ReMar Nurse University: Day 1 of 5 – Next-Gen NCLEX Pharmacology & Critical Thinking Secrets!

0:00 You know, I'm so geeked about this broadcast. Get out your workbooks. Every Monday in June, we are going live for this special event. That's right. Every Monday in June, right here is our schedule. And also during Remar Nurse University, because we're so confident that if you do the work, the reward will come. Hey everybody, come on in. We are doing a remar nurse university money back guarantee if you don't pass INLEX. The money back guarantee is right there plus 50% off of our program. So what a great time to be in this INLEX bag. We have a lot of work

0:45 to do, but you heard it first. We are dropping pow pass inlex or get your money back. It's it's about time. 99.9% passing rate. I gotta go with the money back guarantee. And it's all right if I have RNs, if I have PNS, this is for you. Now, not too much if you're still a nursing student or even if you're interested in becoming a nursing student. We also have products for you, too. So, we have the nursing school V2. Yep. For nursing students. And we also have the TE's for you as well. Okay, so we're gonna get right into it though because time time is winding up. We have

1:31 to make sure that we're on the right track. Hi Jennifer Richards from New York. Hi everybody. Let me know where you're from. Let me know where you're from. Okay, so this is how this class is going to work. Of course, this is all about pharmarmacology, but we're not just going to be memorizing drug names and drug classes. This is an advanced pharmarmacology class, meaning we will be applying the pharmarmacology to an actual patient scenario. If you are going to pass INLEX, you're going to have to be able to anticipate patient care in a safe and an effective way. So advanced class, yes. Think of this as pharmarmacology 103. But can you handle it? New York can handle it. Nigeria can handle it.

2:16 Illinois can handle it. Yes. Also, if you don't have the workbook, we're dropping the link right here in the chat so you will see it. You can go and grab it because we will be using this workbook all month long. All month long. So, not too much on you. Get out your workbooks. Let's get ready to get into it. We're starting off RNU. We're starting off RNU. um knowing that every single week we're going to have Monday classes and Wednesday classes in addition to what we're doing here. Again, money back guarantee is the jam for this week. Our patient that we are the our patient that we're working on is Miss Myra Keller today. Get ready

3:03 to take report on Myra Keller as I get my own report here. I'm going to give you a good report on this patient. Myra Kella, 54 year old female. I need my nurses to tap in right now. You're starting your shift. 54 year old female, are you with me? Put ready in the comments if you are with me. 54 year old female patient here. She's admitted with an episode of chest pain after jogging. jogging outside at 5:00 a.m. Now, this is significant because Miss Keller has a history of asthma, anxiety, hypertension, cigarette smoking, and obesity. So, we know that this patient

3:51 is having a history of cardiovascular issues, right? Presenting with chest pain. Okay, what else do we need to know about this patient if we're going to care for her with pharmarmacology? Let's talk about the presentation of this patient. Her mentation is ANO X times 4. Lungs are clear all fields. She denies nausea and vomiting at this time. Boys freely clear yellow urine moves independently. Now, if there's anybody around you that's not nursing, tell them don't even tell them this is just strictly nursing language, but I know I'm speaking to my people. I'm speaking to my people here. Okay. All right. So, I'm giving a report. All right. And listen, everything that I'm giving you

4:38 is all I'm giving you. You're going to work through this case with the information that's presented. Nothing else. Okay? Nurses note for 6 p.m. patient had two episodes of shortness of breath and hypertensive episode was noted after lunch. The client stated she was nervous watching the war on the news. Client stated she felt better without any intervention. Client is currently resting quietly in bed after ambulating down the hall. And nurse Henrietta Clark wrote that nurse's note. If you know Henrietta, you know Henrietta. Okay. All right. Let's dive more into our patient as well. What else do we need to know?

5:25 if you don't have the workbook. I tried to do my best to give you the the information that was presented in there. So, we're given uh our patient. We see that she's a full code. We see our doctor, Dr. Sani here. The medications that our patient has been prescribed are um I think we are on page the page we are in the workbook. Let me know page number nine. Please put the page numbers in the comment. Um patients on amalodapine, patients on carvettool, patients on lysinapril, patients also on sodium bicarbonate, and we have calcium chloride. Okay, patient medication. Do we know what these medications are

6:11 for? Okay, let's also look at our patients laboratory values here. Okay. And we're going to go through this report pretty briskly, just as if we were taking an actual report. These are your patients laboratory values. There were repeat labs done at um 6 a.m. on today because the patient did have some critical lab values. Now, just looking in your workbook, which two values are critical lab values for your patient? Okay, which two lab values that you see right here are going to be critical lab values. Remember, INLEX is going to give you the normal lab values. And so it is up to you to be able to

6:58 interpret them correctly, but also um also not only interpret them correctly, but also make sure that you are understanding what's causing what what's causing what. Actually, there's there's more than two critical lat values now that I'm looking at the comments. There's more than two. There's actually three. There's actually three. Hey, nice nice testimony here. Posh really quickly says, "Just a year ago, I joined RNU." She said, "It seems like it was yesterday and I'm a Remar nurse now. God bless you, Professor Regina and the Remar team. Please believe and you will share your testimony soon." Thank you so much. Thank you for that. Okay, we see

7:43 the laboratory values. We're on page number nine. Um, somebody asked about the vital signs. Let's look at the trend for your patient. Looking at the trend for the blood pressure, the first one noted here um is 145 over 90. And then the current one is looking at 165 over 99. Do we see that? Is that trend going up or is that trend going down? Also look at your patient's cardiovascular health in terms of the heart rate. What is the trending doing here? Respirations,

8:28 temperature and follow me over to the pulseox of your patient at 92%. Would this be considered normal or abnormal? Assuming that your patient is on room air, are we satisfied with this uh pulseox 92% on room air? Is this normal or abnormal? Okay. During RNU, the information that we present here is specific to RNU. Okay. So, this is not quickfax. Um this is our RNU workbook. Okay. Some charting normal, some

9:15 charting abnormal. Uh for inlex, we want to chart that as abnormal. Okay. We want the 92%. It's not it's not um it's not our it's not our normal. Okay. All right. So, you have the information about your patient. Let's work this case study. There's something going on with your patient already. Does anybody know what it is just by looking at the information without me having to talk you through it? What is wrong with this patient? What is wrong with this patient? Cuz I mean it's plain. It's here. Looking for safe nurses. You are going to give yourselves a grade based on how you do. So we have a grading scale based on how you do. Let's do

10:02 number one. My goal for everybody is to at least get a B a B on this assignment. Every week the case studies will get um I would say progressively more challenging. This probably is one of the most challenging ones because this is the first time that you're doing this activity with me and um we're doing it at a pretty brisk pace. So you have to keep up and you also have to anticipate what the next thing is. Right? So this is a very good exercise for you. Question number one here and I want to see your comments on the screen or you can also write them in your workbook. What is the priority when first evaluating a client at the start of the shift? So just general, what are some things that nurses need to do right

10:47 away? If this was your patient, what would be the first thing you would do when you went into the room? What would be the first thing you would do? So think nursing actions. Okay, think nursing actions. What are the first things you're going to do? Natalie has the probably the the best comment, right? First thing you were going to do if this was if this was your patient, you're right on the shift. Write it down. Put it in the comments. And again, when you're first starting your shift as a nurse, the very best thing that you can do is do these actions for yourself. do these actions for yourself and not delegate them away to anybody else because this is your patient. So, I like this. I actually

11:34 didn't have that one, but the correct answer, vital signs, head to toe assessment of the patient, evaluating pain as well. Somebody says, "Introduce yourself." That's so good. That's so good. Remares, you of course introduce yourself. Forgive me for not even putting that one. of course you introduce yourself. Um, but for this patient particularly, we need to reestablish those vital signs and do that headto toe assessment. It's going to be a quick one, but it needs to be done by the nurse. So, that's you. That's you. I think we're all on here the same page. Okay. All right. Next question is

12:20 this. From the MAR, list four patient needs that must be communicated to the physician. If everybody puts one or two down, we should get them. But when you just look at if you go back to page number nine and you just look at everything that you're presented with, I'm asking you to list four things that the nurse needs to tell the doctor. Now, what are those things? What are those things? And one of the reasons why we're doing this exercise is because clinical judgment, clinical judgment is one of the foundations of every inclelex question. So what do we have to tell the patient? I mean, what

13:07 do we have to tell the physician? Somebody says the vital signs, the sodium, the oxygen. Yep. Because when you say the sodium, if you say the sodium for inlex, then that lets them know, okay, this nurse knows the sodium is abnormal. The next question is, does she know how to correct it? Okay, we're not just working with a a basic recognition exam. That'sm recognition questions, not going to get it. Potassium level, blood pressure, oxygenation, alkaline phosphates is a

13:52 lab value. What is that connected to? What organ is that connected to? Right. Patients heart rate. There are many more here. I only asked you for four. I only asked you for four. I see that. Vital signs, sodium, potassium, oxygen. Most of you guys have this vital sign. Yep. Okay. Are you guys hearing me? Okay. Thumbs up if you hear me. Okay. All right. Next question is this number three. What are three diagnostic procedures the nurse should anticipate? This is the leap here. This is a big leap because I'm asking you now to think ahead of where we are right

14:40 now. Give me three diagnostic procedures related to this patient condition. Absolutely. Absolutely. EKG. No doubt. What else? I see a lot of EKGs. What's another diagnostic procedure? Somebody said, "Check the urine." Check the urine. All labs 12 equally G. Okay, these are ones that I have. These ones I have just based on the patient presentation because you could say anything, right?

15:25 But there are certain things that would go along with what is going on with the patient right now and the laboratory values that you have. So these are the ones that I have here. ECG, EKG, definitely stress test because we want to know is the patient able to actually sustain the activity that they're trying to do or if this is anxiety, right? And the liver function test, some people had liver function tests, some people did not have liver function tests. that when I look at the laboratory values, I'm concerned about the liver. I'm concerned about the liver because the alkaline phosphates is really high.

16:12 And I don't know if that's a issue with there's two two reasons that could be high, the alkaline phosphates. What two things can cause that to be high? The liver or bones. or if the patient is having um if their bones are breaking down from from osteoporosis from some something something going on with their bones, right? And this is a female. So I want to know what is the cause of that um what is the cause of that a alkaline phosphates? Okay. All right. That's why that's why. Yep. Bones. All right. Next question is this. and and think about

16:57 how you're doing. Think about if your answers are matching up with mine's or if you're having different answers. Okay? And why you might be having different answers. Okay? This says safety. Number four, identify three possible causes of hypertension in this patient. Hypertension. What could be causing hypertension in this patient? and you have a good amount of information why the blood pressure could be going up. I just like to go back to it. I'm I'm flipping back and forth. Okay. Think about the patient's

17:44 history. Think about the patient's history. Yep. Spot on. The comments are flowing in so fast. I don't even know. I can't even spotlight them. Yes. And this is good because you know with hypertension you need to understand the difference between primary and secondary hypertension. Is that right? Is that right? Yes. Yes. Absolutely. These are the ones that I had. I had oh from quickfax page 14 all the modifiable things that this patient has going on. She has a lot of modifiable risk factors. So the diet, the smoking,

18:29 the obesity, the anxiety. Yeah. Yeah. These are all the reasons why our patient could have hypertension. Doesn't even have to be a cardiac issue for per se. It can literally be lifestyle. Good job here. Okay. Here's safety question. I'm moving you through like a case study. So, we're going back to safety here. Which medication is most likely causing the hyperc calmia in the patient? Which medication is most likely causing the hyperc calmia patient? Patients potassium level is it's like 6.1, right?

19:15 6.1. Did I have that right? Yeah. What medication is going to cause that? B. Can you see? Now, let's stop here and I see you putting the correct answer, but I asked you two questions. Which medication? And then I'm also asking you why. And that's just as important. The correct answer is lysinapril. Okay. But what about lysinapril causes a patient to be in this situation? What about lysinopril

20:02 specifically? And this is very important because lysinopril interacts with the natural hormone process in the body. It's an ACE inhibitor, right? It's an ACE inhibitor. So what about that lysinopril? don't want you to I don't I want to go beyond the surface level level. Okay. I want to go beyond just the surface level here. So, lysinopriil is correct. But what about lysinopril? Lysinopril blocks aldoststerone. Aldoststerone is very very popular in nursing school as a term, right? We we have eldoststerone blockers. We talk about it. But we learn stuff. so fast in nursing school that sometimes we we want

20:50 to just be familiar with something without saying hey I don't really know what that I don't really know what that is why is that important what's important about aldoststerone and I don't want you guys to forget this because it is it's it's a great building block is aldoststerone promotes the excretion of potassium aldoststerone is what tells the body to initially hold on to salt and hold on to water right but Another thing that it does is it tells the body to get rid of potassium. Aldoststerone get rid of potassium. So what I what I like to think about it is um aldoststerone is like adore man like aldoststerone is like alo the door man and he kicks out potassium. Okay. So

21:36 aldoststerone kicks out of potassium. It gets rid of potassium. So if you have a medication that blocks this door man from getting rid of the potassium then the body will just keep the potassium inside which is not good. Okay. So anything that blocks aldoststerone is going to tell the body to keep potassium. Okay. All right. Okay. All right. We're we're we're diving deep. So, I'm trying to pull out some creative ways to help us to get to that next level. Okay. Next question was this. For those of you who got it right, good for you for getting it right. Even better for understanding

22:21 why it's right. Okay. Yeah. Okay. Next question was this. Do you know this? What information is missing from the MAR before the nurse can properly administer medication to Miss Keller? So, what information do we not have that we need to have before we give medications? Yes. Yes. My safe nurses are showing up. Oh, please everybody put this in. Put what it is. Okay, put what it is. There's one thing that we cannot give a medication for

23:07 without even just asking her this. The correct answer is the allergies. We yet not know what our patient is allergic to. This is significant because on inclelex you you get these case studies. You get these this is what our this is what our workbook looks like. This is why I want you to have it. And these are just like all my notes that I just took during during the day. But we don't have our patient's allergies. That's one of the first things we need to look for. And as you can see, it's not on here. But there is evidence that this patient has been getting medications. So, are these nurses following proper

23:53 protocol? They're not. We have to assume that they're all dangerous. Safety concern. What concerns are present about the new medications ordered on the MAR? What concerns are going to be look at these medications? What concerns do you have? When I look at these medications, when I look at the when I look at the amalodapine, let me see if I can Oh, I don't know if I can do this because I know some of you might not have the workbook. Let me see if I could pull up the medications for us to look at them together. What medications? Okay.

24:40 What medications have you concerns about? And honestly, if this is your second or third or fourth time taking INLEX, I want you to see what your process of studying should look like and should feel like. You should literally, if you're studying with me right now, you should literally feel like you're being trained. And not that you're doing it on your own, but you're you're in a classroom environment. return back to the classroom. Okay? And be okay with starting from just from a foundational level. This is foundations right here. So, very good. What I'm seeing in the comments, you guys are you guys are picking it up. Okay. And again,

25:29 this class is a little bit more advanced. So, we have we have a we have every level here. And honestly, I'll say I'm proud of you for showing up. I'm proud of you for showing up and getting back up on the horse again. Okay. Yes. That's that's that's the issue. If you're reading the comments, you're seeing the issue. People are identifying it. These medications are written without all of the proper knowledge. If we look at amaloapine, we look at amaloapine, it has no route. What? No route. But has it been given? Yes, it's been given the carveta. No route. Is it PO? Is it IV? I

26:18 don't know. Okay. Did you catch that when you first looked at these medications? Some people did. Some people missed it. The sodium bicarbonate. What's wrong with the sodium bicarbonate? Let me try to put it back up again. What's wrong with this sodium bicarbonate order? If we look at it, you can see that the sodium bicarbonate is scheduled to be given how many times? Uh uhhuh. Okay. It's supposed to be given one time, but how many times have this medication been given just based on the documentation? What it's been given? Same thing for the calcium chloride. These orders have been ignored because

27:04 they've only been scheduled to be given one time, yet they've been given multiple times. Did you catch that? Okay. So, this is what I'm talking about when I say INLEX is a a reading exam just as much as it is a critical thinking exam. And you have to be able to spot this right away. Right away. So there are many things again in regards to the medications that we are concerned about. Medications that we are concerned about. And this is what RNU is about too. It's just about taking it um a step further than what you have currently. Moving on. I'm moving on. How about this? Um so after the administration of

27:51 nitroglycerin which expected side effect would require pain medication which medication all right so after the administration of nitroglycerin that's what I'm talking about I'm talking about this nitroglycerin order it says 7.5 mg how many of us have given this before 1/2 of an inch And if you don't put gloves on when you give this ointment and it gets on your body. Oh, help you. Oh, help you. Okay, good job. Good job. Patient will need pain medication. When you give nitroglycerin, just be prepared to have

28:37 pain medication. Patients going to report a headache. And in America, what medication will be ordered for this pain? This is a bonus question. I just want some people, maybe some people are not in America. They're coming here. What would we give this patient for their headache? Yes, absolutely. Would we give them pain medicine? We definitely would. Okay. We definitely would give them pain medication and it would be somewhere along this. This is what the doctor's going to order. And so the patient may say, "No, I need something more. This is really a bad headache." Because it really is a bad headache. It's a vascular headache. Because when we give

29:23 nitroglycerin, what does it do to the to the body? It vasoddilates. So it opens up the vessels. They relax and they open up. But in our minds, in our not in our minds, in our brains, it opens up the vessels. and your brain is like, "Ah, Tylenol, acetaminophen. That's what that's what the patient's going to get. That's what the doctor's going to order." Nothing stronger than that. Nothing stronger than that. Okay, great. Moving on. Moving on. This is a question. Now, the doctor also ordered oxygen therapy to keep the saturation above 93%. When we are giving oxygen, now this is important because

30:10 oxygen is not just a treatment. Oxygen is a what? When we're giving oxygen, what is the greatest risk for the first time it's given? Is it number one hypoxmia, two oxygen toxicity, three respiratory alkalossis, or four, hypercia? What sayith you all? Oh my goodness. Thank you all for the wonderful testimonials is super encouraging. Super encouraging and the fact that you are still watching and you're you know in Thank you so much. We're talking about nurse Cano says thank you Remar. I took my inclelex. Hey, this month, May 13th, my exam cut off

31:02 80. Wow. Thanks for all that you do. Cool. That's the goal. 80 87 questions and out. I see everybody going with number two. Is there anybody going anything different? Uh, number two. Number two. Correct answer is number. It's number two. is number two. I'm sorry, that wasn't the right one. Number two is the correct answer for nine. Let me just go over the other reasons why um it wouldn't be number one when we are initiating it for the first time. Um hypoxmia, if we're giving oxygen, we're probably not going to get into a state where there is low oxygen. Okay. Respiratory alkalossis means is typically seen when the

31:47 patient's breathing really fast and their respiratory rate increases. and hyperkip. This is when you have a buildup of what? You have a buildup of CO2. Now, when you put a lot of oxygen on a patient with COPD, then number four can happen. But yeah, somebody put that in the com. When you have a patient with COPD, number four can happen. However, that's not in our patients history. Okay, not in our patients history. Let's move on. Question number 10 says, which of the following is sodium bicarbonate the appropriate treatment for? And the correct answer is metabolic acidosis. So sodium bicarbonate is going to treat metabolic

32:34 acidosis. Now, here is my question. I want you to go back over all of your answers for this simulation, and I want to know um Oh, there it is. Oxygen toxicity. Um, I want to know were you were you a safe nurse today? Now, this is how you can tell if you were a safe nurse if you did this assignment. This is our grading sheet. This is our grading sheet. So, let me know what you achieved on this on this simulation test. So, if you got five or less, okay, that's an F. If you got six right there, you got an E. Okay, which

33:19 is a new thing, but it just means that wasn't enough. Okay. Um, seven, that's a D. What'd you get? Eight, that's a C. Uh, nine, if you got nine right, that is a B. And 10 or 11 is an A. So don't just tell me your don't just tell me yes or no I was a safe nurse. Let me know what your number is. So nines or B's. Remember our our goal today was a B for this. So if you got less than a B, there's some areas we need to work on and this is part of the evaluation process. You're able to evaluate yourself in a different way. Oh, you got 11 right. You got all of

34:05 them right. Okay. Oh my my my my. And and and if you got an F, this is the best time to get that F. There is no better time to get a F in pharmarmacology than the month of June because this is a working learning environment. Oh, so good. And I know we have different levels here. So, of course, if you're a new nursing student or if you didn't have the workbook or if you just caught the end of the class, that's a different type of F. Okay? But the idea is that you show up, you show up on time because this class moves fast. All right? Now, in the next part of this studying process, I want you to know that we are able to take the

34:54 studying to the next level. All right? We're able to take the studying to the next level. This right here is a very small part of what you need to do to be fully prepared. You need to be fully prepared. And so what I'm going to do now is take you into my total program that helps to make sure you're studying the right things and you're not just randomly guessing, but you have a blueprint of what you're supposed to do. So on your workbook, we are going to literally look at Okay, we're going to look at a V2 preview. V2 is the name of my virtual training system, the second one that I created for NextGen Inclelex. So, we're going to look at the necessary requirements in expected changes during

35:40 the aging process. This is a foundational subject. Why is it foundational? Because the way we treat pediatric patients, what we call normal, is not the way that we treat geriatric patients. And one of the things that you're expected to know, especially if you're a PN, is how the aging process affects the way your patient's body metabolizes medications. What we call normal or abnormal? This is for the RNs on assessment. Okay. What's expected? Is hearing loss expected as you age? Uh are teeth missing expected as you age? Is oxygenation expected as you age? A

36:28 decrease in oxygenation expected as you age. Okay, so let's go into um let's go into the V2 and let's watch expected changes in aging. Uh, let's [Music] go. Welcome to expected changes during aging. The aging process affects every individual differently. We know that. But as our bodies age, there are certain physiological changes that you can prepare for as a natural part of growing old. So we're going to look at different

37:15 systems and I'm going to tell you the changes tested on INLEX. So the first system is the cardiac system and that involves our heart. Of course, what you can expect as you grow older is a decreased cardiac output. So the cardiac output decreases but what happens is there is an increase gradually in the blood pressure and that is because the vessels tend to become more non-compliant. They constrict a little bit more. Now a big thing that you have to understand is orthostatic hypotension. Orthostatic hypotension and

38:02 this is common in the elderly and it's essentially a decrease in blood pressure as the position of the client changes. So with orthostatic hypotension, I want you guys to to understand this principle if this is the first time you're hearing it. But when you take uh orthostatics, you have the patient lie flat, you do a blood pressure, then you move them to a sitting position, you do a blood pressure. And of course, I'm saying blood pressure, but the blood pressure also includes the heart rate as well, and then you have them up to a standing position. You check the blood pressure and you check the pulse. Now if a client is positive for orthostatic hypotension

38:48 then as they sit up and as they stand you will notice that the blood pressure decreases and the heart rate goes up to try to compensate for that dropping blood pressure. So it is kind of common with our elderly patients. So that is why we encourage them to change positions slowly. Change positions slowly. Another point that I want you to know is that the peripheral circulation in the elderly client also decreases. So think about that remar nurses. As the patient grows older, if the blood and the nutrients are not

39:34 getting to the periphery or the extremities, how is that going to affect skin? How is that going to affect capillary refills? All those things. Okay. All right. Now, we need to look at the respiratory system. Of course, here as you get older, you're going to have increased oxygen demands, increased oxygen demands, but a decreased lung expansion. All right? So with increased oxygen demands, that simply means that when an elderly client does activity such as going up the stairs or um going grocery

40:20 shopping or driving, anything that's going to have them to be doing activity, getting in and out the car and driving somewhere, they're going to require a little more oxygen. But as we age, the vascular the vessels and and and the muscles and everything, they don't expand as freely. They're not as flexible. So the decreased lung expansion will be noted. Here is a question. Is it normal for an elderly client to wear oxygen? What do you think? Is it normal for an elderly client to wear oxygen? Think about this. When you turn a certain age, is it happy birthday, you're 59, you're 65, you're 75, here's

41:10 your oxygen, because this is a normal part of aging. What do you guys think? No, absolutely not. Anytime you see someone wearing oxygen, there is some disease process that is requiring that additional oxygen all the time. So it is very very important for nurses to understand that oxygen is a medication. All right? It's not something that you just give casually to someone. It's a medication and there needs to be a disease process to back it up. Now, one of my hobby horses as a a nurse instructor, as a preceptor, as a mentor, is that when you put oxygen on a

41:56 patient, make sure make sure that after the oxygen is no longer therapeutic, you remove it. And this is a a personal matter. As nurses, as an enclelex expert, I need you guys to know that normally after about 6 hours, oxygen is no longer therapeutic for acute conditions. So, I'm going off here, but this is important for you to understand. If a patient comes in and they have a myioardial inffection and we put oxygen on them after about 6 hours that oxygen is no longer therapeutic. And so you're just having the patient to maintain oxygen with no benefit. And so what

42:44 happens is people come into the hospital all the time, oxygen is initially put on them for the reason why they're there, but it's never taken off. And so they may be in the hospital for three and four days. And then when it's time to be discharged, the nurse attempts to take the oxygen off. And what happens after a patient has been on oxygen for 3 days? They cannot breathe. They have shortness of breath, they need the oxygen. So many people come into the hospital with no oxygen but leave with a prescription for continuous oxygen because nurses have failed to take that oxygen off the patient when it was the appropriate time. So I say all that because I want

43:29 you guys to be excellent nurses. As a Remar nurse, you have a responsibility to do no harm and to teach others to do the same. [Music] Okay, let's move on to the integimementary system. We're talking about the skin here. As you grow old, the skin becomes dry, thin, wrinkled. Yes, that is what we expect. There is also a decline in the ability to repair damaged tissues. and also a decline in wound healing abilities. And so this this goes

44:14 back to the other organ functions, right? If the heart is not able to effectively um supply the the periphery with nutrients and oxygen, then that's going to de decrease the amount of healing that can take place. You know, skin changes in the elderly can lead to lower self-esteem as well. Oh, the reproductive system in the elderly, you need to monitor the hormonal changes. So, for women, there is a decrease in estrogen. A decrease in estrogen, which of course leads to menopause. For the men, there is a decrease in

45:01 testosterone. Let me give you these inclelex tips that you want to know. Elderly adults are still sexually active and they have to be educated on STDs, sexually transmitted diseases. If you look at the prevalence of sexually transmitted diseases and the top five groups who are contracting them, you will find that the elderly tend to be in that top five. So, we have to make sure that we educate them on those STDs. For women, vaginal dryness is common and it is something that needs to be discussed with the nurse or healthcare provider. Erectile dysfunction is also common in men. So we

45:47 need to know those medications for inlex as well. You can check them out in your quick facts for [Music] INLEX. The muscularkeeletal system includes the bones, the joints and the tendons. For the elderly, there is a decreased range of motion, a decreased calcium level, and a decrease in overall muscles. You need to know that bone loss begins at age 40 commonly. The GU system, the genital urinary system, there are changes that happens to the urinary tract and urinary system as well. The kidneys actually get

46:33 smaller as you age. So, as well, the bladder size decreases. So, if you have a smaller bladder, what you're going to have is urinary frequency because that bladder needs to be emptied more frequently. Dehydration is a common issue in the elderly. U let me ask you this question. Is urinary incontinents normal as you age? Is it expected? Um, is it normal? What do you say? Yes, it is normal. Kegle exercises, kegle exercises can be used to strengthen the pelvic floor muscles in women and in men. I talked about that

47:20 during pregnancy and we're seeing it again. As you guys can tell, the INLEX, so many things tie together to help you have a really strong foundation for this exam. The gastrointestinal changes that you need to know, dry mouth is common. Constipation, there is a delayed gastric emptying that will contribute to that constipation. The overall digestion ability decreases for fatty, greasy kinds of foods. Let me say this. Is tooth loss a normal part of aging? What do you say? Is it common for the elderly? And I know

48:07 we see it a lot. A lot of elderly people have false implants and dentures, but is that a normal part of aging? Is it expected? The answer is no. It is not. Tooth loss is not a normal part of aging. It indicates that a client has poor dental hygiene. Poor dental hygiene. The nervous system. The changes that are experienced are a decrease in activity of the central nervous system and the peripheral nervous system. So the CNS and the PNS are the abbreviations. there is a decrease in reaction and reflex times as you grow older. So as nurses we need to monitor

48:56 for the need of assisted devices such as canes, walkers. Yes. Um because with a decreased reaction time and also flexibility, mobility, those assisted devices are important for balance and coordination. You know the mental function of the elderly should remain intact. If intelligence decreases, a disease process is present. I got to talk about the immune system. there is a decrease in the functioning of the immune system. So that means that our elderly patients are at an increased risk of illness and for

49:42 inclelex you want to encourage the seasonal flu vaccine. The endocrine system there is a decreased secretion of the thyroid hormone. This as well affects the metabolism of our client. Also, there is a decreased insulin production. So, let me ask you this. If there is a decrease in insulin production by the endocrine system, will that make the blood sugar levels increased or decreased? What sayith you? If there's a little insulin production in the body, do the blood sugars go up or down? Those blood glucose levels will be

50:31 increased increased. So, you want to definitely watch out for that for your client. And finally, we have the senses. Hearing, tasting, touching, smelling, seeing. What do you think happens as you age? Everything, all of the senses will decrease. The smell declines, the taste declines. Hearing, there is a loss of high pitch sounds. And these are the first sounds to go. So when I'm educating elderly clients, I have to make sure that I talk in a lower, deeper voice because if I talk in my regular voice, they cannot hear me. Also, we're

51:18 encouraging the use of visual and hearing aids. And again, we're speaking in a slower tone, in a deeper, lower tone so that they can hear us. All right, your expected changes of aging have been reviewed. Let's move on. [Music] Hey, so now what you just experienced is how to approach INLEX. We just listened to a lecture that went over exactly what to focus on. That's part of the preparation process. Sometimes nursing

52:05 students like to skip that step of returning to the classroom. That's what makes INLEX so challenging when you don't do that work first. All right. I hope that whatever you're feeling, whether it's tension because the simulation was more challenging or whether it is excitement because I did good, I got a good grade. Um, this is the work that is needed in order to be able to prepare for your license exam. Your nursing license is a gamecher and it's a huge responsibility. So during Remar Nurse University, I don't want you to leave here with just notes. I want you to get into that V2 system so that you're able

52:52 to focus on what is going to be on that exam. Okay? It's it's part of your journey. It's part of your journey. and during Remar Nurse University. And I'm sorry to all of those who um who maybe have come in late. We will leave this video up until the next class. Um but the training system that is available for you here, this one right now, we're doing a sale because it's Remarnish University and we're also adding back the money back guarantee. We have not had this money back guarantee um since before co actually. So this is big for us. We want you to understand that we are confident in the things that we tell

53:38 you and we're also confident that you will do well. You will do well cuz what you're getting for the V2 course is one course, one next generation INLEX question bank, two CAD exams, two books. That's the V2 trainer. you will have exactly what you need to focus on. And actually, if you started studying this last week, you probably came to this class well prepared, okay? Well prepared. So, jump in. If you're a repeat test taker, if you're first-time test taker, u this is your opportunity to go deeper. Now, for those of you who are Remar nurses, you know the routine. I'm coming back on Wednesday for winning Wednesday at 9:00 p.m. Thank you so much

54:24 for attending this class. All right, I want to do like Do I need to do like a question and answer? Do I need to do like two minutes of just Q&A? If you have any any questions about today, I'm just going to do like two seconds. Okay, two two seconds of Q&A because I don't want to keep you too long. Actually, we're doing so good. You got through that so fast. Okay. All right. Um, when should I start looking at my Remar books? I have two months left and I'm nervous about the exit as well as INLEX. You can use the INLEX program to ace your exit exams. If you can get through, if you have the if you have the V2, you have your two books. If you can do, okay, if you can open it up and look at that study calendar right here, this is my study calendar. If you

55:09 could do the 20 study sessions, you will be so much better off on your exit exams than you can imagine. That would be my advice to you. Okay, I'm just going to keep it simple. Um, are the books physical or downloadable only? So, with the two books you're talking about the course, if you get the V2 course, you're going to get a Let me show you. So, you're going to get the lectures that are ready for you already. You're going to get QuickFax. Quickfax is a physical book. This is the one that we studied out of earlier today. And then also the workbook there is a downloadable workbook. So this will be a physical book. The workbook that looks like this. I don't have my Inlex one, but you can download it or you can have

55:55 the option to purchase the physical book, but this comes extra. Okay. Um, let's see. I'm 90 days out from graduating. Should I get V2 now or nursing school? You're at You're at INLEX. You're too close. You're you're nursing school is behind you. You are preparing for exits and and INLEX. That's where you are. Okay. [Music] Um I take my INLEX end of June. Should I get the 30-day still? Absolutely. Some people do my course in two weeks. If you take the INLEX at the end of June, you have so much time. There's only 20 study sessions in my course, so you absolutely can do it. Uh, where do we download the

56:42 workbook for Remar Nurse University? It's in the it's a the link in the comments. I also put it in the video. If you signed up for it, it was sent to you in your email. Check your spam. Um, let me see. Got the pay. Can I do the classes with you or do I have to go to nursing school? Um, you do have to go to nursing school. you do have to go to nursing school, a physical nursing school where you you have clinicals. Um, so what we do is we support you during nursing school and then we help train you for your exit or INLEX exams. Okay, thank you. I'm starting nursing school. If you're just starting nursing school, then you need to get the nursing school course. Okay, we have an INLEX course and we have a nursing school

57:28 course. Get the nursing school course. Can students studying for the TE's benefit from your program and how? Yes, we have a TE's nursing program. So, actually with Remar, if you are following Remar, it doesn't matter where you are, we have a video course plus a quickfax book for you. No matter where you are, I'm looking for my tease one. I don't have it. But if you're studying TE's, please do the tease videos. Please. it the program right now is it's like almost you can't even say it almost the nursing school course right now because it's RNU usually $89 a month is $29 a month and that's lectures you you

58:14 get question bank you get fundamentals math med surge all that is in the nursing school course and then if you're doing TE's that's $39 a month you study that course for one month in the TE's program It's $39. Literally, it is uh it's such an unbelievable resource that we want we want to make people aware of it. A lot of people don't even know that we have that. So, that's it. Okay. All right, everyone. We have come up to our 1 hour mark. We're at 59 minutes. So, we're going to close this class. I do want to invite you to go beyond uh the next step, whatever that is for you. for somebody that could be just setting a test date. You have been studying for a

59:01 long time. Set that test date. Just do it. Pick one. Get started. Okay. Um and for other people, it's, you know, making the next step, opening up your QuickFax book, enrolling into the course. This is the time to do it now. And also preparing for next Monday, setting your alarm so that you come back getting your grade for next week. uh we have a different case study but we have the same goal of making these this pharmarmacology a workable um something that you're not afraid of something that you're looking forward to. So until we get to the point where pharmarmacology is no longer a sore point for us and we're confident then we still have to keep trying we still have to keep studying. So our first session of Remar Nurse University has been completed.

59:48 Thank you all. Have a good evening. I will see you on Wednesday night, 900 p.m. Have this book out. We will be doing quick facts. We will be reading from this book, making sure you have it studied. We did lung sounds today. Um, look how look how much extra notes I took for lung sounds today. So, don't miss Wednesday because we are diving into this book as well. Okay. Um, or actually we might do this book and nursing school. I'm not sure. We might do nursing school quick facts as well, but this one hm bring it, bring it, bring it. Uh, courses will be on discount all month, all month long. So, this is the this is that month. Have a good evening, everyone. Bye-bye.