How to start a peripheral IV in the dorsum of the hand: clinical nursing skill technique.

Starting an IV (intravenous catheter) can be an intimidating experience for nurses, especially nursing students and new nurses. However, nurses will perform IV insertions often, so this is an important nursing skill to learn.

Before starting an IV, always follow the protocols of your facility, as well as manufacturer's instructions for any supplies used.

In this video, Nurse Sarah demonstrates how to start a peripheral IV in the dorsum of the hand. Prior to inserting the IV, you'll want to do the following:

-Gather supplies
-Perform hand hygiene
-Prepare supplies (including priming the saline flush, removing air from extension tubing, opening packages, completing labels, and any other steps required by your facility.
-Locate a suitable vein
-Perform hand hygiene
-Don gloves


If the patient has a lot of hair, you might want to use clippers to trim the hairs prior to starting the IV. You may also apply a tourniquet to help veins move near the surface of the skin.


Next, you'll want to clean the site using the cleaner that came in the IV start kit, such as ChloraPrep.


Once the site has dried completely, you can insert the IV. Stabilize the vein with your non-dominant hand, and insert the IV's needle into the vein, watching carefully for blood return (or a blood flash) in the chamber. Advance the IV around 2mm more to ensure the plastic cannula is in the vein, then thread the cannula into the vein and press the needle safety button.

Notes: https://www.registerednursern.....com/how-to-start-an-
IV Video Series: https://www.youtube.com/watch?v=MbG_1-_mnoo&list=PLQrdx7rRsKfXr6kruqEpIovf66sxo0gxh



This video also demonstrates how to flush the IV using the push-pause method, how to secure the IV using the Tegaderm dressing that came with the IV start kit, considerations of the different cap types and the clamp sequence, and more.



For more information, watch the complete tutorial.

#nurse #nursing #iv #startiv #ivtherapy



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Full examination of the female from head to toe by Loyola Medical School, Chicago. Part 4

The examination room should be quiet, warm and well lit. After you have finished interviewing the patient, provide them with a gown (a.k.a. "Johnny") and leave the room (or draw a separating curtain) while they change. Instruct them to remove all of their clothing (except for briefs) and put on the gown so that the opening is in the rear. Occasionally, patient's will end up using them as ponchos, capes or in other creative ways. While this may make for a more attractive ensemble it will also, unfortunately, interfere with your ability to perform an examination! Prior to measuring vital signs, the patient should have had the opportunity to sit for approximately five minutes so that the values are not affected by the exertion required to walk to the exam room. All measurements are made while the patient is seated. Observation: Before diving in, take a minute or so to look at the patient in their entirety, making your observations, if possible, from an out-of-the way perch. Does the patient seem anxious, in pain, upset? What about their dress and hygiene? Remember, the exam begins as soon as you lay eyes on the patient. Temperature: This is generally obtained using an oral thermometer that provides a digital reading when the sensor is placed under the patient's tongue. As most exam rooms do not have thermometers, it is not necessary to repeat this measurement unless, of course, the recorded value seems discordant with the patient's clinical condition (e.g. they feel hot but reportedly have no fever or vice versa). Depending on the bias of a particular institution, temperature is measured in either Celcius or Farenheit, with a fever defined as greater than 38-38.5 C or 101-101.5 F. Rectal temperatures, which most closely reflect internal or core values, are approximately 1 degree F higher than those obtained orally. Respiratory Rate: Respirations are recorded as breaths per minute. They should be counted for at least 30 seconds as the total number of breaths in a 15 second period is rather small and any miscounting can result in rather large errors when multiplied by 4. Try to do this as surreptitiously as possible so that the patient does not consciously alter their rate of breathing. This can be done by observing the rise and fall of the patient's hospital gown while you appear to be taking their pulse. Normal is between 12 and 20. In general, this measurement offers no relevant information for the routine examination. However, particularly in the setting of cardio-pulmonary illness, it can be a very reliable marker of disease activity. Pulse: This can be measured at any place where there is a large artery (e.g. carotid, femoral, or simply by listening over the heart), though for the sake of convenience it is generally done by palpating the radial impulse. You may find it helpful to feel both radial arteries simultaneously, doubling the sensory input and helping to insure the accuracy of your measurements. Place the tips of your index and middle fingers just proximal to the patients wrist on the thumb side, orienting them so that they are both over the length of the vessel.

Delivery of the placenta

Pediatric surgeons at Texas Children’s Hospital West Campus perform general surgical procedures such as circumcisions, removal of foreign objects, hernia repair, and suturing of minor lacerations. While more complex surgeries take place at the Texas Children’s Main Campus, pre-operative and follow-up outpatient care for those procedures is available at the West Campus.

Everything about Texas Children’s Hospital West Campus is dedicated to the health and wellness of children. As greater Houston's first suburban hospital designed exclusively for children, we offer the expert care you've come to trust from Texas Children's Hospital coupled with a location that's convenient and accessible for area families. Our facility is located just off the westbound feeder road of the Katy Freeway (at I-10 and Barker Cypress).

For more information about Texas Children's Hospital West Campus, visit http://www.texaschildrens.org/....Locate/In-the-Commun

Meet Dr. Allen Milewicz, chief of community surgery at Texas Children's West Campus
https://www.youtube.com/watch?v=uMoCdipuKfA&index=16&list=PLiN68C9rloPBD-E9ChWhVy73h7V3SEMlm

Breast abscesses are often linked to mastitis – a condition that causes breast pain and swelling (inflammation), and usually affects women who are breastfeeding. Infections can occur during breastfeeding if bacteria enter your breast tissue, or if the milk ducts (tiny tubes) become blocked. This can cause mastitis which, if not treated, can result in an abscess forming. Women who aren't breastfeeding can also develop mastitis if bacteria enter the milk ducts through a sore or cracked nipple, or a nipple piercing. White blood cells are sent to attack the infection, which causes tissue at the site of the infection to die. This creates a small, hollow area that fills with pus (an abscess).

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A new video illustrating the horizontal breast exam technique whihc is performed by doctors for any breast masses or abnormalities.

Professional breast exam

Watch that Real Human Body Decaying Process

A video showing the examination of femoral hernia.

What factors should I consider when deciding whether to have surgery? The following factors should be considered when deciding whether to have surgery: Your age—If you have surgery at a young age, there is a chance that prolapse will recur and may possibly require additional treatment. If you have surgery at an older age, general health issues and any prior surgery may affect the type of surgery that you have. Your childbearing plans—Ideally, women who plan to have children (or more children) should postpone surgery until their families are complete to avoid the risk of prolapse happening again after corrective surgery. Health conditions—Any surgical procedure carries some risk, such as infection, bleeding, blood clots in the legs, and problems related to anesthesia. Surgery may carry more risks if you have a medical condition, such as diabetes, heart disease, or breathing problems, or if you smoke or are obese. New problems—Surgery also may cause new problems, such as pain during sex, pelvic pain, or urinary incontinence.

Dr. Debbie Song at Gillette Children's describes in detail selective rhizotomy surgery.

A selective dorsal rhizotomy is an operation performed to treat spasticity. It is thought that high tone and spasticity arise from abnormal signals that are transmitted through sensory or dorsal nerve roots to the spinal cord. In a selective dorsal rhizotomy we identify and cut portions of the dorsal nerve roots that carry abnormal signals thereby disrupting the mechanisms that lead to spasticity. Potential patients go through a rigorous assessment that includes an in-depth gait and motion analysis as well as a physical therapy evaluation.

They are evaluated by a multidisciplinary team that includes a pediatric rehabilitation doctor, a neurosurgeon, and an orthopedist, Appropriate patient selection is vital. Ideal candidates for selective dorsal rhizotomy are children who are between four and ten years of age, have a history of being born prematurely, and have a diagnosis of diplegia cerebral palsy. These patients usually walk independently or with the assistance of crutches or a walker. They typically function at a level one, two, or three in the gross motor function classification system or gmfcs. A selective dorsal rhizotomy involves the coordinated efforts of the neurosurgery, physiatry, anesthesia and nursing teams. The operation entails making an incision in the lower back that is approximately six to eight inches long. We perform what we call a laminoplasty in which we remove the back part of the spinal elements from the lumbar one or l1 to l5 levels. At the end of the procedure the bone is put back on. We identify and open up the Dural sac that contain the spinal fluid spinal cord and nerve roots. Once the Dural sac is opened ,we expose the lumbar and upper sacral nerve roots that transmit information to and from the muscles of the lower extremities.

At each level we isolate the dorsal nerve root, which in turn is separated into as many as 30 smaller thread light fruitlets.

Each rootlet is then electrically stimulated. Specialized members of the physiatry team look for abnormal responses in the muscles of the legs as each rootless is being stimulated. If an abnormal response is observed then the rootlet is cut.

If a normal response is observed, then the rootlet is not cut. We usually end up cutting approximately 20 to 40 percent of the rootlets. The Dural sac is sutured closed and the l1 through l5 spinal elements are put back into anatomic position, thus restoring normal spinal alignment. The overlying tissues and skin are then closed and the patient is awoken from surgery. The entire operation takes between four and five hours. A crucial component to the success of our rhizotomy program is the extensive rehabilitation course following surgery. With their tone significantly reduced after a rhizotomy, patients relearn how to use their muscles to walk more efficiently through stretching, strengthening, and gait training. Approximately one to two years after a rhizotomy patients undergo repeat gait and motion analysis. The orthopedic surgeons assess the need for interventions to correct bone deformities, muscle contractures, poor motor control, impaired balance, or other problems related to cerebral palsy.

At Gillette we work closely with patients and families to ensure that our selective dorsal rhizotomy program meets their goals for enhancing their function and improving their quality of life.

VISIT https://www.gillettechildrens.org/ to learn more

0:00 Why choose selective dorsal rhizotomy?
0:56 Who is a good candidate for selective dorsal rhizotomy?
1:31 What does a selective dorsal rhizotomy entail?
3:26 What is recovery from selective dorsal rhizotomy like?

A wet mount is the suspension of a small amount of vaginal discharge in a liquid medium. Two liquids are commonly used, normal saline and potassium hydroxide. Each has it's own unique properties that make it useful in this setting

Watch that video to know about the Anal Intercourse Medical Risks

Watch that video to learn How to Know When You Are Ovulating

Surgeons in London removed a woman's brain tumor during a very unusual procedure. CBS News' Tina Kraus reports, the patient's love of music helped guide the surgery.

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To record the sequence, Stephan Gordts and Ivo Brosens of the Leuven Institute for Fertility & Embryology in Belgium performed transvaginal laparoscopy, which involves making a small cut in the vaginal wall and observing the ovary with an endoscope.

"This allows us direct access to and observation of the tubo-ovarian structures without manipulation using forceps," says Gordts.

For the photos of ovulation, which only accidentally captured the critical moment, Jacques Donnez at the Catholic University of Louvain (UCL) in Brussels, Belgium, used gas to distend the organs for photography. However, Gordts and Brosens planned the procedure to coincide with ovulation and used saline solution to "float" the structures.
Perfect timing

Observation was timed for the day of the peak of the patient's luteal hormone cycle. Ovulation was predicted to occur on the evening of the day of the LH peak, and the endoscope introduced at 6 pm.

A small amount of saline was used to float the opening of the fallopian tube, its fimbriae (the "fingers" that sweep the egg into the tube) and the ovary itself. This gives a more natural appearance than gas, says Gordts.

In the video, the fimbriae can be seen sweeping in time with the patient's heartbeat. A mucus plug can be seen protruding from the ovary – this contains the egg.

"The ovum is not captured 'naked'," says Gordts. "There is no eruption like a volcano."

Gordts says that in clinical practice it is not easy to organise the observation of ovulation. "We were probably lucky to be successful at our first attempt," he says.

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catheterization of the male urethra by a foley catheter