I had the opportunity to observe the insertion of a nasogastric (NG) tube. An NG tube is a tube that is inserted through the nasal passage, passed down the throat, and positioned into the stomach. Medication can be given through this aswell as liquids and foods. It is often used for patients that are unable to take fluids or foods orally.

From this, I have learned the importance of accurately measuring the NG tube before insertion. This involves measuring from the tip of the nose to the earlobe, and then down to the sternum, to ensure correct placement. The tube is marked with numbers, which are essential for tracking the depth of insertion.

The procedure is classified as a clean technique, which means sterile gloves are not required. After measuring, the tip of the tube must be lubricated to ease insertion through the nasal passage.

I found this particular experience challenging, as the patient was confused and became distressed during the procedure, shouting and screaming. I made sure I focused on reassuring her, using calm communication and distraction techniques to help reduce her anxiety and maintain her cooperation throughout the procedure.

I had a learning day about CKD, renal dialysis and AKI on the 23/05/25.

Although I have had a whole placement on renal dialysis in the past, I found this beneficial to my learning and growth to develop my knowledge in this long term-condition and a opportunity to learn new things. I learnt that AKI is a syndrome not a diagnosis and health care professionals use KDIGO which stands for Kidney Disease Improving Global Outcomes. KDIGO provides national guidelines and is a nonprofit global organisation developing and implementing evidence-based practice guidelines.

I learnt that the prevalence of AKI is because of factors such as diabetes is increasing in individuals. I also learnt that hyperkalemia is when potassium is to high above 5.5. This can be life threatening for people that have renal disease/AKI. The normal ranges for potassium is 4.0- 5.0 and it is crucial to the heart function and can cause arrhythmias if it is too low or too high.

I also learnt that it is important to check patients creatinine. This is because when patients become ill less creatinine is generated which can result in a decrease of muscle mass. Creatinine also assists in the results of the EGFR score which is the kidney function/stage (1-5).

The management of CKD is iron and epo to manage anemia, managing the underlying cause for example diabetes, control the patients blood pressure and finally prepare for renal dialysis or kidney transplant.

Overall, this learning day made me feel more confident in renal and how to meet patients needs and carry out necessary assessments.

I spent the day with a critical care nurse which was a good opportunity to expand my knowledge in ITU.

During the outreach, we reviewed a patient who had recently been stepped down from ITU. I was able to observe the thorough assessments carried out by the critical care nurse, which included chest auscultation, pulse oximetry, and a series of holistic questions which aimed at evaluating the patient’s overall condition and led to interventions.

I also had the opportunity to observe a peri-arrest situation. Although the environment was intense and fast-paced, it was managed effectively by the multidisciplinary team. Watching their coordinated efforts, clear communication, and rapid assessments was a valuable learning experience, and it showed the team’s commitment to providing the best possible care for the patient.

I learnt the difference between type 1 respiratory failure and type 2. These results are shown on a ABG. Type 1 is a low paO2 of 11.0KPA and a normal PcO2 of between 4.5-6. Type 2 is a low/normal paO2 and a high pco2. Patients with type 1 respiratory are required optiflow or cpap on the other hand, patients with type 2 require bipap.

I also learnt the normal range for PH is between 7.35-7.45 and a patient below 7.35 is acidotic and a patient above 7.45 is alkalotic.

Overall, I really enjoyed this experience. It helped me learn more about critical care and the role of a critical care nurse and how different team members work together to support patients. I found it interesting and it made me want to keep learning more in this area.

Today I had the opportunity to sit in on a clinic with the heart failure nurse. We saw 4 patients that had heart failure aswell as other long term conditions.

I found the experience insightful and enjoyable. On this occasion the patients were follow up patients. The nurse conducted thorough reviews, which included assessing current medications, discussing how the patients were feeling holistically, reviewing recent blood results, and considering any necessary interventions. She also performed physical assessments, such as auscultating the lungs for any abnormal sounds.

I also was introduced to the heart failure in traffic light patient self-monitoring and management leaflet. The leaflet included information on establishing a daily routine, an explanation of what heart failure is, common symptoms, possible causes, contact details for the heart failure team, and an overview of the four pillars of medication used to manage the condition.

The heart failure nurse also expressed to me the importance of asking the patients how many pillows they sleep with at night. This is important because it can indicate how breathless the patient is. For example, if the patient sleeps with 1-2 pillows and this is their normal before they were diagnosed, then this is ok. However, if they have to sleep with more then 2 or in some cases have to sleep completely sitting up right or in a chair this shows that the patient is extremely breathless.

I learnt that the four pillar medication to treat heart failure is are ACEiS: Ramipril, Lisonopril, Enalapril/ARBs: Candesartan, Losartan, Valsartan/ ARNI: Sucubitril Valsartan (Entresro). Beta Blockers such as Bisoprolol, Nebivolol, Carvedilol. MRSAs: Eplerenone/ Spirononlactone. SGLT2s: Empagliflozin/ Dapagliflozin.

Diuretics such as Furosemide and Bumetanide may also be used for fluid offloading and symptom control if you have fluid retention.

During my placement today I cared for a patient with a tracheostomy who required routine tracheostomy care, including suctioning, changing the inner cannula and replacing the Swedish nose.

I firstly carefully removed the swedish nose and the inner cannula. I then began to suction through the outer cannula of the tracheotomy to remove any secretions this also helps the patient to cough, which aids in clearing the airway.

Once the airway was clear, I inserted the clean inner cannula and replaced the Swedish nose. After ensuring the patient was comfortable and stable I cleaned the used inner cannula in preparation for its next use.

This was a really good experience and it enabled me to get hands on with tracheostomy care and develop my skills and knowledge. However, I was nervous as it was my first time performing this skill. My aim for next time is to approach this skill with more confidence.

As part of a group task, three other students and I were asked to collaborate on a project related to ITU. After discussing various potential topics, we decided to focus on dignity. For our project, we created a poster that explored the importance of maintaining and promoting dignity for patients within ITU. We highlighted key principles of dignified care and included real-life scenarios we had observed during our clinical placements.

These examples helped show how dignity can be upheld in practice and emphasised the crucial role healthcare professionals play in advocating for patients rights and well-being. This project not only deepened my understanding of dignity in critical care environments but also highlighted the importance of empathy, respect, and advocacy in nursing practice.

I had the opportunity to follow a patient through to surgery and watch a tracheostomy be put into place. A tracheostomy is a surgical procedure creating a hole in the neck and windpipe to allow for breathing through a tube. The tube is called a tracheostomy tube and it provides an alternative airway, bypassing the nose and mouth.

I learnt that a tracheostomy can be temporary or permanent and is used for many reasons, including managing long-term respiratory support, or facilitating secretion clearance. I was drawn to how sterile the procedure was, I understand that this is very important because of the risk of infection.

I found watching the procedure interesting and I was amazed at how the procedure was done. However, it was also unsettling to watch because of the invasive nature of the surgery and the vulnerability of the patient. Seeing an opening made directly into the airway was a reminder of how critical these procedures are. The sound of surgical instruments and the sight of blood, made the experience intense and emotionally challenging.

This is a reflection on my time spent with the home dialysis team. Reflecting on my time with the home dialysis team, I feel a great sense of growth as I am able to develop my knowledge in dialysis. I was able to shadow amazing professionals, who gave me a good back ground on home dialysis and the benefits which has deepened my understanding of patient care and the importance of personalized treatment plans. I learnt that patients are able to dialysis at home and do it themselves. However, in order to dialysis at home themselves they have to be competent in cleaning their own dialysis line (central venous line). I was able to shadow the nurse in teaching the patient how to clean the line in the best and most sterile way as possible. The patients have to attend the training at the hospital for at least 3 weeks. This means the patient has to attend 3x a week for the next 3 weeks at the hospital to be shown how to clean their own line, be shown the dialysis machine and connect themselves.

Patients on home dialysis get delivery’s and are able to come into the hospital to collect stock. Once the patient is competent and the nurse and the patient are happy for them to dialysis independently at home, the nurse visits the patient once every 6 weeks to carry out assessments such as, relevant blood tests and to check their competency’s again. Personally I found home dialysis to have many benefits such as, more flexibility and better health outcomes. I was also able to speak to a patient on home dialysis and she said she is able to go on holidays now where as before when she had to come into the hospital 3x a week this was hard for her. Overall, I felt I had a positive experience with the home dialysis team and spending my time with the nurses and patients has contributed to my learning.