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The Next Generation NCLEX (NGN) Case Study

Good morning everyone. Welcome to Connetics College. This is a joint project by Aspire RN and Connetics USA and they were going to havea live show to discuss about next generation NCLEX and case study that I prepared for today. All right, so for everyone who's watching today, my name is Paul, and social media. My name is Dr. Nurse Paul. But you can call me Paul as well. All right. If you're joining us today, can you please put in the comment section, your name and where you are coming from? All right, let me just prepare my slide real quick.

All right, just want to know where everybody's coming from today. Good morning, everyone. I'm streaming live from Houston, Texas and we do this Connetics you as a partnership. This show that we do with Connetics Tuesday, we do this every first Monday of the month. Alright, so Aspire our industry show every first Monday of the month.

Similar to what you're gonna see in you in your next gen NCLEX. Okay, I'm assuming that you guys are already familiar. All right. We have Jay coming from Edmonton. Thank you for joining us today. Good morning, Errol. Good morning. Zulfikar. Zulfikar is joining us from Dubai. And he's in YouTube right now. Thank you for joining us. Kumar is joining us from LinkedIn, Pakistan. Right. He's from Pakistan. Thank you for joining us. And Elma is joining us from the Philippines. Lisa is live in YouTube watch watching us live from the Philippines. Eugene is joining us from Iran. So Connetics college is something that we do every day. Let me see if this is the right slide that I have.and is joining us from Philippines to genius joining us from Iran. And join us joining us from Germany. All right. So we're all over the world today. So like I said, this is Connetics College, where we do classes, in partnership with different agencies, and organizations. So every first Monday, I do the classes for Connetics college. So my name is Paul. I'm an NCLEX. Educator, I'm an extra expert. And I am the owner and CEO of Aspire RN, which is an equity review course provider. All right, and we are in partnership currently with Connetics USA for their scholarship program.

So if you are interested to get scholarships for the NCLEX, we're going to flash the link right now on the screen. This is where you can apply cusalink/aspirern. And so you can join our classes that we do together with Connetics USA. So this is for their scholars. So if you're interested to come here to the United States, all right, just like many nurses that have already done so click that link right now and copy that link and put it in your browser right now fill up the information that we need. And Connetics USA recruiters will get a hold of us. So we do this every first Monday. So please put in your calendars. Check your Connetics USA page and Aspire RN page so we can so you can be informed once we go live right? And that's it. Let me see. Follow me on social media Doctor Nurse Paul and Facebook, YouTube TikTok. All right. What else Instagram. So I do short videos multiple times a week to give you NCLEX tips next gen NCLEX steps, select a lot of like quizzes. So just do follow me on social media so you can get updated with the latest in nursing. We have Pamela joining us from Kenya Monica from Ghana, Kinter from Kenya. And Sophie is also here from Dubai or Monica from Qatar, and Arancio. from Cameroon. All right, Vanessa from Philippines RIA from Qatar, do me a favor, guys, if you can just share this show, through your Facebook or to the Facebook groups that you guys are members of so we can reach out to more nurses, one of my advocacies is to inform nurses and educate nurses about next gen NCLEX This is the major change that NCSBN the one who does our NCLEX are doing right and this went live meaning it's already on. We're already using it beginning April 1 And today it's April three in the morning here in the United States. So

what does that tell you? You got to be aware of what's going on with natural networks that way you you're more prepared with your NCLEX All right, anyone here taking their exam very soon. We have Michael joining us in linked in from Ivory Coast. Thank you Yannick are His name is Yannick Mona Lisa from Kuwait. Thank you guys. Please share this to your pages. We're going to talk about next gen NCLEX today all right and again and quick scholarships are available in partnership with Connetics USA and Aspire RN right. So again, please put in your browser's if you're interested with NCLEX scholarships, alright Connetics two is a will find employers and sponsor your NCLEX exam and NCLEX review with Aspire RN  by typing cusalink/aspirern and so we're gonna flash that in a little bit. We have a lot of people joining us today from all over the world today. Thank you guys. And you can also follow me on LinkedIn My name is also Doctor Nurse Paul there. Right Thank you. I knew in LinkedIn about that for a while but there really never paid attention to that but now networking professionally. Alright, so I'm new there. Esther from the hungry. Thank you. Oh, I love our grid visited. Budapest back in 2019. I want to come back. Mona Lisa from Kuwait and edgy from Beco Philippines. And NCLEX if you want to get scholarship or sponsorship, type cusalink/aspireRN that's how you apply in the Connetics you as a an aspiring scholarship program, right? The link is on your screen right now. It's a web link. So put that in your web browser today or after this show. All right, guys, give me one huge favor. Can you share this show to your pages? Right? Do your whatever social media pages and can you add sign me which means tag me on it so I can see it later?

All right. And if you have questions, I can answer it to you live guys next agenda view classes are also available in my website, Aspirern.com. All my courses have three tiers that you can choose from are all next gen NCLEX compatible. All right, and I'm over here based in Texas, USA, where I completed my doctorate program, Family Nurse Practitioner program and advanced practice registered nurse. And I've been teaching NCLEX for almost 16 years now. Right? So

I've helped a lot of nurses come here to the United States. And they're not successful nurses. And that's where I'm focusing. I'm a practicing ER nurse as well here. But because of my love for teaching, and helping people achieve their American dream, just like I was, if someone's following me on social media shared in social media, my story, right, I grew up from a very poor family, but I never let those past traumas and those things to hurt my future. So I took a hold of my future and decided what my future will be right? And now I'm here in America, living the life of my dream,

you know, is able to provide for family. And you know, there's so much flexibility and respect for nurses here autonomy. So this is what I love here and there's a lot of opportunities to be honest. Okay, so get on board with your American dream. Start with passing your NCLEX All right, because you really cannot start with your immigrant petition from any employer. All right without the next step.

Why Connetics USA is providing this because we understand that a lot of nurses could probably not afford NCLEX because NCLEX itself is expensive, right? And review courses are expensive, but we're here to help you out if this is something that you guys are are interested, go click that link cusa.link/aspirern for scholarship programs. Otherwise, you can also visit Aspirern.com. To check whatever courses I'm offering we have a different key from UK feed that is also joining us from Pakistan. Hello, guys, please follow me on my social media pages at Doctor Nurse Paul. So you can get more glasses. I only do this first Monday of the month. But in my social media pages, I do secrets of NextGen NCLEX shows case studies tips do little classes every Saturday 8am Central Standard Time. So that's every Saturday on my own page in Facebook and YouTube. I go live and if you follow me on Instagram or TikTok I also do short videos about SATA. I do set that every week. So that the questions examples, and I rationalize it live. And I also do NCLEX quizzes and click steps next gen and click step. So follow me on social media and tell your friends about it. That's my advocacy to inform and educate nurses. And of course, we also want to take thank God Connetics USA for moderating our class today. Miss Melanes is our live moderator. She's in the backend right now. But she is here to moderate our class today.

Thank you Miss Melanes, it's right so kindly follow me on my social media so you can get advantage take advantage of all the shows that I did in the past. With the secrets of next gen NCLEX, I already did a total of 12 shows over the last six months, right. And I have another show that's called the USA nurse series where I talk about immigration stuff, you know, migrating to the USA adapting to the US culture working as a nurse your opportunities, your challenges, your educational progression, career progression work, but the cultural differences. All right, and reassess. I've received an NCLEX RN scholarship I didn't sign yet. What will be the agreement RIA agreement if, if this is Aspire RN, let me be sure if this is my RN, because there's different partners with his firearm, and if you're gonna sign the agreement with his firearm and Connetics is a it's just mainly asking you to be committed to the program, right? Because, of course, as a scholar, we would want you to be committed to the study plan, because the study plan is how we know you best following the study plan.

Alright, so basically, it's just telling you that, you know, we're signing this commitment to say, Okay, I'm committing myself to this scholarship program with Aspire RN and committed to USA, and we're gonna adhere to their policies as far as attendance as far as you know, doing their checkpoints, or informing your recruiters and inspiring about your ADTs and eligibility. That's it. So mainly, we know that 90% of our students are working. Alright, so our program is very flexible. That's why we're Connetics USA chose us as a partner. We know that nurses are working and we're not telling you to stop your jobs, right. So what we did as a workaround is you just have weekly tasks that you need to catch up with, but our live classes that we do, every week is recorded so you can watch it anytime Miss Anna is here miss and it's my go admin, and one of the biggest Facebook groups for migrating nurses to the USA it's left for a nurse and see USA we now have 187,000 members as of last night, probably 188,000 today and growing. And Miss Anna, I just met her last night. We've been friends for years since I joined live for us so that six years total seven years, but for the first time she visited Euston and we've met for the first time it's Anna, I'll see you later in San Antonio, Texas. I was happy to see you last night as well. Thank you Maria for sending me a message over my social media and I can clarify things for you. Right.

And thank you guys, please tag your friends. And again secrets of next generation that's every Saturday in my own ah doctor nurse Paul. So let's support both Connetics USA. You know what I love about Connetics, USA and Tanya, and old Connetics tutors at Luciana Holly are the free educational shows. Right? In fact, they're my template. It's all done there. You know, I want to do something for our nurses too. So they're doing their shows. You know, Monday, Tuesday, Wednesday, Thursday, it's Friday. So I was like, I'll take the Saturday spot or it's I can do classes to nurses too, but I can Only Tuesday does a lot of shows to about immigration stuff about nurses sharing their real life experience living here in the US, right. And my show is focused mainly on NCLEX. And adapting to the US culture, right. So that's it, follow Connetics using follow doctor nurse Paul and you get free shows. All right, and the shows are like one hour. So it's not going to take a long time, out of your day. But you can just flag your page every time we have a new show. You can watch it while you're running while you're on your commute. So you can learn more about the US before you come over here. Right. And Armen, this Edwards needs to be taken in Germany. No, and NCLEX is only for US, Canada, and now for foreign graduates or international educated nurses. Moving to Australia. Alright, so that's three countries only. Okay.

All right. And what about next gen NCLEX. Next Gen NCLEX is a new type of NCLEX that just went live on April warning, today's April three in the States, everybody will be taking their ethics today will do the next gen NCLEX. Major changes include different item types, like matrixes and highlighting. And both eyes, right? And the introduction of case studies. Right. So case studies, it's like an evolving case scenario where there is one case, right, it's like reading your chart. When you're practicing as a nurse in the hospital, right? You read your chart, whenever you get report from a patient, or from a nurse for a patient. You read your patient's chart, right you read your medical record, you see what's going on. This is similar to the case studies, you read your chart, you read the nurses notes from the previous shift, or from the current shift, you read your diagnostics and labs, you read your doctor's orders, right? You need your read your progress notes, you read your histories, and then you answer the questions and case studies are six parts. Okay, so there's six parts, right, we have question number one to question number six.

This will be based on the clinical judgment model, or question number one is about recognizing cues. Question number two is about analyzing cues. Question number three is about prioritizing hypothesis, which is your diagnosis. Question number four is all about generating solutions. Question number five is all about taking actions. And question number six is about evaluating outcomes. All right. And there's a question here. I know it is for us, but does Pearson VUE NCLEX Testing Center in Germany? I think I'm not really sure about Germany. I think there's one in UK, but I'm not sure about Germany, I can check it out in a bit. But um, not all Pearson VUE in the world has NCLEX. But let me check that out. Alright, just to be sure. Okay. Does anyone have a question about next generation NCLEX? Or Is anyone taking their exam very soon?

No. All right, because I'm about to go through the case study. Today we're gonna talk about a case study and this is my part for over the last several months, every first Monday of the month, I will jump into classes are the Connetics college. So do me a favor, go to Connetics college and find all my videos. I did one last month on March 1, Monday, one in April 1, Monday, one in January 1, Monday, one in December, and then so many classes, we started Connetics college since if I'm not mistaken, that was August. All right, so that's eight months or so of free classes that's available to you recorded in YouTube, LinkedIn, and Facebook f Connetics USA, or you can also go to my page doctor, your response show and you're gonna see similar case studies that I did, right, Mary, no third week of this month, good luck. You can do it believe in yourself. we've sacrificed enough. All right. And just be confident about your preparation and performance. All right, and also to raise for those who are taking

has Simon said I heard it's more difficult than the previous one I face difficulty in getting marks now since it's more difficult. What are the tips to gain good marks? Right? That's a good question. In the last doctor, nurse fall shows that I did back in March, I have two parts where I say we're talking about tips and tricks and doing next gen NCLEX but mainly Hassan

it's gonna be difficult in the sense that there will be changes to the item test sets without preparation without knowing those different item test steps. You might get confused of how to answer them or be anxious during the actual NCLEX. So very important that you get introduced to the new item test types. And this is what we do with my students in Aspire RN, we do those next gen NCLEX mass

They're classes where we do next gen drills every weekend, Friday, Saturday, Friday, Saturday, right? And more importantly, and I'm a big advocate for this. I'm such an educator, where I always say, content mastery is king, very important of content mastery. So you see it next year, Netflix, they changed the item test types and the scoring, but they did not change the content, right? So stroke is stroke, whether next gen NCLEX or not, right? Am I is MI, the pathophysiology artists same, the management's are the same. The signs and symptoms are the same, the history and risk factors are the same. They didn't change, the only thing that changed is how questions are delivered. Okay.

So if you're having difficulty with next gen NCLEX, let's look back to what's really the problem? Is it your content, because you do not know the topic that's being talked about in a case, and we're gonna find it out later. Okay. Or the other side would be, maybe you'd know the topic about what we're talking about about the case, because in case study, there's a certain diagnosis that we need to figure out what it is, right. But your problem is test taking strategy where you get confused with options, right? When you're presented a case, alright, so it can get very overwhelming and understand, but very important to balance these two things, content mastery, and then test taking strategy, right. And that's how we do it in Aspire Rn. So our NCLEX program is built into this premise, right? We, our students undergo three phases, especially our scholars from Connetics, USA, so we monitor you guys, make sure you pass and we have great success 98% passing rate.

They undergo three methods or three phases, my students, it's called the doctor nurse Paul method, right, so our DNP method, the Doctor Nurse Paul method, or DNP. Method D is didactic space, where we build your content mastery introduce you to different concepts, pathophysiology as pharmacology keys, and all the concepts for the earthquakes. Once you get past this, you go to the next phase, which is, which is the end phase or neuro phase. This is where we do your test taking skills, improve your test taking strategies, and then you attend your next gen master classes every weekend, right? So in the didactic space, you get 24 live classes, plus every other activities that you have post tests, reading the modules, and so many things in the neural face, you get eight, next generation master classes with me, I'm conducting it myself, and you get an access to question bank. That's over 2000 questions, right. And, of course, you also have post test in the first phase where it's over 1500 questions. And then the last phase is the P phase is called precision phase, where we do your hip glasses and final coaching, it's 10 days of high impact tutoring, where we just you know, review all the concepts that may come out in the NCLEX too difficult to memorize it has that that's a good point. So here's the thing you don't want to memorize. The more that you memorize, the more the more that you're going to forget. The most important thing is comprehension and knowledge, right, which means understanding of the concepts. And if you're getting confused with certain concepts, most important thing is repetition. So if you attended one class of cardiology today, and you didn't get the whole concept, watch it again. And watch it again. And watch it again until you can memorize that. Right. So that's it and generally ask her the questions given at the end of the adequacy exam sample questions for new for next gen and bucks.

Yes, generally, yes. Those are called pre tests. If you have taken your NCLEX in the past, you would have next NCLEX experimental tests, they would ask you if you want to join or you want to try it? And yes.

All right. Now let's go to case study, guys, we're gonna read this, we're gonna enlarge our screen to where we can show the case study better. All right, there we go. You guys can see this screen perfectly. You're gonna help me answer this question today. Okay. So again, in the case study, there will be six questions. All right, six questions. And question number one would always be about recognizing cues. All right.

So some are saying that NGN is harder. Some are saying it's easier. It's actually a I'm sorry. It's actually a subjective statement. For some people. It might be easier for some people it might be harder. So here's the thing, right? If a case presents presenting right in front of you, and you don't know anything

thought that case, then that will be trouble for you because that six questions about something that you don't know, for example, what if the question about Duchenne muscular dystrophy comes up? Right? There's a case study, for example, for Duchenne muscular dystrophy, and you start asking me what is the shins muscular dystrophy? Right? Exactly my point, if a case comes out, and that's something you do not know, you don't know the pathophysiology, you don't know the signs and symptoms, you don't know the priority management's for this type of cases, then all six questions might spell trouble for you right now, this is where it gets advantageous.

For example, the case is about stroke. I have one case study before I think that's case study number one that I did is about stroke. Now if you know stroke, you know, the management's for stroke, you know, the signs and symptoms we're watching, or, you know, the priority interventions and diagnostic tests, you know, the pharmacologic treatment for stroke, then the six questions might be easier for you, you got me. So that's the thing. A case study is composed of six different questions, one after each other. All right. So very important that you know what we're talking about here, and we're gonna find out they're going to help me answer this case study today. So you see your screen. You have your case, on the left, you have your questions on the right, we're going to focus on the case study on the left first. All right, let's read it together guys. The nurses in the long term facility caring for a 19 year old blind, right 19 year old guide, the nurse notes this client has

Beiler erection on the arms and legs. What is power erection? Can anyone help me with that? And Daya freezes on the forehead? Glide is wearing new low top athletic shoes purchased by the client's parents instead of prescribed foot splints. During abdominal palpation a semi firm mass is noted in the left lower quadrant and the bladder is non palpable. All right, so that file erection is goosebumps, right? All right, so let's see your history of physical we're gonna click on the history and physical screen right there and this is what we see and the neurologic your findings our spinal cord injuries see for that your friends here guys and share this to your pages so people can see this case study as well. Your friends can see the case studies, spinal injury et Cie for from a gunshot injury two years ago, and they use a sip and puff wheelchair right. And the pulmonary the patient is receiving pressure controlled portable mechanical, ventilation and tracheostomy in endocrine a patient has diabetes mellitus. In psychosocial, we have a family that leaves three hours away from the facility. And since the client designer clothing and gifts once a month, friends have no dog visited a client in 1.5 years grind prefers to sit in the room alone rather than interact with other rest. That's right.

How about vital signs? Let's see vital signs, temperatures 99.

Not fever those 38 degrees. False is 56, Rs 18. What do we see here? Low polls, right? Blood pressure is 192 over 102. That's high, right? pulse oximetry is 97% or mechanical ventilation. For the lab results, what do we see in the sugar? It's 140. All right. So it's, it's right there where it says high, but it's really not high, right? I mean, it's not an emergency at the old reaches 200 or something, right? But you see guys here, look, look at the screen right now. What do you see about the labs? Is it showing you the normal values on the left side? And the first box yes or no? Look at the labs right here.

Is it showing you the normal values? Just like I would show you in the medical records? Yes or no? Yes or no?

Can you see the normal values? I honestly can see it. It says for zero to 50 years old, the value is less than 140. So here's the thing in the new next gen NCLEX. Right. You do not need to memorize lab values, because they will now show you the lab values. That's one good thing that we like about NASA and NCLEX. No more memorizing lab values. They want you guys to focus more on clinical reasoning, clinical judgment, critical thinking, versus memorizing all these numbers because in reality, we guys are working in a hospital right? A lot of our internationally educated nurses are working in the hospital right now. Correct in your hospital. When you guys check your patients charts or medical records. Do you also

See your lab values? They're on the charts. Right? When the lab reports come in, we see the normal values in real life scenario, right? So this is what we're doing in NCLEX. To we're teaching nurses, future nurses out to read charts, how to critically think based on information presented to them by the patient, and by the previous nurses and healthcare providers reading the chart, you know what I mean? So we don't need to memorize that. Why do we need to memorize that when all our medical records are showing our mobiles? Anyway, so we're going to simulate the same in the clinics. Alright, that way, nurses will focus more on analyzing and critically thinking about the case versus memorizing Latins, right? It's not really a competency that we want for our nurses Now, considering this. What is our question? So the question is, the nurse has collected the data from the client? I'm sorry about that.

There we go. Which of the following require immediate follow up, select all that apply? Can you give me your answers? I'm going to give you guys about 30 seconds to give me your answers. Both respiration diet freezes, bile erection black blood pressure, glucose, and wearing low top athletic shoes. Give me all the numbers, it's Alecto that apply? Come on. Let me see. And share it with your friends guys, because we're actually doing a real scenario that may come out in your NCLEX

Alright, so I'm getting all the answers now. Let's see. Very good. Very good. Now here's the thing, guys, for next gen NCLEX. We're not only introducing new question types, select all that apply it select Apply, it's been like that for years right. But now it can be longer it can be as much as 10 options, okay. Listen to me very carefully, for those who have attended my classes in the past in my own show and in Connetics USA or Connetics college, you know, that select all that apply is a right minus wrong type of question. Right? Right, minus wrong type of question, right? So be very careful, because now during the next run NCLEX, every incorrect answer in select all that apply will be a deduction to your points, you get a deduction. So be very careful, right? So in the NCLEX, there are 14 subtypes of the questions. Five of them will be right minus wrong, be very careful, because when you answer these types of questions, you get, I'm sorry, you get your What's this? You get?

Resist deduction for the points now, the answers are pulses. respirations is not included in the answers. Diaper resists. Yes. So one in three bit biller erection. Yes, blood pressure, yes. And wearing low top athletic shoes. Because the patient shouldn't be wearing foot splints, right? The patient does spinal cord injury, right? Without food splints that load up athletic shirts can cause a lot of ankle movements. Right? And we don't want that that's a stimuli, right? It can cause pain. He got it.

The gene very good point the Gene said false is not in the normal range, but doesn't mean immediate follow up. All right. In fact, it is the gene. You know why? Because let's go back to the nursing notes. All right. Let's go back to the nursing notes.

Can anyone tell me what is going on with this patient at the moment? The patient is rich erection right. abdominal palpation reveals Fermat's Sandmann firmness and LL Q. Right. The patient is wearing low top athletic shoes. Has diaphragm resists bladders not palpable and look at your history. When we open Israel again. The patient has a spinal cord injury of C for right injury. Right. Right. Okay, now listen to me. You remember the blood pressure of the patient that's on the screen right now what's going on with the blood pressure? up or down? Up, down up? What happens to the pulses up or down? Up or Down? Down? You see this going up blood pressure and going down? Paul says in patients with spinal cord injury that's a sign for a neurologic crisis. Right. But together with your pulses and everything else what is that guy's possible ICP?

Alright, or possible autonomic dysreflexia? So yes, I will include that because that's part of the neurologic complication called autonomic dysreflexia. You got it. Now listen to me carefully, your answer should be 123457. If you've also checked two, then you get one point deduction. If you've also checked six, then that's another deduction. All right, so any anyone who check to deduction, anyone to check six gets also a deduction. All right. So that's it, you get two deductions there if you've answered both of them. So be very careful with SATA now, because you're gonna get a deduction for every incorrect answers that you've checked. Okay? Be very careful. All right. Questions.

Right, so be very careful when doing your SAT. It might not be a follow up for you, but look at the bigger parts of, of the picture of the case study, right? And pulse will certainly be included because of the remember spinal cord injury or complications or autonomic dysreflexia ICP are also all sorts if they don't move because they're paralyzed. Thank you for your answers, guys. All right. So 13457

How son Paul's is not normal. Paul's is 56. Our normal is 60. respiration is not included in our answers. I said our answers are 13457 You got it. So respiration is not part of the answer. Paul's is part of the answer, because I just answered it earlier. Because we're considering autonomic dysreflexia here. All right. So see, just first question in error. Do you see people who probably are not familiar with autonomic dysreflexia? All right, so given that, for example, this comes out in your actual emigrants? Can that be a problem? That can definitely be a problem. Hassan, our normal is 60 and above, right?

I'm not sure that ACLs told you that. 50 and above is normal. I believe it's still 60 and ACLs. Okay. All right. So nurses, let's do this. Check your ACLs American Heart Association manual. Okay. But anyway, our false normal is 60 to 100. All right, any lower than 60. We don't even give Metoprolol and beta blockers less than 60. Because that's already considered Brady. Okay. Anyway, plus your blood pressure going up and your Paul's trending down. That is your priority. Again, let me repeat, this is a patient with spinal cord injury, you're not looking only in the Paul's. If you get very obsessed with the Paul's, if it's gonna be included or not, you're gonna have a mistake and you're gonna have a deduction, right? Look at the whole picture. It's a case study, right? There is a spinal cord injury and I keep repeating autonomic dysreflexia is manifested by hypertension, and bradycardia All right, so see I already told you guys the case, but this is autonomic dysreflexia.

Okay, anyway, 11 o'clock 1115 There's a catheter that was performed 400 ml of clear yellow urine was obtained by this facial flushing foul smelling liquid still leaking from the anus. Right? So now the patient also as to foul smelling salts heavy firm mass is still pressing into lol Q guys, what could possibly be the cause of that mass and the LL. Q. In the setting of autonomic district, I'm sorry, spinal cord injury where they could probably not move and their body is paralyzed? Are we expecting constipation? And impaction? Your yes or no? Yes or no? Yes, there could be a constipation, which is actually a trigger for autonomic dysreflexia right. So content mastery is very important here. The good thing with case study is if you master your content, and it gives you the case that that you know very well, then the case will not trick you. You can get the answers correctly. The problem is if you don't know what's going on and the case is unclear for you, or you don't know the topic, the sees that it's talking about the pathophysiology it's talking about, it's going to be going against you so that's why I said earlier, whether it's hard or easy, it's objective high performing students in my class say case studies II

See low performing students and average performing students in my class, say EnGenius ARD, I can understand because then again, the main important thing that everybody needs to know is content mastery. Right? So guys, the nurse would recognize that the client is potentially experiencing Why do things? Do things here? Anyone? This is called drag and drop. All right, you complete the word. fecal impaction Very good. What else? What else autonomic dysreflexia. Vanessa said Marian all said going back Shannon automatically reflects you there. Very good. All right. So those are answers. Right?

And can anyone tell me what's going on your dog not and this reflects that this is a complication of spinal cord injuries from C one to D six, where your sympathetic and parasympathetic nerves are not working together and they're trying to outbid each other right? Basically or books as autonomic dysreflexia is a hyper stimulation of your sympathetic nervous system. And it can be triggered by many things right? But many things usually with me i giving them only for triggers for autonomic dysreflexia and my mnemonic is best B E S, D, B, Sc, letter B is bladder and bowel infection or retention, right? So bladder retention, bowel retention or impaction. Constipation, that's a trigger. letter E is extreme temperature too hot, too cold, can trigger autonomic s stress. You see the patient is now back into long term facility. And that could be causing stress for the patient stress and letter D type clothing and dramas tight clothing and dramas. Alright, so in this case, the trigger is the fecal impaction. Do we all agree to that? Yes, yes, because the bladder looks fine. The catheter is fine, right? Usually in the ethnics, the most common trigger is the catheter is kinked or obstructed, causing bladder retention, but it's not the case here. Now let's look at further nursing notes. Let's continue further. So now we're getting we're seeing the better understanding of how to deal with the case study. Alright, especially for those that have just attended my class today. But don't be scared guys. That's why we're doing this free classes. Right? That's why you're attending your NCLEX review prep courses, because you're trying to hone that skill to answer next gen NCLEX questions properly. Right. And the instructors are here to explain to you why this may be the answer.

In verses you're not answering that right, so we're trying to lead you to the proper way of critically thinking that way that will help you during your NCLEX all right 1130 Guys, the blender reports at eight are ported 10 over time and blurred vision. Well that's a symptom of autonomic Now we already have the answer here. I'm sorry. So the answer is autonomic. The options are infection autonomic dysreflexia and abdominal aneurysm The answer is autonomic this reflex you agree Do we all agree to that? Very good. All right. Question number four considering that all right there's no changes to your nurses notes history and physical vital signs and lab results. Let's go talk about your matrix this is a matrix question a grid right you guys can still follow me right all right Dr to answer this drive to answer all right potential nursing intervention indicated plays that glide in the left lateral position yes or no remove the client sloped up athletic shoes indicated or not indicated inform the client that creed method will be performed indicator not indicated and forgot to share these on my page to show all right, how about your request for prescription for an over the counter laxative indicated or not indicated?

All right. We have a lot of watchers today in Facebook. We have over 400 people watching us today. That's good. All right, but I only see like 20 nurses answering. All right so here's the answer left lateral know if this is autonomic dysreflexia we don't want to put them in left lateral. What's the purpose of that? Right? That might actually trigger some pressure to the area right, causing more sympathetic responses, triggering more autonomic dysreflexia. So we want them lying down or semi Fowler's position if possible. Alright, remove the class load up athletic shirts. Yes. Again, the patient should be on foot splints to prevent too much movement of the ankle which can cause pressure pain. The patient is done wearing athletic shoes, which is low sneakers below the ankle, we don't want that because the ankle might be moving too much or the shoes might be causing pressure. Alright, grid method will be performed grid method is for the bladder, alright, it's a managed management for the bladder where you know, when we're doing catheter and the patient's not being properly, what do we press for? What do we do with a bladder we press it right?

To squeeze a more urine now. So yes, we want to try to, you know, catheterized them if they don't have a Foley catheter yet, at least, you know, straight intermittent catheterization to make sure that the bladder do not distend again, bladder distension. Bladder retention can trigger more sympathetic responses, which can trigger more autonomic and of course, laxative. Alright, so who got them correctly? It's one point per check, who got them correctly?

All right, very good. And we have a lot of watchers today. I'm surprised. Thank you so much, guys, for following with this. But let's wrap up and then I'll spend three to five minutes later to answer questions about next gen, right. And for those who are like struggling with case study, this is your first time I've did this multiple times already. And again, in my own show, the doctor nurse Paul show. I did tips and tricks of how to answer case studies in March. I have two shows part one and part two. So kindly watch that on my Facebook or YouTube and share that to your friends as well. All right, guys, same situation, same nurses notes, history and physical vital signs and lab. Let's go straight to the question. Select two actions that you think the nurse should take select two actions, do you think the nurse should take two actions?

All right. So here, this is what we call, select n, right? Select multiple response select n talks about a specific number, right? So this is not SATA. Sata is select all that apply. Here, it's only telling you to select a certain number. In this case, it's two, it could be three, it could be four, this is a new, next gen NCLEX type of question, right? This is better, because this one tells you how many correct answers you need to find you're not gonna go over it, you're not gonna go under it.

And it's also not a right minus wrong question, which means you do not get a deduction even if you get it incorrectly, there's no deduction, don't worry now and select all that apply. It's a right minus or a question where you get a deduction, this one is point for correct question only. So it's a little confusing if you don't know what I'm talking about. I did this in my past shows or I tell you about, I told you about different types of questions and how they are scored. Right? Answers hydralazine

Trendelenburg position, blood pressure every 30 minutes. Someone in LinkedIn has answered us as well. Thank you, I just couldn't see your name probably prefer from your privacy settings. But thank you apply lubricant to gloved finger and remove fecal impaction and inform the client that a magnetic resonance imaging scan will be performed and the answers are thanking a gene for joining us in YouTube. How about the others? We have more than 400 viewers today from all across the platforms. Well, thank you guys for joining me today.

It's one and four. That's our priority, because remember, your concern is fecal impaction. So let's, let's do that first, right, that's one of the triggers. And the hypertension. We really don't want hypertension. It's 192 over 102. Guys, that's hypertensive urgency, more than 170. Right? So we want to lower that down as well because again, it might cause more pressures to the brain, that blood pressure. So the other options may also be correct. But MRI is not really indicated right at this time. We already noted spinal cord injury. We're not suspecting of us possibility of stroke here. Blood pressure needs to be checked at least every, you know, one hour after I draw those in. You can do it every 30 minutes for the first hour. Yes, but there's no need to do every 30 minutes right now. The main goal

Is to relieve the trigger. And in this case your patients trigger is the fecal impaction agree. And of course the blood pressure needs to be lowered down Agree. Agree. All right, final question. And then guys, tell me your questions about natural neglect. I will have few minutes to answer them. Alright, look at 1145 notes. The patient's had Elena was elevated, right? elevate the head of the bed of the blinds better room the clients load up athletic shoes request a prescription for digital impaction and lidocaine lubricant at 12 o'clock at 12 o'clock Glide is having tonic clonic seizure. So the client has been placed in Hold on.

Let me remove my face first. So that's it. And that's it. All right now, guys, for each of the data collection finding click to specify whether the finding indicates the client has worsened or unchanged. This is another form of what we call matrix or greed. Which means it's a table. Alright, they're only going to choose one per column or per row. I'm sorry, false considering the polls.

Let me see if we have a certain physical window. Okay, so the vital signs are right here guys. 1145 the polls is from 56 to 47 Did it were a center did it change? Did it were a sinner? Did it change 40s it from 56 to 47 than it was in or did it change it worsen respirations from 18 trending down to 17 worsen or unchanged. Worse than that very good blood pressure 192. Now two to three. My goodness, that's very high. That's typical autonomic dysreflexia their blood pressure picks up so easily. Alright, because of the sympathetic response.worsen, pulse oximetry is now trending down to 96. The patient was 97 earlier worsen. Alright, so it's all getting better for the patient. Okay, we need to call the neurologic team. The goal is to reduce all the sympathetic triggers, including blood pressure reading fecal impaction in this patient's case. So that's it. That's six question of one case studies right? Rough at the beginning, because we're figuring out what is this? What is that? Alright, remember this guys? This is one of the things I told my students in next gen NCLEX. All right, listen, the more information that the case is showing you, the more the case becomes specific, right? So the more information we're gathering from a patient, from the labs, from the diagnostics, from the vital signs, from the nurses notes from the progress notes, the more that we are being accurate with what diagnosis we're looking at, all right, for me at the beginning, when the patient already had a tonic clonic seizure, yes, the patient, the patient is worsened. And we're gonna click worse and why. Look at 12 o'clock notes outside. Alright, the client is now having tonic clonic seizure. Right? So earlier there was no tonic clonic seizure now because probably of the high blood pressure. The patient is seizing. So yes, we're going to check worsened, right? In that case. Yes. For Daisy, all this all the links in your screen is clickable. Right? So you can still check your history you can still check your labs you can click all those tabs.

So the answer to this question is all are worse and okay. So it is very important that you guys are familiar with a case study today's case study is a little difficult than the others the other case studies that I did were stroke right? Triple A I think those are fairly easy because a lot of students know that autonomic dysreflexia is one of the case just said then enter our or probably Alright, let's back Up All right, we guys are still here. I'm sorry. Oh my God, my computer froze guys. I didn't realize that I wasn't charging it. So the whole screen went blank. But you guys are still here. But yes, so let me wrap up my, my presentation. So like I said, case studies can be very confusing. All right, and case studies can be I'm so sorry that's one problem with alive I didn't realize that I didn't charge my screen so I mean my computer so went blank because it drained the battery, but I was able to save it sorry about that.

But yes, so let me complete my presentation, like I said, in case studies very, very important that you guys are familiar with the case there's content mastery, and always remember like what I was saying earlier, remember that the case is cohesive, which means they're all connected, right? So when we identified fecal impaction in case number one question number one, it connects all the way to the end until number six so yes while we know that autonomic dysreflexia can also be caused by many things like tight clothing, tight clothing seems not to be connected in this particular case. Alright, so always read all the information in the screen. Read all the information very important that you know what it's talking about. All right. And again, for more tips and strategies you can follow me in my social media doctor nurse fall, right and can you pass the NCLEX or next gen NCLEX say yes, I can we can we can we say that? Alright, let's manifest this and claim this you want to pass the NCLEX tell yourself Yes, I can write Yes, I can. Alright.

Someone said I thought it was having bad connection in the internet. It's actually me. Very good. Let's manifest that and let's claim that yes, I can Yes, I can. This is one of the things that I like telling my students every time in class we start the day with saying yes I can. Yes, I can. Yes, I can. Alright, so guys, please follow me also in my social media Doctor Nurse Paul if you check my YouTube and Facebook, I did NCLEX next gen strategies their tips and tricks Part One and Part Two reasonably right. Thank you guys so much. I appreciate your time. I apologize for the Little Miss sharp. And if you have questions you can also message Connetics USA or myself. Again one last time if you want to apply for a scholarship. It's right on your screen right now. cusalink/aspirern or message me and my social media too. All right. I hope you guys enjoyed that. Next month, on May 1 Monday of the month. What is that? May?

What's this May one first of May. All right. I will do another case study. All right. But that's it. Thank you so much. Appreciate all your participation and cooperation today and Y'all have a great week. I'll see you soon. Follow me at Doctor Nurse Paul Facebook, YouTube, LinkedIn, TikTok, Instagram, you name it, you got it. Alright. Take care guys. Have a great day. Bye.