Event 3: Pharmacology for NCLEX®

00:00 Let's go ahead and get started.

00:02 Um, and my name is Rocy O'Keefe.

00:06 I'm happy to see all of you here.

00:08 I've actually worked with many, many students throughout my career.

00:12 Um, I worked with, um, students as well as faculty.

00:16 I've been working in higher ed for over 13 years.

00:19 And today we also have Professor Lawes.

00:22 Some of you may be very familiar with her.

00:24 She was a professor at the University of Oklahoma.

00:27 She also works at Oral Roberts, also in Oklahoma, and she has many, many videos on YouTube.

00:34 So some of you may be familiar with Lecturio.

00:37 Um, and so she also has taught some NCLEX courses throughout her career.

00:42 So if you had the privilege of seeing some of her awesome, awesome videos online, you're sure in for a treat today where she's going to be covering a tough course on pharmacology.

00:52 So pharmacology can be very difficult and somewhat boring.

00:56 But if you've seen her present, you know she's going to be making it very exciting for all of you today.

01:02 Hey guys, my camera is just warming up there I am.

01:07 Hello. Hey! I am so excited that you're here today.

01:11 Now, I like pharmacology way more than you do, but let's get warmed up.

01:16 Alright, so what I want you to do is to pop in the chat.

01:19 One generic drug name that you know, just any generic drug name.

01:23 Pop it in the chat. Right? Okay, so put it in. Oh fancy amantadine.

01:28 And look at you guys. You're saying things I can't even pronounce, let alone spell. Rock and roll.

01:34 Look at this. Okay, nice.

01:37 Nice. Okay, so I think there's a few more of you out there.

01:42 Let's hear it. I need to see a few more.

01:43 Let's go before I get revved up.

01:45 Nice. Very good. Okay.

01:50 You've done a fantastic job just getting right in there.

01:53 Okay, now, what I want to do is kind of show you why we're here.

01:57 Oh, honey. Carbidopa levodopa.

01:59 I love that Carbidopa is levodopa.

02:02 Best friend. Right? He kind of runs interference for him and helps him get into the brain. Well done. Here's what we're going to do today.

02:11 I'm going to give you some tools that help you study critical farm information.

02:16 I'm going to help you recognize farm emergencies.

02:19 So you have the NCLEX coming up or you have a final coming up.

02:23 We're going to get you ready.

02:24 Now I just have an hour.

02:26 Okay. So I'm going to introduce you to these topics.

02:29 But I have loads of farm videos available on Lecturio.

02:33 You can always check it out. You get the first 24 hours for free, and then it's only like 9.99 a month.

02:38 So they priced it for students.

02:40 So I like that part of it for sure.

02:43 We're also going to talk about answering farm questions.

02:47 Now we have some other webinars that are all about test taking strategies dosage calculation if you're worried about that.

02:54 Those are available for you and I hope you'll check them out.

02:58 Okay, so let's get looking at let's get going and looking at evaluating and creating study tools. Because how many of you now be honest.

03:08 What do you think the highest number of flashcards are that you've ever made for a test. Right. So put your number in there for a farm test.

03:18 Oh my goodness. There's 300 200 501 to 0 I love it.

03:24 Yeah yeah okay look at that.

03:26 Too many to count I love it.

03:28 Oh Sophie for okay. You guys have done some major flashcards.

03:33 The problems with flashcards is if you make too many of them.

03:37 Oh, you bought 500? Okay, if you make too many of them, here's the deal. You don't have time to study them.

03:45 Has anyone had that experience where you spent all this time making flashcards? I've had students bring tubs of flashcards into my office, and then they're like, hey, I didn't even get the time to study them because I was so busy making them.

04:00 Right, Danny? I hear what you're saying.

04:01 I didn't feel like I had time.

04:03 I'm going to give you a better way.

04:05 Okay. One of the things we do is that we have videos that you can download notes and then write your own notes. See, just using someone else's notes are not the best way to supercharge your memory.

04:18 Studying as you go. Now, we call it spaced repetition.

04:21 But also, I want you to think when you're looking at your notes, try and pause. So when you're studying, when you're previewing for your final exam or you're getting ready for a test, I want you to always stop, pause, even close your eyes and think.

04:36 Two questions. Why would a nurse need to know this? How would it keep a patient safe? Okay. You're so busy cramming fun facts into your brain.

04:47 You miss the application piece.

04:49 And you know what the application pieces.

04:52 Their test questions? Right.

04:54 It's how you're going to use it in practice, but it's also how you're going to get that grade on the exam that you need to keep going in nursing school.

05:02 Like let's take a look at an example.

05:04 If you looked at IV solutions now, if you have ever studied IV solutions, just write a name of any IV solution that comes to mind.

05:12 I want you to write it in the box.

05:16 Nicole. The two questions were.

05:19 Why? I just need to know this.

05:21 And how would it keep a patient safe? Okay, good. Let me see some more.

05:25 Alright. Who's got a fancy one that involves? There we go. I need one with a five in it.

05:30 Do you know any IV fluid that has a five in it? Yes. D5w for the winner.

05:36 Ding ding ding ding ding ding ding. Okay.

05:38 So when you start looking at information like this like look here's a slide.

05:42 Yeah there's good information on here.

05:44 This helps us recognize how fluid shifts in and out.

05:48 And if you're not familiar with this, it's okay.

05:51 I mean, we're not going to teach this part of it today, but I just want to give you an example.

05:55 When I look at a piece of information with all this data and stuff on it, my brain doesn't know how to focus on it.

06:02 So this is what I want you to stop, pause, recall.

06:05 Think. Hey, why does a nurse need to know the osmolality of 0.9% normal saline? Oh, the reason I need to know that is because normal saline is the same osmolality as blood. And if I'm giving normal saline, then fluid is not going to shift.

06:24 That means I'm likely not going to shift fluid into the intracellular space and drop that patient's blood pressure.

06:31 I'm not going to shift fluid into their brain cells and cause them to have a massive headache or maybe cerebral edema.

06:39 So instead of just memorizing a lot of information, which honestly, is that not how nursing school feels like? I'm not an encyclopedia.

06:47 Why do I have to memorize all this stuff? Memorizing never works.

06:52 It is much better to put things in your brain in an orderly fashion.

06:57 You're going to do better on your exams than if you try and just cram a whole bunch of stuff in there that's not going to stick around for long.

07:05 So, for example, when we teach the IV fluids in there, we'll talk about like stop and think, what are three types of IV solutions? So if you have like one, two, three, I want you to think about in your mind, you don't have to enter it for us.

07:20 But what are the different types of IV solutions if we're talking about tonicity.

07:26 So one is isotonic. Can you guys tell me the other two.

07:30 Yeah. Good. Isotonic. Hypertonic and hypertonic.

07:38 Good. Hey Lina you have a fantastic question there.

07:42 Can we help you study? The answer is Absolutely, because I get overwhelmed.

07:47 It's like when you go to the grocery store and try to buy deodorant or girl things.

07:53 There's too many choices, right? Sometimes you get overwhelmed.

07:57 So absolutely, we can help you.

08:00 Um, we can help you figure out what your goals are and help you sort that out.

08:03 So not a problem. Now, look at this as I was.

08:08 If I was studying IV fluids more than just writing a flashcard out that says this is isotonic, this is hypertonic, I'm going to start asking myself questions like which IV fluids would cause fluid volume to shift this way or to shift that way.

08:23 So when you're studying, I want you to start thinking about how can I ask myself questions? Because how many of you guys use this when you study? So just tell me, what's your favorite color? Put your color in the chat.

08:37 What? Guilty. I love it.

08:39 What color? Okay, good.

08:42 Now. Sometimes. When you guys come into my office and you want to meet for office hours because I still teach with students, um, you'll open up your textbook and I'm like, whoa, I gotta put sunglasses on because that is coloring, not highlighting. So highlighting is okay, but it's not the best way to learn.

09:02 Asking yourself questions.

09:04 Kind of an education nerd.

09:06 Like, that's what my doctorate is in.

09:07 And I promise you, I could bore you to death with the research that says this.

09:12 Just reading and highlighting is not an effective way to study.

09:16 Okay. You have to start asking yourself questions.

09:19 Now if you're frustrated with like, I don't know which questions to ask.

09:23 We have those questions associated with every video to get you started, kind of get you warmed up in your brain juices flowing.

09:31 Because here's another way you can look at studying IV fluids.

09:35 You would name the solution like if we said hypertonic solution, right? Who shouldn't take that? Wait. Why are you asking me? Who shouldn't take an IV solution? Because that's how we ask test questions, right? The purpose of NCLEX and nursing exams is how do you keep a patient safe, right? So they want you to recognize do you recognize when this patient is getting into danger or if that order would put the patient in danger? Well, if I have someone with a head trauma, I don't want them to have a hypertonic solution because that will cause fluid to shift into the cells like the ones in their brain. Okay, cool. Well, Danny, we're going to teach you more than just warfarin, I promise.

10:23 You're going to walk out of here knowing more than that.

10:26 So the first thing is, I want you to think about how you're studying flashcards. No. Okay. I want you to not do that anymore.

10:35 That feels comfortable to a lot of people because you feel real busy.

10:38 But I promise you, it's not efficient.

10:40 Highlighters. That's a first step.

10:43 But remember, it is not going to get you where you want to go.

10:47 Asking yourself questions.

10:49 Aha. That is research based.

10:52 That's what's going to help you be successful.

10:55 So let's take a look at a question.

10:56 You guys ready. So tell me in the chat if you're ready.

10:59 Say ready. Yep. Go. Whatever.

11:01 Let me see that you're still there. Oh, yep.

11:04 With two P's. I like that.

11:06 So sweet. Okay. So we're going to look at this question.

11:10 Now let me give you some ideas as you're talking through a question.

11:13 The nurse cares for a client.

11:15 Where are we. So tell me in the chat.

11:17 What's our setting here.

11:19 Because that makes a difference.

11:21 Er. Perfect. So I was admitted.

11:23 The patient was admitted with abdominal trauma.

11:27 Well, if you've done our our test taking strategies with us, you know, that's a diagnosis.

11:31 And what am I most worried about with an abdominal trauma.

11:35 Anybody tell me in the chat.

11:37 What am I What's the biggest risk? Bleeding. Awesome. Okay, so abdominal trauma.

11:42 I'm worried about hemorrhage. They have this accident.

11:45 The client's vital signs are heart rate of 126.

11:48 Well, you know, when you study with us.

11:50 Heart rate. That's the number.

11:52 Is it high? Lower number.

11:54 Low or normal? So 126.

11:57 High blood pressure 90 over 58.

12:00 Is that high? Low or normal? Oh okay. So we're putting it together right.

12:05 We got a patient who has a risk for hemorrhage.

12:08 They're showing us signs of what does a heart rate over 100 and a blood pressure below 100 mean. You got it. You get great.

12:17 Yes. Bleeding. Hypovolemic shock.

12:20 Respirations 24. Yeah, that's kind of fast, but I'm not super impressed. And temp of 98.9.

12:26 That's not a problem. Last sentence.

12:29 We even put a space in there for you to help remind you the last sentence is super important. So which of the following orders.

12:36 Would it be most important for the nurse to what the nurse to question? So, am I looking for something that's safe for the patient, or is the question asking me for something that's wrong or unsafe for the patient? You got it unsafe. That's one of the main errors people make on test questions or NCLEX questions. Do you know what you're looking for? Now, we recommend that you go all through this and eliminate answers, not gravitate toward answers.

13:07 But what I'm thinking about here is that's a is an IV fluid.

13:12 B is an IV fluid. C is an IV fluid.

13:14 And D is a volume that we're putting into patients.

13:18 So I'm not going to be as worried about the unit of packed red blood cells.

13:23 Right. Because that might replace what we know is going on when it comes to IV fluids.

13:28 I have to know are they isotonic hypertonic or A bird tonic.

13:34 Now, can you tell me which type of fluid we don't want to hang? What type of fluid do we not want to hang? You got it. I see a couple of you already on it.

13:44 We don't want to hang hypertonic.

13:46 Now tell me why we don't want to hang hypertonic.

13:49 What's it going to do to this patient.

13:53 Fluid is going to shift into the cell.

13:55 Yes David on it dude. On it, on it, on it.

14:00 You guys are fun. Yes.

14:03 If I hang a hypertonic fluid, fluid is going to shift from the bloodstream, the intravascular space, into the cells, and that's going to tank the blood pressure. You got it.

14:14 It's also going to go to the brain, but it's going to go into all the other cells. And it's going to drop the blood pressure. And that puts our patient at work, uh, at risk so that you got it.

14:25 Good job. Okay, guys, if you need a little brush up on IV fluids, we have a lot of stuff on that.

14:30 But more study tips When you're thinking about side effects, there's like 4 million of them, right? So I looked at beta blockers.

14:40 I want to tell you, when you think of a patient, I always think of a patient from head to toe, because I don't know if you have ADHD, but I do.

14:49 Okay. So I have to teach my brain to do things in order and to focus.

14:54 And so I systematically think through things in my brain.

14:58 Head to toe. That's how I take care of my patients.

15:01 That's how I take report I give report, that's how I prep to talk to a doctor, to make sure I have all my ducks in a row. You see what we've done here? I think about beta blockers and I think about what are the risks for this.

15:14 Well, you know, beta blockers and bronchospasm, remember that gets those beta receptors.

15:18 Anything a drug can do well it can do overwell which students have got me a t shirt with that saying on it before.

15:25 So it can cause hypotension, can also cause some nausea and vomiting.

15:29 But am I really worried about nausea and vomiting? You guys worried about nausea and vomiting as a side effect? Is that going to be a major test question? Yeah. No. We sound real mean when we say that because I hate nausea and vomiting, but it's not the priority.

15:44 So when you think about side effects this is how you can chunk them in your brain.

15:49 Think is there a is there a neuro issue? Not really. Is there a lung issue? Oh yeah. Bronchospasms.

15:55 Does it affect the heart? Yep. It's going to slow it down.

15:58 Make to low blood pressure, GI nausea and vomiting.

16:02 But any medication can make you nausea and vomiting. And then.

16:05 Oh well how do you do.

16:07 There's a new one. Impotence.

16:09 Yeah. Men are not going to be super excited about taking this med.

16:13 Uh, so here's your other study tip.

16:15 I want you this write.

16:16 It won't kill you, Wanda, but it is an issue.

16:19 It'll make people not compliant, which will eventually kill you.

16:23 So think about the side effects.

16:25 Group them together. Head to toe.

16:28 Make sure that if it takes out an organ like bronchospasm is going to be a really big one.

16:33 But make sure if it's hard on your kidneys, hard on your liver, you note that in your studying, look at calcium channel blockers.

16:40 We did the same thing head to toe.

16:44 So in your notes, if you do that right, right.

16:47 Abcs are always important.

16:49 Breathing's going to be an issue. But if you also start grouping symptoms together head to toe, that's going to be an excellent study tool for you.

16:58 Now let's get down to business.

17:00 Here are the pharm emergencies you need to know.

17:03 Remember, I don't have as much time with you here today because we want to keep this short to respect your time. But I go through all of this in more detail on the website.

17:13 So let's talk about pharmacology and pain control.

17:16 Well, you guys know these things, right? Let's do it in like 60s pain is what the patient says it is, whether they appear to be very calm.

17:25 If they report that pain is a level eight out of ten, it's an eight out of ten.

17:30 After you give any pain medication, always reassess and respond, okay? So always reassess and respond.

17:37 No. This drug naloxone.

17:39 Does anyone know the trade name for naloxone.

17:43 What do we give to patients with an opioid overdose? Narcan. You guys are the bomb.

17:50 You're on it, right? So remember, I don't I can't speak for your nursing schools, but on the NCLEX, you need to know the generic names of the drugs. The trade names are not on their opioid triad.

18:02 Ding ding ding ding ding ding ding ding. You need to recognize that pinpoint pupils respiratory depression and loss of consciousness.

18:09 So if I'm thinking about man what are the main emergencies I need to know about pain meds? It's these pain is what they say it is.

18:16 After giving it, reassess and respond.

18:18 No Narcan and recognize the opioid Triad because a test question may come at you like, hey, your patient's pupils look like this. Their respiratory rate. Is this their loss of consciousness? It's going to throw it at you in a way they want to recognize if you know the patient is on opioids.

18:38 So I love it when teenagers when you ask them if they've taken anything, they say no. And their pupils are like teeny tiny.

18:45 You're like your eyes.

18:47 They say something different, my friend.

18:49 Now let's talk about the respiratory system.

18:51 You're going to be getting all kinds of information about the respiratory system.

18:55 So ready. Tell me in the chat if you're ready.

19:00 There we go. All right.

19:04 Asthma. Not a fun thing, but let's talk about it.

19:07 It's got two parts. So if I'm thinking about studying for asthma, I know I've got to treat the inflammation and the bronchoconstriction.

19:16 That's why they can't breathe.

19:18 So if I'm going to have a complete therapy for somebody with asthma.

19:23 I'm going to do something that reduces the inflammation of that airway.

19:27 Corticosteroids like a beclomethasone.

19:29 And I'm going to give something that treats the bronchoconstriction.

19:33 Now remember that in my lungs in my bronchial tubes wrapped around them are smooth muscle.

19:40 And when someone has an asthma attack it clamps down.

19:44 So you're trying to breathe through something like this.

19:47 That's why it can't be done.

19:49 So you guys need to recognize bare minimum.

19:53 What is a rescue inhaler? That's a short acting inhaled bronchodilator.

19:59 A saba, right? Short acting s a b a beta two adrenergic agonist.

20:07 Which ones are rescue inhalers? Like albuterol? Yeah. You guys got it.

20:12 And then which ones are longer acting? So have to knows. I remember when I would be working with teenagers, you would always be like, hey, who's got their inhaler? Because not every kid with asthma remembers to bring their medication.

20:25 So we share that, just as sometimes you get real desperate on what you need to know.

20:29 Great way to test you is to recognize.

20:32 Do you know the difference between a rescue inhaler and one that's used on an everyday basis? Do you recognize with asthma, we need to have long term treatment for the inflammation and rescue treatment.

20:45 Okay. Now we're going to look at infectious diseases.

20:48 Oh my lanta. There's a lot of content here right.

20:51 But this group highest potential for allergic reaction of all the medications we give, if there's one that's going to cause an anaphylactic reaction, it's this group. So on a test question, if a patient is taking antibiotic they're showing you any signs of reaction.

21:11 Stop it completely okay.

21:12 So tell me in the box okay.

21:16 Tell me in our chat what would be a sign of I don't know why I did quotation marks.

21:21 What would be a sign of an allergic reaction? Hives. Good. Rash? Yes, yes.

21:27 Itching rash on it. Whoop, whoop.

21:31 You guys are getting it.

21:32 There you go. Okay, we got some, like, near-death ones and some minor ones.

21:36 So anything as a minor, as a rash, completely stop the medication.

21:42 Right. It's always about safety.

21:44 Stop it, stop it, stop it.

21:45 Don't take anymore. See, as nurses, it's within my scope of practice to say, don't take that medication.

21:52 Contact your health care provider. Okay? I can't change the dosage, but I can tell them to stop now.

21:57 This other one, they'll try and zing you with it.

22:00 Cultures before antibiotics, cultures before antibiotics, cultures before antibiotics.

22:06 So if I have somebody come in with I think they have pneumonia, I'm going to try and get that sputum culture before I give antibiotics.

22:13 Now I'm going to give those antibiotics quick, but I'm going to give them a good estimate.

22:17 Educated on what I know is in the community. I'll give them that antibiotic and then after the results come back, I make sure it's the right drug for the right bug. That is what we're looking for.

22:29 Okay. So here's generic things you want to teach all patients if you're on antibiotic.

22:34 Lots of fluid. Well, short of you having heart failure or renal failure.

22:38 Everybody should have lots of fluid.

22:40 But specifically stay out of the sun.

22:42 Wait a minute. You guys have had a lot of note cards, right? And so you've you've probably tried to come up with like this whole phantasmagorical system for remembering which, which, which I'm telling you, you can't do that. Okay.

22:58 So just know if you see a test question there on something that you recognize as an antibiotic, they're having something of a reaction.

23:06 Stop it. Okay. Just stop it.

23:08 The ones that are worth you spending time noting are the antibiotics that take out your kidneys. Right? Those that are really nephrotoxic, those would be the ones that you take a look at.

23:19 Otherwise let's look at antibiotics as a category.

23:23 Drink lots of fluid. Stay out of the sun.

23:26 Not all of them make you photosensitivity, but nowhere in healthcare do we say, you know what? Go on out and fry yourself.

23:32 Or hop in a tanning bed.

23:33 So that's a good one to remember that some antibiotics make you photosensitive.

23:38 You want them to take the entire prescription, not just part of it, and stop when they feel better.

23:43 And don't take antibiotics for a virus so you don't get antibiotics for the flu.

23:48 You don't get antibiotics for a virus. Make sure they know that.

23:51 Here's a really tricky one.

23:53 Did you know that there's a small percentage of patients? If they have a penicillin allergy, they cannot take cephalosporins.

24:00 They may have a cross allergy.

24:02 So that means in a test question you could say the patient has a history of a penicillin allergy. Which of the following questions or which of the following orders would you be concerned about anything that involved a cephalosporin would be a no way in NCLEX world. Okay. Because of that small percentage of yes that right.

24:22 And Ebony don't drink antibiotic alcohol.

24:25 Really we don't recognize you like tip it high and drip it dry on any medication.

24:30 But antibiotics also is true.

24:33 Be familiar with the treatment for MRSA.

24:35 Okay. That is something that could likely come up because it's such an issue.

24:39 I wouldn't go through and memorize all the drugs antibiotics for certain treatments, but no, that one I cannot recommend enough.

24:46 Look up the drugs that are ototoxic and nephrotoxic.

24:48 We give you a list of those on the website if you want it now here.

24:51 No the evaluation. It's not enough to know that a drug is hard on your kidneys.

24:56 You have to know how to recognize why and how that drug is if it's affecting your kidneys.

25:02 So for kidneys, you need to know the normal values of bun, Bun and creatinine. We've got those here for you.

25:10 This would tell me if a patient was on a nephrotoxic drug.

25:15 I would look at a Bun and creatinine and make sure it's within normal range.

25:19 If the Bun is high or the creatinine is high, I would not want to give the next dose of that medication.

25:26 Yeah. Gfr is even better because then you're right.

25:29 So when you're thinking about what are the negative side effects of the 4000 that are listed for every drug, any drug that is toxic to an organ, that's the one you got to know.

25:42 Okay. That is the one you got to know.

25:44 Now we have a good couple hundred drugs in our farm.

25:47 Course. I would actually feel comfortable with you just learning those drugs and recognizing it is not unusual to hit the NCLEX and see a drug you don't know.

25:56 That shouldn't happen to you in nursing school, because you should know which drugs are going to be on the test.

26:00 But it could happen to you in NCLEX and you just stay calm.

26:04 So think about if the drug goes after an organ, know the lab values and the ways we would assess that.

26:09 Think of weird extreme side effects like I'm going to talk about vancomycin in red man syndrome. That's one that's worth your time.

26:18 And sulfonamides. Stevens-johnson syndrome.

26:21 So those are two that are really unique and could likely have a test question whether nursing school or a standardized test.

26:29 Those are the types of things, the outliers.

26:31 That's why I'm sharing them with you today.

26:34 You absolutely want to know those.

26:35 Remember, we've talked about overall things about antibiotics as a category.

26:41 So tell me one example.

26:42 Write it in the chat for me of something we talked about for all antibiotics.

26:46 What's one patient education piece we tell anybody on an antibiotic.

26:53 That one's going to take a little longer. Increased fluids. That's right. What else? Step out of the sun. You got it.

27:00 You guys are good. Finish the course.

27:02 Man, that works great for nursing school, too.

27:05 Okay. So we've talked about.

27:09 Yeah. There you go. We've talked about some big categories, some individual things to remember when I'm studying and prepping for what I need to know about each category, I first think about them as a group and then I break them into families. So once I know these overall categories, I would remind myself about which drugs go into cephalosporins, which drugs are falling into the penicillins.

27:34 Those are easy because they all have cell ins in them, right? But we have lots of other categories of antibiotics.

27:40 Learn them as categories, like there's a fluoroquinolone that if you give it to somebody who's too young, you can risk a tendon rupture.

27:49 So fluoroquinolones have that weird side effect.

27:52 If that sticks in your head, that's a good thing.

27:55 But I don't likely think that is going to be the major point of the question.

27:59 They're going to be looking for big things.

28:02 Sophie. Cultures first.

28:06 Yes, they'll try to trick you on those questions.

28:08 So remember you need antibiotics quick but cultures first okay.

28:14 So let's talk about fluid balance now.

28:16 Diuretics. Hey, guys. Um I want you to look at this word.

28:21 Alright. Thesis. And this is a tip a real study tip for anything that you're studying.

28:27 E that can be a diuresis, which is if we give you diuretics, it can be a thoracentesis.

28:35 So a thoracentesis is pulling fluid out of what body cavity.

28:40 What's a where's a thoracentesis.

28:42 Pulling fluid. Lung. You got it.

28:47 That's perfect. Now if I have a pair of centesis pair a centesis.

28:53 Where am I pulling it? Abdomen. All right. Fantastic.

28:57 Anytime I remove fluid, whether I'm sticking a needle in you and again pulling it out. Or I'm giving you medications that cause fluid removal, right? You pee it out.

29:10 The biggest risk to my patient is circulatory collapse.

29:13 When you cause fluid volume to shift, we're at risk for their blood pressure dropping. Okay, so I know with diuretics, you guys are really up online.

29:23 Like, watch that potassium, watch that potassium.

29:25 It's true. But I want you to be aware that any diuresis thoracentesis, paracentesis diuresis with medications.

29:34 I'm really going to watch that blood pressure.

29:36 That's a circulation issue I'm going to watch it closely.

29:40 Now Lasix is also known as furosemide right.

29:43 That's the generic name that would be on your test. It's the most potent, the one that we have, but it also drops your potassium the most.

29:52 Here's a trick. Here's a tricky question.

29:55 If you have a patient on digoxin, I'm going to say this really slow.

29:58 Not because you're slow, but I want to make sure it's clear.

30:01 Anyone who has low potassium for any reason is at an increased risk for damage toxicity.

30:09 If you have low potassium for any reason, you're at an increased risk for ditch toxicity. One more time.

30:19 Low potassium for any reason puts you at an increased risk of ditch toxicity.

30:27 So you want to watch for that in NCLEX questions or in testing questions because they won't say ditch toxicity.

30:35 They'll show you the signs and symptoms of ditch toxicity.

30:38 Even though that's a drug we don't give a lot. Sometimes that's a test question that comes out. Now we use diuretics for first line hypertension treatment.

30:45 Because diuretics drop the amount of volume you have in your body, lower volume in your intravascular space.

30:54 What happens to your blood pressure whenever I have less fluid in my intravascular space.

31:00 Does my blood pressure go up or down on it? Nice, right? Remember any fluid volume shift when I say risk of circulatory collapse, which vital sign am I talking about? When you say circulatory collapse, which vital sign am I talking about? Bp. Nice nice nice. Now, here's another thing about some diuretics.

31:21 Don't drop your potassium.

31:23 Furosemide. Hydrochlorothiazide.

31:26 Those are considered loop diuretics. They drop your potassium.

31:29 So I'm on the lookout for that.

31:31 But potassium sparing diuretics, they don't pull a lot of fluid off, but they don't mess with your potassium.

31:38 So what the deal is with these you don't give them with.

31:44 There you go. You got it.

31:45 Spirolactone is a great example of a potassium sparing.

31:49 You don't give them with Ace inhibitors, because let me tell you something about Ace inhibitors. And it starts with ace.

31:55 See. Okay, there are three really important side effects that I want you to remember about Ace inhibitors. The first one starts with a.

32:05 All right. So a is any edema.

32:09 That is when that Ani.

32:12 Got it. Sweet angioedema right there.

32:15 Tongues starts to swell.

32:16 C is for cookie. Anyone know what E is for? Beautiful. E is for elevated potassium.

32:26 That's right. So if you're going to remember three things about Ace inhibitors, that's what you want to know.

32:31 Let's take a look at this one.

32:32 The nurse is caring for a patient on a medical floor who's receiving furosemide daily. We're already thinking I'm a nurse.

32:39 Medical floor furosemide.

32:41 I know that drops their potassium.

32:43 What about blood pressure? Which of the following is the most important nursing action? Okay, look, here's the deal.

32:52 Are any of those wrong? All of those are correct answers.

32:59 So when you hit a test, prepare yourself.

33:02 They might all be right, but now you eliminate and say which one keeps the patient the safest intake and output.

33:09 I'm going to do that, but that's not what keeps them the safest.

33:13 I see a lot of guys going for blood pressure.

33:15 Let's just see. Okay. So blood pressure that's a circulation thing.

33:19 That's good I'll leave it in.

33:20 But let me compare it to be.

33:22 No. A would keep you safer than B.

33:24 I can eliminate B because daily weight can change for lots of things.

33:28 Let's look at C and compare it to a.

33:31 Assess the patient's heart rate.

33:33 Well that might tell me if they're really low their heart rate could be high.

33:36 Yeah. But blood pressure is going to drop before then.

33:39 So a is a better answer.

33:41 What about D. We already ruled that out.

33:43 So you are right. The correct answer is A.

33:47 I want to get the earliest sign.

33:50 What are they trying to test you on here.

33:52 Do you recognize that furosemide causes a diuresis? Okay, that's what you're looking for.

33:59 Excuse me just a second.

34:08 Apparently, I tripped over my my power cord earlier, and it was just telling me I'm going to shut down if you don't plug me in right now.

34:17 So there we go, back to what we're talking about.

34:22 Um, they're trying to get at.

34:24 Do you recognize as a student that a diuresis will cause your blood pressure to drop? That's what they're looking for.

34:32 Okay. So, Catherine. Right.

34:33 A is your top priority.

34:35 But yes, B, C and D are all correct.

34:40 Right, right, right. Marina.

34:41 The heart rate changing would be a later sign than your blood pressure.

34:45 First, your blood pressure would drop and then your heart rate would start compensating. Yes. You guys are thinkers.

34:51 Thank you. Yeah. Daniel.

34:54 Highest degree of correctness.

34:56 I think that is the most politically correct way I've ever heard that said yes.

35:01 Very, very, very good.

35:03 Okay, let me talk real quickly about lithium toxicity.

35:07 When it comes to psych medications, we give a lot of lithium.

35:10 So again we have them head to toe right.

35:13 Sedation. Confusion. Tremors drowsiness nausea vomiting diarrhea.

35:17 Okay. Are we worried about nausea and vomiting? We know it's there, but it pretty much comes everywhere.

35:22 But muscular weakness and loss of coordination.

35:25 If my patient is having all these changes, it's going to start to make me be more alert.

35:31 But honestly, I can't memorize sedation, confusion, severe tremor drowsiness, seizures.

35:38 Okay. So I'm going to chunk this information together.

35:41 You guys tell me in the chat how would you group all those things together? Not so you remember each individual thing, but so you remember, there's a problem. What might you do? You're thinking, I like that.

35:58 There you go. Excellent.

36:01 Excellent. Okay. That's how I want you to study.

36:05 So instead of trying to memorize one, two, three, four, five, six things, say, if anyone's taking lithium and they got anything weird CNS side effects.

36:13 I'm on alert. Okay. Period.

36:16 Pretty much if anyone's taken a CNS medication, a central nervous system, medication, and they're having anything abnormal in the CNS system, be on alert.

36:27 Okay. So you got that.

36:29 Now, I saw someone wrote CNS and Ms..

36:30 Yes. Those would be the two things I would look at.

36:33 Any neuro things or any muscular things which is still controlled by your CNS.

36:38 Beautiful. Now I just have to remember a major category in that I can do therapeutic range for now until the NCLEX in 2023, you're going to have to know therapeutic range. You check with your schools.

36:52 Do you need to know the therapeutic range of these medications for your test? That's really important. Toxic.

36:57 Toxic is usually greater than 1.5.

37:00 As a general rule, if a drug has a lab test like this for a serum level, you should know it. In practice, they put that right on the little lab form, but it seems to be a very, um, a very popular way for faculty nursing faculty in school to test you is to ask you a question about the therapeutic range.

37:21 Now, let me ask you this.

37:23 If the medication, if the therapeutic range is at 1.2 and you have an order to give the lithium, should you give the medication or should you hold it? If the therapeutic range is 1.2, should you give the medication or should you hold it? Okay. If the if it's 1.2 and when they did it and normal is 0.4 to 1.3, you should give the medication okay.

37:54 Don't hold it. The only reason you would hold it and contact the healthcare provider is if it was above 1.3. Okay.

38:03 So that's another way they can ask you a question when there's a therapeutic range.

38:07 They can just give you the range and say would you hold the medication.

38:10 Would you give the medication.

38:12 What would you do? So know that if it's within that therapeutic range, if it hasn't exceeded it, give the medication.

38:19 Otherwise they won't stay in that therapeutic range.

38:22 Make sense? Okay so let me know in the chat.

38:26 Did that make sense why we would give that medication.

38:31 Brett 1.2 is still within the medical.

38:34 You know what, if it was 1.3, you'd still give it.

38:37 If it was 1.3, it's still fine.

38:39 You would go ahead and give it.

38:41 Yeah. Great. That's why.

38:43 Uh huh. That's why we're here.

38:44 Yes. That's right. We want to help you.

38:46 So let's look at this one. Mr.

38:48 Yost has a history of bipolar disorder.

38:49 He's been taking lithium daily, and he's called the clinic to discuss a concern with the nurse working with the health care provider.

38:56 Which of the statements is most important for you to follow up on? Okay. That last sentence.

39:02 Remember, it's our last focuser, which is most important for you to follow up on, is the one that says what this particular patient in this particular setting is in danger. So what do I know about this patient? Bipolar. And they're on lithium.

39:19 So looking at this. What else do you need to know about lithium.

39:31 Okay. Now remember we talked about those negative side effects right. The adverse effects. You would ask yourself through each answer choice, what does this have to do with lithium or bipolar risk? What does this have to do with lithium or bipolar risk? Now you can see, um, even though we do want people with bipolar taking their medication every day, that's not the biggest risk right now of these D is the intended effect of the meds. So B and D we eliminated.

40:03 We're left with A and C a.

40:07 I get very dizzy when I stand up.

40:08 Could be orthostatic hypertension.

40:11 So I do want to worry about that because you know lithium does cause someone to pee out a lot sometimes. But see, my legs don't seem to work right.

40:21 What do we remember about worst case scenario with lithium? Oh, it's lock changes or muscular changes.

40:28 Alright, so muscle weakness.

40:31 That's what we're looking at.

40:32 Okay. Again that means they're getting toxic on their lithium because now they're losing muscle coordination. And we know that with lithium, two things for sure CNS problems and muscle changes.

40:47 That gives you an idea. We've talked about the two questions.

40:50 Why does a nurse need to know that a sign of lithium toxicity is CNS problems and muscle problems. So you can recognize it in your real life patients and know that this person's in trouble? We need to get a lithium level to know if they're in danger.

41:07 So that's how I keep a patient safe by learning about drugs like that.

41:10 Because I'm going to recognize early when they're in trouble.

41:13 Now here's one you got to know.

41:15 Neuroleptic malignant syndrome.

41:18 This will kill you okay? This will kill you. These are the people that go who they have.

41:23 Lead pipe rigidity. They arch their back.

41:25 They're super stiff. You're going to see their temperature go up.

41:29 Hypertension, tachycardia.

41:31 They will eventually die from respiratory failure or death unless we treat them with the meds you see here.

41:37 Who's at risk for this is people who take antipsychotics.

41:41 Is that not the worst? We have people that are having psych issues, and then we give them a medication to try to help that. And they can risk this.

41:49 Now, first generation ones are the biggest risk for this.

41:52 But I want you to remember lead pipe rigidity.

41:57 This is very uncomfortable painful for your patients.

42:00 They're just they can't move and they're going to eventually die from respiratory failure unless we treat them with those medications that we put right there.

42:09 Now while it is rare, all of my ER friends have seen it.

42:13 That's usually who sees it as people come to the ER.

42:15 So let's take a look at how you take this information right here and we'll apply it to a question. So the nurse provides care for a patient in er who has been receiving.

42:27 Hello Panadol. Well this is an antipsychotic.

42:31 So which of the following requires an immediate intervention.

42:35 Now they're asking us for which one of these is a priority.

42:40 So people who are at risk for neuroleptic malignant syndrome, right or autonomic dysreflexia, is spinal cord neuroleptic malignant syndrome. People who are on antipsychotics.

42:53 So which of the following is an immediate intervention.

42:55 Well blood sugar is 70.

42:57 That ain't good. Two plus deep tendon reflexes.

43:01 Do we? Is that a risk with haloperidol? No. Temperature of 103.

43:09 That's not normal. But does it have any connection to haloperidol? Heart rate of 58. That's just below normal.

43:18 Does that have a connection to haloperidol or put them at risk? No. The one that you've got.

43:24 I see a lot of you putting it in there.

43:27 It's see, because we've eliminated A, B and D, the topic of the question is asking me about a risk factor with haloperidol.

43:36 Remember, with what we have here with neuroleptic malignant syndrome.

43:42 Look at that severely elevated temp.

43:45 That tells us we're going to be in a lot of trouble.

43:49 Okay. So everyone see why it is.

43:51 See? Beautiful. All right.

43:55 Noreen, that's my middle name.

43:56 That's so cool. You don't see that very often.

43:59 Okay, now, here's an example of foods with tyramine.

44:02 Who knows which medication you don't want to take with tyramine? Rich foods. Anybody know? Yeah. I can't get anyone by you guys now.

44:14 Can you memorize all these foods? Well, you might be able to.

44:17 I can't. I like to eat food, but I don't like to memorize food.

44:21 So really, think of aged foods.

44:24 Aged cheeses. So do you think Velveeta is a problem? Would it be a problem for somebody with, uh, the Velveeta to be taking an maoi.

44:33 Oh no. Velveeta. We don't even know what it really is.

44:36 It's just like a processed cheese food.

44:38 We're thinking more of like cheddars or really good parmesans.

44:42 When you talk about lunch meat, it's the aged salamis that are going to be a problem. So now when we look at this, how would we use that in a question? Which of the following patient statements indicates appropriate patient understanding for a patient receiving phenelzine.

44:59 Now you and I all know that's right.

45:01 Banana peel specifically Marina, you know well you know I know together wink wink wink. This is an Mao inhibitor.

45:10 But what it's asking me for is appropriate understanding.

45:14 So what I want you to do is to read each statement and see if it is appropriate.

45:21 If it is not, you cross it off and move on to the next one.

45:24 So you guys go ahead. I'm going to give you about 30s.

45:27 I know I'm super generous, but I give about 30s to work through those and then tell me in the chat which one is yours? So what type of answers am I throwing out wrong or unsafe? Right? That's what I'm throwing out.

46:10 I'm looking for the one that is correct.

46:14 I am super impressed that some of you got this.

46:17 That's really impressive that you knew that.

46:20 But they cannot take Meperidine, which what is the trade name for Meperidine.

46:27 Anybody know what the trade name is for Meperidine.

46:29 Starts with a D. Beautiful.

46:33 Demerol. Okay. So? Well.

46:36 But why did you talk to us about food? If the answer was Demerol.

46:39 Because I wanted you to recognize that A, B, and C were wrong. Those are foods.

46:43 And they should not be taken with Phenelzine.

46:45 But you can not take Demerol.

46:49 Good job. Really good job.

46:50 Now, if you didn't know that, just add that to your notes. And we look at it now let me give you some bad combos.

46:55 Right. Let me go over some bad combos.

46:58 Like I love Reese's peanut butter cups.

47:00 That is milk chocolate and peanut butter.

47:02 I don't know who thought white chocolate and peanut butter was a good idea.

47:06 That is a bad combo. Let's talk about some others.

47:10 Low potassium and did you know? Increases your risk of toxicity.

47:14 We already talked about that.

47:15 Low potassium for any reason.

47:18 Now what are some reasons that you can have low potassium.

47:21 Furosemide and Corticosteroids.

47:25 All right. If it's got a mineral corticoid going on, it has aldosterone. So if your corticosteroid has a component that's a mineralocorticoid, then it has a dasturan which tells my body to hang on to sodium.

47:41 And wherever sodium goes, water follows.

47:44 But when I hang on to sodium, I get rid of potassium.

47:49 So that's why some corticosteroid meds can cause a low potassium.

47:54 Hey, Ace inhibitor. Potassium sparing diuretic.

47:57 Woo hoo! If I'm on an Ace inhibitor that raised my potassium and a potassium sparing diuretic that raises my potassium.

48:04 Wah wah wah. You got hyperkalemia.

48:07 Bad deal. Maois. Food with tyramine.

48:10 Hypertensive crisis. Hey, look at the GS, baby.

48:13 Ginkgo, garlic or ginger? Those natural supplements.

48:18 Now you can get garlic ginger chicken at your at a favorite restaurant, and that's okay. But if you're taking ginkgo pills, garlic pills, ginger pills, and you're on an anticoagulant or antiplatelet, just say no.

48:31 Ginkgo, garlic and ginger supplements are good, but they can increase your propensity to bleed so you don't want them with anticoagulants or antiplatelets levodopa carbidopa.

48:42 Right. So, um, I tell all my students, you know what? You cannot memorize all the foods that you should take with food or without food.

48:50 You can't do it. But this is what I recommend.

48:54 Foods like this. If you take levodopa carbidopa, which is a medication to treat Parkinson's.

49:00 Remember, if I put dopamine in your veins, I can cause an effect in the rest of your body, make your heart pump harder, etc.

49:07 but it can't get over the brain blood brain barrier to help patients with Parkinson's that don't have enough dopamine.

49:14 So I gotta kind of get it over there as levodopa and my brain can turn it into dopamine once we get that over the threshold.

49:22 But if I take levodopa carbidopa with protein.

49:26 So if grandpa is taking his levodopa carbidopa with the scrambled eggs and sausage and biscuits and gravy with all kinds of protein, it's not going to be effective. And the last thing somebody needs is less effective Parkinson's meds. So don't do it.

49:43 Duty to remember levodopa carbidopa and protein.

49:46 No, no. He'll it'll fight each other for, um, those protein things. Receptors, binders.

49:52 Okay. So antacids, 1 to 2 hour window.

49:56 Right. If you take a I'm talking 1 to 2 hours.

49:59 If you take an an antacid, an over-the-counter antacid, if you take it at noon, then you shouldn't take another oral medication until 2 p.m..

50:10 Okay. And then you should wait another two hours to take the next dose.

50:14 So what am I saying? I want a 1 to 2 hour window before and after an oral medication.

50:21 Okay. 1 to 2 hours before and after an oral medication.

50:25 Why? Antacids change the pH in your stomach.

50:28 If you change the pH in your stomach, you alter the absorption of a drug.

50:33 Okay, that's no bueno.

50:35 It's probably going to be less effective or a little later. So antacids.

50:38 That's a great way to ask you a question.

50:41 Bisphosphonates and doxycycline.

50:44 Bad deal okay. These two groups of medications do not let the patient take it at bedtime. If they lay down, if they take it, they're going to get horrible esophagitis. Okay.

50:53 Horrible esophagitis. Uh, Coumadin.

50:56 I saw some of you guys said, hey, that's the only drug I remember.

50:59 Coumadin. And don't let them eat vitamin K rich foods.

51:02 So you guys gotta remember, um, excuse me, but what foods are rich in vitamin K? Green leafies.

51:07 A lot of dark green leafies are rich in vitamin K, so then you're going to have negated the effect.

51:15 Vitamin K is the antidote for Coumadin.

51:18 So it's very important that your patients know they can't eat vitamin K rich foods when they're on Coumadin, unless they want to eat that same kale salad every day, same time, same amount.

51:29 So you really got to commit to kale.

51:31 Exactly. Thrombolytics.

51:34 I don't give thrombolytics to somebody, like, out of place.

51:37 I don't give a thrombolytic to anyone who's had a recent trauma surgery.

51:41 Think of people who have important clots because they're going to rip those apart.

51:45 When we give a thrombolytic, we're trying to dissolve a clot in your brain or in your heart. But if you have other important clots from surgery or a trauma, we're going to rip those apart, too. And you're going to die for hemorrhage.

51:56 Tetracyclines teeth. We don't give them to teeth.

51:59 Teeth, kids, because they have yuck mouth.

52:01 So tetracyclines and teeth fluoroquinolones can cause a rare tendon rupture.

52:07 We also don't give those to kids.

52:09 All right, let's do a couple more questions because I see what time we're at.

52:13 Look at this one. Okay, this is like a total setup when I ask you this question. Why? Because there's no way you can remember this.

52:23 You know why? Look at this.

52:27 Yeah, yeah. Can you memorize all those? Someone tell me. Legit.

52:33 If you think you could memorize all those.

52:36 Okay. Catherine. No one likes select all that apply. You're not alone. Okay.

52:39 So if I come up to a question like this, all I can do is my best.

52:44 Is it worth my time to memorize all these drugs and come up with some bizarre sentence, like you guys are really good at to try to do that? Nope. Can't do it. So what I would do is I would remember I would remember statins, I would remember statins are not really good with this.

53:01 I remember maybe some fentanyl and I'd pick something else.

53:06 But then it is done right.

53:08 That's right. That's what drug guides are for on the unit.

53:10 But when I see a question like this, I would say like I call them, I call them question writers, angry South Pole elves, because this is really not a fair question in my opinion, because there's this many options.

53:23 You're not going to be able to remember that. But remember, you guys already know this.

53:28 Mmos are bad combos, but also antidepressants don't go with TCAs or SSRIs.

53:34 Maois don't go with antihypertensive meds.

53:37 And as you know, they don't go with meperidine.

53:40 So MAOIs just don't play well with anybody.

53:43 All right. We've got you to the end of my part.

53:47 I am so happy that you came today.

53:50 So fun to see all of you.

53:52 But here's what you do next, okay? You need a study plan.

53:56 So you guys were talking about that? Hey, I don't know where to begin.

53:59 I'm going to tell you something. Just start.

54:02 Okay? Pick the area that you feel uncomfortable with.

54:05 Go after that content.

54:07 We've put it in order for you.

54:09 And we also what I want you to do to start your study plan is pick the area you're most concerned about. So go to the website, pick the ones that you're like, oh, I've got that test coming and I don't understand it.

54:19 Start watching those videos.

54:20 Once you start kicking into those practice questions, that's the first level that's going to help you recognize, hey, do I have the basis, the foundation for these concepts.

54:31 Then you can do practice questions.

54:33 All right. Spaced repetition is the bomb.

54:36 Keep going over those questions every day and keep your scores up there.

54:41 Then you're going to be able to reinforce and encode that information in a way that this educational psychology nerd says is going to work for you.

54:49 And most important, don't forget, I promise you right there.

54:55 Kaylee, Josephine, Marina, Bridget, all of us.

54:59 You guys can do it. Alright.

55:02 I'm going to hand it back over to Rocy. Thank you for coming and hanging out with me. I hope you come back again.