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.

I was able to observe Linda today (20/11/23). We went to a supported living accommodation for learning disability individuals. Before meeting Linda I was unsure of what her role is however, I understand more that her role is to go to different services and support them by looking at their patient files and staff files to prepare them for CQC visits and improve their service.

This also promotes the quality of life for the individuals that are being cared for because if their documents are up to date and correct their care needs can be met correctly providing them a person-centred care.

I was able to get involved with the meeting by looking at patients’ files and noticing things that needed changing or weren’t done correctly. I enjoyed this as it developed my skills and knowledge in the paperwork side of nursing and how care plans and Mar charts etc should be.

I liked the fact that Linda was positive and friendly because it taught me that you shouldn’t be against the staff. After all, as a Quality Improvement Officer, you should be there to help them. I noticed the benefit of this which was that the staff were grateful for the help and were willing to make the suggested changes, to meet the end goal.

To summarise, I had a good day and would love to be able to spend time with the Quality Improvement Officer team in the future to learn more and maybe follow this up as a potential career path to make a difference in care homes and supported living accommodations.

I had the opportunity to work with Vincent the Admiral nurse on 23/11/23. Before meeting Vincent I was unsure of what an Admiral nurse is and their speciality. I learned that an Admiral nurse specialises in dementia. Their job role is to support families that have a loved one suffering from dementia. I understand that some families don’t understand what dementia is and the effects it can have on an individual; they can find it frustrating seeing their loved ones in some cases deteriorating and they don’t know how to deal with it.

Therefore an admiral nurse offers a free service to families that are in need of support, knowledge, skills and somebody to talk to. Families are able to self-refer and call the Admiral nurses for information, however, for a family to qualify under the admiral nurses and be taken as a “client”, the individual suffering from dementia has to live in the Sutton area and have complex needs. There are 3 complex needs that the individual/ family must meet which are, health, social and risk to be under the Admiral team.

I was able to attend a home visit with Vincent during my time with him. We met with a lovely lady whose husband is suffering from dementia and meets the 3 complex needs mentioned above. The individual also has an addiction to alcohol use and was a risk to himself. I understood that his health was being damaged by the alcohol which was making his dementia worse. He is a risk to himself as his wife reports he is getting himself into trouble, being found in parks beaten up and constantly being robbed for his money and shoes.

However, prior to and during the meeting the individual had been in the hospital for 6 weeks, due to being found in the park alone and under the influence of alcohol whilst his wife was on holiday. The benefit of the individual being in the hospital is that he is currently 6 weeks sober! His wife had reported that due to not being under the influence of alcohol his memory seemed to be better. The reason the individual had been in hospital for 6 weeks is because his wife didn’t want him at home as he wasn’t treating her very nicely. She said she could deal with the dementia but not the drinking.

Vincent explained that the individual couldn’t stay in the hospital any longer as he didn’t need to be there and of course, hospital beds are valuable to which the wife understood and agreed.

The end result of the meeting was that Vincent arranged for the individual to attend a club in Sutton twice a week to keep him busy and do things that he was interested in as a hobby which was, laying tables and helping people. On the basis that the individual doesn’t continue to drink,

the wife said she was happy for him to come back home and for the Admiral nurses to continue supporting her.

I understand that dementia is a progressive long-term condition that can sadly destroy families.

I enjoyed my day spent with the podiatry team on the 27/11/23. I learnt the different types of dressings they use for wounds such as soft pore, inadine and melolin dressings. Melolin dressings are good for absorption. Semi-compressed felt is used as padding for the toes and aids in toe separation. This provides comfort and won’t allow the other toe to rub against the toe with the wound. A wound must be cleaned during dressing change. This is because the patient’s skin hasn’t been exposed to air therefore, the skin becomes flakey and you can’t see the base of the wound without cleaning the top.

inadine dressings are often used as it helps to dry the wound out and keeps biofields and organisms out preventing infection. I also learned that it is important to use a scalpel for the edges of the wound to allow fluids to exudate. I understand that patients who are diabetic often have poor circulation and immune system therefore, it is important to use a Doppler to check the pulses of the feet.

The instruments that the podiatrist uses to clean the wound is in a packaging with a catch number. It is important to record the batch number to cover yourself so the patient is aware that the tools are sterile if they were to call up and ask. If a patient’s wound doesn’t start to heal within 2 months then the patient has to be referred to the hospital.A patient is seen as low risk if they can feel the podiatrist poking the bottom of their foot. This means that if the patient was barefoot they could feel if they stepped on a piece of glass preventing the risk of infection.

Sutton and health care don’t cut nails routinely.

I spent the day with the diabetes nurse Jane. I was able to sit in the room during appointments with patients which I enjoyed. I enjoyed communicating with patients and I found it interesting listening to how they manage their diabetes at home. Jane gave me a huge insight about diabetes which really increased my knowledge.

Type 1 diabetes is when no insulin is produced. Type 2 diabetes is more complex and usually the insulin isn’t working and often the individual is overweight and extra adipose is blocking the cells. A hypo is when an diabetic individuals blood sugar is to low. The expression i was taught was 4 and 7 is diabetes heaven. If the individuals blood sugar drops below 4 this is seen as an hypo and immediate action should take place. The appropriate actions for a hypo would be to give fast acting sugar that will quickly get into the blood stream and bring the sugar levels back up fast.

Fast acting sugars are considered as, insulin, orange juice, jelly babies, glucogel. Chocolate should be given as a last resort as dairy takes longer to break down.

I learnt that every person that has diabetes has to have an annual review. They have to have screenings annually for their feet, eyes and HBA1C. HBA1C is a blood test that determines how much sugar is in the bloodstream. The ranges are 20-41 for an individual that doesn’t have diabetes, 42-47 for pre diabetes and 48+ for an individual diagnosed with diabetes.

The feet are checked by checking the pulses, the temperature of the feet, checking in-between toes for fungal infections, sensitivities and capillary refill (3 secs).

I also learnt that it is important for individuals that have insulin to not inject themselves in the same area all the time, this is because it can cause lipos. Lipos are damage to the skin from sharp objects that are being injected into the same subcutaneous areas. The fat starts to gather together in one area and holds the insulin being injected. The insulin then is released at different times.

There are 3 components of diabetes which are, medication, diet and activity. Medications that are often used for diabetics are metformin and glipizide.

I was advised by Jane that is very important for needles to not be reused. This is because it puts the individuals at risk of an infection.

Overall, I enjoyed my day with Jane and learnt a lot. One thing I would like to develop my knowledge and skills on is different types on insulins. I aim to do self directed study at home

I attended wound and pressure ulcer training. I learned a great amount of information about pressure ulcers and wounds.

A pressure ulcer is a localised damage to the skin and underlying tissue usually over a bony prominence caused by pressure. I understand that it is really important that patients who are not very mobile should be repositioned or encouraged to move to relieve the pressure from their prominent areas such as their bottoms. Wounds are skin breaks that could be caused by injuries.

I learned that the different categories of wounds are category 1- the skin is not broken and should be blanchable. Category 2- superficial loss of the skin, the top layer is broken and it could be a blister. Category 3- full skin loss, there may be slough however no tendons, bone or muscle are exposed. Category 4- You can see the bone, tendon or muscle. Then theirs unstageable which is nacrotic and you can’t see what is going on therefore, you need to debride the wound to see what is underneath. Lastly, there is a deep tissue injury which means that the skin is intact however it is purple/maroon or a blood blister due to an underlying issue. Overall there are 6 categories that a wound should be identified as to be able to select the correct dressing and heal the wound effectively.

I understand that to clean a wound the water should be warm as cold water delays the healing process. I also learnt that the peri-wound is the whole skin around the wound and hyperkeratosis is a high build-up of chitin and is often hard.

A patient who is bed-bound or not very mobile should be repositioned every 2 hours at the maximum. I learnt that this helps the blood to keep flowing which prevents pressure ulcers.

I lastly learnt a word called TIME which is a word that is used when assessing a wound or pressure ulcer.

T stands for Tissue.

I stands for infection.

M stands for moisture balance.

E stands for environment/ edges/ exudate.

S stands for surroundings.

I enjoyed this training because I didn’t know how complex wounds and pressure ulcers are but, I can confidently say that I feel more positive that my knowledge and skills have grown from this session.