to give well we're not going to give it over six hours we're going to give it over thirty minutes we're just actually pretty sure that's working well we've got in the next next slide sorry to confuse you I know I hate when I mixed something up on one of these and then everyone gets mad at me so it's over thirty minutes is what we're doing so if you're doing this calculation already and you're speeding through it it's six it's every six hours over thirty minutes because that's a little tidbit that will mix you up because you'll calculate it to be given over a long six hours when in reality it's over thirty minutes and if you think about if you have the knowledge and you're doing your NCLEX or you're doing your HESI or you're studying for a TI final exam you know because antibiotics are not given over a long period of time they're given over an hour to come in over thirty minutes they're a dose that he's been given right now because you're going to repeat the dose in six hours or in 12 hours there aren't very many antibiotics or any other drug that's given on a constant infusion that's a that's a you know given every certain number of hours it would be given at so much milliliters per minute or you're going to be calculating it on a wait per milliliters per minute if it's a constant infusion just a little tidbit to keep in mind so and I think that's what happened when I wrote this question I was thinking too much of reality but I fix it the next one so how many believes should be missed in misery first off how many milliliters per minute so the total to give is cefepime 1,000 milligrams every six hours over 30 minutes so you've been given two grams in 500 milliliters hmm definitely definitely break infuse and I agree something you kind have to stop and think about so we think about first off we got to start with the basics so if the first thing you do right away is you convert everything to the same constant simplest form then you know that everything convert into milligrams is going to help you because that's really where you're going to get to the end so if we convert this to grams to milligrams then we're going to be easily be able to tell that we have two grams is 2,000 milligrams we're going from 1 grams 1,000 milligrams multiplying two by 1,000 2,000 milligrams easy super simple the next thing we want to do is really calculate how much medication is in every ml of this bag so here I've got I've converted to milligrams so I've taken my two grams solution that I've been given and I've converted that to 2,000 milligrams per 500 ml so by a 2,000 per 500 ml how many how much medication is in every single milliliter how many how much medication is every moly it's right so you have to bide 2000 if two thousand is in 500 MLS literally all you have to do is divide what is on that what the calculation is I could divide two grams by 500 and get 0.25 grams per 500 per ml right but I'm sorry up for point zero zero four so I'm going to see right here two thousand divided by 500 is four milligrams per 1 ml right that's right for ya four milligrams per ml and that's what we can think about breaking it down to the simplest form so then we know right there we can give 4 milligrams in every ml so let's just put that on the side burner and think about that basic form because now we need to think about how much we need to get how much do we need to give with this medication well I know I need to give 1,000 milligrams 1,000 milligrams of the medication I need to give and you give a thousand milligrams and I have 4 milligrams per ml now look so hard I've got 1,000 milligrams I need to get so if I have a thousand milligrams I need to give and I have four milligrams per ml so I take with 1000 milligrams and then I do what I divide it by four so I take my thousand milligrams and I divide that by four then I'm going to end up being 250 MLS and when I when I when I give this kind of example every single time and every student comes to me like Ken okay great I followed along with what you said perfectly and then I got to my exam and it didn't give me the exact same format and I fell apart and the problem here is what's problem is you didn't set yourself up in the same format if you set yourself up with question how what's the question asking me okay it's asking me how many milliliters per minute well we're not there yet so this is not the answer we're not done what's the total that I that I need to give I need to give 1000 milligrams over 30 minutes so is my answer right now as we stand 250 MLS so I need to give 250 MLS over 30 minutes right so we're not really there's a whole another level of the question we can go into and then if you always give yourself what you've been given 2 grams in 500 and then you break it all down to the same simplest form and then you calculate 4 ml then you calculate how much to give then you can build back up it's like breaking everything down simple and then building back up Namie so she just skips these questions because they're complicated I don't think that's the best policy nor do I think that the best practice nor do I recommend it but I understand your frustration but you just have to break it down I mean you really just have to break it off form and then build it all back up it's really simple so let's keep going because we're not done with this one because the next thing is here we have this over 30 minutes part right so we know we have 250 MLS that we need to give over 30 minutes so I know the whole dose now the whole dose of what it's what I know I need to give I know I need to give 250 MLS of my 2 grams in 500 milliliters bag that's a lot of words to say out loud I try to keep straight and that's why I always write it down that's why I always follow the exact same thing I calculated my dose to be given I know I need to give I've got my 2,000 milligrams in 500 MLS right it's the same question is literally I could ask you the same question completely different but it's literally the same I'm asking you to come up with a different answer so with our one before this question here this could be a question all by itself what's the overall does that needs to be given how many MLS well it a snoo milliliters a minute or million ELLs the answer could be 250 but it could take me into the next level and ask me the exact same thing again but it's going to ask me how much per minute make sure you pay attention to that because that's one thing is going to trip you up and cause you a lot of easy questions that you're gonna miss so how many MLS per minute total to dose again same thing all of is the same so I know my calculated dose to be given is 2000 MLS and 500 MLS or 2,000 milligrams and fiber nails so I know I need to divide my ml by how many minutes so I'm going to take that same 250 MLS I got from the last book building on top of it and divided by my 30 minutes here my 30 minutes of time so I know I need to get 8.3 m/s per minute yeah I know lots of your smarty pants and you did so well by getting that faster but if you follow the same same process you're always going to end up with the exact same answer all right she uses a kind of like a mnemonic and she it's a good one I like it so I'm gonna share with you it's um D so remember D is what the doctor orders it's really the order because we know we have nurse practitioners which many of you may end up being someday so we have the the practitioners order or the order so doctors order D age what's on hand so in your hand essence the stock and a is the answer hmm I kind of like it it's a simple form it's a lot of the same thing follow the exact same steps every time and you won't mess it up that is absolutely right lots you guys come up with I'm just looking through see if we got any questions so somebody asked what what what decimal point should the MLS be rounded to well most of your questions if you get on a standardized exam I'm not talking about your nursing exam that joe schomacker tell your nursing instructor wrote and gave to you that you're filling in i'm talking about a standardized exam like hesse or anything like that it's typically the hundreds you don't want to go past hundreds because we don't usually give any drugs past hundreds place but usually to the tenths place is what they probably are going to hit you with so we end up with a bizarre answer if it's point zero bla bla bla bla bla it's probably going to be round into like something like 8.3 m/s per minute but no further than no further than hundreds so let's uh little turn here so IV medications again so you receive an order for vancomycin fifteen milligrams per kilogram over two hours you're thirty two-year-old female patient weighs one hundred and forty six point five pounds you have a solution of two hundred and fifty mm MLS per one gram what's the MLS per minute you should administer what emails per minute should you administer follow the exact same thing whether we're using the same formula that we're using or using something like what a read a rec says she uses what what are we what do we have what are we giving what is the question asking us so the question is asking us two things the dose per weight and how many emails per minute do we need to give and that's really what we're coming down to so here you can kind of restate that because we restated then you can come down to the you know you need to write that down so you make sure you don't miss any of the easy stuff so the first thing we need to do is get that way calculate it out every time you see a pounds you've probably newly converting that that weight two kilograms so that's an easy thing that's so often I see people miss so 146 pounds well I know that I'm much lower number in kilograms than pounds so if I'm one hundred and forty six point five pounds or this thirty two-year-old female patient is what is that in kilograms well I take one in forty six point five and divide by two point two which gives me sixty six point six eight kilograms and you can see I've taken this two hundredths place for now because that's a great place to come back to this hundredths place so if I come back to hundreds place right there we've got it I see lots you guys typing in answers and skipping steps so that makes me feel good that we're definitely making taken time to do that so sixty six point six eight or two is two point two there you know two point two is a round around it number so you can use two points but we can go further to two point two and do kilograms pounds so you should come up with right around sixty six point six eight now what's the next thing you know well let's calculate how many milligrams per kilogram I need to give for this patient what's the total dose I need to get how much dose do I need to give for this weight well the order I have is 15 milligrams per kilogram so if I have sixty six point eight kilograms of the patient I need to give then I need to do what I need to give 15 milligrams times sixty six point six nine and I don't know why I have six eight and six nine here I must have done this question two different ways but I rounded up at the top and on the bottom but sixty six point six nine sixty six point six eight the point is it's going to come out literally almost exactly the same way sixty six point six eight six point six nine kilograms equals right at about a thousand milligrams one thousand point to one thousand point two to one thousand point two three milligrams so that's the total does we need to give I could have given you a question that like the last question says give a dose up 1000 milligrams to this patient over a certain number of time right you can make it much more complex and what happens is if you don't understand how to do each piece of it the weight and kilograms to pounds pounds to kilograms you don't understand to do each piece then the when someone says jump in and teach me IV drug calculations they're literally lost because they don't understand one of these little pieces along the way this is messing them up so if you follow the same thing over and over and over you're not going to make any mistakes because you're building the same template that you're always following so if I calculate this milligrams per kilogram it's going to tell me my total dose of 1,000 milligrams a lot like our last question which is a thousand milligrams a thousand milligrams is how many grams one gram so one gram it's going to tell me the next thing we need to do is say okay well how many how much vancomycin do I have per MLS well I have a solution of 250 MLS per 1 gram 250 MLS per 1 gram what ml's per minute should I administer now I know and you know that I could have given we could have made this a lot more complex question by changing this up to where this wasn't one gram because we know one gram is one thousand milligrams so if I take my one thousand point two milligrams and I know that I need to convert that to grams or convert grams to milligrams that I know that here is the exact same amount that I need to give over 250 MLS or inside of 250 MLS so it matches so I know that I if I put it in the simplest form one thousand milligrams is one gram one gram here one gram is a thousand milligrams divided by 250 is 4 milligrams per ml so at every single milliliter of fluid there are four grams of medicine so what's the total that I need that I need to give this is duplicated because it's obvious I know I need to give 250 ml this is the same because I could have just skipped this stuff this is where you see so many people skipping ahead and I go yeah I did in my head but we're not skipping ahead because I know 1000 milligrams divided by 4 right is 250ml it's essentially the same thing this is one gram per 250 ml so here's my 250 ml or 1 gram what do I need to give I need to give 1000 ml milligrams what is 1000 milligrams it's also 1 gram so I could have looked at this easily and said okay well it's 1 gram here well I need to just give all 250 amounts but if you want to double-check and that's one of the things that's really good and your Janey's questions if you're learning and you're trying to figure it out is if you have that double check you're never going to miss one of these questions because so many times you end up with it all the way to the end of the answer and then you stop all the way at the end like okay well how do I double check my work well let me just do it all over again and then you do it all over you need something different you still don't go if you do the little double checks as you go then you know that you're not making United States it's an extra step this is entire extra step but it gives you that reassurance that you're doing the right thing so how many MLS per minute do we need to give well we need to give how many MLS per minute well how many minutes do we need to give it over where our question asked us that it says we need to give it over two hours two hours is how many minutes I hope I don't have to make a slide to tell you that one hour is 60 minutes and two hours is 120 minutes so I need to give 120 minutes of fluid so if I take how much I've got my 250 MLS that I need to give now right and I take my 250 ml and then divided by that total minutes then it's going to tell me to milliliters a minute to milliliters minute 2.08 milliliters or to be exact but it would be very common to see an answer of two point one or even two milliliters minute as an option and those are all ears unless and this is where I'm talking about the rounding if the rounding is why you do the rounding at the end because of your rounds in the beginning you could very easily end up with a a very evil nursing instructor that gives you two point one five two point zero four two point one two you know and is very close I mean it's very it's the best practice around at the end that's about right if you said two point one if you said two point zero eight those are absolutely correct if you said two I don't I don't know sorry stitch come down that those are all correct answers that I would definitely believe is correct and on a fare any type of style question that's out there you would you know you would if it was a standardized exam you would you would get it correct I mean that's absolutely absolutely true now the other thing we can put in here just the last little bit last hinge and I did make a slide for this because we are our time limit is if we put drops so drops are written G TTS so if I if I had dripped right and that's a really common hard one but if you understand all of this at the end and I know I need to give two emails per minute right all I have to do is add a whole nother step of drips per minute I could take this exact same question and I could say how many drips a minute do I need to give with a sixty drop set a sixty drop set 60 G TT s how many drops well the first thing the first thing that's important to remember is that drip sets are how many drops equal one ml you go your micro drip sets which are 60 drops a minute you have your macro drop sets which are 10 drops or 15 and there are some 20 drops per minute sets so if I had a 60 drop per minute set then I know I need to get to MLS which is 60 drops a piece which is a hundred drops per minute that I would measure to give this rate over two hours to equal to 250 MLS or one gram 1000 milligrams of the medication very simple if you follow the same steps every single time definitely definitely definitely definitely true so today we I think I think this is the last question yeah so just you know just to kind of recap everything make sure you know those medicine medication administration basics don't miss that stuff routes administration yes important don't miss those conversions make sure you're doing that every time make sure you're not missing the easy stuff and of course when you do those equations make sure you follow every single step all the way you can see how we don't need to do a hundred examples of questions so for you hopefully to realize today where you're doing the problem is the problem that you're having is it not doing the same steps every time it's very high likelihood that that's what you're doing and you need to build a routine when you if you're having trouble and you're failing farm math questions because you're looking at a question every single question is going to be different and you're not in setting up yourself for success by saying okay well what have I been giving what's the question asking me what's the dose that I need to give do they match create a step process checklist so then you can follow the same steps every single time so you're setting yourself up for success and if you can skip over a step because obviously you realize one milligram equals or 1000 milligrams equals one kilogram and you don't have to actually sit there and multiply it out times a thousand great for you but you're following the same steps every time whether you're doing it in your head or not is irrelevant and that is exactly what people are doing exactly what people are doing for sure when you see them saying they're doing it in their in their in their head um jazmyne asks if we're doing another live math webinar I don't have any questions prepped right now for live Math webinars but definitely for sure it's possibility Julie asks even more questions next time can we work kilograms per day every eight hours and ask for a dose working backwards um we could do that that is true it's not very likely that you're going to get that kind of question on a standardized exam because it's not a very unless you're doing pharmacy it's not a realistic question however it's important to know to do that to check your work I'm going to work backwards but definitely is a is an extra level to go through dude it to do Oh Arlene Arlene always ask if we have a study guide I don't mistake I good for this one but I am making lots more study guides now finally uh Leslie asked where next webinar is I don't have another webinar scheduled right now I don't think but we're going to have one either a week probably week after next amita asks about copy of the webinar there is a cop we are recording this webinar of course you can check us out and we forget to put this I don't know if I got a slide in here or not I might need to do it um you can write into as a feedback at pick Montcalm you can go to Twitter you can follow me on Twitter at Pequannock Kendall if you're interested in seeing all my quirky tweets or seeing where I'm at at a convention or where I'm hiding in the world you can follow all of the recorded versions of this there is a reported version of this webinar where I probably went a little bit slower there is a Pediatrics webinar teri all on YouTube at pick Montevideo they're all free there's no game makes there's no catches absolutely correct you can go do those they're there if you have any questions you can reach out to us feedback up aquatic calm you can follow us on youtube go to youtube our feedback and our polls say that only about 50% of our users have seen those or that you're aware that they're out there they're recorded versions but so I'm not going to be talking to you but you can talk to me or you can leave comments and we'll get that you can write in what not but as always you can check out pick Montcalm it's free to set up for account to get all this stuff sign up for our email so you're in the loop for the next webinar no matter what it will be and if you check on those YouTube videos at Tech monic video on youtube there are some study guides and free things in there as well as always have a great day good luck studying reach out to us if you need us and have a good night yes I agree Carmen Steve is crazy good night and good luck studying

Channel: PicmonicVideo

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Keywords: picmonic, visual learning, Nursing School (Organization), Nursing (Field Of Study), nclex, ati, hesi, mnemonics, nursing student, nursing mnemonics, pharmacology math, pharmacology basics, pharm math, kendall wyatt, needle sizes, pharmacology, pharmacology pharmacokinetics, pharmacokinetics, pharmacology crash course, basic pharmacology, pharmacology introduction, pharmacodynamics, drug metabolism, first pass effect, bioavailability, pharmacology lecture, pharmacology made easy

Id: 0dmK-pK_8Ps

Length: 71min 36sec (4296 seconds)

Published: Mon Oct 17 2016