The gastrointestinal system processes food through digestion starting in the mouth with enzymes like amylase, followed by peristaltic movement through the esophagus, acid secretion in the stomach, and nutrient absorption in the small intestine (duodenum, jejunum, ileum), with water absorption occurring in the large intestine. GI bleeding can be classified as upper (esophagus, stomach, duodenum) or lower (jejunum, ileum, colon), with diagnostic indicators including hematemesis (vomiting blood), melena (black tarry stools indicating digested blood from upper GI), and hematochezia (bright red blood indicating lower GI bleeding). Assessment involves checking hemoglobin levels (normal 12-16 g/dL), hematocrit (approximately 3 times hemoglobin), and using endoscopy for upper GI and colonoscopy for lower GI evaluation.
GIT 2026Added:
So type in your name in YouTube.
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>> Yeah. So I think I've seen the link myself. Oh.
Then if you want give it to you first.
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Like I'll give it to you on the WhatsApp.
>> Type in your name in YouTube.
And don't say A lead. I don't want you to say about lead. I think so one of you is there.
I see.
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Now give me feedback. Do you still see me live on YouTube even though I'm no more there?
Um yeah, I still see you. Still see me.
Okay. That's perfectly fine. So I think we can maybe start.
Okay. Just I want the YouTube link.
I'm sharing it now the page. Yeah.
Don't get tech.
S A class >> And I the May May June other groups and so so on.
Okay, the old links, right? Yeah. Yeah.
What about the key banker as well? Yeah, even if they want to.
>> Okay.
And I think I don't know are you able to type or chat over there?
Let me see. Yeah.
Um Yeah.
Yeah, let's try. I just put in a chat.
Okay, so when people type there maybe you can one once a while be looking through if there's something worth noting now. You must send a message.
I will I will zoom. Okay.
>> Okay, all right.
Okay.
Very nice one.
I think we should start.
I'm getting a feedback.
Unless you mute that phone otherwise you'll get a feedback here.
Can we start? Um I think we I have Cassie Genevieve Helsing.
Millicent Yeah. Anti-pale Yes.
Are you active?
Yes, please. Okay, beautiful. I will worry you more more power.
>> [laughter] >> Okay. All right, so I'm I'm about to start. I'm going to hit record here record on Zoom.
So it starts from now.
All right, ladies and gentlemen, um good morning, good afternoon, good evening.
I bring you greetings. My name is Samuel Asamoah Boateng. I am a nurse in the US.
And today we'll be looking at um the gastrointestinal um system.
And this is more like a rapid review.
We just want to brush through quickly so that we can have basic ideas needed for our exam. Okay, this this particular section is for NCLEX. We are trying to prepare for the NCLEX. Okay, so I wouldn't waste your time. There is no formality, no other introduction. We're just going straight to the point.
You feel like eating.
You feel like eating. So, without wasting time, you just decided to go and find some food and then you started eating.
Now, as far as the GIT is concerned, um there is something we call digestion.
It's just the process through which the food will go through, be broken down to the point where it's going to be absorbed into the body.
And then the needed nutrients will go to where they are supposed to be.
And we are by this saying that digestion is quite starting from the mouth.
However, if you go deeper into it, it even starts way before the mouth thing.
Sometimes, the scent of food we have some phases that you go through. You have the cephalic phase and all that.
The sense, the sight, they attract you.
Um they give you stuff that you can actually um like send your mind to, right? Sorry, I was having a little bit of distractions from my WhatsApp page.
You you you you when you sense the food, when you sight the food, it turns your mind. It turns your mind to the food and certain juices may be produced, certain hormones, certain enzymes will now begin to work in that regard. So, we are saying digestion starts from the mouth. And this is going to be a very quick and fast um review.
We're just going to walk through it quickly and we wouldn't spend much time.
The contest here is just to give you a brief idea of how the anatomy is like.
Um anatomy and physiology, a very quick one. So, it starts from the mouth, you start chewing, and then even in the mouth we have some enzymes. We have amylase um that will act on the food. Um especially if it is carbohydrate, you see that amylase is really working on the the tongue helps you, the teeth grinds them. And then from there, you swallow it. When you swallow it, it pass through the the esophagus.
Okay?
So, I have here esophageal transit. Um the food will travel down the esophagus in a peristaltic movement. If you If you look at the screen carefully, you will see that um there is something moving down somebody's throat and you could see the peristaltic movement of that food. Okay? Huh. So, the food travels down the esophagus via this peristaltic or wave-like thing that we're talking about. And then at the bottom, that's the lower esophageal sphincter. There is this coiled uh um tubes or a sphincter. Some people call it the cardiac sphincter because of its anatomical position. It's like a gateway. It can open for food to pass through and it can close to prevent food from going through with either up or down in both ways. But as we are looking at it, it's actually coming down and that is how we want it. Okay?
Then from the esophagus as it passes through the lower esophageal sphincter or the cardiac sphincter, it enters the stomach proper.
It enters the stomach proper. Now, in the stomach, um there are some secretions that will act on them. okay?
Huh. There are some secretions that will act on whatever has been gotten so far in the stomach. Now, we have the hydrochloric acid that will act on them on the food. Some of them will even kill bacteria for you. Some of them denature protein and all that. Okay, it's all part of the digestive process.
We have some modifications because the stomach is producing um acids, it has undergone some modification. The mucosa lining is very thick, okay? Huh, and so it's it's prevents the stomach itself from burning. In the near future, we're going to talk about ulcers. When the acid overwhelms um whatever mucus is being produced to protect it and all that. We will learn about all these. And then we have um hormones like gastrin that also stimulate um acid production. We will learn about them, but this is just to give you an overview of how the food travels in the system. It's been quite a while some of us learned this. So, it's very important I outlined it. Now, very soon when it leaves the um stomach, it comes to the small intestine. I had this acronym I call DJI, okay? There is this um what do we call it? A drone, a camera drone produced by DJI. I had one camera drone when it was written DJI. So, duodenum, jejunum, ileum. These are the small intestine. If you don't recall, don't worry about it. Not really necessary, something that you're going to test you on the NCLEX per se, but it's quite also needed. Okay? So, what is going to happen is that um the duodenum will receive whatever food is coming from the stomach. And remember, acid had fallen on it. So, maybe the duodenums will have some sort of things that will neutralize the acids for you.
There are some juices from the pancreas that are bicarbonate in nature, mhm.
The bicarbonates are basically bases, and so they're going to neutralize an acid. So they will come and then they will act on them. We have the amylase lipase trypsin and these are kind of enzymes and pancreatic enzymes that are all going to take part in digestion. I'm rushing through. I'm rushing through. Just stay with me and bear with me. We want to get to the most important stuff and then we move from there. Okay?
So this is what you're supposed to know.
Then you go to the jejunum and ileum, the other parts of the small intestine.
In fact, it is the major part of absorption.
Carbohydrates will be breaking down into glucose, protein into amino acids, fats into fatty acids for digestion to take place, right?
And so a lot of things There are a lot of diseases that can come from this side. We have diseases like Crohn's, dumping syndrome and a lot. But this is just to give you an overview so that you know where the food is coming from.
Then at a point we have a place where the small intestine kind of meets the large intestine and it's at a junction we call the ileocecal valve.
In fact, the cecum is part of the large intestine or what we call the colon, okay?
So we have the ileocecal valve, the junction that it it it primarily controls the flow of digested food from the small intestine into the large intestine.
And it also helps prevent reflux from the large intestine back into the small intestine. We are We are rushing through. We are rushing through. Just bear with me and stay with me.
Now when you get into the large intestine, this is where it gets funny.
If the food passes through the large intestines quickly, you have diarrhea because the water will not be absorbed.
If it passes too slow, you get constipation because there's not enough water to move it as well.
So it has to be in a very regulated nature's pattern for you so that you can have a very good free and easy bowel movement.
So this is the part where water mostly the electrolytes and other stuff are really absorbed, okay? And then we are we are told that we have um a bacteria sitting in the gut.
Please, who can guess the name of the gut bacteria?
Any idea?
There is there is a normal flora in there in in the gut.
We are told that um this this um normal flora it's it helps in vitamin K.
I've given you a clue.
It is this same type of normal flora that when ladies wipe themselves um like from front to from from back to front can introduce and cause infection.
E. coli E. coli, well done.
>> [laughter] >> So that that is E. coli. It lives it lives in the in in in the in the gut. It's a gut bacteria and it it produces vitamin K.
It helps us um with even coagulation and other stuff that we need to do. So it is still moving, okay?
Now, let's get to the rectum and anus.
The rectum and anus, that is where at least your stools will be formed and then you have the sensations. There are some nerves there that will tell you to go and empty it. Some of us the nerves that are supposed to tell us that the place is full, I think they are on strike. So you you never see them in your life.
And so you get to the bathroom and people will hear you screaming for help.
Then as are you okay? So yes, I'm fine.
Oh.
>> [laughter] >> It it's it's not easy at all, but God day we day in a Nigerian man's voice. Okay.
Ha. So, we have an internal anal sphincter and we have the external one that you could see. They are all sphincters are like gateways, okay? Just to open and close to allow things in and out. So, this is just a little bit about the anatomy and physiology of the gastrointestinal system. Just a quick refresher course, a very overview from the bird's eye.
Now, let's take our time and start from bleeds.
GI bleeding.
Now, if we say there is GI bleeding, it means that anywhere in the gastrointestinal tract, you can be bleeding there. We all know what bleeding is. So, blood is leaking from somewhere there.
Now, we are saying this could be over it.
I see we can see where it is, where and we even know where it's coming from or occult, meaning it's hidden. So, we have first two tests we call the him occult.
Excuse my language, you have your feces.
Some of you when they tell you to go and bring a sample, huh, you really make sure it count. You bring a sample and gaza gaza gaza gaza.
Uh uh can you bring a whole bowl of sample? Something small we need, no, go and bring a whole bowl of sample. Say we should take it.
So, when you come, maybe sometimes just looking at the outward appearance, there is no suggestive thing or nothing pointing to the fact that you could be having um a bleed anywhere.
But, there are devices that we can use to test. You can use We have um some laboratory um devices and then we also have the quick rapid test. There is a short cassette-like um card-like device that you can just put the feces on. It uses color principles to change.
Okay? Uh it it it will let you know.
Sometimes the one I've seen changes to color blue when there is um blood in it.
It has been strained to perform or do that.
Now, where is it coming from? If you want to know where the bleeding is coming from, we can divide it into two, the upper GI and then the lower GI. So, the upper GI and lower GI all will be the division of the duodenum. That's the small intestine. So, the upper part of the small intestine will belong to the upper part of the gastrointestinal tract. And then from the duodenum down.
So, I always use the principle of less than or greater than.
So, the doctor will look at which specific part of the duodenum is involved to make a conclusion. Mhm.
Maybe from the duodenum downwards, then we can say say, "Oh, okay.
The bleeding is from a lower GI source."
But if it's anywhere up, it could be in the esophagus. It could even be in your mouth.
Mhm. It could even be in your mouth and you're swallowing it down. All of them are bleeding. And so, we can detect it.
So, if we want to look at the causes, things that will cause an individual to bleed, there is a lot.
But each and every one of these in itself is a condition that we need to really go through. So, I'm just going to brush it off. Not brush [snorts] it off as in not learning. We'll there be I'm going to kind of have a quick overview of it. Then we'll go to the signs and symptoms and spend a little bit of time there.
Peptic ulcer. Mhm. Peptic In peptic ulcer, it's like there is a wound. There is a sore somewhere in your stomach or sometimes in your duodenum, okay? Or the small intestine. And this one this this wounds could bleed.
Could bleed.
And then we have esophageal varices.
Like those days when I was handing off in an American hospital, they say they don't say esophageal. I say esophageal.
I'm say eh.
The way they are giving me the words, I don't know if I'm going to survive.
>> [laughter] >> Esophageal.
Esophageal.
Esophageal varices. I'm say okay. So these are swelling veins from the liver. I mean we will look at it. We will We will I will show you where it's located and you get to understand how and why we are calling that it's it's something it has something to do with portal hypertension, okay? Huh. We will also look at gastri- gastritis. Mhm.
Inflammation of the stomach lining. Then we have the Mallory-Weiss tear. A tear at the junction of the esophagus and stomach. Maybe after forceful vomiting.
I always tell people that there are individuals in this world who can vomit for the Guinness Book of Record. So if you think vomiting is pleasurable and you would You know there is a condition like that in psychiatry?
Yes. Mhm. Some individuals they do not want to gain weight. And so when something get out they will bring it out. What condition is that though?
Anorexia bulimia.
Oh. Hey. Bulimia nervosa.
Ah. Bulimia nervosa. Bulimia nervosa, okay. It's anorexia bulimia >> [laughter] >> combined two things so.
Bulimia.
Okay, good good job. So um anorexia nervosa.
Okay. Anorexia nervosa. Bulimia is more of eating digadigadigadigadi then they will gain weight.
Okay. Huh. Due to they can also They can also vomit to create space for more.
And then the anorexia nervosa. That's why they are all having the nervosa. The nervosa I think has something to do with nervousness and probably vomiting whether invoked intentionally or whatever. That's what happens in those cases. We one day look at the psychiatric system and then the psychiatry and then we will see what goes into that. Um if the bleeding is from a lower GI source, those that we mentioned were for the upper GI. If it is from a lower GI source, then you are getting conditions like um diverticulosis which is like a purchase in the colon that can also bleed, okay?
Hemorrhoids, swelling veins in the rectum, colon cancer, inflammatory bowel disease. All those are possible causes.
But when we get to these conditions proper as a standalone, then you get to embrace them better. This is just as a cause of bleeding in the stomach. Now, let's come to this.
The first word you are seeing here, how do you pronounce this word?
Hematemesis. Okay.
This particular aspect means what?
Blood.
Blood. The hema means blood and then the emesis will definitely be what?
Vomiting. Vomiting. So, it technically means what?
Blood in the Blood in vomit.
Vomiting blood.
>> [laughter] >> I like your answer. Yeah, blood in vomit. That is it. I So, the person is actually vomiting blood, okay?
Um now, if if it is bright red, the bleeding is fresh and active. If it is coffee ground, it has been digested.
So, this is what the NCLEX wants to know and understand if you get the trick.
Let's say you were bleeding in your throat just where your tongue ends.
When you bow down your head and the blood begins to come.
Don't you think that blood will look a little bit reddish and fresh, right?
Because it's very close to your mouth.
It will be that. True or false?
True. True.
Now, this same blood when you swallow it and it gets into the stomach, what do you think will act on this blood in your own understanding?
The hydrochloric acid acts on it. Good.
Now, looking at the corrosiveness and the harsh shape or somebody said harsh shape.
On the of HCL or the hydrochloric acid, do you think that blood will have the same color it was before the acid acted on? Do you think it will be the same?
No.
>> No. No. No. Okay, so when a person is vomiting and then the the the the blood coming out is bright red, we know that it is not from where?
It's not from the stomach. If if he's vomiting. And then it's bright red, we know that it is not from there.
It's not from the upper GIT. Yes, it's not from the stomach. It is not from the stomach rather. From the stomach. We know that it's not from the stomach.
Because if it was from the stomach, what would have happened?
The color would have changed. The color would have changed. The color would have changed. Why?
Because of the acid.
>> Because of the acid.
>> Yes, because acid would have acted on it or maybe it would have attempted to be absorbed, right? Uh-huh.
So, when a person vomits and then it is coffee ground, what do you Where do you think it's coming from?
Coffee ground is a color which is not like somebody's vomiting coffee. I'm telling please.
It's not about coffee that we drink.
It's about the color. Coffee ground is just a color.
If somebody vomit and the color of whatever is coming out, um if there happens to be blood in it and the blood is coffee ground, it means that it's coming from where?
From the stomach. From the stomach.
Because because the acid might have acted on it. Guys, do you understand what we are doing?
Yes.
>> Yeah. Okay.
So, when we talk about hematemesis, the emesis means vomiting.
And then the hemi is blood, blood in the vomit. Okay? So, if it is bright red or it is something that you see glaring like that, pinkish sometimes, you know that you know it's very close to the mouth. But if it is coming as dark in color or coffee ground, then it tells you that no, this one is coming from the stomach. It has been there for a while.
Now, the next one we are going to learn is melena.
Now, what Let me give you a clue before you solve this puzzle for me.
There is something about black people that they talk about more.
It's an aspect of their skin. What do they normally talk about?
The melanin. The melanin.
Melanin. And normally they are trying to say that they have melanin. That's why they are black, right? They do say funny things like that.
>> [laughter] >> Yeah. Now, melena or melena is also known as black tarry stools. In fact, when we talk of tar, what comes to mind? There is something they used to make in our roads. They call it what?
Coal tar.
So, all this is giving you a clue that melena may have something to do with which color?
Black. Black.
So, you see that it's not very easy to forget. cry. You try to forget the things. you know, you won't forget. You lie. You have melanin. You have coaltar.
So, black tarry stools have got everything to do with black.
So, there is no way they will bring it in the exams and then you'll be like, "Hey, I've forgotten what a tarry stool.
I've forgotten what melena is." No.
Think of melanin.
And then you get to see what how it's related to black.
Now, this one is about stools. The first one was emesis. So, it was about vomiting.
This one is about stools.
And had it not been that I am online, I would have said something bad that the African race will come and then cut my head off.
>> [laughter] >> Yeah, because I don't know why people have this inferiority complex.
Why can't you be head and you always want to be tail?
Mhm. So, when you think of the melena, then you are looking at things of the tail. Me black. The black person feels he's down there. No, come on.
It shouldn't be that.
So, that is that should also give you a clue. I'm not saying this because I meant it. I'm saying this so that I create an association for you in your brain.
The other one is hematochezia.
Hematochezia. So, the concept is that if the word that you are dealing with is not having emesis, then it means that probably it is in the what?
It is in the stool, right? Huh. If it is having emesis, then this is from where?
The mouth. In the mouth. From the mouth or vomiting. Mhm. But, if it is So, when I see the word and I forget what hematemesis mean, at least I know the emesis has got to do with emitting something. So, I know it's about vomiting. However, if I get to melena, hematochezia, and whatever word that they will bring to me, and I don't know what it is, I actually have an idea that it probably may be talking about stools.
Because if it was about vomiting, I would have seen emesis there.
So, melena is about black tarry stools, whereas hematochezia hematochezia is talking about fresh red blood in stools. So, right now, the difference the main difference between the melena and then the hematochezia is the color of the stools, and the color of the bleeding in the stool.
Now, the melena is what color?
Very black.
>> Black. Black. And then the hematochezia is what color?
Red red.
>> Bright red blood. Okay. So, now, looking at the way the lower GIT is, if it is black, don't you think it is coming from afar?
What do you think?
Yes.
Huh? And then if it is bright red, then it means that the bleeding is close by. Oh.
Yes. So, let's let's let's go back to a diagram and see. Let's say maybe we are using this diagram.
If somebody Let me change the color of my pointer so that you see. I'm using color green.
If somebody is bleeding around this area, there's a probability that it it can come out as bright red, right?
But if a person is bleeding somewhere here in the throat, it passes through the stomach, passes through the intestines, and get to the anus. Do you think it'll still be bright red?
No. No. Okay. So, now, if I ask you a question that a person is having melena stools, is the person bleeding from the upper GI or lower GI? Which one would you likely say?
The upper.
Why are you saying upper?
Because it's um It's what? Because it's dark red.
And the acid have worked on.
>> One at a time. I want to hear somebody.
Somebody should say it.
Because where it is bleeding from is not closer to where the acid is.
Your your network is not too clear.
Maybe you're using a ear piece, right?
Okay. Okay.
So, I'll I'll say upper because um probably it has been acted on by the hydrochloric acid in the stomach before even passing through the intestines and getting to the rectum to be excreted.
Good.
Good. Another person, why are you also thinking it's upper?
Oh, you don't think it's upper at all.
You think it's midline.
I suspect you.
Jenny V, I suspect you.
No, I actually said the acid the hydrochloric acid.
>> acid. Okay. So, if a person is having hematochezia, where's the person bleeding from?
The lower It's on the lower GI tract.
The lower.
It's closer to the Because it's closer to the That's why the color will be what? So, the color will be what?
Fresh. Bright red. So, do you think now from henceforth this particular thing will not be confusing anymore?
Yeah. It will not confuse. It will not confuse us anymore.
Okay.
It will not confuse us anymore. Somebody is asking how he will he will she will answer questions on YouTube. Please, if you get the last year of time, let the person know that they can chat there.
>> [laughter] >> Okay. All right. Now, let's look at it.
This one we are all nurses. So, though it's on the screen, but we will look we just read it and then we get the concept.
If a person is bleeding, the person can feel dizzy. True or false?
True.
>> Yes, they feel dizzy. Why? Why do you sometimes think so?
Because of hypertension.
Okay, I'll give you two over 3,452.
A now better. Yes, any other?
Because the person is losing blood.
This is your network in there. A, I couldn't hear anything. Couldn't hear anything.
Are you using earpiece?
Please can you can you repeat the question again, please?
So it's because a person is losing blood and that loss of blood can lead to hypertension and this hypertension will bring about the dizziness and the fainting.
Cassie, what Cassie, what did you say?
I said because the person is bleeding a lot. Your network is clear now. What did you do to your network?
I was using a headset. Sorry.
>> this is clear I'm better now.
Head clear.
Okay, [laughter] all right. So I I also probably think you know there are some places that when blood does not go there you can easily feel dizzy.
Places like the brain, right?
>> Yeah, yeah, you're right. Yeah, you're right.
The brain. The brain is very important.
Do you know why we do CPR?
Any idea? Yes, Genevieve.
By force, by hook or crook.
>> [laughter] >> Genevieve, why do we do CPR? What do you think?
Tell.
I The blood can get to the vital organs.
Especially the brain.
Okay, especially the brain. Why why what happens to the brain? Why are we kind of prioritizing the brain?
It can't regenerate within few minutes.
So you need not to be deprived of blood supply.
Um to also help with blood and the oxygen movement to move it through the body.
Mhm.
The English is too sweet. I I don't Okay.
>> [laughter] >> That is true. So when the brain is deprived >> happens to come. When the brain is deprived of blood supply for some few minutes, it dies, right? Yes. And and unlike the hepatic cells and other cells in the body, these cells they do not regen- What was the word? Generate themselves.
When they die, they die.
So when you get stroke and your brain cells, whatever part died is dead. What is dead mean? Never die.
>> [laughter] >> Is dead. So you probably use other parts of your brain to support your activities. That's why you need rehabilitation to learn a skill with another part of the brain.
Brain cells, when they are gone, they are gone.
But the hepatic cells and other body cells, they are gone, but they can come back to life.
And that's how amazing it is. So when a person has been dead for six minutes, meaning the heart is not beating for a while, and the brain is still active, the person can easily be resuscitated.
However, if the brain dies, especially when the midbrain dies, the pons and all those things, forget it. That is clinical death.
Um my specialty is in palliative care and we kind of read on some of these things, certification of death.
When your heart stop, I don't I'm not I'm not I'm not scared at all.
But when your brain dies, then I'm scared.
Because it will be very difficult to bring them back to life. That one, when they come back to life, then I will agree that there is a miracle.
But so far, we've not really seen anybody whose heart that brain stem death and coming back to life.
I doubt.
Okay, so there could be dizziness.
We have ascertained that tachycardia, low blood pressure, pale and sweaty.
Now, in fact, on the NCLEX, when you see this combination, when you see that the BP is down, and then the heart rate is up, what comes to mind?
This one, Helsinki.
Shock. Shock.
Shock. Hypovolemic shock. It is a trick.
Ever since we saw this trick, they've not decided to take it away from us because it's a trick. No. It's It has always been appearing on your NCLEX.
This combination, when you see it, you are going to deal with shock. So, does that tell you that if you lose blood, you can go into shock? The answer is what?
>> Yes. Yes.
>> Yes. Yes. Okay. And why do you think the heart rate is going up?
To compensate.
>> to compensate.
So, it's still prioritizing the brain, eh? Since that there are some important organs that they should have constant supply. So, if the blood returning to the blood is to the heart is low, your blood pressure is even down. When they sense that the BP is down, the heart is supposed to try to beat faster.
>> Yes.
>> Okay. Because when the brain die, what is dead be never die.
You will not get it back again. That is the issue.
Okay.
And then, we are having pale and sweatiness, and all the other shock symptoms that you can think about can happen in this regard. Please, is there or are there any questions?
Those on YouTube, Genevieve is monitoring, oh. If you put wrong answers there, the way we will deal with you is spirit. Things they are not there, so you are doing anything you like, eh? My eyes are watching you. And I'm going to cause melena. What is melena, guys?
Black tarry stool. Black tarry stool. It means they are going I'm going to hit your upper part of your body, you bleed.
And then by the time it gets down there, it becomes black. You see, I will deal with you.
Okay. When we are doing this, if a person has bled or we suspect bleeding or even if we are aware he's bleeding, what test should we do or what can be done?
We need to check the hemoglobin level most especially, okay? Now, in on your NCLEX, you see something like CBC, but I'm pretty sure it's quite different from what you know in your country. In your country, they write FBC. What's the differences? What's the C and what's the F?
blood count and this one is complete blood count.
>> count. I think it's the same thing, right? There's no difference. So, when you see CBC, just treat it as you would you had seen FBC, full blood count or complete blood count. It's just substitute of for it to change it, okay? And mostly, you're looking at the HB.
What would be your normal HB in humans?
Normal HB in humans. I'm not specifically asking for females and males, just any good HB you think we can work with.
12 to 16.
12 to 15, not bad, yeah.
So, if I have an HB of 20, is it worrisome?
Yes. Yeah, >> [laughter] >> I hardly find people with that plenty HB, oh.
Now, there's another one. It we call the hemoglobin and something else, H and H. What's the other H?
hematocrit hematocrit There is a relationship between the hemoglobin and then the hematocrit. What's the trick?
I say once once the HB is low, the hematocrit is low. That one is 100% true.
But then, what's the trick? Let's say if the HB is 12, how can I guess the hematocrit?
It's times two. It's times three. You are wrong for 3,000 minus 14,000 points.
>> [laughter] >> You were close, cadet. It is times three. Mm, hematocrit is times three.
So, if a person's HB is 12, what will be the hematocrit?
36 36. Guys, is it easy? Is it okay?
Yes. Yes.
When people say there's intelligence in nature, sometimes some of these things they try to talk about. That you know, mathematics is logical reasoning. But when you apply it to um a human body, for example, like calculation of blood and all some of these things, it's almost always true with some marginal errors. A confidence level of about 95%. Don't worry if statistics is not your thing.
>> [laughter] >> Right. Let's look at coagulation profile.
What do you think is trying to What are some of the things that are going to coagulation profile anyway?
Clotting factor. The clotting factors.
Factor one, factor two, factor three, factor four, factor five. Hey, factor 12.
And I we teach all these when I'm doing coagulation with you guys. I'll teach you all the factors. We have the intrinsic pathway and the extrinsic pathway. Where they will all convert at the Stuart factor.
That's the factor XA. Right? Together with calcium and some other factors like factor five.
Then we have prothrombin activating to thrombin and then acting on fibrinogen, converting it to fibrin. Mm.
Fibrin is a mesh. Then it goes to solidify the platelet plug that has been formed. I'm not telling you this to sound intelligent, but I'm telling you this to excite something, an inquiry in you for you to go and read it out. But I'll teach you by the way.
All right. Now, the coagulation profile, yes, clotting factors. You're looking at prothrombin time, the activated thromboplastin time and all those kind of stuff, right? We'll look into You are looking at international normalized ratio. You are looking at platelet count. What is the normal platelet count?
There is a lot to learn, eh?
>> [laughter] >> But don't worry. Don't worry we will do all of them and I will give you tricks and ways you can always remember like I'm always writing like 150,000.
To 400,000 you will learn some of these things and it will become very easy for you. We can do an endoscopy.
So endo will look at which part of the GIT?
Hey, who is fighting with somebody and commodating for there? Hey, make sure you don't hit anybody or the way I say commodate for there.
>> [laughter] >> Okay, your mic was on. Take control of it. Now endoscopy will check the upper GI.
Then colonoscopy will check the lower GI, colon, right?
Colon this is endo.
Now there are so many types that these days that they will do and people will still call it an endoscopy. In fact, to the lame person in America sometimes they will just say a scope. He's going for a scope, right? It could be any of them uh-huh just to be on the safer side. He's going for a scope and I've I've answered the question on my question bank askaclass.com.
I'm going to go to askaclass.com. I have a very good question bank. I use the I use first authoritative sources of um item writing. Mhm we have rules and principles. You can't say that madam AJ, no. You say you don't even say patient you say client. Uh-huh. We have rules of writing it. You have to give the right one good answer and then three distractors. Okay, we have to do that.
You don't give two opposite answers.
It's a lot of principle. When I get into the question bank some of you use it's a it's it's a mock. Like I don't know how they set the questions. Even though the thematic areas may prepare you enough, but I could 100% criticize the style and approach with which they wrote the questions. Especially when you look at the 2023 test plan and that of the 2026 and NCSBN test plan. I speak as somebody who have really delve into this and know what I am doing.
Now, let's look at colonoscopy.
A person is going for colonoscopy tomorrow. Do you think the person can eat this evening, specifically jollof rice?
No, sir. What about benguet?
No. No, can't the person drink water at all?
You will drink water.
You drink water, but um you should stop drinking water from um 6 to 12 hours.
Okay, let's see.
Will it be nice if you want to examine the colon and there is nothing in there?
Yes, so you need to clear the colon with feces.
From feces, eh?
So, we need to we need to give the the the patient something to drink. To prepare the patient.
Now, as the patient is drinking, he's bringing things out. So, you the nurse, you realize that the doctor has not put any IV infusions on the patient. What can happen if the patient keep [ __ ] things out all in the name of colonoscopy prep?
What can happen?
Offense, so you need to Electrolyte imbalances. A lot.
What you are saying can cause electrolyte imba- So, the doctor Normally, they give some fluid, maybe.
Some doctors may not do it. Not intentional, but probably does not really click to them. Their ideas is to just clear.
But mostly because it's the GI team, if you work in a magnet hospital where we have the interdisciplinary care um teams of care, then there is a probability that the GI team will never leave the patient like that knowing that this patient can do this and that.
And the funny thing, the patient will be on an IV.
And the patient will have to also make bathroom trips. Any you do.
So, either you'll be removing the IV or you'll be pushing the IV inside. A whole lot of complication that day.
Normally, they give it twice. I have forgotten the name of the solutions, but it creates concentration gradients.
We have so many solutions that you can use to that. In fact, what solution you can use to get rid of them, you can. But most of them uh we have standardized one. It's sodium something something.
They pour into a glass, fill it with water to a brim, to a particular measurement, give to the patient. So, we want to clear the stomach of all that so that we can visualize. Now, another NCLEX question.
The doctor says that it is colonoscopy and the patient can take clear liquids.
Because that one will help ease and wash the colon up. Do you agree with the doctor?
Yes, I do. Okay. I also do.
But do you think the doctor should give specific instructions to the clear fluid?
Yes. Yes.
What what what example of specific instruction could that be?
What are we going to look out for when we do the colonoscopy?
What what are we checking for when we do colonoscopy? What are we actually checking for?
They are visualizing um the inside around the colon.
They are visualizing colon.
Me and you guys have been talking for about 10,000 hours now and I'm asking you something. You say you're visualizing colon.
What?
>> So, um pertaining to what they're discussing, I think they're trying to find where the bleeding is coming from.
>> Exactly. Exactly, my brother. Can you please walk into their rooms and give them 17 drops each? Give eye for eye, give him 20.
Cuz he was even talking around.
>> [laughter] >> So, we want to see where the bleed is.
So, do you think now those in Ghana, do you think this person can should drink sobolo because sobolo is an example of a clear liquid?
No.
>> No. Why? Why? Because it's >> Because of the color. Because of the color. So, the endless is going to ask you a question based on this color.
Are you with me?
Yes. That doesn't make sense for the doctor to specifically advise the patient not to include anything of such color.
Yes. Yes. Yes. Huh, so this is why I am teaching you all this rule. Get the wisdom in answering the question. So, that when they bring it, it will not be that eh, now how will I know the food the be any food I say okay I don't know what to do.
Any food I say it's not about food.
So, colonoscopy now.
>> think the strawberry juice.
Yes. So, it's about you using your own tricks. Sometimes your knowledge of the foods help, but I mean they will make it quite obvious.
The moment they bring the question and it's about colonoscopy and they're talking about food, you and I know that it's about color they're looking for.
Two of us.
True. True. Yeah. So, so when they talk about you not forming bulk agents over like having feces there, and so they'll put you on clear liquids to clear the place. I mean, come come and they restrict certain type of things for you. Endoscopy too So, when a patient comes to me, like for example over the weekend Yeah, my boss.
Sir, please so so the clear liquid meaning it is just normal water.
Um water is an example of a clear liquid, but we could have chicken broth.
Mm, tastes like soup. Light soup is an example of a clear liquid.
Sobolo >> Apple juice. Apple juice, they are all examples of clear liquids in the US.
Okay.
Yeah. So, if they if they mention something you don't know, maybe it's color Yes. So you you will now eliminate those you know first, and then you deal with those you don't know, okay? Something will pop up.
You see the >> [clears throat] >> You see the trick.
It will work out. Don't worry. I will teach you I have test-taking strategies where I teach you what to do when fools come in.
I teach you that if you do And yes, it's true. You may not always know the type of food. But then you should know what is going on. Um Genevieve, can you give me a report of about how many people are on the YouTube right now? Just an idea if you can see them. Yeah, 71.
Oh, can we tell them to please hit the subscribe button if they've not?
Mhm. If they've not, they are they are still on it thinking that this thing is a good thing, but they are not supporting the agenda.
Tell them when I clap my hands and pray, I'm going to put the agent used for colonoscopy preparation there.
And this night, I promise them they will not find it easy. Since they what? They come and they say me to I come some. I dey YouTube. So what?
Yeah, it's currently 72 actually.
72. Yeah. Actually pleaded for her. If people are here, please kindly subscribe for ourselves. Yeah.
Let let's support our own.
Our own. Mhm. They can hear you.
Okay. Okay, typing that in chat.
Okay. You see Okay, so tell them I said they should support our own, eh?
Okay.
>> [laughter] >> Uh somebody was asking I want to talk I I I I think I saw something on WhatsApp like that. Genevieve, did you see anything like that? The person was saying, "No, I want to contribute. I want to I want to say use audio like they are using." Meanwhile, when I asked them to come, they didn't do.
>> [laughter] >> Okay. [clears throat] You see now it is fun they are finding their level. So endoscopy two and colonoscopy, when a patient comes to you, let's say it's weekend, the emergency is full, they are trying to create space. So, the patient went there and all they saw is a bit stable, pop, they push him to your ward.
Then you read the notes and you saw that this patient is actually bleeding. He has a history of bleeding in stools. What are some of the things you the nurse you would What What do you anticipate and what do you do? I mean, let us have a very good discussion right now and move forward.
Uh serve IV fluids.
You will serve IV fluids. Maybe you administer the one that they prescribed, right?
Okay.
Because you you presume that the bleeding might have caused some loss of fluid and so you try to replace it. Loud enough. What else? You are hydrating the patient. What else?
What do you want to anticipate or what do you do?
You probably anticipate You You monitor and plan vital signs, especially the the BPs.
The blood pressure. So, what does that tell you? So, monitor for what? For hypotension because of the bleeding.
Okay. So, if you check and there's no hypotension, end of story.
>> [laughter] >> I mean, you should keep an eye on it, right? We have critical levels of vital signs, true or false?
If it is getting risky, we know what to do. Yes. Yeah, we will be watchful. What else?
Then you start preparing cleaning the colon for examination the following day.
That is what I wanted.
This one This one you know be body and and and and soul that has revealed to you.
And it's it's also not the spirit. I'm sorry.
>> [laughter] >> It is the seven dwarfs responsible for the fall of the US dollars. That's give it to you.
What is the A? You be there.
Sure.
Okay. All right. So, you prepare for a scope.
Now, what will give you an impression of which scope we will do?
I want to see >> The color of the The color of the stool.
Ladies and gentlemen, the color of the stool. What about it? Tell me more.
If it is dark um You know it Mhm.
If it is dark Okay. Continue.
From the top, eh? If it is dark Yes. And so And so if it is dark, which which scope would they do?
Endoscopy.
Yes. So, you now understand why the doctors are prescribing certain labs and not some labs, right?
Right. So, uh-huh. So, now you can even correct a doctor. True or false?
Yes.
>> Yes, in a very nice way.
Mhm.
>> Because it's not that they intentionally did a mistake, but it could give you an impression. And some of them, if it was a mistake, they will not tell you it's a mistake, oh. They will let the patient go and do the endoscopy.
Then later they will let the patient go and do what? The colonoscopy.
Mhm. Yes. Some of them, it has a a a very strong medical backing why they should do the two, right? Just to rule out You know, mostly sometimes you could have it a bit of something like that, but they just want to rule out any other bleed from Mhm. But in other ways, too, or in other places, too, it's a pure mistake.
So, you question, doc, um are you saying we are doing the endoscopy for his um lower GI bleed?
The doctor said, "Y- Yes. Uh lower GI, eh? in? Charlie, let's let's do the colonoscopy. Right?
It just works like that. Then we become a very formidable team. Looking out for each other. But when the allowance come, doctor will say, "No, we are not looking for each other."
>> [laughter] >> But I said, please, don't you also think that sometimes too, the patients are also part of it. Because today she he or she will come with a symptom saying, "I I saw a dark stool."
And then the nurse you will say, "I saw a bright red Exactly. And so the symptom, you know, That's why you bless the first time they will do both.
I mean, That's why you the nurse, you should do your assessment.
Mhm.
So we were discussing what we would do before the doctor even come in the morning to meet the patient.
Mhm. Or whoever was on call, the next practitioner is on call, the physician assistant is on call, or even the doctor is on call. You you ask for the fluid. Say, "Doc, um the the the patient came from the emergency.
You say, "I have you seen him?"
The doctor, there is no IV fluid, so is it okay?"
Oh, put some normal saline on. You say, "Okay."
Then you start your monitoring. "Doc, the the BP's are extremely soft. Oh, assistant, now it is around 70 over 30."
Oh, open open the fridge.
>> [laughter] >> I'm coming down. No, no, no.
Then he will come there. Then he will write, "Maybe bring the BP's up."
Because you are monitoring the patient.
"Doc, it's good you came around. The patient has gone five since he came here.
And the color was pink.
The other one that I saw was bright red.
You see, when you do that, you are really being helpful. Oh, you are being helpful for going to watch people's feces. No, you are being helpful.
I do my way. This work, eh?
>> [clears throat] >> People [ __ ] by heart, and you have to be watching.
Okay. All right. It is what it is.
Now, we also can do fecal occult blood test, the one that we check to find what is hidden. The simple cassette one or whatever in the blood in the in the in the in the lab, sorry.
Um And we can also do a CT Yes, dear.
So, that one is a normal stool, but we want to find out if there's a hidden uh blood. Yes.
Yes.
>> Mhm. And the hiddenness is in the word occult.
Mhm. Yes. The occult people The people Yes, sir.
So, you I I I may be able to understand very well. Comma. Yes.
I understand very well. It doesn't mean that they they H. pylori test they do, no. They also do to find out the hidden blood or No, that one is the H. pylori.
They are trying to search for H. pylori, right? Yeah.
So, they are searching for H. pylori.
Most of them pylori pylori are moving now.
So, that one That one is like you said, they are looking for something, so Is it not bacteria?
Yes.
Okay.
Helicobacter pylori.
>> Mhm.
Mhm.
Very notorious for causing ulcers, right?
>> Ulcers. Mhm.
Then we tackle them with the people in Ghana call it the triple action.
Mhm. One of PPIs, maybe some antibiotic, then some flagyl B. Do that combination for like 2 weeks.
Then they will tell you you are healed.
>> Right, that one is the Mhm. Okay. They will tell you you are healed, my dear.
Within 3 weeks, your your heart will be burning like fire.
Mhm.
So, let's let's let's move on.
Let's move on. Okay.
So, we did well. You are checking vital signs every 15 to 30 minutes. I've answered the question where they said the woman postpartum was bleeding.
And then as part of the options, they they were saying you should check the patient's vital signs hourly.
I picked that answer and then they said I'm wrong.
Mhm. Hourly is too long. I'm like, hey, uh so ladies and gentlemen, if bleeding is involved, how soon should you check the vital signs?
Please send me some extra steps.
You know be me talk am, it be you tell me. So please keep up.
Keep it safe or somewhere safe in your head, okay? Uh it's a trick. Nobody taught me. I learned the hard way.
Start having places spoken about it. In some cases, the person has bled, so you prepare for possible transfusion.
You keep the patient NPO for any of the endoscopies or even sometimes surgery.
They have procedures that they say they will collect.
Mhm.
They have some I've forgotten the name of the but sometimes they they inject um certain medicines. I think they even use um adrenaline and other stuff. I've forgotten the name of those things. When I when I get the names, I'll I'll furnish you guys with them. Mhm.
Just to make sure that they prevent bleeding, okay? Mhm.
And then in certain cases, they try to let the bowel rest and also get things out.
Let me give you a secret in life. Do you guys know that blood itself is um a laxative.
Mhm. You know blood uh blood is a laxative. And if you are bleeding, eh, you know be anybody will tell you to have diarrhea.
Mhm. It will come with the diarrhea and it has this offensive smell, eh.
Yeah. Yeah, very offensive.
And I can tell which particular stool is having that type of bleed in it. Mhm.
Time.
And so, they give medications like the PPIs. In your country, omeprazole is common. Over here, pantoprazole is very common.
Reduces stomach acid, so the ulcers don't worsen. Then we have octreotide. That was what I was looking for. Octreotide. It is used in um variceal bleeding, like the one we have esophageal varices. Mhm.
Mhm.
So, my tip for you Is that easy? Is it true that esophageal varices?
Yes, ma. It's I will see some.
I will show you some here, okay?
I will show you some before you. Nice thing, Johnny. I will see some before.
Oh, it's because of your population.
Those people are very careful.
Yeah. They are not daredevils. Have you Have any of your hospital people or the people in your community decided to go to the moon and come back before?
No. I'm talking about people who go and stand in the tall buildings and say I want to jump and see if I will die.
Those people are what I'm telling.
Everything so They have everything so >> They have everything. Mhm.
Mhm.
Somebody is asking me a question on WhatsApp. I'm even shy to say it online.
He's asking, "Why do people get diarrhea when they are menstruating or having their period?"
Guys, do you know the answer?
My honest >> physiology I don't know. My honest answer is that I don't know.
What do you think? Is it a good answer to give?
But the person is bleeding.
>> [laughter] >> The person is bleeding vaginally. The vagina pathway, the uterus pathway is different from where the the the What do you call it? The GIT is.
So, if you want to use a GIT principle for that, I I I honestly can't help you out.
If it was the case of obstetrics where you are looking at a sagittal plane cut through it and you see that maybe the uterus is here, the bladder is there, and the rectum behind it. Uh-huh, that one there in terms of displacing the uterus and it's not in mid-line, the bladder and then maybe I don't know whether tumor in your bowel or maybe huge feces in your bowel can probably displace it a little bit.
But up to the relationship of bleeding vaginally in in the in relationship to what we are discussing that blood can cause diarrhea, I don't really know, to be honest. That will be a question for the specialist.
Okay. Now, I'm teaching you what is coming what is coming.
>> [laughter] >> So, I'm going straight to the point if normally what they would like you you to know.
And the NCLEX is not interested in failing you as the question banks are interested in making you know that you don't know anything.
To be honest with you, there is nursing shortage.
They just need you to demonstrate. Are you listening to me? Demonstrate that you know this thing and that you can take care of them. That's all. I am sick.
So, if me, I am sick and I want someone to come and take care of me, how will I know this person is capable of taking care of me? I will describe my illness.
And that is why some of the test takers know we have to screen them.
The ones that take the question that that particular illness, you know, he has been through it. And so, when he said the question, you say, A difficult question to answer.
Mhm.
Mhm.
So, they want you. Don't feel overwhelmed.
You can.
None of the questions is seeking you a downfall. They are rather trying to employ you or take you.
So, if patient has low BP and is vomiting in addition, something like that.
All that we have to do is to give IV fluids.
And some of these things, just don't say I'm hydrating and leave it. No.
You have to inform whichever provider is around.
Whether it's a nurse practitioner, um physician assistant, or and if as part of the item writing, you see, some of the people that do your question banks, I don't know how they do it.
You know, as part of the item writing, we don't even say doctor.
We don't say physician assistants.
Neither do we even mention the nurse practitioner.
But we use words like what?
Service provider. Service provider, health care provider, sometimes prescribers.
Those are the terminologies we use.
And so when I get to your question bank and I see what you are doing, you are no saying, "No."
I can even read through the question banks and know which one is using AI to detect what and do what. I'm online and can't mention this.
But if you if you ask me, that's why I decided to create my own question bank.
And with what I'm telling you, if you like give my question bank a shot just for 3 months consistent and tell me that your NCLEX questions were extremely different.
Fine, they'll be different, but I'm telling you the thematic areas and the ability to prepare you to think critically, my question bank will do it for you.
Always stabilize before diagnosing and prepare for possible surgery. The patient is having unseasoned type of bowel whatever. You try to patient out first.
It's not about the diagnosis. I mean, you are a nurse. You treat palliatively.
If the patient can't breathe, position the patient well, sit up in bed, give oxygen. You will talk about what is causing the difficulty first, but stabilize them.
Give them that comfort, that symptomatic treatment before anything else.
Let's answer this. Those here, answer in the chat box. Those on YouTube, please, can you write your answer in the chat for me?
Those on YouTube, hurry up because you guys are lagging behind.
Spiritually and psychologically.
I even want you to see environmentally.
Sir, what what should we do?
There is a place on your Zoom call chat, okay?
Click on that chat and then it will open a box.
Click where it says message everyone.
Then type the answer you think is correct there. We'll beat you if you get it wrong. I will deal with you.
It's not I don't have what I was not Is your network freezing on you?
It just when I click on it it goes up and go down again.
Okay.
So, I saw a variety of answers. Some are saying A, others are saying C.
Guys, is it A?
No, I'll go for C.
Go for C.
Because we say always stabilize before diagnose, right?
Yes. The diagnosis does not make any huge sense.
What you are seeing there is what?
Um it could be signs of shock. It's the shock.
>> And she's going into shock.
>> It's actually shock. Mhm.
So, you need to intervene quickly, then you move forward. All right.
Let's try this question quickly.
We have been online for an hour 20 minutes.
And you guys don't even think of sleeping on me.
That is how the classes should be. So that even if they don't pick a book, you can still understand what is going on.
I thought it's what?
Genevieve, has the number reduced so far?
No, it's currently 73.
It was 72 and 72, right? Yeah. It's now 73. The people online, they didn't share the link to their family and friends.
They are very greedy.
I will I will put the thing we use in preparing colonoscopy in their intestine directly.
Someone is asking what was the answer?
I'm not interested in that.
The answer was the C. They should they should find their means of getting to my class.
And then they get them. If you get the answer here correct and you get it wrong on the NCLEX, what shall it profit you, right?
Get the ideas and then we move forward.
My baby mama that person is going to beat me now and now because I spoke.
Guys, those on YouTube, go and share with family and friends. Let them come and watch some It's a free class. Don't You have You have from a a school. You know all these nurses in your class, they can also equally go and write the NCLEX. You don't want to share with them.
And this is a select all that apply.
What do you guys know about select all that applies?
These are you're confident about?
Mhm.
You only choose those you are confident about. Otherwise, what will happen?
You lose marks. You lose marks for what?
For what?
For wrong answers. For wrong answers.
So, when you get a question wrong, deduct one from it, okay?
All right.
Over here, the answers I'm looking for will be Okay, let's go to it together. Unless it's a patient with suspected upper GI bleeding.
Which of the following findings support this diagnosis?
Upper GI. It is upper GI bleed.
Which of the followings um supports this?
Now, it says coffee ground emesis.
Mhm. Will it support? Yeah. Yeah.
>> Yes.
Okay.
Bright red per rectum.
No. I'm going to look at the coffee ground emesis again.
Let's look at this word.
This word means what?
Vomiting. Vomiting.
Vomiting.
If a person is vomiting, how can we know whether it is from the upper GI or from the lower GI?
By using what?
The color.
>> Color. The color.
You see where I'm heading towards?
Yeah.
Now, how will I know it's upper GI?
A running tosser black or dark brown.
>> Hey, hey, hey, hey.
Upper GI and we'll do black, you know.
You see my dear? I'll do huh?
Right.
When it is bright red?
Red.
>> Red. Okay.
When I'm bleeding from the upper, let's say I'm just bleeding in my tooth here and I am bleeding it out. I mean to be bright red. Wouldn't it?
>> Okay. Okay, it's bright red.
>> Yeah, but if I'm bleeding, I'm trying to rinse from my stomach somewhere and bringing it out, what will be the color?
Coffee ground.
Coffee ground. So, if it is from the upper GI This one is questionable, right?
Yes.
And when I'm teaching a student, mostly this is what I teach them.
I wouldn't pick something that is ambiguous. What do you think?
Mhm. Okay.
And you >> Yes, come in.
Um like from the explanation you gave earlier Yes.
>> Um with the upper GIT, I believe that is from the mouth then down to the jejunum.
duodenum >> That is the Yes. So, um and then further explanation I also got that the hydrochloric acid acting upon the blood would also change this um bright red color because it will act upon it.
So, if any bleeding that is coming from the stomach or even the jejunum can also be a coffee color emesis. Or even the jejunum like you mentioned. Yeah. So, and the jejunum like the lower parts of this could also be part of the What do we call it? The lower GI, right?
We have the DJI.
duodenum, jejunum, ileum. Okay?
It's up to the doctor to determine which part we are dealing with here. To determine if it it to be it will be the upper GI or lower GI, right?
So, the concept of this particular one is that this is ambiguous for me.
When somebody picks it, the person can get it correct or the person can get it wrong.
So, when I'm teaching my student, I tell them to pick the one that they are very confident about.
Okay?
So, with this one, my student wouldn't pick it because they are confident that it's not part.
What about the hypertension and tachycardia?
This can be part.
Yes. And then the black tarry stools?
It's true.
Black tarry stools?
Yes. Coming from alpha. Okay. And then the hematemesis?
We're not too sure.
It's true.
It's true.
And then at Say again.
Is it like the coughing of blood or blood in the cough or Then we vomit.
Vomiting.
Blood in vomiting or vomiting blood.
So, he was looking at it from the hemopt.
Oh.
This is hematemesis. Emit. Vomiting.
Right?
You see, Isaac was fighting with some soldiers when the class began. And he won. If he had not won, he wouldn't have come back.
That's why he's missing the emesis.
Okay. So, with that one you are sure.
Now, the elevated serum amylase, I am not sure. What about you? Are you sure?
No.
>> [clears throat] >> No. Okay. So, I will leave it. Now, with the concept of the ground emesis, the coffee ground emesis, I also expect you guys to sometimes leave it.
Unless you are very sure, okay?
But on this case, I would give anybody who pick it as correct. When I was preparing the slide, I didn't actually give it as a correct answer, but I'll give it as a correct answer because of this.
Okay.
If it is suspected, yes.
So, all the answers that you guys chose, including the A, C, D, E, and F are correct. Guys, any questions for me?
Let's answer this question, too.
You see, I am not interested in the correct answers or wrong answers, but the rational. You see how Helsinki was able to say, say, "Ah, sir, from the what you said, I mean He argue with her, he argue with her. They will send him to parliament. He argue with her, then he won $20,000 from the village. Then he also went to the judicial sector. He argue with her, when somebody who committed murder, Helsinki argued and they freed the person.
>> [clears throat] >> Well done.
Sir, I mean, it's just about the critical thinking ability, and I love that. That makes my class a class.
Please, those on YouTube, can you kindly share the link to other people for me, okay?
All that I'm trying to do is that if I hurriedly monetize the YouTube, there was there will be no need to charge anybody for the class. I charge because I pay for services that I also pay.
But if YouTube is paying me back to cater for those services, then I mean, it's okay. I mean, I can it's equally like me taking your money.
Uh whatever I will charge you, YouTube is is paying for you. So, it's like it's okay. So, we can we can just without money. Eh? With just subscriptions and watching the videos create a future for ourselves. Because you don't know what lies in front of you. If within 2-3 months you are by God's grace we are able to I am able to monetize the account.
And God forbid, eh? God forbid though.
You went and you write and then you you don't get it. And you still think I can help you. You By that time you will come back and I don't charge. It's a free class true and true.
Mhm.
I can still talking.
Mhm. I When you are talking, you can mute too because those people on YouTube about 72 or so I'm told are listening to what you are saying.
Yes, sir.
Yeah.
Genevieve, I'm responding to your chat.
Okay.
>> I've seen people writing ABC. Why are we dealing with the English alphabet or what?
Okay.
So, we are looking at it together.
I think most people chose ABC. For the D, E, and F, we had little knowledge that they were answers.
So, if you chose anything between the A, B, C, and D, and E, I think I would agree with you. And thank you, too. The rationals are there, and I'm not interested.
Okay, we are moving forward.
But, before we move forward, please, um Pel, are you still with me in class?
Yes.
How how how do you feel about the bleeding? Is it quite something you are a bit okay about now?
We You mean the topic we are doing?
>> uh Yeah. Yes. confident. On a scale of 1 to 10, how confident are you to answer question on GI bleed?
I want to nine. It's okay. One to nine, it's okay. Great. I even expect five.
Anybody above five is okay with me. That is the intent of my class. If you can have a 50% confident that, oh, at least, oh, I have an idea about it. I'm I'm That's my measure of somebody understanding my class. And then, the That's for the average student. And then, for you, the good ones, you can hit your nines.
>> [laughter] >> But, um if somebody is bleeding, should we prepare to transfuse the person?
Yes.
What will inform us to do that?
The HB.
What test will we do to find out find the HB?
Uh we use a full [clears throat] a CBC. CBC.
>> Full blood count. Okay. What what what what what else apart from the HB would that let us know? Like what else are we finding out from that CBC?
Hemoglobin.
HB and the hemoglobin and the hematocrit. Hematocrit. What's the relationship in terms of numbers?
You said if the HB Okay, it's three times the HB. Thank you.
>> Three times the HB. I'm done.
I am done, oh Lord.
>> [laughter] >> We the old ones. You are good, oh. You see the way you were answering the questions.
If a doctor is on rounds, a doctor is on rounds and then he's asking medical students questions and they are delaying him. And he says, "Sir, can I try?" And he asks you talk. It's like, you know, when we were younger, you know, they have this game, jump to master. Then somebody say, "Master to jump." Jump to master.
That kind of thing.
>> [laughter] >> Yes, me as if I general nurse we we done long time.
Especially in ophthalmic, so of general nurse in there, how many years?
More than 15 years I stopped.
Me. So You are the type you are the type of student I want.
Yes. That's the type of student that I make >> Yesterday. Was it yesterday we we went to the when you were being that but I wanted to tell you for when did I ops when we were doing we did SRN. Oh.
>> Those when we were I didn't get it too but yesterday when I when you taught I got it. You got it.
>> show and then the Trivia.
>> Trivia question.
shoot a point leave it.
>> [laughter] >> Yesterday I wanted to say it but >> [laughter] >> I'm glad. I'm glad. You are the type of student I want because I am in myself an average student.
Sometimes I don't even know what is going on. Yeah.
Okay, and I bond with my students. You see the way I'm talking with you. I have time for you.
I don't care the 70 so so and so on on YouTube. I don't care about them.
>> [laughter] >> You are my student.
And so I I deal with you a bespoke lecture said that you verify that oh, this guy has taken his time. I can't believe I've been on a YouTube or a Zoom class for an hour and over. I don't even feel like sleeping. I don't feel tired.
It's okay. I don't even think I'll even pick a book to recall it. There are so many things when I see it I will see it.
Now we are going to peritonitis.
In fact, when you hear itis at the end of every word, what comes to mind?
Inflammation.
What goes into inflammation?
Not the physiological process of it. So if a person is having inflammation, what are some of the signs and symptoms?
Pain. Pain.
If not sign and symptom or anything about it, let's go.
Swelling, pain, swelling. Mhm.
Temperature. Temperature has done what?
Temperature has done what?
High body temperature. High body temperature. Sorry. Like what?
>> [laughter] >> Maybe above 38.
Okay. It's okay. Then what else?
Isaac, your network has been failing as a as stands now. Find some good space.
Oh, I think you are using headsets. If if you could change it, I want to really hear you at this time around because peritonitis is a condition I'm dashing you for free.
>> [laughter] >> Yeah.
Yeah.
Isaac, me and Isaac have a very long journey. Little did I know that Isaac would become a big man like that. Isaac, those days when he was a student and as a student um he had a motor vehicle and he would put me at the back of the motor vehicle for free and drop me wherever I was going. He never charged a penny. Today I am offering [clears throat] classes.
Isaac wants to use my class and I'm charging him the best I can.
It tells you the word is wicked.
>> [laughter] >> Yeah. Thank you, sir. Uh oh, Charlie, I should be thanking you as well.
Okay, so we were mentioning some of the things that can be did. In terms of blood test, when we do the CBC, what are we looking out for if there's itis, if there's inflammation?
White blood cells. White blood cells.
Tight blood cell or you said white blood cell and I didn't hear well. White white White blood cell. White blood cells. I don't want to ask you the range, but if you don't know the range, guys, go and learn. Go and look for it. Okay, at a particular level when it drops you go into what we call neutropenia, right? Mhm, we have the absolute neutrophil counts and all those kind of stuff. So, when it drops that low then we need to take some precautions. I will discuss with you, but not here.
Over here, there is a peritoneum, a thin layer that covers the abdomen, especially the internal organs.
And it can also get inflamed. And when it gets inflamed, we call it peritonitis.
It's sometimes spontaneous. When we say spontaneous, uh maybe from the internal organs themselves or a a bacteria entering from blood or any fluid getting there to just cause an infection over there. Otherwise, it sometimes have some secondary causes and it mostly act as complication of um gastric conditions. When I was doing my diploma in nursing days, when they asked me of the complication for any GI condition, I bet you I wouldn't even think twice to mention peritonitis. And I don't I I don't I did not even care whether I've learned it or not. I was always getting it correct. It worked.
So, so when the an appendix ruptures, when the peptic ulcer perforate, when the medical perforate, let's say any of those organs in there, when their condition worsens, you are getting what?
Peritonitis.
Mhm. So, it was a trick for me. I'm like, "Wow, the trick works."
Now, there is a cardinal sign that we have to know.
And I will mention that one first before we add any other thing that we know about it.
That is the rigid board-like abdomen.
You see where I've used the red pen to write, the very first line. Second line.
Please, can you see it?
Mhm. Yes.
>> Rigid board-like abdomen. What do they mean by board-like?
It look hard. Hard and round like that.
So, when you see it, when the muscles tighten like that, then you think of peritonitis. And that has been questioned on the NCLEX a lot.
Now, apart from that, we can have severe abdominal pain, which is quite expected with inflammation anyway.
Rebound tenderness. It means that when I put pressure on that part and I leave it, when it's released, the release causes pain. We call it rebound tenderness.
Tenderness, yeah. Yes. And cause of the infection, there will be an increase in temperature, 38 and above mostly.
Then there could be tachycardia.
Mhm? Sometimes in response to the pain.
Pain can cause your blood pressure to go up. It can cause your heart rate to also go up.
And so does infection.
And shallow breathing.
Nausea and vomiting. In fact, when I was also in the diploma nursing school, each time they ask me any sign and symptom about any abdominal condition, it wouldn't take me 2 seconds to write nausea and vomiting. And it always worked.
I was almost always right.
Because it's about the gastrointestinal, right? In the worst case scenario, you just vomit.
Mhm.
Yes.
Low urine output when there is shock.
And then hypotension. But how do they diagnose this?
First of all, the physical assessment.
What about the physical assessment will make you know there is likelihood peritonitis? Tell me right now.
And that's what the the the rigid the board-like nature of the stomach. Good. And then high temperature. The high temperature. What else?
And the rebound tenderness.
>> Rebound tenderness. You see You see say we've learned the tune, oh. So now the tune will be coming. I've I've just simply asked signs and symptoms in a very paraphrased manner, right? Yeah. So you just be rattling whatever is down there. And you're good to go. But what what will be a cardinal assessment to find?
The cardinal one is what? The rigid board-like abdomen. The board-like Yeah.
Please do not forget. So we can do the WBC count or the CBC which will show us the white blood cell count anyway.
An x-ray or CT may show air in the abdomen if perforation occurred.
And then we have paracentesis or paracentesis as in they they draw the acidic fluid or whatever the abdomen has become now. They draw a fluid and then they want to check if there is a microorganism in it.
Blood cultures to check if infection spread into blood.
Check if infection spread into blood.
All right guys, any any questions so far?
Mine mine is actually an addition if I may.
So what what I learned about the the rebound tenderness so first and foremost the tenderness has to do with pain. So when you apply pressure or you palpate a certain areas specifically you're talking about the abdomen.
When you palpate you're going to feel pain. So pain is tenderness. So the rebound tenderness has to do with you are palpating the abdomen you're going to feel pain but when you release the pain would increase.
So that's why the rebound comes in. So rebound tenderness has to do with you releasing the pain increasing. Thank you sir. You're welcome. So he stored a very good light on it to enforce it.
By the way when you are examining the abdomen first of all you see this middle-aged woman.
You don't mention her name. Don't tell people she's called Genevieve. No, that is not the actor we are talking about from Nigeria.
Say a middle-aged woman. Sometimes you say she's well-dressed for the weather because you can see somebody the place is as hot as Makola.
And then she's having 17 blankets on. It tells you that no, this person is feeling chills or fever. Gives you an idea.
Mhm, despite the fact that you're going to examine the abdomen, you still need a general descriptor of how the patient is looking.
Maybe she looks chronically ill.
Or she does she's not chronically ill-looking.
Mhm, she looks well-dressed for the weather or whatever. You make that impression.
Then you talk about if she's having jaundice. Guys, what is jaundice?
Yellow discoloration.
Mhm, yellow discoloration of the the conjunctiva.
No.
The my my bilirubin.
In the blood. Yeah, I mean you get the concept, but I would prefer the sclera to the conjunctiva. Okay, let's say conjunctiva. Sorry, sclera.
Yes, uh-huh. So, yellowish discoloration of the skin and mucous membrane, specifically maybe the sclera. Yes, yes, I will I will take that one. Yes, you look for jaundice.
Mhm, you look you also check the patient temperature and see if she looks febrile.
Mhm, or afebrile.
Then you check for central cyanosis and all generalized cyanosis. You mostly see it in light-skinned person. If the person has turned blue or not.
Okay.
Then you see if there is any obvious edema. In this case, you have to see if there's ascites.
What is ascites?
It's a fluid in the abdominal cavity.
cavity. Okay.
Swelling, fluid, enlargement, whatever.
I mean, you can explain it better, but I will be the technical definition actually, but I will accept that for now.
Then when you look at it, you see if she's pale or not. And all these things that you are looking, you know, definitely have a relationship with the abdomen. It's not like you are checking heart rate and all those things and rare. We even have major vessels in the abdomen. Have you heard of triple A before?
Mhm.
Abdominal aorta. Yes, dimension is let me see here.
Hey. Hey, now we come. Abdominal aortic aneurysm. Good.
So, it's in the abdomen where we have some bruits. About three fingers from the umbilicus, you can get the aortic.
And so, there are blood supplies and other stuff in the abdomen that we all need to understand as well. So, now when you come, you look at the physical appearance of the abdomen. Is it round? Is it flat?
Um does it look like some contours in there? It's not symmetrical. You can point it out. Are there obvious surgical incisions that you can see? Is there striae? Mhm. For a woman, pregnant woman, you are talking about the linea [ __ ] right? Suggesting that she could be pregnant. Sometimes there's obvious ventral hernias.
What is the meaning of ventral?
Back. Front. Mhm.
Front. And I think those are the back.
Okay. Hernias. Sometimes you can let the patient cough. Look to the side and cough. If there's herniations, you see it. It will protrude.
Mhm.
You discuss about that.
That's the physical things that you are seeing. Striae stretch marks.
You look about the hair distribution. Is the hair distribution uniform or some parts are different? Is it shining? You talk about all those things. Then the next thing about the abdomen or the abdominal assessment is that you don't go ahead and palpate. Have you heard of that before?
Yes. What do you do next after the physical assessment?
After the inspection, sorry. After inspection, what do you do next?
You auscultate first. You're auscultated. You don't want to You don't want to change the fluids or you know those dynamics, right? Yeah.
So, you go and auscultate. What are you auscultating for?
Mhm.
Mhm. Something.
You're auscultating for the bowel sounds. Are they Yeah, the presence of bowel sounds. Mhm.
The presence First of all, is the presence.
Yeah.
Is the presence. And then you will now describe the nature of it, whether it is what?
Hypoactive or or borborygmi. Borborygmi. It will be hyperactive, right?
>> So, as I be what? The bowel sound what will you hear?
You The nature of it, you know. One say, if you have not eaten and you see how I am in a stomach like boo boo Mhm. They are using the sound you produce to call it borborygmi.
Mhm. So, when I put my You put the stethoscope there. You can divide the abdomen into, if you like, four parts.
Left upper quadrant, right upper quadrant.
Mhm. In terms of right um upper quadrant, left upper quadrant, right lower quadrant, left lower quadrant. You You just divide it into four. I normally start from the patient's right lower quadrant when I'm doing my inspection so that I have a systematic pattern of going around. You can also divide it into nine regions.
>> [clears throat] >> Where you will have the epigastric, okay?
Mhm. And then you have the When you come down, you probably have the lumbar areas because that's where we have the lumbar spine, right?
Mhm. Mhm. And then you have the epigastric um hypogastric. Then you have the what we call the hypochondriacs.
You know when we talk about chondro as a medical stem chondro means cartilage.
And the rib cage that you are seeing like that is a cartilage.
Mhm. True or false?
Mhm.
True. And T when you see the immediate region beneath the cartilage they call it hypo chondriacs.
Meaning beneath the cartilage. So when you are doing the nine regions also of the abdomen and you see hypogastric and also say hypo. Yes, hypo because they are making reference to a cartilage above.
Mhm. If my teacher had told me that my heart would have been settled forever in heaven.
Yes.
Okay, so those are some of the contest where first anatomy should be taught. If you tell the patient or the students that um jugular means neck.
Then when you mention jugular veins the patient the students will not wonder around what where you mean, right?
You're talking about a vein in the neck, right? Ah, this is the um clavicle. So subclavian will be something under the clavicle. Then you learn it in that way.
There is a very big bone called femoral.
Femoral that's called femur, right? So if there is a very big vein crossing that part we call it femoral. That is how they supposed to teach us the anatomy to for us to actually link it so well so that we don't forget.
But they use the book textbook principle so we also memorize which you put it there and forget. It's it's not the best. We will get to some of those things.
So I was trying to give you a brief um idea to how we do the physical examination. So you listen to the sounds of the abdomen and our brothers were chipping in some for it. Thank you so much. I I always appreciate you guys.
Mhm. Then sometimes if you don't hear it, you don't hear it. If you want another person to come and check, you are at liberty to do that.
Then when you finish, you can palpate and percuss or percuss and palpate.
Any of them, I don't care about the sequence from there. But when you are percussion for the abdomen, the type of sound is what?
Tympany.
Second name.
Mhm.
You hear that tympany sound. I am an organist. I play piano, so I'm able to >> [laughter] >> detect those sounds.
And we can even palpate for the liver. We call it the liver span.
When you start Did I say palpate?
Percuss. When you start percussing from the top of the chest down, you'll get to a place just beneath your breast or maybe sometimes at the level of your breast at your right side where the sound will change because from the top coming was resonant. That's the lung fields you were percussing. Oh, if there's any word like that, percussion.
Uh-huh. But when you reach this particular place, you see that no, the sound changes to a little bit dull.
Then you come and take it from the abdomen up.
Okay?
Huh.
You come and take it from the abdomen up. You percuss the tympany and then you reach to a place then it becomes dull.
So you measure the two place. The one from the the top and then the down so maybe I could do in our sound is a sign where the sound changed. Then you get the liver span.
Don't worry about it. The NCLEX may not ask you Yes, I think the normal is around 12 cm or so. It's something that you may talk about when you are assessing. Then you should not palpate Sometimes there is There are organs you should palpate and there are organs you shouldn't palpate.
Mhm. If If an organ is supposed to be in the right upper quadrant and you are feeling it in the left upper quadrant, then it means it is inflamed.
Organomegaly and all those kind of things. As time goes on, we will we will do that. I'm pretty sure I have the physical assessment at the back of these slides. So, let's move forward from here and then we'll talk about it later.
By the way, if a patient is having peritonitis, your nursing priorities and interventions are immediately don't put anything in the stomach.
Now, this particular combination that I'm going to give you, eh, it will cut across all my slide.
And so, it makes GIT very easy.
Very, very easy.
The moment you hear the peritonitis thing, allow the stomach to rest because there there there is a likelihood they will do a surgery.
Very likely.
Then, they will start IV fluids to prevent shock or even if shock exists, to treat it.
And of course, IT'S is infection, so you'll be on antibiotics.
Then, it is painful. It's not a small pain. No, most times moderate to severe pain.
So, we will look at that.
Then, we pray for possible surgery as as well if it caused by a ruptured organ like appendicitis and all those kind of thing. If it's a ruptured appendix, you look at it. You monitor for sepsis and signs of it.
Then, strict intake and and output. Let's answer these questions.
We've done an hour 56 minutes.
I will close when the time is an hour and 20 minutes.
So, just so you know, we have technically like just 30 minutes to complete things.
If you just joined the live session, my name is Samuel Asamoah Boateng. I'm a nurse in the US and I call myself an average student and my aim is to help average students understand the nature of the NCLEX. The exams which you write to become a nurse in the US.
In fact, I have survived as a nurse in the US for just 2 years.
They have not sacked me yet and my patients are happy with me.
How do I know that? Yes, they normally nominate me for Daisy Awards and that is how come I know they like me. My instructors are also rating me well.
And so, I think I should share my knowledge with you. Whatever is working for an average student, an average worker like me. Okay?
Sometimes best in class is not best in life.
There are some best things that you can do in life, not necessarily a measure of you.
And to that boy at the back there, I just want also want to tell you that if we judge a fish by its ability to climb a tree, it will live all its life thinking it's an idiot.
But that is us doing a categorical error. Okay?
Fishes don't climb trees, they swim.
How about if we do a fair competition and allow fishes to swim?
Then we can know. Maybe some things are not yours.
That is why I felt so before you.
But trust me, with determination and with practice, we can do lots of things.
If not to the highest excellence satisfactory, at least the other compliments like satisfaction, satisfactory, fair, pass, good, very good, well done. There are other things. Even if it is not excellent, these terms can still work and it will be accepted. So, I'm encouraging you.
Do not yield to mediocre. Okay? It works.
It works. We have a WhatsApp platform with currently I think we have about 1,000 people. It was to the brim.
I had to sack people from the page.
I have to plead with them. Those who passed, they do not want they did not want to leave. So I had to plead with them to leave so that others can come. As it stands now, we have some spaces about 25 people more.
So if you feel like joining, you can comment here or I don't know how YouTube works, but you just leave a comment there. I think I can trace you via email and then I'll let you know what is going on.
Or whoever sent you the link. Or if you just chance on this, I have a couple of other videos and I have a website uh where I have question banks, high-yield question banks, very cheap.
But it is not as cheap it is as cheap as I teach you. I'm teaching you for free right now. But do you think what I'm teaching you is cheap enough?
No. Right, huh? So you go there, you subscribe. There will be a place to contact me. You'll see all my information also there.
And then you contact me.
All right, my students have answered and their answer they said C, which probably I agree.
Let's try this question.
I've seen I've seen your answer and you are totally wrong. You are wrong beyond wrong.
I'm kidding.
You nailed it.
Thank you.
>> [laughter] >> All right. So, my students choose B.
They also choose D.
And they choose E.
B D E. And I think that is correct. Um Let's answer this question, too.
Jennifer, please, I'm responding to your chat.
Okay.
As you pick the the B in addition, Mhm. When they take an action, >> [laughter] >> you see they will see A.
Because it's peritonitis.
>> So, those who want to join the class, you can send me an email at [email protected], okay?
[email protected]. Or go to askaclass.com, www.askaclass.com.
You'll see my question bank. Try it for 7 days.
Once you register or sign up, you'll see that I have a contact me over there.
Mhm. So many ways to contact me.
Yeah.
Okay, so the final answers will be B, C, D, and E. My students got it correct.
And we are going to end here, which is intestinal obstruction, where we will look at the hernias, adhesion, volvulus, intussusceptions, and what have you. I will pause here. I will stop here for questions and any additions or inclusions, and then I would thank you guys for coming at this time.
Any questions?
Any additions?
Okay, on that note, then um we're going to end it here.
And I thank you all for coming.
Um thank you so much.
Okay, let me just quickly go on YouTube and see the chat. Okay, so I'm going to write this is me.
This is me.
And so if you've seen me trace me.
Yeah.
Yeah, so that is a circle review.
Um I really thank you guys for coming.
And I'm going to end the live at this at this time.
Okay.
Thank you.
And
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