okay today we are going to have a each pack on very important chapters in our textbook or pathophysiology let's start first with blood flow right why because obviously it's important that we work as nurses and doctors we deal with patients having problems with blood flow right okay and of course when you say blood flow it involves working blood vessels right so if you remember the anatomy of the blood vessel the blood vessel has three layers in them right yes the first layer is the outer layer which is where blood vessel the outer layer is called Shaniqua one adventitia right and what's the second layer media media for mm for middle layer and what is the middle layer of the innermost layer okay in other words what surrounds the lumen is called Tunica intima does anybody know what Tunica means what does Shaniqua mean but of course they're very good tunak tunak um is layer intima is the innermost layer and what is found in this layer of intima what do you find yes very good it's called the endothelium right and it is very thin made of famous plant cells and normally when you're young we don't expect to have fat deposits they read right now what is the second layer the middle layer it made out of what smooth muscles and if you remember muscles can either work on track or relax now you might be wondering it to really go back to my anatomy and to shoulder it definitely right right okay when muscles contract in the wall here so this is an example of an artery and a vein right which one is the artery the red one because it carries oxygenated blood what about the blue one veins are these blood vessels now these two blood vessels have exactly the same one layer right now apparently with the muscles contract it leads to what they saw very good and what happens to the blockquote few basic ones Rick the blood flow or the motto blood flow it will be what decreased right but not to be the effect on blood pressure if you've a second trick it will go up increase blood pressure right and let's pay later on some formula what is the opposite of contrac relax now remember when we talked about muscle they can either contract or relax they do not technique they do not constrict what will constrict would be the blood vessel but what happens to muscle they can either work contract or relax you learned it from Anatomy right but these muscles relax what happens it needs to be so die nation and apparently everything will be the opposite which is one but opposite about club you dilate you make this bigger the lumen becomes bigger and therefore the amount of blood flow will be great but what will be the effect on blood pressure they drop in your blood pressure so remember these things apparently what we need to wanna make you understand is that the reason why we need to know this is because when we gave certain medications for example with patients with heart disease because of that deposit in the arc here okay remember the word coronary artery this is your heart this is the idea what to hear and the coronary T there are two right in left and I mentioned this last week with the moment your fat deposits at the wall of an artery like this one here when opposite the lumen get smaller what happens to the blood flow decreased blood flow right and when there is decreased blood flow in this area here because of the presence of fat deposits what happens you have one ischemia remember the risks Kimia decrease blood flow would that lead to chest pain yes it can and I don't know if I mentioned the name of the drug that we give you place it under the top it's called what nitroglycerin the doctor will tell the nurse let's give the patient nitroglycerin under the tongue what would this drug do make the muscles one with track or relax we're in the wall of the coronary arteries of the heart it gives the base of dilation will that increase the blood flow remember in this case is ischemia decrease blood flow because of the presence of fat deposits in the wall or Tunica intima of the coronary arteries of the heart by causing the base of dilation these coronary arteries will that increase the blood flow it will will that help relieve the chest pain yes what is chest pain again so what kind of medication is not tube listen this anti angina medication you know what anti means against chest pain or in China the idea where for there is nothing that you cannot answer in your nursing board exam from pathology through parts of physiology if you know what is normal then you know what's abnormal you know what is going to be the pharmacology of this disease process now my question to you is this if you give now tube listening to these patients what do you think should I top the nurse to watch out for a possible complication when you give this drug yes well up into the blood pressure why would it go down as you can clearly see expect that pressure to drop as a result of the giving of nitroglycerin because remember this tribe will not only affect the coronary arteries of the heart that can also affect one all the other arteries of the body do you understand in other words what I'm trying to show and sit make you realize is that before you give the drug you must document the baseline one blood pressure pulse heart rate respiration and all these things right the fact of science for example you gave a drug at 6:00 in the morning because a patient complained of angina and dr. gamma said give ISOs or by dye nitrate or nitroglycerin five milligram sublingual PRN what is PRN as needed okay so you put in the chart at this time at six I gave five milligrams under the tongue sublingually and at 6:00 in the morning because of chest pain reading from zero to ten it was around seven or eight it's a it's a way with it's called pain scale you know ten being the most painful experience I ever had and then when you gave the trout the blood pressure was 130 over 80 heart rate of 85 after 30 minutes or 15 minutes you get the blood pressure again from 130 it went down to 100 is that the drop of a blood pressure systolic Lee yes it yes you call me and say doctor Gamow I gave nitroglycerin at 6:00 in the morning the pain was relieved but there was a drop in the blood pressure systolic from 130 to 100 so what do you think will I tell the nurse to do yes Lord it you could be a doctor then huh I will tell the nurse I will lower the dose from 5 milligrams to maybe 2.5 million right now if it's they're going to persist Lee go down there and I may have to give another drug does that make sense okay so that's important that you and doctors work together we cannot afford to have a nurse who is not smart and competent there's a nurse must know the pharmacological basis of giving the drug called nitroglycerin we cannot afford not to know because this is going to be 15% of the questions in the nursing board exam has to do with pharmacology and the possible complications of a drug do you understand okay now this is something very very important you give the medication under the tongue how it's able to go to the art yes in the time what about the capillaries in the tongue hmm okay so if you were to trace following a GPS Gamow positioning system now you're joking how would you trace the flow of the drug from the tongue all the way to the heart you know to know them okay precisely so your answers and your answer are related blood vessel capillaries under the tongue it travels through the blood circulation if you remember the anatomy of the heart the right atrium the right ventricle left atrium that bendigo what brings blood to the right atrium superior one disappear vena cava gets all the blood the veins from the head the neck and the upper limb okay so the time is that part of the head there you go so the tongue is part of the head there are capillaries there the medication which is a chemical product goes by diffusion into the capillaries at the top and these calculators will go into the veins of the time then the veins of the neck which is called the jugular veins the killer veins keeps goes into the one eventually into the superior vena cava then right side of the heart then to the LOC left side of the heart that the left atrium left ventricle and then what happens the medicine the one from the left ventricle to the aorta but it goes down to the one your talk to the coronary arteries do you understand what about if you give it in the form of a medication skin patch can we give this drug in the skin patch on the form of the skin patch in the chest of course why why would I give it in the skin patch here yes does anybody know is it possible for the to the medication to it to the pores okay now remember my dear student what comes out of the skin pores sweat so the expect of medication to go to the sweat glands what is funny to sweat gland sweat what is it that we want that the medicine to travel through so what do you think is funny in the skin miss me there is but Padre Sheila I know which barrels vessels the one you said of course do we have capitalist everywhere because every single cell and tissue of the body has to have a capillary in order to provide oxygen and carbon dioxide removal so skin brain muscle bone every part of your body has a capillary which is the smallest blood vessel in the body other capillaries in the skin in front of the chest so the same thing so therefore if you put the medication patch here this time anything below the heart inferior vena cava anything about the heart superior vena cava does that make sense the same thing if you put the patch here go to the veins hair medica bar right HRI petticoat goes to the law but it's not in that in the law well back to the left atrium and ventricle then I order then eventually into the coronary arteries what about if I decide to give the drug in the form of aura I so deal or also sort by die nitrate can it be absorbing the blood circulation of course why if you remember this is the esophagus the vault is here okay stop back and then the small intestine here what do you find in the wall of a small intestine the villi and again the capillaries and therefore if you take a drug in the form of oral medications it will travel through the small intestine where it will be absorbed and we say absorb it goes to the blood circulation and again the same thing you have the mesenteric veins and eventually it ends up with a theory visit cava because all the blood passes below the heart will be trained by the inferior vena cava and eventually ends up the same spot way the right side of the heart right each of my critical pulmonary artery to the lochs then back to the left atrium the pentacle then aorta in other words the final destination has to be one the coronary arteries yes in the case of all of medications all of means stomach then small intestine but as I said there are medications like sublingually given under the time because this is the dilemma we have as doctors of medicine we expect the nurses to know these things because they are supposed to be one smart competent critical thinking but the moment we ask them these questions they cannot answer them because what happens to their anatomy background they forget in other words there is going to be a scientific basis for everything we do with our patients and we expect you to do the same thing expect to be able to justify why was it given under the tongue why was it given in the chest played in the skin why was it given orally so what do you think faster through the time or to the stomach or oral part of the most faster but by sublingual given what about IP pass test you might pass the time you might bust stop luck at small intestine if it's given intravenously do you understand class right does it make sense okay now going back to these therefore as you can see therefore whether it is an artery or the vein both of them have the same layers Tunica intima tunica media and tunica adventitia right the only difference is that the veins the lumen are usually bigger and wider and the walls here are much much thinner ok the veins are the one that are in blue as we said carries deoxygenated blood or blood rich and carbon dioxide well on the other hand the arteries are the one that carries one oxygenated blood now who is going to transport the oxygen and the carbon dioxide which cell what the red blood cell what is another name for your red blood cell every through side every throw red side means cell ok now let me ask you this review the anatomy and physiology of the arteries and the veins what is a unique feature that is found in the veins or later is not found in the arteries very good and what is the purpose of the valve in the veins what is your name Scott Scott why do you have part in the veins Scott it allows for a one-way travel wine we travel in other words you need directional flow travel towards where hot Scott of course pass each one they'll be the car and inventor lean to the right a triple to heart super vena cava from the head neck and upper limbs lower limbs and this area here abdominal pelvic area inferior vena cava so that's one thing to allow the blood to flow in one in one isn't that a bad one direction automatic or something that they get disbanded one direction and most importantly number two it prevents one prevents what prevents what hi my name is prevent backflow what is your name hi my name is bars what is your name that is one way of learning and retaining information by clunking what is clunk to group together that words that are related cousins brothers and sisters so when I say valve veins prevent backflow allow one direction the you understand so if we work for Holy has veins blood flow one direction the other name is fun prevent backflow right this doesn't make sense so if I ask you a question therefore in the quiz what is the function of the valve two things a lot of blood flow in one direction air prevent backflow in therefore based on that knowledge in the leg veins we call them saphenous vein as a pH Eno us the great and the lesser saphenous veins of the legs and the thigh what happens if the valves are not working properly and the valves are mall Mali Spanish means backward and malfunctioning what would be the result of a mouth fortunate venous valves yes DVT unfortunately is not the answer of district right yes unfortunately it's not the answer Tigers [Music] never last thing this man if the answer is correct again I'm not saying that your answers are wrong but they're the best answer always would be very convinced and we're going to talk about 12 of about this and deep vein thrombosis right DVT right so we'll talk about that later on okay now the bottom line therefore is that knowing what it's normal bumps and what happens with the Bloods are not working varicose veins will happen okay logs are present only in the veins not in the arteries is that clear okay now so how important is knowing the chambers of the heart and the blood will through the heart and a way to die very important because if you do not know the blood flow to the heart and away from the heart you will be l OST what exactly is L OST loss and during the quizzes and you take the nursing board exam you'll also be 100 St and what are the chances that the student or graduate of West Coast will guess hundred percent if you do not study right and guess what you can afford to be guessing it's a matter of your future you want to be sure of your answers right okay now there are certain formulas that are important for blood flow what is Q is equal to P over R what excuse type or okay what about be Russian reject right put Delta P or pressured reject of the blood okay bearing in mind now in order for the blood to flow for example if this is the heart this is the lap and if you listen to your table the pressure is highest where in the aorta why because that is where the blood came from the pub what is the main top of the heart with chamber 11 ecology it's called systole contract and in relax they ask to learn when they contract it generates a tremendous amount of pressure the mob the blood will flow from high pressure to low from high pressure to low high pressure to low right it pierces the diaphragm assembly art descending aorta then in the thoracic cavity what is the name of the are Yorta in the thoracic cavity what is the name of the aorta in the thoracic cavity huh keep it simple student I already gave you the answer terrific Albert don't you love that to me the moment it pierces the diaphragm it answers the abdominal cavity what is the name of the iota in the abdominal cavity oh my goodness with a second a verse and you say there though what is the name of the outturn the abdominal cavity and they will look at each other it's just a trick question don't come home it's called ki SS what is ki SS give it simple smart student the fish at home why because the word complicated is only used where in Facebook but Facebook relationships complicated here in this class will you simplify thanks and that is my role my role is to simplify things that you will understand and most likely what remember and will not forget right okay so the comma the problem of your divides in the public figure to the common iliac and then external iliac internet LF you have becomes femoral artery it becomes ephemeral becomes t belly the perineum fibula okay now the idea that for is by knowing this blood flow will only flow from high pressure to low pressure but then you know now what connects the artery with the veins what we call a small artery what do you call a small vein and what connects the two okay let us talk between the two and these are all found everywhere every single part of your body has a capillary brain capillaries muscle bone everywhere right and you are we ourselves here themselves here cells cells so with the blood is coming from the rtl side the red dots are the scaling one oxygen oxygen will diffuse from high no from hard to know now what will the sell produce as a waste product carbon dioxide co2 will come from heart so now the red blood cell has a new passenger it's like a red fox who becomes a new passenger co2 goes into the veins in other words for this to occur from right to left which one has a higher pressure the artery or the veins arteries capillaries and veins it will have to flow from high pressure to low pressure does that make sense okay it's called pressure reject or Delta P now what is our my dear students and what is the definition of resistance huh how would yes perfect so if this is the blood is flowing this way if you have a party positive that will not oppose the flow of blood what about the do basically decreasing the Regis with that oppose the flow of blood will it recess the flow of blood or post is the key word to remember right okay so resistance pressure and flow is this a formula that you must not forget now the problem with us many times is that the same thing with me when I was a student I just simply memorize things now I learn more than that I did not just memorize think but I need to understand what is the significance of this formula to me as a doctor and to you as a nurse very simple I need to be able to determine the relationship between all these factors listed here what is the relationship between pressure gradient and blood flow inverse or Derek the brick relationship means if you increase the pressure region opposite the blood flow if you decrease the pressure gradient what happens to the blood flow remember that a direct relationship what about resistance and blood flow inverse which means if you increase the resistance what happens to the blood flow on the other hand if you decrease the resistance what happens to the blood flow there you go now let's go now to the next formula that I expect you to memorize and know it's called the poi cells law boy sells more than anybody tell me what exactly is this law the name give me the detailed formula of the point sales law because it's very important for this chapter on blood flow yes my dear I [Music] think that this is what is not that you talk about cardiac output heart a stroke volume is this not what I'm looking for yes did you try it I like that do not hesitate to answer even if your answer is wrong try your best just give me whatever you think I will not try to publicly humiliate you by taking our job I don't know try your best yes you are trying to raise your hand [Music] am i smiling at you but the only reason I my spell is not complete smile because you are not sure you have to be sure what your name the reason I'm shot it to give me a wink because I only had four hours of sleep last night so I'm not shouting because I'm angry I'm just sorting to keep you alive you know stayin alive stayin alive okay according to Maria Malia said it is what the system's the D races are for assistance here is equal to 8 and L over PI R to the 4 whereby our is Regis air is the length of the blood that self and what about n viscosity of the blood a [Music] formula is going to be useless unless you know how to apply the formula in clinical resistance ok let's start first the relationships resistance compact what is end viscosity of the blood what is the relation direct or inverse in other words increasing the viscosity what happens is the resistance increase resistance if you increase resistance well opposed to the blood flow it goes down do you understand on the other hand if you decrease resist and discuss it even upness decrease resistance decreases system of the blood flow it goes up you see how important that is now it's not just a matter of knowing what is resistance and the effect because it is the direct relationship can you give a concrete example of an which the viscosity of the blood becomes increased what clinical condition can increase viscosity of the blood top but I'm having an intellectual seizure mm-hmm I do the same thing at the cadaver up top you answered a good correct ok explain to your classmate my dear Wallace polycythemia of course imagine your red blood cell count goes up in other words there's so many 1 red not cell in other word becomes concentrated in a polycythemia pol YC y th emia that will increase the viscosity because what concentrated it creates more drag on the wall here does it make sense okay do you understand now the length of course I do not have to explain over the net the blood vessels the longer it travels the more resistance because there will be one friction forces of the wall right and therefore increase length increase resistance and increase resistance means one decrease blood flow does that make sense okay because these are all direct direct direct increase length increase for systems increase resistance inverse decrease blood flow do you understand am I too far so high to fast if I am fast I'll may especially the people at the back and you see my illustration here to be honest I always tell people at the back to come to the front I took about two days I don't really smell and we didn't have any kind of intersection today so I'm just joking okay so what about Regis what is Rangers Rangers is defined as what what is it this time for me to hear the young meter what is half of Rangers take my base faster but my mouth my mouth is so slow okay the young meter from one end to the other end and then half of that would be Regis the idea therefore is this when you increase the Rangers can imagine our to the form exponential power increase the Rangers what happens in the resistance inverse opposite increased Rangers decrease the system decrease assisted opposite of Knoxville thatx is reason why it explains what happens in basic cuts they said dilation with new base will dilate when opposite the ranges of course you think the Rangers become higher the moment you dig increase the Rangers what happens with the resistance decreases and the moment you decrease the resistance what happens to the blood flow it increases the blood throat is the reason why we give nitroglycerin if you can explain in that scientific way I am pretty sure you will part the Nursing Board Exam with your eyes closed after you read the question of course and up you are the answer but it takes a lot of hard work and that of knowledge acquisition and what comprehension and most importantly what retention because if you cannot even memorize this formula and this formula you are going to be in deep stool that's yeah okay um stool excuse me it's too cool Sh ideas told me in the same thing right feces excreta poopoo did you make blue pill already does that make sense so you guys okay so the presence of fat deposit on the wall of our blood vessel particularly an artery is called one at thorough sclerosis does anybody know what is chlorosis huh what well that is the deposit of fat is called plaque black is the fat deposit on the wall PL AQ e BL a qu e is black it's a plaque of recognition because you will die soon I'm just joking look at me what do you find here inside my abdominal cavity wall used to be a 6-pack of muscle it's now one pack of fat now I'm just joking I never leanest expire don't even know what it feels like but that's my dream I have a dream for 10 years now I see these models you know but instead of having a 6 but he became one pack of that am I at risk of developing heart disease will I develop atherosclerosis of my coronary arteries I have a sedentary lifestyle do not exercise used to be a basketball player a varsity plane that is cool I would run for one end of the court to the other end I used to climb the stairs but I always use the elevator because I'm a lazy man with a sedentary lifestyle I'd have to go to Panda Express and eat a lot of food with I develop atherosclerosis in my coronary artery disease is that coronary artery disease or ischemic heart disease while it's called ischemic heart disease because there is one fat deposit in the wall due to atherosclerosis that's why it's called coronary artery disease otherwise known as ischemic heart disease otherwise known as atherosclerosis heart disease thank God I have no chest pain yet not yet okay so want to come to this theater okay now the bottom line therefore is when you have fat deposits there what happens in the ranges goes down what happens in resistance of flow increase any peak which we support up to the blood flow here but hopefully I will not develop an angina in other words what I'm trying to tell you is that it's still not there but soon it will come I can just predict in the next one or two years it will be there okay do you understand now so what we're trying therefore to show to you is that this formula is so important because this is the formula that will explain the signs and symptoms of your patient this is the formula that will tell you what is the reason why we give nitroglycerin it is a ventilator which will dilate increasing the rages and if you increase the ratio will reduce the resistance decrease resistance means one increase blood flow the reason why there is relief of it angina or chest pain among our patients but of course we have to monitor one drop with the blood pressure because we have to one titrate or lower the dose of the medication does that make sense now so we have discussed about atherosclerosis and this is something very important right because in terms of atherosclerosis can you form a clot in the arteries yes yes in other words if you form a clot in the arteries or particularly in the chambers of the art can it travel yes that's why we said if you have a lot here in the left ventricle can that clap travel to the aorta can it go to the brain of course go on what the common core did eventually ends up in the brain right this rebar arteries like you understand so whatever is form inside the wall or an artery can up with a classmate now what about in the veins somebody mentioned a while ago about trauma phlebitis and deep vein thrombosis these are all involved what arteries or veins don't you love it what does Flippo mean vein phlebotomy what does phlebotomy mean creating an opening or halt so that you can drain the blood you are directly bottom is what did use to drain the blood of a patient a needle in a syringe the word phlebotomy therefore is the creation of an opening or hold with the use of insulations extract the blood of the patient now the word thrombophlebitis DVT thrombophlebitis what does rhombus mean right here huh the club and where is the cloud power [Music] but what if the car is gone we're in the vein that's West Coast liebo Trumbo flea bite what is itis inflammation what are the cardinal signs of inflammation room or redness the Lord symptom pain calor palpation one and two more two more increase in size swollen right so if a patient comes to us a nurse nurse I have a 70 year old male patient and what's your name Gina Gina I have pain in my right leg what would you do nurse Gina a 70 year old male patient which happens to be me I am now retired and I am your patient in the home care facility and I tell you I have pain in my right leg what would you do what would the good pre what is the first thing that you are nervous do so so what are you going to do so this works smarter than the hardest woman huh so before you tell the doctor anything you will do your own initial physical examination okay so what you how would you go about the physical exam Gina and my buddy how can you be able to look at the leg are you gonna look at the leg like this okay so we're gonna pull my pants up like whatever I wear in the nursing home so I said right leg so what would you do by pulling up the path like this right and you see my leg right are you going to pull the leg on the left side yes or no on the left leg are you gonna open them are you gonna pull the pants though yes or no because you listen to their answers right and they skidded you were your first answer okay okay so make sure you know the answer correct right so you always want to open the left leg and open the right that you can compare even though the comparison the pieces of right leg but you have to compare with the left leg right so you should look for what redness can or the Lord open all the signs of inflammation because in phlebitis means it's inflamed which is inflamed the range the only thing is that not only is the vein explained but there is what what a strombel mean what kind of cloud is a from disk stationary clot in other words for it to be stationary it is attached where to the Tunica intima of the veins it is attached to the wall now the question is [Music] this development of thrombophlebitis among patients is very common what is a previous posing factor to the development of trouble if you buy this in these patients yes yes the gentlelady at the back of the corner yes my there very good Amada this year the European red the mobilization some how can you prevent the development of Rome little by this among my patients mobilize by what how walking very good what about dancing walking dancing and range of motion exercises right that can prevent because if you do not exercise and move the leg the chances of developing from the phlebitis is very high my question now is this prevent primary prevention the problem now is what if you already have thrombophlebitis in that leg and there is redness the lord call or two more you were able to confirm that there is the presence of a 10 by 10 centimeter redness in the posterior calf area which is the common common area why why why here at the back why not in front why is it that the redness and the pathology is always at the back of the leg in the calf area does anybody know yes are you saying something yes does anybody know it's very simple but do you think that the veins found in front or the back don't you love Anatomy rara rara shhh shhh Shh what they have here the tibia how could there be a vein in the bone what is at the back gastrocnemius and soleus muscles and what is embedded in these muscles the name called the saphenous vein leg veins does it make sense again it always goes back to what but not to be heard disorder so the big question therefore is you put that in the chart initial physical assessment nursing assessment presence of a 10 by 10 centimeter redness we call that ridhima erythema misread it is 1 on palpation palpate means to touch you don't say touch we put will palpate the kind of words that you use will determine the level of intelligence the student has I look at the way you answer questions by order answer and verbal and written I know how intelligent you are you don't say Todd to say what the patient there is pain is called tenderness on palpation tender means pain on touch right now are we going to exercise this leg my dear you're a nurse yes once you have diagnosed her to have from the flow are you going to exercise no so the first answer was yes now the answer is no so which one is which I am confused ok is that your title and so on ok why no and then trouble where strap hmm to the lamps are you sure about that not everybody go to the brain yes or no you're not sure okay the first answer was correct it can go to the lung it's called pulmonary embolism why because the stationary plot called promise is converted into what a travelling cloud called an embolus the moment you exercise that leg you will dislodge and it would break off from the wall it's attached to the wall it breaks off it becomes a traveling cloud it choppers from the leg vein to the femoral vein then of course into the inferior vena cava then from the inferior vena cava it goes where the right side of the heart the right edge of the right now why did it not stop in the right host excuse me inferior vena cava it's like the five freeway right five North Union Station why because the the vena cava is big or lunch lunch for big big did it stop in the right atrium when you're identical why because these are big chambers did it stop in the pulmonary trunk no it's a big drop but you'll stop in the pulmonary capillaries of the lamb yeah do you know that a capillary can only allow the passage of one one red blood cell so is the club bigger than the cap red blood cell in other words the club will be filtered and it will definitely stop where in the lock and it go beyond the law never write another in other words a club coming from the leg range will get to stop in the lungs called pulmonary embolism what about a plant in the right side of the heart can its go to the brain yes or no I just told you the answer a cloud that is formed in the light they will stop in the lung and platform in the right side of God will also stop where in the lawn now the big question is this when does it possible what is it possible that you can form a cloud in the right side of the art yes yes my dear where do you form a clock in the chambers of the heart although this would be the topic for one week or next week with two weeks from now but I'll give you an idea how can you form a plan with the right or that it doesn't matter if the cloud is found on the right side of the heart it will stop in the lung if the clock is falling on the left side of the article today order can you go to the brain yeah it's called cardio embolic strokes cardio means it's a source of the pot embolic made the path traveled where to the brain passing to end the 405 North Freeway called the IU attack and now you're talk to the common carotid right are you following me okay so the only possibility that the plat can travel to the brain if the clot was formed in the left atrium and the left ventricle now the question is this now I know it might be too premature to give me the answer but what do you think will cause a clot to form in the chambers of the army the artists chamber this it's a space but there is what this blood in them what do you expect yes yes very good H Aries behind the former one in the form of one atrial one very good I'll tell you what this is to be pretty much obvious give you an idea no heart gggggg when the heart is continuously pumping blood there is continuous one movement of the blood in other words gggg continuous flow why basically pumping what happens when you have an fibrillation or bodies are without arrhythmia without rhythm such as so that time is not pumping blood can you form a clot can you form the cloud during the time when you have a Skip Beat yes you can so it can form a clot now what happens if you go into the trigger fear is different [Music] what is this it's a black line the black line indicates that there is no electrical activity before the muscles coatrack there has to be electrical stimulation coming from the pacemakers of the heart then with the SA node the AV node a bundle of a the Purkinje fibers those are the water to stimulate the muscles to contract in other words if the pacemakers are destroyed then you have an arrhythmia and when you have an arrhythmia is that the most common in each of population if it affects the right side you have a club that goes to the lung if it affects the left side the clutch others where and so they call cardio embolic stroke are you following me for those who are part of what they call silent majority asks your questions now because there's no other time do you understand what I'm trying to show here the importance of knowing the anatomy of the right side of the heart and what are the blood vessels it brings blood there and anatomy on the left side of the heart what's the blood coming from here and going out via the aorta the blood going to the left atrium is the pulmonary veins from the lung does that make sense okay the other point therefore I have to make is this when we're dealing with these kinds of problems are we going to solve the problem of atrial fibrillation now what caused the problem in each of fibrillation what do you think the SA node is there the AV node the bundle of is very important what could damage the pacemakers of the heart when you have one coronary artery disease remember these base makers have what they made of cells tissues right in other words if they do not have enough blood flow from the right coronary would that affect the pacemakers here left coronary would affect the bundle of is the Purkinje fibers definitely does the reason why the Pacemakers of the heart they malfunctioned because the absence or inadequate one blood flow of oxygen do you understand and of course we have to give anti-arrhythmic medications is that clear class okay or if necessary we give one a pacemaker you have heard of the word pacemaker so we were supposed the word lucky every time in the second cadaver some of these pacemakers are implanted here pretending with what bag is that and the asthma this is doctor comma there is a pacemaker greater than J gamma industries I'm just you okay there is none it's a pacemaker as big as this okay in fact remember what happened here the patient invented the ventricular fibrillation not well some of these pacemakers have a built in one what do we do when you're going to cardiac arrest defibrillator that defibrillation is done right we have an AED anomaly IEDs automated external defibrillator is not automatic tonight during the break go to the area there it's wrongly spelled it's automatic is it automatic on automated go there confer take a picture and show it to me your cell phone it's so embarrassing we are supposed to be a University of nursing students and here why I hit the wrong misspelled word automatic it should be automated so this a ad and in the hospital we use a bigger defibrillator start clear everybody clear to you Sableye on the other hand it's done clear I'm clear everybody clear to G start a time for everybody here to G okay everybody clear did you time of death 7:04 p.m. November 13 2018 West Coast University Medical Center signed by the position or the attending nurse okay now I'm going back to this therefore do you understand the importance now whether it now what's the difference between deep vein thrombosis and trauma phlebitis which one involve the deep veins discuss it so simple it's deep vein thrombosis what is involved the deep veins and what happened in the deep pain there is what a stationary one grab the form in the wall attach to the wall of the Tunica intima of the veins in the leg what about trauma phlebitis they usually affect one superficial base but can they also affect the debate yes they can right now in the case of trauma phlebitis is very commonly seen in the nursing home because why we complain and they've been there they've been your patient for some time okay the only way to prevent is by making them walk exercise dance or use the walker but whether you like it or not it could develop even though how much you tell them to exercise or walk which watch out do not access the moment is diagnosed okay now deep vein thrombosis on the other hand is different clinical scenario usually develops when you travel for a long descent by plane like me last year I went on to the Philippines for my 40th high school reunion horrible travel on top of the Pacific Ocean 15 hours right right so well going through the Pacific Ocean what did they go my wife and I we what we danced not skidding okay I walk around looking for pity way back I'm just joking of course honey I love yourself walk around the plane even though I did not have the desire to make wee-wee I pretend that I want to decide to win peewee peewee really I go to the back of the plane pretending to turn it for me line you know and then and after I go back to my seat and go to the front looking at the what you go that the business class they are so paid Ruth rich and we I'm I am so poor what they can do is I cannot do okay and then one time there was this patient was a seizure he should I help myself so I might so not this watch there was a okay go ahead I don't know the city side there's a person seizure but if nobody would attempt to help I would have probably uh attempted but you know somebody was there I am a nurse okay we have a doctor but not licensed in the US I think that you see anything but puzzle they do you know if something happens in the pitch I'll be in dips too but the worst case scenario would have will help but you know I destroyed specialization okay generalized thought I was diagnosing the patient was she's having a seizure she she has what we call a generalized tonic-clonic seizure okay of course there anyway reason why I'm saying this because when you travel for for 15 hours what do most people do they like sit down on the chair for 15 hours it's a good very bad because there is a possibility to form a clot in your deep pains and it's a posse that you'll die of pulmonary embolism yes so this is a usual scenario you have a deep vein thrombosis you don't even know that you have a deep vein thrombosis you go to the carousel where you kept your luggage and while waiting for your luggage all of a sudden you just suddenly feel up chest pain with onset of severe what difficulty of breathing which is called sob or shortness of breath yes incidence why I do not have a statistical data right now but maybe I don't know the data maybe 2 or 3 percent is first of all but still it could happen to you if you are the lucky one I'll see you in heaven 20 years but I'll be there you'll be ahead of me I don't mind you wait for me perfect and even if they serve food there I can text from heaven and said hey hey I am I develop DBT I'm as curious how you pick one you can communicate teach the disciples when you were doing the last 15 hours on the night and they all tell you for 15 hours yeah you know what we should walk around uses it but so sure I would give him the same advice because I am concerned about their safety okay trouble now how about any plans now okay so we talked about provide this now this is one of the common so varicose veins the brightest and all these things can happen right and of course the thing about varicose veins is that the only way to treat them is what you know the sclerotherapy where you can you actually inject a 1's perusing a jet to stop the flow of blood if there's no more blood flow there is no more vein there is to provide a crucifix you know it's a sclerosing a jet it's an engine that you put into the vein to stop the flow of blood and if you stop the flow of blood there's the morphine now you might be what the heck dr. garner what about what happens now there's so many leg veins even you stop them in fact we call it venous strip stripping you know not not stripping when you become nature stripping STR IP pind to strip means to remove the veins surgically okay and like my wife my wife underwent the procedure she has varicose veins it's the fault of my kids because when they when my wife was pregnant with my kids guess what did the baby due to the vena cava have you ever seen this pregnant min is so big baby so I blame my kids see see what you did to mom you caused her to help you you saw very nice like this now because of your size you compress the vena cava of your mother inferior vena cava and therefore it compressed the blood flow and therefore the blood in the leg vein did not go up to the right atrium of the heart guess what happened the vas were destroyed that's why your mamma's leg varicose veins so she went to this very good-looking doctor who looks like Brad Pitt at cedars-sinai she forgot about me okay yes she's very hot I had a crush on the doctor also is very good-looking I just gave you of course so they remove hit her leg pain so she's now us nice legs okay yes what okay it could also be hurry to tell you like if you're this what I tell my kids I say if you want to marry somebody a woman look at the mother I'm not kidding look at them I have a crush on you love you I'm gonna date you right but before I did you I plan to propose marriage to you let it a couple of years but I look at the mother first if the mother has nautical stains I will hundred percent you would have her body whose face I will not marry you now each okay I can have it remove right there like the answer I will marry you because it's love the body goes variance right but I'm not kidding it could be right and it's sure because genetic you cannot you cannot choose your mother and father so mates or varicose veins are most commonly unfortunate among women and men and one of the police posing factor is becoming pregnant but please do not stop getting pregnant oh my god oh what the hell particles based up to the garment when I'm pregnant oh you can read a uterus are you aware of that yeah so I'm a businessman I can you can give me I would give you a surrogate mother for thirty thousand dollars five thousand goes to be then if I go to the manager yes I doubt it because the problem is a permanent damage to thoughts so it will never cure by itself the only way is rob it surgically remove or sclerotherapy or they say they have this endo laser treatment I did a lot of research for my wipers are you like hell makes it because there's a lot of pain there there's a lot and there are these stockings that they have the compression sock is for Vytas veins and she was complaining because you're not a doctor my sense when they don't like me they do not like since your dad and my wife is nice but they did something for me you're a doctor I said yeah okay now anybody talk now let's move on to the blood flow we talked about that for the oxygen transport right okay what about oxygen transport the most important cell is what the red blood cell one why because it don't want to transport oxygen right we know that the red blood cell or erythrocytes has two alpha and two beta change right the hemoglobin change global means protein remember the word protein globulin blood plasma globulin globulin - how far to be to change and in the middle of these chains are what called we call the porphyrin ring right and inside the porphyrin ring is where you find the oxygen in other words the mo globin molecule KK as much as for oxygen right because of the 2 alpha plus 2 beta for total right okay in order to produce the red blood cell doing it higher of course iron okay in order to produce red blood cell do we need vitamin b12 yes we do right b12 now we know that the red blood cell they're produced where where do you produce the red blood cell yes of course which one red or yellow how can you forget red blood cell red bone marrow why what is found in the yellow bone marrow flat what is the color pat like your sweat jet yellow if I die today if you dissect my cadaver it will all be one hello I'm just excited if you dissect me as you'll see I'll be I will be a ghost at your back see I told you okay now the boy so when we look at this red blood cell form in the red Bohr model the lifespan of red blood cell is how many days hundred twenty days that's almost four months four times 30 days is 120 days they are producing the red bone marrow but where is the Forest Lawn Cemetery of this van but where do they die huh of course the spleen and that's what I tell my former students in anatomy they're forming the red bone marrow that birthplace and where is the cemetery the Forest Lawn spleen Cemetery right so how did they get to the spleen very simple for the blood circulation what is the blood vessel breaks blood to the spleen splenic vein what is the blood I'm sorry splenic artery what is the blood vessel that brings blood away from the spleen Hispanic man so how do these red buses go to the spleen spinning artery from here see abdominal aorta what is the name of the artery to the spleen splenic artery dr. Lebon not to me what is the name of the artery to the liver hepatic artery because he Pathak needs liver right okay now so when when the red blood cell I had a chance to talk to this red blood cells before they tie okay so one of them said to me dr. calm oh I'm tired it's I'm now hundred 19 days old in 24 hours I will rest in peace I'm looking forward to my blood at the spleen so I'm about to go so it goes like this well is the spleen oh my god is in the left upper quadrant okay find them if she reaches the spleen okay red blood cell dies now the question is this why of all places why the spleen what will happen in this plane and I spoke to these people and they told me the answer underneath they told you the answer to what in the red blood cell to tell you there will be what recycle that's a secret it to me doctor comma we read that says when we die in this plane recycling and it's good for either what if you recycle the iron of course and if I die I donate my iron they need involving organ donor transplant they the red see how useful I have not only when I carry the oxygen when I'm alive not only when I carry the carbon dioxide when I'm alive but upon my that I will still be useful because you can recycle my iron supplies and where will we bring the iron back to where the red bone marrow don't you love but not to me from the spleen spinning vein and then all the base goes into what the blood circulation towards the red bone marrow in the bone do you understand okay the bottom liner for the red blood cell will be recycled used to be manufactured future generations of knew where urethra sites now as you also know in the anatomy and physiology when the red cell dies armatures it loses its what what has happened it loses what the organelles right remember in the cytoplasm here what cytoplasmic what organized right mitochondria and the plasmic reticulum are guns in other words for the red blood cell survive it will relax solely on what food substance who's that who's that glucose yo though man I would hire you already okay look how's our cars glucose is the only food such that they can subsist on so they don't complain unlike many of us I want fat I want liver I want I want pork I want chicken red blood sir they're so chill you know I just need glucose and okay isn't it amazing and we take our red blood cells for grant that have you ever spoken to them and thank them and choking it so gamma is getting crazy so the red blood cell will some success on glucose does that make sense and it's really amazing what they can do for you when they die they basically won me recycle right recycle okay do you understand no in the manufacturing of red blood cell I told you the importance of what I earn right so what is the most common form of anemia exactly especially women who become pregnant how many of you have been pregnant how do your kids already arrive to suppose when you were pregnant will you give in iron supplements in the form of fira sulfate right why because you are competing with your baby have you ever told your baby or son honey when you were prey I was pregnant with you you were competing with my iron but I love you I got to sacrifice my iron stores the doctor have to give me ferrous sulfate now what did the doctor tell you that when given ferrous sulfate from the word ferric what is the chemical symbol of iron Fe Fe as well it's called ferrous sulphate and so4 in chemistry is Bayreuth sulfate right okay I love chemistry now okay and the doctor could tell you anything when I start you on ferrous sulfate what are you going to W go and what is w om watch out for don't I put that on the chart for the nurses WOM what's out for like lol laugh out loud yes you remember okay what about you who else has been pregnant and had kids with given Frisco's pay anyone yes what will happen to you what will the doctor tell you if you're given ferrous sulfate you are kicked so kids what did the doctor tell you the color of the she's the woman you have two LPs right but still the doctors have told you when I visit the color of your stole when you take pair of sulfate my dear what's your name how about what happens to your stool color what it what's the name of the colors - what's its color stool it's black what's the color of the soul black when you given what this tribe right when a page no this is a very important question what's the name of the gentleman to your front Josh what is the normal color of our words to let your store store but ours - Josh what golden yellow brown gold yellow every time I look at the store I think of gold money money money for the nursing caregivers manual extraction $20 I used to talk about that when I was new here I will have two friends our caregivers okay another my friends who the friends of mine who are caregivers they always complain to me with the patient's constipated and has fecal impaction what do we do aside from giving laxatives in all this mother lecture anyway what's a caller again Josh golden yellow brown so therefore Josh when it becomes black is abnormal Josh normal or not huh on this chart it's expected right but what is the normal color golden yellow brown what a particular is that abnormal abnormal if you're not given this drug so it means there is bleeding we're stomach ulcer bleeding the blood travels through the small twenty feet long intestine and the pipe with long large intestine the time it reaches the stall it becomes black so you mentioned what was the word that you described it's called la melena Valley Cola I'm just kidding Molina has like a Russian name right Marina anybody was rushed in here was rushed in here are you not sure I'm also half Russian okay then I'm just kidding a lot of Russian have liked my nice beautiful eyes right so in the area near it's a China border in Russia all right okay now there's any hope of any Russian name that means Melina oh this is a Russian over that means Melina Melina word no no probably not I'm just joking of course now there isn't Melina is a name right what does Melina mean Oh a fruit but this one is not a pro this is the call of your poop oh it's like poop Oh smells like poop oh okay when your patient has Melina it only means one thing right there's bleeding is stomach ulcer right okay Doris Punjab heiresses now what happens if the stool is cherry red is it what first blood or first blood we call it a motto Keisha okay [Music] this black black tar will start their own asphalt black schools tari tari not native not tarry stool from the word tardy ar-rahman the big parts in the body wanna play the carpet yes no he might do Keisha the color of the school is cherry red cherry red which means one fresh blood usually fallen lower GI bleeding lower GI means anything you know the duodenum and jejunum ileum a large intestine like when you're one exactly who's memorized when you're memorizing you put the dissipative blood oh my god you love it you would end up with beating him race you love yourself when you write because what are hemorrhoids hemorrhoids are just dilated one hemorrhoidal veins it's very common when you become pregnant again this pregnancy thing you know don't get pregnant get pregnant we have got more people in this world right the pregnant uterus is compressing the vena cava so you end up with hemorrhoids or you can have hemorrhoids when your liver cirrhosis that you will tell to talk about that later on okay the owners are now where lots of therefore is also important that your vitamin b1 b12 but in order to absorb the b12 here in the small intestine what is the chemical subset that is necessary to the absorption of the vitamin b12 Wow I can see this group of people studying for the quiz and where is the intrinsic factor produce to be able to absorb vitamin b12 what the parietal cells of the stomach wall exactamente how can you know all these things you took their notes yeah I said this in the teach back why did I say that this back we should have say that because I meant that asset in the question and it's getting up really yeah coming at each pass did you see on these chapters huh I think there were two or three right so you watch all those teeth each box that you subscribe to my only earlier what I suggest you watch too because sometimes because of time limitation and update it stops at the middle of the ditch so there are if there are two or three tea spots on these chapters chapters 10 1134 15 and you might as well watch again and she's absolutely right vitamin b12 right in order to absorb b12 in the small intestine you need intrinsic factor produced by the parietal cell in the wall of the stomach and therefore the lack of intrinsic factor and the lack of absorption of beat up can lead to what kind of anemia pernicious in other words the most common is iron deficiency anemia the lack of intrinsic factor and absorption of b12 is called one pernicious anemia which is a form of megaloblastic anemia do you understand okay and obviously you have to give one basically have to give one in the case of iron deficiency anemia ferrous sulphate does it make sense okay now this is not the kind of anemia and of course policy team is the opposite or any of what basically increase red blood cell count right okay now what is the difference between that and our plastic anemia does anybody know what is a plastic anemia yes the lady to your front Josh what is your name in here yes you course Hayley what is aplastic anemia Hayley [Music] make your time chair relax okay the person in front of you might want to help you what is aplastic anemia what is a characteristic feature of a plastic anemia yes anybody yes yes if they go back to get the breakfast according to square sir and they have to change many questions I can tell you it some people to get a perfect score okay what is my second opinion a guy who's kidding I'm just keeping myself awake yes what is the young lady answered me in a plastic anemia there is fansite opinion and how would you define pancytopenia why there must be a reason remember how do you become smart you always ask yourself why where what and how so in this case why and where is the pathology and this patient with a plastic in one part of the body is affected in aplastic anemia why the rebel Amaro because what better red bone marrow produce red blood cell white blood cell platelet if the bone marrow is destroyed your red blood cell count goes down it's called anemia your white blood cell goes down is called neucopia below the normal range right until 5,000 to 10,000 anything below 5,000 is leukopenia and of course when there is a drop in your platelets it's called thrombo Saito Union now what is a common cause of aplastic anemia my dear did that just knowing what it is the definition but what is the thing that causes you to that maybe the remember the primary prevention was talked about yes of course there was a time when I was in high school and a medical student of that we used to work in the guardian as part of our training as high school students we would make the plot plug vegetables there and everything and then we were using one some of these chemicals like insecticide like Malafaia not realizing that they can cause one toxic effect on the bone marrow [Music] so be very careful in the chemicals that you use I'm not saying all the chemicals are harmful but in the 70s and 80s they were not much of regulation all over the world all they needed was money they want money they said everything even though it will cause the death of people so certain chemicals decided to kill pesticides insecticides in the garden were related to the development of aplastic anemia of course you have to diagnose by doing a bone marrow aspirate and do bone marrow biopsy does it make sense right okay sorry you don't say like a palm read it's a it's a it's a bomb oh it's a missile I don't want to die yet my youngest book graduate is december yes after that I can die but not before December one month and two weeks to go besides I still have to give you a final exam right so okay now so in anemia aplastic anemia it's very difficult the only way you can help them is doing a bone marrow transplant right bone marrow transplant now okay let's talk about malignancy of the white blood cell and let us start with the hypersensitivity right in the Harper sensitivity a some of you is better to do at table right so what are the table that you can create that five one five one two three and one okay right okay Bernie while the way of how many of you have a whiteboard at home I strongly suggest you do what I'm doing here like if you do this 10 times a day how can you forget right you translate your notes in the notes into your brain right okay without looking at your notes okay like the formula I wrote here pretend that you are the teacher and you're teaching your one your dog or cat not to find your kids but is no Roman map yeah my tell me about way to do this job okay no yes unfortunately I have to give the quiz after this okay I can't take the bring your said so what unfortunately I cannot give the break till and besides yeah three that's been what for okay okay dark one what's another name for type one immediate right hypersensitivity so these are hypersensitivity right there's no more ink let's just do it this fast so that you can take your break I know you're excited to take your wheelie break in the poopoo break okay but if you have to leave go ahead but you know this is in the video K type well we get temperatures community effect would be within fifteen to thirty minutes very fast right it's usually seen where what what are the cells involved here what what he'll be okay OB cell what what do businesses produce so all of these I want one two three there on one visa what about four that's one way of what summarizing things type one type to try to involve the B cells and what do B cells produce visa produce one antibodies by becoming what they become plasma cell and the Pastner cell is the one who produces what the antibodies in the case of type 1 here what antibody involved which we'll learn again in an ativan to show the IgE and what will be the effect result it affects what self the mast right so the IgE will involve the mast cells and what does the master will release here's the mean okay what is the effect of histamine on the Buddha it costs us base so on the relation of restriction okay constriction adulation okay what else said that double check is a dilation and constriction let somebody check the book you can come by the Charlie that's what I said dilation why because of course increase blood flow right but it can cause what bronco had constriction but they saw dilation is IRISA why when you visit the rate increase what the blood floor that's why when you have an allergy there's what is it can you double-check it says based on dilation right in the book histamine causes based on dilation that's when you're increased blood that's why here when you have an allergy it becomes rent because there is increased blood flow right okay so basically this is what atopic dermatitis allergic rhinitis when you exposed to the pollen you have an allergy IgE muscle system in so what kind of drugs we give antihistamine a drug it's an amazing if you know what the cost you know the treatment what do we give out the histamine drugs man amazing right pharmacology so atopic dermatitis allergy asthma and everything right what about type 2 was another name for this there's just specific and side to what I'm saying exactl intake drop of type of hypersensitivity what is the example given here [Music] don't hit me Tommy waiting to see these what else but my senior brothers or babies right okay does anyone else you have one hemolytic disease of the newborn what's another name for hemolytic disease of the newborn every throw last post is what the toilets now why is this disease process dangerous I forgot what about blood official right right doctors fuchsia what happens if doctors fusion yes [Music] I'm talking about blood transfusion first before they multi perceives him doctor special let's say I am blood type B who can give blood to me as blood type B only be an O why because I am B what that what do I did my plasma untie a I hate all the ace if you're type A don't give your blood to me why because if you have a in your blood on the surface of the red blood cell the moment it goes to my blood what will my antibodies do attack the RAB that said it was given to me so who suffers me why because I was giving their own blood but the red blood cell it was given to me who was a antigen it is the red blood cell hey I'm vegan I am anti a antibodies what is lysis first it will attack any enemy to attack mine so this one occurred in my own blood but I also prep because I was given the wrong blood because I should not have been given type a because I am Type B right the only blood that I need is P or and Oh which is the universal one and where's the universal recipient TB baby now what about the multi disease of the newborn very simple in a nutshell so that we can have a break in a short time a mother is what is our age our H stands for recess one monkey another name for this is our it's antigen or what D as in dog antigen right in your red blood so therefore not only do you have the a antigen and the B antigen but the red blood cell of the a or the B antigen for the surface of the red blood cell for our age is that the letter R age but it's something that is an antigen or surface map so example like me I am type B positive the word positive means I am Rh positive anybody here who is Rh positive anybody here or is Rh negative if you are Rh negative and you are a woman you better pay attention to my discussion this hemolytic disease of the newborn or every Thomas ptosis metallus only happens in women who are one negative mother and for the mother is a woman if you raise your hand if you are ready to get the pay attention your husband or your partner in sex is positive most of all is a partner in crime it's positive this is your husband so father husband is positive the mother is negative they have sex mother gets pregnant the first baby is one Rh positive why because it got the genes of the father father is party of the baby Spartacus your problem there is a big problem why mother is negative for the antigen but the father and the Son and the baby has positive antigen right you know what happens during labor remember ninth month of pregnancy during labor remember there is percent of separation but two counts out first baby rachel is in class when the baby is into the China and to go take this vagina here vagina here push push [Laughter] I came up first thank you mommy now what did it baby thank the money because when the baby came out the first baby has no problem why because when the baby comes out what comes next plus a term separation to present him follows and this will come out to the nursing board exam in the form of one lengthening of the umbilical cord and a sudden gush of warm blood that will tell after there is one same of separation of the placenta which was providing blood the baby now the problem now is that when there is the central separation happens to the uterine arteries they become open right so Julie placental separation in a mother who is Rh negative and the father is Rh positive the babies are positive the first baby is safe one because when the baby comes out the presenter will follow that means the baby is safe but the moment there is percent of separation is it possible for the blood of the mother and the blood of the baby to mix definitely okay so if there is mixing of the blood what happened next are was interceptors immediate launch the mother will develop what are antibodies against the RH antigen and it will not be found in the blood circulation but the good news is that the first baby is safe because the baby came out the reason why the baby was thanking the mother mommy thank you thank you I meant killing these babies like to thank the mothers you know even though they crush their heads you know might be the baby be fresh mom but it's okay and maybe come on first right so why did it happen to you it did not happen to me thank God because I was by cesarean section I remember the first time I was doing this I kept on telling my student had the same experience I and my aunt was a physician in Philadelphia so you didn't do that you told them that you were born by c-section yes I was the one who delivered I did see such really a look at my boy GUI how you write my name was Joe Phyllis arabiya in my birthday my name is there and she's no I was nice too much to I kept on telling them that you know that's what I learned from my aunt anyway so there is no antibodies produced in the first pregnancy again mother and father have sex mother gets pregnant second baby there is a problem houston we have a problem why I can leave the babies is there going to be a problem yes one in the second pregnancy you cannot you can never guarantee that the placenta will filter the blood so during the eighth month of pregnancy is it possible for the blood of the mother with antibodies against Rh to infiltrate the blood of the baby so what happens is that what is hemolytic disease hemolysis the antibodies formed when the mother will destroy him Tommy's remember the oberst hemolysis been bursting and rupture of the retinal cells in the body of the baby the baby could die right it's called also known as urethra what blast doses feat of sweetness Vitalis is it gonna be paid on yes it good okay so what is the more of lesson from this it environment or situation how many of you here have or do not know your blood type very good so if you don't know your blood type most like you don't know what they are as positive or not right okay but some of you raise your hand and say you are Rh negative at least you were honest to tell us that you're Rh negative so I'll tell you a story