Goal. What do you want to happen? So let's think about let's just let's go back to the moment. I'm gonna just pick a moment's hands. Let's look at that one.
Okay? Get a good look at it. Now what's our goal? So you wanna see healing. What do you gotta remember about goals?
Smart. Smart. Smart. So when you do your, care plans, when you go into clinical and then you're gonna say, okay. What's your goals?
Your goal needs to be SMART. What does SMART mean? Specific, tangible, realistic, and timing. Yeah. Specific, measurable, attainable, realistic, and a timeline.
So did you say you wanted it to get better or you didn't want it to get worse? I didn't want it to get worse. You didn't want it to get worse. Is that specific? Can I measure it?
Yeah. How? How about if I said my goal is that the wound will decrease in size by two centimeters length and one centimeter width and half a centimeter depth by Thursday. Is that specific? Yeah.
Is it measurable? Yeah. Got something to measure. Is it attainable? I mean, that's a lot of healing for that wound.
Probably not. I might wanna give it a little bit more time. But do I have a timeline? So realistic, attainable, gray area, for this particular wound. What about how do I get there?
That's what your intervention is. So when you're filling out your care plans, it'll ask for what the problem is, what your goal is, and what your interventions are. I say interventions are what the nurse is gonna do. Goals are what the patient's gonna do. Patient's wound will heal by this, by this, by this, by this amount.
Patient's wound will heal by this, by this, by this, by this amount of time. Intervention, how am I gonna get there? So what am I gonna do to heal this wound by Thursday? Was that on a heal That was on yeah. Like this side.
You can use like a like you can use like a OODA boot or, the Xero Foam k. Dressing. So I'm gonna do a Xero Foam dressing change. Daily? Daily?
I'm gonna apply the OonaBoot. The Oona Boots I see when they come in every other the older ones I've seen when they come in every other day and have a change because typically they don't do that themselves. K. If they're in the hospital, then they can have that changed. I guess they would put out a provider's orders.
K. What did you say back there? What did you say? Yeah. Confused?
K. So I just kinda watch it. So my job's done. I'm like, okay. I'm done.
Okay. I like to make sure that it's reassessing. Okay. So I'm gonna do my dressing change daily. I'm gonna change the Oona boot every other day with dressing changes.
I'm going to monitor size with every dressing change. Nutrition. Nutrition. Make sure they get some protein in their diet and all the other good important vitamins and minerals. What did you say?
I said, make sure our patients do Okay. So maybe I'm gonna get them up to the chair three times a day. Patient education. Like what? So you're gonna wanna, probably gonna wanna have your patient do exercises to keep So get them up, move them, do some exercises.
Yeah. Typically, I think think for foundations, Brooklyn makes you do three goals and three interventions for you on your care plan. When it comes to wound care, so when we're talking about because we should be charting, like, what we're doing for the wound care. We need to talk about what we're using for cleaning it. So, what type of drainage is there?
Is does it look like it's infected? How do the patient tolerate it? Are we washing it with just, like, a normal saline flush? Should we just kinda flush it out a little bit? Are we doing, in lab, I think we had sterile water.
Right? And then are we just doing that to clean it? There's the stuff that literally is like bleach that they would give me. It's a prescription. Smells like bleach.
And that's what they would give me to, like, sometimes pack a wound to clean it and then pack the wound to help with healing. So I need to know what the cleansing agent is. I need to know what kind of debridement we're doing. If it's sharp debridement, mechanical debridement, wound care nurse or surgeon's probably gonna do that. I'm not gonna do that because I haven't been trained on how to do that.
However, I might do the enzymatic or autolytic debridement because that's gonna be putting something on it, and the dressings. So I don't wanna put a hydrocolloid dressing on a wound that, basically, when I remove it, it's gonna make it worse. Like, it's gonna take off a layer of skin. I gotta make sure that that dressing is going to match the type of wound. So if I put on a dressing, I had a a stage one pressure injury.
And I put on, like, a I'm trying to think. Like, a wet pressure dressing thing that I just kinda put on there. That doesn't match the wound. That wetness is gonna come in. It's gonna break down the skin more.
Then I'm gonna take it off, and it's gonna be a whole great big mess. Does that make sense? So that's why the foam dressing is better. It protects it. It gives it a cushion.
It's dry. And then hopefully, we turn, we reposition, and they go about their day and their butt heals. Make sense? And you got a chart. Chart, chart, chart.
Chart what you used. Chart what you did. Chart the kind of dressing it is. It drives me crazy when one of the places I used to work, we had to do a lot of the wound care. And I am not a wound expert.
Brooklyn, I think, has her wound care certification. I do not. I do not want to. There's nothing about wounds that really excite me that much unless I'm standing back and watching and you're doing it. Totally down for that.
I don't wanna do it. However, at this one place I worked, we had to. That's just what we did. But if the nurse before me didn't chart what the wound care nurse told her to do because sometimes before the wound care nurse would assess it, she'd say, hey. Do this, this, and this, and then I'll go do an official chart on Tuesday when I do my rounds on them.
If that person didn't chart it and I'm going in there, I'm going in blind. I don't know what to bring into the room with me. So, basically, I gotta go in. I gotta take this apart. I gotta figure out what supplies she had.
Then I gotta leave them where they are for a minute. I gotta wash out. I gotta go gather up supplies. I have to come back. I can gather what I think that they might use depending because sometimes you kinda get to know what people use on the patient, but chart it because I need to know that what I'm doing is what you're doing so that we know if it's working or not working.
Okay? I'm gonna be a bug in your ear. Did you chart it? It says it on my desk. If you're ever at my desk, it says but did you document it?
Drains. So why do we need drains? We'll have like, you'll see people with JP drains, and we said we'll bring out the drains this week too because you guys didn't get a lot of time to look at the drains last week. But there's drains like, drains that will take blood from the area. They'll kind like, people who've had a mastectomy, they'll have, like, four drains coming out.
The purpose is that it's gonna prevent excess swelling. Do we need to assess the drains? Yes. What are we assessing for? Whatever.
Yeah? And what else? It might. The the The site where the drain is coming out. Yes.
So the site where it's coming out, I wanna look at the drainage in the drain. I wanna chart how much drainage is in the drain. I'm gonna empty that drain and measure how much is coming out because I wanna know if the drainage is slowing down. If it's increasing, we might have a problem. If it's like frank red blood that's coming out and it's not slowing down, I might need to call somebody because that's not good.
But, hopefully, it'll slow down. Certain surgeons I've had have told me, like, I want you to chart the amount coming out of that drain. I want it charted every six hours. I want some of them said every four hours because they wanted to see if it was coming down or going up. And they did not like it when people would just chart once a shift.
If the wound facts you'll see in lab, those are super cool. So we'll put it on a wound. There's, like, a piece of foam that you cut and fit it into the wound. Don't let it overlap on the healthy tissue because then it's gonna suck healthy tissue and you don't wanna do that. You put it in the wound and then you put this like Tegaderm over top of it that has a little hose coming out of it and you turn that wound vac on and it sucks it down like a VacuSeal?
Like, Like the Vactor Vax? Yeah. For food, you know? What I forget what they're called. VacuSeal.
Right? Sucks it all down. And so then it uses that negative pressure to pull out the drainage and it collects in a canister. I like wound vacs. I'll play with a wound vac any day, because it's cool.
Sutures and staples, you want to make sure that we are assessing. Is it well approximated? Does it is it red? Is it swollen? Does it look infected?
We only leave those in seven to fourteen days because, otherwise, the tissue is gonna grow up and around it, and then we're gonna be in a whole world of hurt. So we gotta get in there, take them out, remove them. The beauty of it is that it speeds up healing and it reduces the scarring because we kind of put it all together. And if, like, if a staple comes out, a lot of times, I'll just put a steri strip over it. If it's one staple, not a big deal.
If I got more than one staple that starts to fall out, we might have a problem because now we're looking at, is it gonna dehisce or not? So those are my assessments for the sutures and the staples. Are you a hot or a cold person when you have pain? Hot. Me too.
Me too. So here's the thing. You can use heat or cold. You sometimes they say the cold, like, heat for the first little bit and then the cold because it'll help clamp down on those vessels, and it's going to, not necessarily spread the, like, the inflammation and all that. Sometimes they say the heat makes it worse.
I don't know. You give me something cold, it's not really gonna work well for me, and I'm not gonna like it. I am a hot person. I want my warm pack. If something is healing, I want the heat.
However, think about post surgical. What do we do with, like, knees and shoulders and stuff? We have what we call an ice man that they'll put on it, and it's literally like a cooler full of ice, a little bit of water in it, and it circulates super cold water all around that knee or all around the shoulder. Theory is it keeps the swelling down, and it'll slow down the bleeding because you're clamping down on those vessels. There's benefits to it.
I just don't want it. Depending on what it is, you are going to need to order. So the doc's gonna order if they want, like, a particular hot or cold application. That little ice man cooling thing, that is an order. You can't just go grab one.
They're super expensive. Potential for harm. Why? How? Yeah?
Really hot bad or whatever. Yeah. Same cold. Same cold. Yep.
Especially with our older generation, regulator isn't working as well. That's why it's a hundred degrees outside, and grandma's running around in a sweater again. And she and it's, like, 87 degrees in the house. That's why, you know, you think peripheral neuropathy, different disease processes, they just don't regulate the same. So I may put a hot pack on them, and they don't know that it's burning.
I may put an ice pack on them, and they don't know that it's too cold and it's burning and causing damage. So you gotta be careful. There is a lot of potential for harm. That being said, if it's a young person, like, we're talking twenties to, like, fifties, sixties, they're alert and oriented and life is good, put a little pillowcase around the hot pack and give it to them. You know?
It I've had patients that are sitting there in pain, like, back pain because the beds are horrible in the hospital, and they want a hot pad. And I literally had a nurse tell this, like, 47 year old man, it's gonna burn your skin. I can't get you a hot pad. And I'm like, god. So and he was getting crabby.
And maybe I'm selfish, but I don't wanna have a bad shift. And if you want a hot pad and you're 47, feel like you got this, buddy. Gave him a hot pad. We're gonna have a warm blanket. Warm blanket.
I mean, that seems logical. Yeah. It's like you're saying. I'm just I'm just saying. Maybe I'm selfish, but I want a nice shift.
I don't wanna fight with anybody. And if I can give you a he literally told me. So this and maybe part of it was this gentleman, had a reputation. He's one of the men that I played dumb with because I'm like, shut up. You got a, like, you got a medical marijuana card?
Like, how did you even get that? What do you do? Like, what does it make you feel like when you take it? Like, how do you take it? Do you smoke it?
Do you put it in a brownie? I don't know. How does it work? What's better? What's not better?
So he's giving me all the the ins and outs, and I'm thinking, this is good to know if I ever whatever. And, he he was complaining of his back pain. He had had surgery, and he had chronic back pain. He had been in a motorcycle accident. And I'm like, what do you do for your pain?
And he's like, well, I smoke marijuana. Like, that's what I do. And, so we chit chatted about that. And I'm like, okay. I can't give you marijuana.
Like, I have synthetic marijuana. You're not gonna want it. It's not gonna do the same thing for you. I can do it if you want me to, but it's not gonna work. What else can I do?
I'm like, can I get you a hot pad? And he's like, yes. I'm like, okay. He's like, I've been asking for one for two days. And I'm like, why did they give you one?
Because they told me I would burn myself. K. I feel like I trust you. I'm gonna let this happen. So when I got a hot pad, I checked them, I'm like, please don't, you know, lay on it if it's burning your back.
Feel your skin peeling, please call me. What? I said, see, the reason of your trust issues, did it scare you off? It didn't. The reason of my trust issues issues is a seizure man who told me, I don't get seizures.
What are you talking about? And then proceeded, like, five minutes after I left to have a grand mal seizure. I haven't had a seizure in twenty years. I don't even know why it's immature. It was one time.
Straight out lies. So we trust them, but we don't trust them. It's a gray area. So you don't always have to get pain meds. You can do interventions.
You can get an order for an intervention. There are hot packs and ice packs that, like, you know, those ones you break? That if you just wrap them in a, pillowcase, it literally takes away the the risk of the burning of the skin because you have that barrier there, so it'll never get so hot that it burns the skin. So there you have it. At a nursing home, you need to order for everything.
It's kind of like you're getting ready to go into the nursing home, you need to order for everything in the nursing home. In the hospital, you get a little bit more autonomy, not a lot, but a little bit because Your left gravity is different. Because what? Your left gravity. Yeah.
It's yeah, it's just different. True. I feel like for the state task, it would be Order. Order. Order.
Order. Order. K. That's all I have. I have a question.
I would like to answer it. No. And if they instituted Glad I'm telling you. Done. No.
And they it's just it's it's just your n and flex board thing. Do we have an exam? For this class? Literally have no idea. Monday.
Yeah. But we also I'm gonna say that you probably do, because she's not gonna gonna wanna get that far off. So study like you do, maybe she'll do something special for your exam. You think she's gonna email us at all? Probably.
We haven't had No. I need to go get water. I'll give you this something. Coffee. Thank you.
I'm gonna drop my stuff off in the Assessment Room, and then I'm going to get some fluids. Almost defibrated. What? Who's whining? What'd you say?
Oh, no. I'll bring them back for you. Christina. I'll bring it back for you. Christina.
I drive it everywhere. I brought a wound for us if you didn't. An exercise. Did you? What did you make?
Yeah. It's a pressure wound for two. Okay. My ears probably looks weird. My back feels the pain.
Okay. I'm driving as much. I started with the mouth