 Welcome back to another vlog. If you're new, huge welcome and thank you so much for tuning in. And to all my followers, thank you for coming back every time. But first things first, how amazing is this jumper? This is my new jumper, guys. I know you saw it here first. So Nix wanted to get in on the action. Go Geonix, where's Dylan? Anyway, distracted back to the serious stuff, the nursing related stuff. So today's vlog is all about AdPie, A-D-P-I-E, AdPie. So I'm gonna take you through the findness and process and explain a little bit about each one. Assessment, so the first thing you wanna do is assess your patient. The first thing you're gonna do is obviously introduce yourself. Hello, my name is Claire. Then you're gonna do a full assessment on the patient. The first thing you're gonna do is history taken. Okay, what are they here for? What is the issue? What matters to them the most? What is causing them the most trouble that they want to get seen today for? Obviously it depends where you are as well. So I'm speaking from a GP point of view, but in the ward, you would do the whole assessment of the patient, okay, why is the patient here today? Your goal is to get the patient out of hospital and back home to the safety net. And then you will do your full assessment, so your observations. And the same in GP as well. We do observations all the time. So you're gonna do the blood pressure. Make sure the blood pressure is in range. You're gonna do the pulse rate. Is it regular? Is there any like ectopic beats or anything like that? And make sure you do the pulse for one minute, guys. 60 seconds, not 30 seconds, and double it. No, one full minute, because I have had a patient for the first 30 seconds, that felt like a normal pulse. And it wasn't until literally the 32 seconds point that it skipped a beat. And I was like, oh, did I feel that right? And then I had to go a whole 32 seconds again. And it went again, every 32 seconds it did this. And I was like, that's really bizarre. So please guys, please, please always check a full minute when you're doing respiratory rate, when you're doing your pulses, anything like that. Don't fob it off with 30 seconds, 15 seconds. It's not good enough. And you could miss vital information and cause problems to your patient. Then you're gonna do the temperature. Is the temperature normal? Is it too low? Is it too high? Is it regular? Who knows, but you'll find out if you do it. Respiratory rate, is the respiratory rate in range? Is it normal breaths? Are they exerting themselves a lot? You're listening to the breath as well. You're not just watching the respiratory rate. Are they wheezing? Are they struggling for breath? Are they using their accessory muscles? What sort of breathing is this? Is it just a normal standard breathing? They don't look like they're struggling. Or is it something a bit worse than that? Oxygen levels, are they in normal range? Are they again? Are they struggling to breathe? Is that oxygen dropping? Is there an obstruction there somewhere that's causing the oxygen levels to drop? You won't know until you assess it. So assess it and find out. And not only are you doing your observations, but you are physically observing the patient in front of you. Just because their observations are normal doesn't mean that they're okay. I've had a patient who was literally projecting our vomiting, all this green bile across the room. And I'm not exaggerating, it was horrific. It traumatized me a little bit when I was a student nurse. And they looked, they literally looked like they're about to die. I did all the observations. The observations were perfect. And I was just like, how is this even possible? This person is so sick. But I just wanted to throw in an example that your patient can be completely fine with the observations, but to look at they are really unwell. Some of the observations that you might wanna do are things like urine. So sending the urine to the lab, dip sticking it. Also checking your patient's skin. Are they sweaty? Are they clammy? Are they pale? Are they shivering? Checking if they've got sinosis maybe. Are the fingernails blue? Lips blue? That is another giveaway about oxygen as well. In GP, I would be assessing their movement. So then walking into my room, can they walk? Have they got problems with their legs? I'm looking at their legs. Have they got a demer? Have they got a demer to their hands, to their arms, to their face? What are their eyes like? Are the eyes looking clear and fresh? All these different little things you're gonna observe about your patient. It's not just, okay, let's just take some quick ops. You need to look at that patient holistically as a whole. And when you're doing your full assessment, it's not just about observations. You're gonna be taking the family history, their past medical history, what medications they're on that could be causing any problems. You're also gonna bring into effect Maslow's hierarchy of needs, so that psychological wellbeing, the self, the self-esteem, their love. All these little bits are gonna make up a whole picture for your patient. And then once you've got your whole assessment, your whole picture of your patient, then you're gonna move on to diagnosis. So in my role, it's not up to me to do an official diagnosis. We have to take it to the doctors and the doctors do the official diagnosis and the treatments. However, if you're an advanced nurse practitioner, if you've got a special practitioner qualification, if you've got a prescribing qualification, those little things are gonna really, really help you to be able to diagnose your patient. However, as a nurse, I can say this is what I suggest. So if I've got a patient, for example, with a wound and I know it's infected, they've got a temperature, it's red raw, it's hot to touch, it's painful, it's oozing out. I know that's infected. I don't need to be a doctor to know that, I know that as a nurse. Then I will go to my doctor and say, listen, I've got this wound, this, this, this, this, this is what it is, it's really infected, I need to mandi-biotics, can you have a look and can you prescribe? And I'll just go, yeah, yeah, yeah, here you go. So you've done your assessment, you've got your diagnosis, now you're gonna plan. What are you gonna do about this? What is your patient gonna do about this? So this is where you are working alongside your patient, you're working with the patient to set targets and goals, how you're gonna help this patient, but also how they're gonna self-manage it themselves as well at home. You're gonna set goals with that patient, so when they go home, they're gonna be okay, they're gonna be safe, and they're gonna be able to recognize these signs in future to get urgent help or if they need it in future. So it's about working with your patient and implementing these little things. And this is the same again with me, with my asthma. I will have a personalized action plan for my patients that they fill out themselves. What do you want to achieve? So some people might say, I can't walk up the stairs without getting really, really breathless. I wanna be able to manage that. So then we'll put in little steps to help them manage that. And it's all about instead of rushing up the stairs, you know, taking a couple of steps at a time, stopping, go a couple more, stopping, and it'll just help them manage that. So they will set their own goals and we're using smart goals here as well. So they've gotta be achievable, timely, all of that jazz and it's just gonna really benefit your patient. At the end of the day, this is about your patient, it's about their needs and how it's gonna help them as well. It's not all about you and you being this superhero. Yes, I've saved my patient. Okay, what now? What about your patient? And also you need to give your patient informed choices. So you need to say, okay, here are your choices. This person's got an infection. Okay, here's your choices. We can give you this antibiotic or this antibiotic. If they've got penicillin allergies, for example, then they might not be able to have a certain antibiotic. They might have a different antibiotic, but this antibiotic causes a lot of nausea, it causes a lot of diarrhea, it can upset the gut a lot. And it's about giving your patient all of these choices and then saying, okay, what would you rather? What would you like to do? And gauging it from there. Basically giving your patient a choice, empowering your patients and that is what it's all about. Empower those people and you'll be well away. So now you've got the plan in place. You need to implement that plan. So you're gonna prescribe your patient the antibiotics or you're gonna give them IV fluids, for example, or you're gonna give them the action plan for the asthma to help with them targets. So now you've got to implement it. So for me personally, it would be the doctor has prescribed the prescription. The patient has to go and take their prescription as prescribed. So you're relying very much for me. It's relying very much on the patient and making sure they're self-mallaging it. If you are on a ward and you've got to give the IV fluid, you've got to give antibiotics, you will be that person doing that. So you will go, you will give the antibiotics, you will give the IV fluids. You'll be implementing whatever the plan is, but also your patient will be implementing their plan as well. It's about working together and getting your patient to manage things themselves and taking a bit more responsibility for their own health. And then you're going to evaluate. So you've assessed your diagnosis, you've put a plan in place. You have implemented that plan. Your patient has implemented the plan. It's all going fantastic. So then you're gonna evaluate it. So for example, for me again, if someone was suffering with the asthma and I've given them a new inhaler for example, I will follow it up in two weeks time to make sure that it's working and they're not struggling. I will also tell the patient on the day that we implemented everything or planned everything. I will say to them, if you struggle even more, if you don't get on with your inhalers, for any reason at all, you need me, call me and book a review way before the two weeks time because we need to see you a lot sooner. So you're also giving the patient that responsibility to call you if they need you. So yeah, so you're gonna evaluate it. So in my two week follow-up, I will be doing all from the start again, assessing my patient, seeing how they've been for the two weeks, is there inhaler working? Have they been taking it religiously for two weeks? Is it helping? Is there any benefits? I will go through my whole asthma questions as well. Are you getting shortness of breath still? Are you chesty? Are you waking at night with it? All these little things, how often are you using your ventilant or your salputamol now? Are you using it less than you did before? All these are gonna tell you if this has worked, if your plan that you've put in place has worked. So if you're giving your patient antibiotics, for example, so I will be seeing my patient a lot sooner than two weeks, I'll be giving them a week worth of antibiotics or two weeks worth of antibiotics, but I will be seeing them like within a few days. It won't be left until it's sepsis because it can still progress into sepsis. So if my patient comes to me, they've got an infected wound, I've prescribed them antibiotics, I'll be seeing that person like every three or four days anyway. So I'll be constantly evaluating it and making sure it's okay. So that if this gets any worse, the patient's going to hospital for IV antibiotics to make sure it's gone. That would be my next step. And again, with the assessments, I would be doing full sets of observations when that patient comes with their infection as well, be checking the temperature, the O2 saturations, blood pressure, pulse, respiratory rate, all of that to make sure that nothing is declining, nothing's getting worse and it's improving hopefully with your antibiotics. But you know, sometimes infections are resistant to antibiotics and this is why we have to evaluate as well because your patient, you might have put in place everything for your patient but they still might go downhill. So it's really important that you keep checking on your patient, make sure that what you're doing is working for them and make sure they're compliant with the medications or the plan that you've put in place as well. Because if they're not compliant, then you're in a sort of losing battle really. So you have to get your patient on board as well. Just as a little example, I've had actually a couple of patients do this but one patient in particular refused to take all of their medications that they need to keep them healthy. They've told me that they've stopped all of their medications. They don't think it's doing any good. And now the blood pressure is sky high and I'm sat there and I'm like, you need to take your medications because if you don't, you could end up with a heart attack or stroke. Like your blood pressure is really rising now and they just won't listen. They don't care. They're just like, no, no, no. So as long as you've documented everything, refer it back to the GP, which is what I've done. I've referred it to my doctor. They're booked in actually for a medication review and everything and a chat about it. But this is what you would do as well. Even if you're in a hospital setting, you would go back to your doctors and get the doctors in to explain things and that's all you can do really. Document what's happened, document what's been said, sign it, date it, all of that, cover your own backs and get witnesses and get doctors involved as well because you need that backup as well. However, I just want to add, just because someone makes not the best decision for their health and they're causing themselves more problems, doesn't mean they lack capacity. Doesn't mean that you can force them to have their medications or anything like that. If they've got the capacity to make their own decisions, whether it's right or wrong in your eyes, you have to allow them to do it. But as long as you document it, you cover yourself, can't go wrong. So that is ad pie. I hope it was helpful for you. I know someone requested this, so thank you for requesting it and I hope I've done this justice and gave some examples and stuff to help you understand it a little bit more. But it's stuff that we do anyway. It's a natural process that we do as nurses. It's how I was trained. It's just the way that we do things anyway, but it's just given some examples and maybe some things that you might not have thought of, like the complicated patients or complex things that you might come into. But yeah, I hope this video has been some sort of help. If you have any other requests that you would like me to do, please comment below and I will try my best to do it justice. But yeah, but that's it from me for now. I hope you'll have an amazing week as always and see you next time.