Today after placement I came home and did some self-directed study on INR’s as I wasn’t sure what this was. upon my research, I now know that INR stands for International Normalized Ratio. I understand that it is used by Nurses to monitor the ratio and effectiveness of anticoagulant medications such as heparin and warfarin that are taken subcutaneously; it also assesses the risk of bleeding. This is done by a blood sample from the vein which then goes to the laboratory and is tested to measure the time it takes for the blood to clot. The results will allow the Nurse to adjust the dosage of anticoagulant medications if necessary which will maintain the desired level of blood clotting.

Patients who would mainly need an INR are patients who are taking anticoagulant medications to help thin their blood for example patients with atrial fibrillation, DVT’s and PE’s. The normal range of INR is normally 0.9-1.1. The INR score is important because it tells the Nurse that the anticoagulation medication which the patient is taking is in the therapeutic range and stable.

Direct oral anticoagulants (DOACs) are anticoagulant drugs that are taken orally however, due to the pharmacokinetics and pharmacodynamics of DOACs they do not need monitoring as you can’t adjust the levels because they respond as a fixed dose.

Going forward, I feel like I have greatly developed my knowledge and feel more confident in understanding what an INR is.

I had the opportunity to attend a frailty meeting with Emma this was a multidisciplinary meeting. It was explained to me that a patient is assessed using a Rockwood fragility scale which includes a description and numbers 1-9. If the patient is seen as frailty and has a high score the nurse must use the Rockwood frailty scale to give them a score; the nurse then mentions their queries regarding the patient in the meeting.

In the meeting it is discussed the patient’s history, medication, what matters to the patient, skin integrity, waterlow, nutrition, MUST score, continence, podiatry requirements, previous fractures, falls risk, cognition, physiological well-being, alcohol and smoking intake, SALT requirement, power of eternity, if they have or require carers if any referrals have been made, is a DNAR in place, the fire and safety in their home environment and if they have any glasses or aids.

I learnt and understand that frailty meetings are important to discuss the patient’s holistic well-being with the end goal of meeting their needs and their quality of life.

I attended the syringe driver training that was held by Jo and Diane. I didn’t know much about syringe drivers as I hadn’t had previous training or much knowledge about it however, I enjoyed this training and took the opportunity to develop my knowledge and skills by participating and listening.

Syringe drivers require batteries and deliver medication subcutaneously.

The trainers brought in syringe drivers for us to learn how to set up the medication; which I found useful as I learn better by physically doing something. I learnt that syringe drivers are given continuously over 24 hours and often to patients who are at the end of their lives. Syringe drivers can also be used for any patient who can’t take medication orally and are ill. They make patients feel comfortable by managing their symptoms.

I still don’t feel completely confident in setting up/administering medication to a patient through a syringe driver however, I feel like I had a good introduction to the device and going forward I will have more of an insight about it.

I had the opportunity to attend the catheter and Bowel training with Wendy today and I honestly learned so much. I learnt that It is important to assess your patient for a catheter before putting one in. A patient may need a catheter for many reasons such as urine retention, after surgery, long-term conditions or because they have a pressure ulcer on their bottom which could get infected if they are incontinent.

I also learnt that long-term catheters increase the risk of developing UTI’s and blockages therefore, it is important for patients themselves and Nurses to give catheter care by cleaning the catheter every day. Is important to clean down the catheter and not up and cleaning down will not spread infection up into the genital area.

I was taught what solution to use and how to use it if a catheter does block. I was also given a leaflet with the relevant information.

I was able to practise inserting a catheter into a female and male model which I found beneficial to understand how the procedure works and the anatomy of the reproductive system.

During bowel training, I learned different types of procedures that can be carried out if a patient is suffering from constipation such as enemas and suppositories. Enemas are to be used if the stool is lower down in the rectum and other types of treatment don’t work such as medication.

Again, I was able to practise this procedure on a model working in pairs with other students. firstly I explained the procedure to the “patient” and explained why it was necessary to carry out the procedure. I asked if they had any pain, if they needed to use the toilet before the procedure and lastly when their last bowel moment was.

I then washed my hands, put on my gloves and then I went ahead with the procedure on the model. I reassured my patient that it may feel a bit uncomfortable but it won’t last long. I inserted my index finger into the rectum and turned my finger clockwise and anticlockwise (12-6). Wendy had inserted faeces into the model to which we had to guess which type of stool it was from 1-7.

Overall, I found the training beneficial and would love to join Wendy again for other training.

I worked with Resmi on the virtual ward team on 16/11/23. I had a really good day we went around to patients’ houses and checked their vital signs such as blood pressure, pulse oximetry, respiratory, temperature and heart rate. One lady that we visited was suffering from a cough so I was able to listen to her chest with a stethoscope. I found this very interesting as I had never had the opportunity to do this before.

I learnt that you can identify and diagnose a patient by the noises that you hear from the lungs through the stethoscope. An example of this is, pneumonia is a popping sound, COPD is a wheezing sound and normal is a soft smooth sound. It is important to check for crackles and wheezing.

For another lady that we visited we installed a current health monitor in her home. Again I found this very interesting as I hadn’t seen anything like this before. It consisted of a Samsung Galaxy tablet, a watch for the patient to wear, a blood pressure cuff and an internet box. The idea of the current health monitor was to record the patient’s blood pressure 4 times a day for 7 days.

The benefits of this I found were amazing, as it saves the nurses time so they don’t have to visit the patient every day to check their blood pressure. It also benefits the patient’s well-being positively; this is because the patient can have a normal day-to-day life by doing stuff that they enjoy and getting the things that they need to do done instead of being in the hospital or staying at home waiting for the nurses to arrive to check their blood pressure.

I enjoyed spending the day with the virtual team as I learnt new things and enjoyed visiting patients in their own homes and having nice conversations with them.

I worked with the respiratory nurse on 17/11/23. I found it to be an amazing opportunity to learn and develop my knowledge of the respiratory system. I was able to sit and observe Neethu in pulmonary rehab which was interesting. I learnt that pulmonary rehab aims to promote the quality of an individual’s life before going down the route of medication

The routine of pulmonary rehab is to first have an initial interview which involves wearing a monitor on the ear or finger which tracks the heart rate during exercises. The patient then has to walk up and down when they hear the bleep and the nurse is present to keep an eye on the heart rate and to see how breathless the patient gets. The patient then attends 12 sessions of rehab that contain exercises that patients can manage at home.

One thing I learnt is that pulmonary rehab improves your physical strength which aids in preventing chest infections; if you are not fit it is easier to develop infections.

Another thing that I also learned is that spirometry tests are used to diagnose COPD however, an X-ray of the lungs is also required to rule out other symptoms of breathlessness.

and lastly, I learned that it is important to use a spacer with inhalers and rinse your mouth after every use this is because you can develop oral thrush.

Observing the respiratory nurses i feel more confident on the respiratory system, signs and how to manage shortness of breath/ COPD.

I was able to observe a Capillary Blood Gas (CBG) while working with the respiratory nurse on 17/11/23. This was done using the patient’s earlobe. I was able to ask questions about why the earlobe was used and the anatomy. I have more of an understanding that the ear is used for this procedure as it is more comfortable for the patient and the gravity helps draw the blood from the ear.

The respiratory nurse bled the ear and collected the blood into a tube which then was put inside a machine. The machine then told us how much oxygen was in the patient’s blood on room air.

The patient then was asked to put on nasal specs and 2L of oxygen was delivered through the patient’s nasal cavity for 20 minutes. The same procedure was then carried out and tested. The nurse then compared the results to which we found on room air the patient wasn’t receiving enough oxygen and her o2 levels were 88% however after oxygen had been given for 20 minutes her o2 levels were 94%.

I found the procedure interesting and a good opportunity to watch and understand the anatomy behind a CBG and its different results.