EDelivery Initials Made Easy

Edelivery initials

[Music] uh all right we're going to talk about fetal monitoring patterns there are seven of them that you should know don't panic because they're actually easy to remember i'm going to go through here and tell you which ones are okay and which ones are bad and what to do for them all right so that's the way we're going to go the first one is a low fetal heart rate that means under 110. this is bad when you see it you do lion l i o n left side iv o2 notify and if it were running what would you have done stop the pit high fetal heart rate that's a fetal heart rate over 160. this is no big deal you would document it and take mom's temperature because it's probably mom has a fever that's base but there's nothing wrong with who the baby baby's just fine you don't have to do anything specific if you did anything you'd take mom's temperature that's basically all you do it's no big deal it's not a high priority low baseline variability this is bad this is when the fetal heart rate stays the same and does not change whether high or lower in the middle it just stays the same it doesn't change that's bad that's bad and what you do is lion l i o n left side iv o2 notified high baseline variability what that means is baby's heart rate is always changing that's good documented now it's kind of interesting once a person is born if their vital signs stay the same over time what do we call them stable and they are in good shape or bad shape good but when you're before you're born if your vital signs stay the same over time it's low baseline variability and it's bad you want to see so what we want to see before you're born we don't want to see after you're born and what we want to see after you're born we don't want to see before you're born so we want to see vital signs all over the map when the baby's in utero that's called high baseline variability that's good we don't like to see stable vital signs which is low baseline variability late decelerations decelerate means to slow down and late means near the end of a contraction so the heart rate slows down near the end or after a contraction this is bad so what you do is lion l i o n left side iv o2 notified early decelerations what would this mean early decelerations baby's heart what slows why didn't you say slows decelerate when before a contraction or at the beginning of a contraction and this is fine this is normal it's no big deal so you just document it which brings up the last tracing variable decelerations this is very bad think of variable very very very variable very bad variable very bad so when you see variable think very bad how very bad well this is prolapse cord this is what happens when you prolapse the cord so what do you do for this push position so of the seven abnormal fetal heart traces of the seven abnormal fetal heart traces which one is the most unique and it's very bad so it's the only one which is treated by push position because it's prolapse now if we look at the remaining six how many are good and how many are bad three are good three are bad what do you notice about all the ones which are bad they begin with the letter l which is the first letter in lion so if you get a fetal heart tracing that begins with the letter l what do you do for it lion and so is it good or bad bad so if it doesn't start with an l it's okay unless it's variable in which case it's very bad so if you want to know your fetal heart tracings just look at the first letter it starts with l it's bad it needs line if it doesn't start with l it's okay but if it's variable it's very bad it needs the prolapse routine the push position so do you feel a little bit better about those um there's one other thing i want to show you that tells you what they are you know what are they what do they mean and i'll see you probably heard of it but for some of you that haven't heard of it this might work um i've told you what they what the implications of them are but um what are they write the word veal you know like like young beef beef veal so right veal vertically down and then write chop like lamb chops pork chops veal chop do you see what i'm saying so veal chop now what this is is this is the first letter of the tracing and this is the first letter of what it means so variable would be y v would be variable that is chord compression you see that variable is chord compression what would this stand for the e early d cell and that's what it is what it's caused by it starts with an h so what that what would that be head compression what would a be well we didn't talk about it but it's it's high fetal heart rate acceleration which is high fetal heart rate correct and that's okay okay meaning it's fine remember we said that ip larvae was okay what would l stand for late d cell and what would that stand for starts with a p plus cental insufficiency plus central insufficiency so veal chop variable cord early head accelerate okay when you need it not at the beginning okay they'll give you a little white board kind of thing and you'll use that for your scratch but when you fill it up you raise your hand they bring you another one okay you don't erase they don't like your racing freak out if you're erasing so i would i would erase just for that person back to what i would do i go like this but i would be doing absolutely nothing you know i wouldn't really be a racist i just would go like this to freak them out okay they can make me take this test they can make me sit there but they can't make me behave so that's i always think a little civil disobedience goes a long way you know you're are you in control of this test no you have to go take this test you have to sit where they tell you to sit they have to take the questions you have to take that you have to do it so do something you know civilly disobedient you know wear a wear you know pair of clown ears i don't know don't wear underwear i don't know um do something that's you know where you're you can sit there and you can say i'm in control you know to give you a little little edge okay ace of spades an ace of spades means what answer always wins in a tie there are certain answers which they're always winners they just they just win all the time and you know b there is one answer that always wins and if you've ever worked ob you'll know what it is and that is check what fetal heart rate you cannot work ob if you don't know that no matter what happens in ob no matter what happens it'll be what is the one question that surfaces all the time what's the fetal heart rate she's doing this and doing that well what's the fetal heart rate well this is doing that well what's the fetal heart rate so you'll always check a fetal heart rate [Applause] all right that's the first stage of labor in delivery labor let's talk about the second stage of labor and delivery delivery of the baby this is all about order what do you do in what order well first you deliver the head and you say well what if it's breach come on don't go breach unless they say it's breach okay go with the common so it's a cephalic so deliver the head number two suction the mouth then the nose it always goes alphabetical you suction the mouth first then you suction the nose then number three check for a nuchal nuchal n-u-c-h-a-l chord what does nucle mean around the neck nuchal means neck so check for a nuchal cord then number four deliver the shoulders and the body in that order so first out comes the head then you suction the mouth then you suction the nose then you check for a cord around the neck and then you deliver the rest of the baby right that's the ideal number five the baby must have an id band on before it leaves the delivery area a baby must have an id band on before it leaves the delivery area okay third stage of labor and delivery delivery what's this about placenta two things you need to know here number one make sure it's all there number two check for a three vessel cord make sure the cord has three vessels three blood vessels how many of each two arteries one vein think of the woman's name eva eva how do you spell eva a how many a's are there two that's two arteries how many b's one that's one vein so the woman's name ava two arteries one vein okay that's all you really need to know about the placenta fourth stage of labor and delivery called recovery correct recovery that's what goes in that blank recovery the first first two hours after delivery of the placenta right now there are four things you do four times an hour in the fourth stage so you're gonna write four three times there there are four things you do four times an hour in the fourth stage so what are the four things you do every 15 minutes which means four times an hour in the fourth stage well the first thing you do is vital signs vital signs and you're assessing for signs and symptoms of shock which is pressures go down rates go up you get pale cold and clammy pressures go down rates go up and you look pale cold and clammy those are the signs of shock anything that's called a pressure goes down anything that's called a rate goes up and that number two fundus check the fundus if it's boggy you massage it if it's displaced you catheterize number three the pads the perineal pads check the perineal pads look to see how much she's bleeding if she is bleeding excessively she will saturate a pad in 15 minutes or less so how often are you checking her every 15 and when you check her you put on a new pad you go back it's 98 percent saturated is she in trouble or not 98 saturated she's in trouble or not how many say she's in trouble and we say she's not she's not in trouble because it has to be saturated 100 and 98 is not 100 and when you learn these rules you have to live and die by them you can't start budget do i mean you can't say well as close to that then pretty soon you start you know losing your anchors so a hundred percent means a hundred percent if it's not a hundred percent it's okay but if you want if you give put a new pad on her checker in 15 minutes and it's a it's fully saturated saturated if they say saturated what does that mean a hundred percent she's in trouble but if they say 98 saturated i'd say she's okay close but she's okay number four roll her over roll her over in other words check for bleeding underneath of her a lot of people will check the pads but won't roll her over and that's not safe because could you saturate half a pad and bleed out underneath so you gotta you gotta do both so what do you do four times an hour in the fourth stage vitals fundus you do those every 15 minutes in that stage stage okay turn the page and let's do postpartum this is talking about postpartum assessment what do you assess and usually you're assessing this every four to eight hours it's either four hours or eight hours it just depends on whether she's stable or not and what you're assessing is bubble head now there's a whole bunch of stuff here but i won't only want you to highlight and know three of them and i'll tell you which three the first b stands for breasts this is not a real important one the u stands for uterine fundus and this is the one the first one you must highlight this is an important one here again you want it to be firm if it's boggy you massage you want it to be midline if it's not you cap them just like in the recovery but there's something new that they will ask here in postpartum and that is the height of the fundus related to the belly button where do you find it because what they'll do is they'll tell you how many postpartum days it is and you gotta locate where fundus should be it's really simple all you do is bundle height equals day postpartum fungal height equals day postpartum now what do i mean by that is this if a woman here's her abdomen here's her navel this is minus one minus two minus three minus four minus five minus six and it's the fourth post partial day and they want you to point and click okay here's a hot spot here hot spot here hot spot here one here one here one here one here one here one here you know a b c d e f g h i all right and she's fourth postpartum day which hot spot would you click on g that's how many below four four below on the fourth day now be careful because f will be there too why would you not click on f it's displaced you want it midline so they will have hot spots so that you'll get the right level but if you're not precise you'll be off to the side and you don't want to be off the side you want to be in the middle okay the next two b's are bladder and vowel they're not a big deal bladder and vowel the l is lokia l-o-c-h-i-a this one is the second one you highlight this is the second important one they are rubra serosa and alba rubra serosa and alba rubra is r-u-b-r-a serosa is s-e-r-o-s-a and alba is a-l-v-a now it occurs in that order first the lo by the way the loki is the vaginal drainage rubra is first then serosa is second and all becomes last now they want to know what color they are okay if you rub you see rubra has the word rub in it if you rub and rub and rub something what color will it turn red so rubra is red sarosa has the root rosa for rosie if your cheeks are rosy what color are they pink so rosa is pink and alba if you are an albino what color are you white so alba albino white so rub red rosy pink albino white rubra sarosa alba now the amount four to six inches on a pad an hour is is okay excessive is saturated pad in 15 minutes or less it's the same idea the e stands for episiotomy episiotomy no big deal it's an incision the h stands for hemoglobin and hematocrit no big deal there they're not going to focus on that the e stands for extremity check checking the extremities this is the third important one you must highlight and right now on this one they're looking for thrombophlebitis so they want to know what's the best way for you to determine if a person has thrombophlebitis or not what's the best way exactly bilateral cath circumference measurement measuring their calves how many have heard of home and sign that's not going to be the best answer now it's not a horrible answer but it's not the best one because you can have a positive home inside and have equal calves and not have thrombophlebitis and you can have thrombophlebitis and not have a positive home inside so it's not as reliable or valid some places don't even want you to do it a stands for affect means you're emotional don't worry about bulby's stages you know latching on letting go taking in throwing up i don't really know what they are you know you've never heard of those don't worry about all that that's that's nuts and then d discomforts and that's just that's there's really no big deal there either so the three big things you're going to be tested on it was part of our what the fundus the lochia and about thrombophlebitis anybody ever work postpartum that's the three big things you talk about in rapport you know where's the pandas how's the lokia and how are her legs she got trouble full blast okay turn the page let's talk about variations in the newborn yes no the the number of days when things go all varies boys likes to test what does not vary the lengths vary but the order never varies and what they are never varies so it's just like with chadwick's goodells and he guards they're not going to say what week or what month they're just going to say what order and what is it okay um variations in the newborn all of these things are normal so i just wanted you to know that i'm not going to read it so you don't have to have it read to you but all of these things are normal even though they sound some of them sound bad look at number four erythema toxicum neonatorum sounds horrible doesn't it but it's just a rash it's no big deal the only thing specifically i would need i would want you to know from this page other than the fact that all these are normal is the difference between number six and number seven because they always test about the differences between six and seven capital succideanum and cephalohematoma what do they always want to know what's that one's bleeding was bleeding and that would be hema and then also what else which one crosses sutures which one does not which one's symmetrical which one's not the easiest way i know that know to memorize that is look at their initials what are the initials of capet sucsadam c s what could cs stand for crosses sutures so the one whose initials are cs is the one that indeed crosses the sutures so what about cephalohematoma are its initials c or ch certainly not cs so it does not cross sutures and of course the one that crosses the sutures is also the one that is symmetrical so i always say cs stands for crosses sutures and cap it symmetrical and leonid on number eight uh it's talked about the hyperbilirubinemia normal physiologic john disappears after 24 hours so there's a there's a reminder of the difference between physiologic jaundice and pathologic okay the last page ob meds top 10 group you've got to know your ob meds now good news you don't have to know much about your ob max because you're not expected to be an expert in ob meds but you've got to know generally what they are and just a couple of things about them so rather than feel you full of all kinds of stuff you don't need to know let's focus on what you do need to know with these six different meds the first two meds are tocco linux which stop labor they are turbutaline and mag sulfate these are drugs you give to women who are threatening prematurity and you want to stop their labor turbulene the only thing you need to know about it is that it causes maternal tachycardia it speeds mom's heart rate up that's really all they'll test on that one that it stops labor and speeds up the heart mag sulfate will also stop labor if you give a person a lot of magnesium what electrolyte imbalance will you create hyper magnesium and you know that magnesium is do the opposite so a high magnesium makes everything go down so the uterine contractions will go down well the only problem is so will everything else so what will your heart rate do go down write that down what will your blood pressure do go down write that down what will your reflexes do go down write that down what will your respiratory rate do go down write that down and what will your loc do go down write that down so mag sulfate yes the good news is it stops the uterine contractions the bad news is it brings everything else down too which of those two do you think are the top two that boards will will check your knowledge on respiratory and reflexes they'll want to know what does mag sulfate do to the respirations and what does mag sulfate do to the breathing and it's it lowers both of them so when you're giving mag sulfate to a patient you must monitor what two things reflexes reflexes and respiration what are your parameters for titrating the mag sulfate and lpns what parameters would you use when you notify the rn about it 12 okay so what do you mean 12 12 yes so as long as the respirations are above 12 what do we know about the mag is it okay or not it's okay but if it goes below 12 what do we need to do with the mag slow it down lpn's you notify the rn of that what about the reflexes what do we want for reflexes two we want plus two so if it's plus one what do we do to the mag slow it down if it's plus three what do we do to the mag speed it up so what do we want 12 and 2 we want at least 12 respirations and we want two reflexes what we don't want to see is 11 and 1. we don't want to see 11 respirations in lower and we don't want to see one reflex and lower plus one and lower so 12 and 2 is good 11 and 1 is bad okay the next class of ob drugs are the opposite of the tocolytics they are the oxytocics now the oxatoxics stimulate and strengthen labor remember the tocolytics stopped it these ones started the most famous is pitocin we've talked about it before the big thing you need to know about pitocin is it can cause uterine hyperstimulation which would be defined as what uterine hyper contractions longer than 90 seconds closer than every two minutes if you see that back off your pit remember that before from the last couple of pages longer than 90 seconds closer than two minutes the next drug that will cause your uterus to contract is methergine and the only thing you need to know about method gene is it causes high blood pressure now if it's going to contract blood vessels and contract the uterus if it contracts blood vessels what's it going to do the blood pressure increase doesn't make sense that vasoconstriction increases blood pressure so do you see the two m's method gene and mag they're both used in ob method gene and mag right what does one do to the blood pressure lowers it well the other one does what's in the blood pressure raises it so one of it low one of the m's lowers the bp the other m increases the bpm okay the next two meds are the fetal lung maturing meds the meds to make a beetle's lungs mature faster the first one is beta methyl stone what is it steroid and the other is cervanta which is surfactant so let me talk about three things you need to know about each with betamethasone number one it is given to the mother mom gets the beta method number two it is given i am and number three it is given before the baby is born before the baby is born and you can repeat it as long as the baby is in utero however cervanta on the other hand three things about it number one it is given to the neonate to the baby not to the mother it's given to the baby number two it is given trans tracheal which means blown in through the trachea and number three it is given after the baby is born not before cervantes is given to the baby transtrachealy after the baby is born whereas betamethasone is given to the mother i am before the baby is they both are given to make the baby's lungs mature faster is blown in they use a nebulizer kind of thing they can even put it in a connection to a ventilator pump it in okay that's it on ob we're done with ob that's the longest lecture of the whole review that's why i like to split it up with lunch okay we're going to go to page 51 medication helps and hints this is a very short lecture just designed to help you get some basic basic basic facts down because if you don't know these facts and you miss these questions you're in a major hurt the first one is what is humulin 70 30 what is it [Applause] it's a mix of insolence of r and n now you can have list bro 70 30 but but that's a variation when they say 70 30 they're talking about n and r basically now 70 and 30 are percentages so it means it's 70 percent 1 and 30 percent the other which one is which seventy percent is n and thirty percent is r so if you give a hundred units which you would never do it's way too much but if you gave a hundred units of 70 30 how many units of n would there be and how many units of r would there be if you gave 50 units of 70 30. how many units of n would there be 35 how many of our would there be 15. you see it's just you just multiply the percentages you know how to get a percentage just take that number and multiply by 0.7 for 70.3 for 30. the way i remember that n is the 70 is 70 30 is like a fraction what do you call the top term in a fraction what letter does that begin with n so n is in the numerator number two can you draw up can you mix insulin in the same syringe yes or no yes when you draw it up is there a certain way to do it which one comes first area says clear to cloudy force doesn't use the words clear or cloudy they talk about n and they talk about r now those of you that are taking the nclex are in this this will work better for you but is that what you want to be then do it that way rns will do it this way meaning draw up the what first r followed by the end that way you don't get into this clear cloudy garbage okay rns do it that way now if you're talking about pressurizing the vial which vial would you inject the air into first the end then inject then inject the air into the r then draw up the r then draw up the n so it's n r r n but it always ends in rn injections they will tell you what injection you're giving and they will ask you what needle you're going to use what needle will you use for giving a particular particular injection here's how you do that if they say you're giving an im injection and they want to know which needle you'll use 21 gauge 5 8 inch 22 gauge one inch 21 gauge 1 inch 25 gauge 5 8 inch they want to know what which one of those needs will you use for i am the clue is in the abbreviation look at the first letter of the abbreviation what number does that look like a one go pick the answer in which both parts have a 1 in it which one would that be c would be your answer did you see that why see the answer because both the first the gauge and the length both have a number one because an i looks like a one okay but what about this what if they changed it to sub-q here again look at the first letter in the abbreviation what is the first letter in the abbreviation s what number does an s look like a 5 go pick the answer that has a 5 in both of the parts and the answer would be d because you've got 25 and 5 8. so when you're asked to pick a needle just look at the abbreviation look at the first letter and go find the numbers okay turn the page we're going to talk about heparin and coumadin because they're in the top three most commonly tested drugs on boards if you don't know these you're in trouble heparin versus coumadin very very important heparin it is given iv or sub-q coumadin is given only po see i'm comparing and contrasting is what i'm doing everybody go back to heparin heparin is working immediately works immediately go to coumadin coumadin takes a few days to a week to work anywhere between a few days to a week go back to heparin heparin cannot be given for longer than three weeks and in parenthesis put except for lovenox remember the lovenox can be given for a long time regular heparin cannot be yes three three because in 21 days you start making heparin antibodies which could be really life-threatening coumadin can be given for the rest of your life can you not you can take cumin forever go back to heparin the antidote to heparin overdose is protamine sulfate they love that kind of stuff coumadin what's the antidote to coumadin vitamin k vitamin k how do you remember that yeah and put go back to heparin the lab tests that monitors heparin is the p t t p t t which is the partial thromboplastin time they'll give you both names the one that monitors the coumadin is the pt which is the inr from which the inr is derived now the way i remember that is several ways if you have your hands you can go what h e p a r i n how many fingers are left three p t t okay let's spell coumadin c-o-u-m-a-d-i-n how many fingers are left two p-t or you can cross you can write p t t cross them together what letter does that make which stands for heparin any of you guys computer people have you ever seen this http read it backwards ptt is h which is heparin okay so you can do it either way any way you want to do on that one heparin can be given to pregnant women coumadin cannot be given to pregnant women heparin can be given to pregnant women coumadin cannot be given to pregnant women by the way speaking of pregnant women what's the only major antipsychotic tranquilizer that can be given to pregnant women remember all those zines and zapines the only one that can be given is how long how doll is the only one you can give and a psychotic can give the pregnancy that's not gonna do what we're talking about but i just thought we'd throw it in the next thing is the k wasting and case fairing diuretics hay wasting and case bearing diuretics probably the only question you'll ever get about a diuretic is does it waste k or does it spare k the easiest way i know to do this is this any drug ending in x any diuretic ending in the letter x x's out k so if it ends in x it x's out k so what is it a waster or a sparrow if it ends in x it x's out okay it wastes it yes plus diurel so the k wasters are all the diuretics that end in the letter x plus diurel if it does not end in an x and it's not diuril it's a sparrow so i'm going to give you a bunch of drugs and you tell me whether they're wasters or sparers spironolactone aldactazide moderatic modoratic sparing lay six bumax klotrix etherdrex demodex direl wasting and uh yeah so you got it okay and back low fat is the last drug i want to talk about boards tests muscle relaxants as a class and you need to know your muscle relaxes now the only thing they test about muscle relaxants is the two side effects and the three teachers teachings two side effects and three things to teach the two side effects of a muscle relaxant are fatigue and muscle weakness does that make sense that a muscle relaxant would make you tired and relax your muscles fatigue and muscle weakness the three things you teach are don't drink don't drive and don't operate heavy machinery so what do you have to know about baclofen what are the side effects fatigue or drowsiness right drowsiness fatigue same thing right and muscle weakness what do you teach them don't drink don't drive don't operate heavy machinery now the other drug that they test is flexoril f-e-l-f-l-e-x e-r-i-l that's that's the other muscle relaxant they test flexoril and baclofen are the two muscle relaxants they test i am not going to teach you how to remember that flexural is a muscle relaxant because if you can't figure that one out i can't help you right so flex cyril you should remember say what because you flex your muscles well how in the world are you going to remember that baclofen is a muscle relaxant well i always say this when you are on your back low fan you are on your back low fence which means you're doing what if you're loafing what are you doing aren't you relaxing so there's your clue it's a muscle relaxing because baclofen puts you on your back loafing it's a muscle relaxant [Music] semi m-s-e-m-i-d-e-s not all of them but most of them okay let's talk about pediatric teaching on the next page we've only got three left guys actually three and a half left so we're cool this takes about five ten minutes this one because it's very short it's just a review of piaget's theory of cognitive development have you heard of that you do need to know piaget's theory but they will never mention piaget's name they will test your knowledge of piaget's theory of cognitive development by asking you how you would teach children and you're supposed to if you get a pediatric teaching question that's a chance for you to show your knowledge of piaget so let's talk about it piaget has four stages for kids thinking the first one is the zero to two year olds who are in the stage of sensory motor thinking in the middle column piaget says these kids are totally present oriented they don't think about the past they don't understand the future they only think about what they are sensing or doing right now so when do you teach these kids can you teach them ahead of time why why not they don't understand the future can you teach them after you do it no they can't understand the past so when do you teach them while you do it so when while you do it you teach them as you do it what do you teach them what you are doing do you notice the present tense there what you are doing and how verbally just tell them don't use play they don't understand play so if you get a kid from zero to two years of age and he's going to have a spinal lumbar puncture and they want to know how you're going to teach him what are you going to say while we do it we're going to tell him tell him what we are doing bingo that's all you do there really is no such thing as pre off or pre-test teaching for this age group for this age group who do you pre-teach the parents not the kid okay the second stage of piaget is the three to six-year-olds he calls them the pre-operational which i like because three to six is a preschooler correct and he calls it pre-operational so the two pres go together preschooler pre-operational they are fantasy oriented they are imaginative they are illogical their thinking obeys no rules you cannot reason with a preschooler if they can think it it can happen i mean they just there's you can't it is whatever well do they understand the future yes do they understand the past yes so when would you teach these kids would you teach them before yes how long before or doesn't it matter how long shortly before so here's the deal pick an answer that says the morning of or the day of or something like two hours before that is fantastic preschool because you don't want to give these kids a whole lot of time to what get their imagination going on it you so i'm saying my kids never at this age my kids never knew they were gone to the doctor's office until they pulled into the parking lot of the doctor's office otherwise we'd have had disaster that's why they never rode with me after that no what do you teach them what you are going to do what you are going to do what tense are we talking in now future what did we talk what tends to be talking with the younger ones present so now so how old does a kid have to be before you can start using future tense verbs three at least three good how play these are the kids that learn through play so in a nutshell if you've got a four-year-old who's going for a lumbar puncture how do you teach it when the day of you tell them what you're going to do using play some kind of a play thing alrighty a story a book equipment whatever dolls okay the next stage are the seven to eleven-year-old concrete operations kids the way i remember that 7-eleven age is concrete is have you ever seen a 7-eleven grocery store what's it surrounded by any flowers grass trees no just a bunch of concrete 7-elevens so just think of concrete 7-elevens you got 7-eleven age concrete operations these kids are rule-oriented they live and die by the rules they cannot abstract with these kids they are so rigid if you tell them this is the way it's going to be that's the way it has to be how many at 7 to 11 that age group how many ways are there to do things one and only one and every other way is wrong this is the age where the parent hears the teacher said and the teacher hears my parents said now have you ever taken care of these kids this age group have you ever changed a dressing for them or something like that what do they always tell you when you change their dressing you're doing it wrong which means what you're not doing it like the other person did it now are you doing it wrong no but they don't know that they're they're so rigid so when do you teach them days ahead because they're not going to blow it out of proportion if you tell them this is what's going to happen three days later that's what they think is going to happen so you can teach them a day or two ahead of time so how old does a child need to be before you could teach them the day before seven now you can give a little one a three or four year old a tour of the facility you just don't tell them what's going to happen there do you understand what i'm saying tours are okay you give anybody a tour what are you going to teach them what you're going to do plus skills what you're going to do plus you can teach a 7 to 11 year old how to do skills you cannot teach a three to six year old how to do skills why if you teach a 7 to 11 year old how to do a skill how will they do it every time exactly the way you taught them because they're rigid concrete if you teach a three to six year old how to do a skill how will they do it any way they can imagine you know you teach a three or four five-year-old how to give themselves insulin they'll do it just fine for you then the next day what will they do well i think i'll not put anything in there and i'll just jab and out and then the next day they go oh why don't i give it to the dog that'll work you know and they just don't they just no so what age does a child have to be before you could teach them a skill seven how use age-appropriate reading and demonstration use age-appropriate reading and demonstration okay the next stage group are the 12 to 15 year olds and they are formal operations these kids can abstract that's the big huge thing that they can do that the younger ones can't they can abstract and they can think cause and effect so here's the good news as soon as a kid hits 12 and they ask you about teaching it's not a pediatric question anymore it's an adult med surg question because how do you when do you teach a 12 year old and above like an adult what do you teach them like an adult how do you teach them like an adult so at what age is a child first taught like an adult trick question when's the first age that a child would be able to manage their own care 12. why can't can a seven-year-old do the skills related to their care could they manage it no what does manage me make what decisions which require abstraction because if you tell if if you got a board question like this which of the following four children could manage their own care a seven-year-old with cystic fibrosis no an eight-year-old with diabetes mellitus no a ten-year-old with a scraped knee no a 13 year old with chronic renal failure yes why did they put the 10 year old with a scraped knee in there to fool you because it's not the severity of the illness that determines who can manage but the age of the kid why could a 10 year old not manage a scraped knee what will you teach a 10 year old to do about a straight knee you tell them to do what wash it dry it put on neosporin and a bandit okay what will he do the next day wash dry neosporin bene because they do it exactly the way you said so when they do the third day wash dry neosporin band-aid the fourth day it's swollen what will they do wash dry neosporin band-aid the next day there's pus coming out of it what will they do walk dry neosporin bandage the next day it's swollen strike twice the size of the other leg what will they do wash dry neosporin band-aid the next day they're semi-comatose and they've got red streaks coming up and down the leg they can barely get out of bed what will they do wash dry are they managing no that's why they can't do it but a 13 year old with a chronic renal failure if they are taught auscultate your shunt every day to hear a brewee if they don't hear a brewery what will they do get help that's managing managing doesn't mean doing everything managing means knowing when you can and when you can and what's necessary so just be careful if they say manage it's a 13 year old if they say skills it's a 7 year old [Music] all right let's go to page 58. i want you to read this this is for you to read about and learn about i want it's about how to take psych tests all it is is a bunch of seven principles you have to obey the first principle says make sure you know what phase of the relationship you're in remember the nurse patient pre-interaction introduction or orientation working and termination phase remember that this tells you how to answer in each of those phases the second principle is gift giving which means don't give gifts in psych don't accept gifts in psych if your psych if your schizophrenic gives you flowers don't accept them why because to you it's just flowers to them it may be a marriage proposal and when you accept that you're in trouble okay number three don't give advice if the patient says what do you think i should do what should you say what do you think you should do i know it sounds corny but that's what they want you to say don't give them advice now can you give advice in med surgeon peace sure but not in psych because if a mother says to you how should i care for my child's picc line when she goes into the shower you should not say how do you think you should care for that guy when she go i'm saying it's stupid in med surg it makes sense in psych number four don't give guarantees in psych don't say if you cry you'll feel better if you talk to me we can help you remember all those stupid those are those are guarantees don't do that on that next page immediacy and you can read all about this i'm just showing you what it's about immediacy says if the patient says something what's the best answer the one that keeps them talking if you're between two psych answers and you don't know which one to pick pick the one that keeps the patient talking the one that says let's talk about it right here and right now let's keep talking don't pick answers that say refer them to the social social worker why if you're referring to the social group what are you doing to the communication right then and right there shutting it off don't do that even if it's appropriate for the social worker to deal with do you see what i'm saying keep them talking it's never wrong to get your patient to talk did you hear what i said it's never wrong to get your patient to talk so if one of the answers gets that patient to talk you better pick that because if you don't you're saying it's wrong to get a patient to talk it's never wrong to get a patient to talk that rule alone can really help you on site questions if you're sitting there and you're between two answers for example like a woman has has had a breast biopsy and she says to you when will there's when will the results come back do you think i have cancer my sister had cancer she died of breast cancer what's your best response and you're between a which says your results will come back in two to three days and the doctor will discuss them with you or b which says you're concerned about what the results may show both of those are okay but one of them doesn't get her to talk the other one gets her to talk which one gets her to talk b now is there anything wrong with a it's absolutely 100 correct but it says the results will come back in two to three days the doctor will talk to you talk to the hand that cares you know i mean not talk to someone who cares because i don't care whereas you're concerned about what the results may show gets her to talk but you see those are that's a real dilemma that a lot of people get into so when you're between two site quest answers remember it's never wrong to get the patient to so it's probably always right okay concreteness number six means don't use slang you know if the patient says i feel rotten about what i did don't say you feel rotten because then they go oh maybe i have you know maybe i'm you know rotting away and don't tell an upset patient to chill out you'll probably find them in the refrigerator [Music] because psych patients take you what literal and concrete so use don't say to a a client oh you know what goes around comes around now they're going like this all day long because they're worried about something going around and coming around that's figurative speech that stinks inside if a patient says to you you're a real prince levick what should you say um what's your brethren ah i tricked you prince lupic is not what concrete so you wouldn't say what the brisbane like you'd say you're confused about what my role is here i know it sounds really stupid but that's what they're gonna say or you're a real prince slovak i see you're angry you see what i'm saying that's perfect you don't use the dumb word they used you know what i mean you're a shabazniak what does shabazz no no you don't go there you know you don't believe me you don't want to go there now you may want to go there because sometimes it's really fun to hear about it it can be very entertaining but that's what makes me a bad psych nurse okay um the one i want to camp out on is empathy here you gotta know empathy because they won't license a nurse who's not empathetic believe me they won't empathy says the best like answers are those answers that communicate to the patient that the nurse accepts the patient's feelings feelings as being valid real and worthy of action empathy is all about feelings remember we talked about this the other day acknowledge feeling you're empathetic always be empathetic here are some really bad answers if you ever see an answer written this way don't even finish reading it it isn't worth your time here's a really horrible one don't worry don't feel you shouldn't feel i would feel anybody would feel nobody would feel most people feel all of those are as stupid as stupid gets i saw a question in a review book that shall remain nameless called saunders that said that a woman had a miscarriage and was crying and they wanted to know what the nurse should say and they said that you should say i know how you feel i had a miscarriage too now it's true you did have a miscarriage you know i'm saying it's not that you're lying but they said you should say that i'm telling you you never say that that is the stupidest answer i've ever heard you say something like what tell me how you feel well remember i don't like tell me how you feel that's very upsetting yeah that is so sad everything that has happened is so devastating you see i we don't like to say how are you feeling we want you to look at the scenario and assume remember you're always told don't read into questions but on these ones you have to read the feeling into what's going on this is the one place where you have to read into the question if you don't read in you're going to miss it because see if you're she's crying you say how do you feel that's kind of oh yeah you know but i see you're so sad everything is just this is just devastating you know that's good you don't say i know how you feel i did it too you know who cares okay turn the page i want to teach you a four-step process for answering anthony questions and if you use this you will do really well with them number one recognize that it's an empathy question empathy questions always have a quote in the question and each of the answers is a quote have you seen that format patience says quote what would you say a quote be quote see when you see that format what should you say to yourself every single time chance for me to show my empathy okay now here's how you do it because you're gonna have to read aren't you gonna have to read the feeling into it number two put yourself in the client's place their shoes and say their words as though you really really really really meant them be an actor get into it role play number three then ask yourself if i said those words and really meant them how would i be feeling right now okay now you got your answer now you got your answer all you have to do now is number four go and choose the answer that reflects that feeling or anything close do not choose the answer that reflects their words because these empathy questions always have what i call the sucker answer there it's an answer that's wrong but it's there to sucker you into answering it and what it will reflect is what the patient said but it will ignore what the patient felt you're supposed to pick the answer that reflects what they felt and ignore what they said did you hear that empathy ignores what is said and goes with what is felt don't get it switched around when people have a hard time answering empathy questions it's usually because they respond directly to what the patient said rather than how the patient feels do you remember when um i don't know your name but i said you're a real prince slimmick if you respond to what they said you'll say uh brinselbeck but if you respond to how they feel you'll say i see you're angry do you see the difference now i want you to do the next three questions practice questions and i want you to use these rules put yourself in the client's place say the words as though you really meant them ask yourself how would i be feeling if i said these words pick the answer that reflects that feeling i also want you to identify at least one sucker answer that over emphasizes what the patient said but missed how the patient was feeling so do that and then talk to your buddy and stay on task i'll be right back so yes um so the third one is really hard that third one the problem with it is when you put yourself in the patient's shoes and say those words no feeling really pops out so what you have to do is go to the answers and see what feeling the answers are reflecting and see which one has the best the most likely feeling so go to your answers and see if you can get it that way well let me ask you about the first one she said your killers you all killed my mother whatever you know you she died before i was born how does she feel if you said those words and believe them how would you feel scared okay now go to the answers and find the answer that reflects being scared which one is it b what is the sucker answer c c because that focused on what she said she isn't concerned about her mother she's scared she's frightened so the answer is b the sucker answer is c the next one what's the right answer d and a sucker answer is any of the others because the others focused on what he said d focused on how he feels did anybody get an answer on the third one what did you say the answer is c what's the sucker answer b because b says religious he's not feeling religious he's using a bunch of religious what words that's the hint that it's the wrong answer he's feeling out of control so that's why c is the answer because with those words i can prove to you that he has a control issue i can't prove to you that he feels religious so c is the right answer how many gods see on that one wow that's great how many got all three terrific if you missed any do you see why you missed it what were some of the problems you had with that anybody here you've learned from it any questions you have to me about those did you use the process [Applause] did the process help okay since that's what i want you to start doing i don't want you guessing on psych answers i want you to know the answer here's what i'm saying so many times you guys just guess on psych answers i want you to know why you're picking what you're picking okay take a quick break come back at 25 after and we'll just do the last lecture and a wrap up and be done okay and the sooner you're back the sooner we'll get done