Date of Learning Log: 10/05/2024
Time: 09:30-16:00
Learning Activity 1: Complex Endocrine Conditions: Living with DM.
The gastrointestinal (GI) tract, also known as the digestive system, is a complex system responsible for the digestion and absorption of nutrients as well as the excretion of waste products. It consists of several organs, including the oral cavity, pharynx, oesophagus, stomach, small intestine, large intestine, and anal canal. Additionally, there are accessory organs such as the teeth, tongue, and glandular organs like the salivary glands, liver, gallbladder, and pancreas that support the digestive process.
One of the primary functions of the GI tract is to break down complex nutrients into simpler forms that can be absorbed by the body. This process involves the conversion of ingested food into essential components such as glucose (sugars), amino acids (constituents of proteins), and fatty acids (building blocks of fats). Once the food is broken down, the nutrients are absorbed into the bloodstream through the walls of the small intestine and transported to cells throughout the body.
In addition to digestion and nutrient absorption, the GI tract plays a crucial role in eliminating waste products. Any undigested food, as well as waste products from the breakdown of nutrients, are passed through the large intestine and eventually excreted from the body through the anal canal. Overall, the GI tract is a vital system that ensures the body receives the necessary nutrients for energy and sustenance while efficiently eliminating waste products.
The digestive process involves six key activities: ingestion, propulsion, mechanical and chemical digestion, absorption, and excretion. The gastrointestinal tract (GIT) facilitates digestion and absorption by breaking down food with saliva, moving it through the oesophagus and stomach, and further digesting and absorbing nutrients in the small intestine. The primary organs of the digestive system are the mouth, oesophagus, stomach, small intestine, large intestine, and anus, supported by the pancreas, gallbladder, and liver. Digestive disorders encompass a wide range of conditions, and the GI tract performs functions such as digestion, absorption, excretion, and protection through a series of distinct organs.
Regarding diabetes, the pathophysiology is closely linked to insulin levels and the body’s ability to utilise insulin. Type 1 diabetes involves a total lack of insulin, while type 2 diabetes is characterised by resistance to insulin within peripheral tissues. Diabetes mellitus is a chronic metabolic disorder with a complex pathogenesis, resulting in elevated blood glucose levels due to abnormalities in insulin secretion, insulin action, or both.
The long-term effects of diabetes mellitus can result in various serious health issues due to consistently elevated blood sugar levels. Acute complications encompass diabetic ketoacidosis (DKA), a life-threatening condition triggered by high levels of ketones caused by insufficient insulin. DKA can lead to unconsciousness or even death if left untreated. Hyperglycaemic hyperosmolar state is an extreme form of high blood sugar without ketosis, commonly observed in Type 2 diabetes, leading to dehydration, changes in mental status, or unconsciousness. Hypoglycaemia is an abnormally low blood glucose level that can result in dizziness, disorientation, seizures, or loss of consciousness. Chronic complications include cardiovascular disease, neuropathy, nephropathy, infections, and skin issues.
Managing DM is focused on keeping blood glucose levels as close to normal as possible. The approach varies for Type 1 and Type 2 diabetes, and several elements overlap. Lifestyle management, including a balanced diet, regular physical exercises and weight management, are essential in managing DM—pharmacological management such as insulin therapy, oral medications, injectable medications and combination therapy. DM can be monitored by blood glucose, HbA1c test and continuous glucose monitoring.
To effectively manage diabetes, it is crucial to adopt a comprehensive approach that encompasses lifestyle adjustments, appropriate medication usage, regular monitoring of blood sugar levels, and proactive measures to prevent complications. Timely detection and treatment play a crucial role in preventing or delaying many of the severe complications commonly associated with diabetes mellitus.
Learning Activity 2: Importance of Decision-Making in CNS Emergencies
In this learning activity, I learned in depth the anatomy and physiology of the neurological system and conducted nursing assessments – ACVPU, GCS, Pain, and BGM. Neurological conditions and commonly used medications were explored, such as stroke, seizures and traumatic brain injuries.
The human body’s neurological system plays a crucial role in coordinating and regulating bodily activities. This system consists of the central nervous system, which includes the brain and the spinal cord, as well as the peripheral nervous system, which is composed of nerves extending throughout the body.
The central nervous system, particularly the brain, serves as the control centre for the entire nervous system. The brain is divided into several key parts, each responsible for various essential functions. The cerebrum, the largest part of the brain, is primarily responsible for higher brain functions such as reasoning, emotions, and sensory processing. The cerebellum, located at the back of the brain, coordinates voluntary movements, balance, and posture. The brainstem, encompassing the midbrain, pons, and medulla oblongata, regulates basic life functions like heart rate, breathing, and sleep-wake cycles.
Additionally, the spinal cord, extending from the base of the brain throughout the vertebral column, is responsible for transmitting neural signals between the brain and the rest of the body, as well as coordinating reflexes.
The peripheral nervous system (PNS) is a crucial part of the nervous system and can be divided into several components. The PNS consists of the cranial nerves, which are twelve pairs of nerves originating from the brain and responsible for controlling various functions in the head and neck regions. Additionally, the PNS includes the spinal nerves, which are thirty-one pairs of nerves emerging from the spinal cord and responsible for innervating the rest of the body.
Furthermore, the autonomic nervous system (ANS) is a vital subdivision of the PNS and is divided into two main parts: the sympathetic nervous system and the parasympathetic nervous system. The sympathetic nervous system is responsible for preparing the body for “fight or flight” responses, while the parasympathetic nervous system promotes “rest and digest” functions. These two divisions work in tandem to regulate involuntary bodily functions such as heart rate, digestion, and respiratory rate, among others.
The neurological system is incredibly complex, involving both electrical and chemical signalling processes to transmit information throughout the body. At the core of this system are neurons, which serve as the functional units of the nervous system. These specialized cells can transmit electrical impulses along their axons and communicating with other neurons or effector cells via the release of neurotransmitters across synapses.
One key aspect of neuronal function is the generation of action potentials, which are essentially electrical impulses that travel along neurons. These action potentials are produced when a neuron’s membrane potential reaches a certain threshold, leading to a rapid and coordinated change in electrical charge along the neuron’s membrane.
Furthermore, synaptic transmission is a critical process in neuronal communication. When an action potential reaches the end of a neuron’s axon (known as the axon terminal), it triggers the release of neurotransmitters into the synaptic cleft. These neurotransmitters then bind to receptors on the next neuron or on an effector cell, initiating a series of chemical reactions that transmit the signal to the next stage of the neural circuit. In summary, the intricate physiology of the neurological system relies on the precise coordination of electrical and chemical signalling through neurons, action potentials, and synaptic transmission to facilitate the transmission of information throughout the body.
KSB ADDRESSED:
Knowledge:
| K1 | Understand the code: Professional standards of practice and behaviour for nurses, midwives and nursing associates (NMC 2018), and how to fulfill all registration requirements |
| K3 | Understand the professional responsibility to adopt a healthy lifestyle to maintain the level of personal fitness and well-being required to meet people’s needs for mental and physical care |
| K6 | Understand and apply relevant legal, regulatory and governance requirements, policies, and ethical frameworks, including any mandatory reporting duties, to all areas of practice |
| K7 | Understand the importance of courage and transparency and apply the Duty of Candour |
| K9 | Understand the aims and principles of health promotion, protection and improvement and the prevention of ill health when engaging with people |
| K10 | Understand the principles of epidemiology, demography, and genomics and how these may influence health and well-being outcomes |
| K11 | Understand the factors that may lead to inequalities in health outcomes |
| K12 | Understand the importance of early years and childhood experiences and the possible impact on life choices, mental, physical and behavioural health and well-being |
| K13 | Understand the contribution of social influences, health literacy, individual circumstances, behaviours and lifestyle choices to mental, physical and behavioural health outcomes |
| K14 | Understand the importance of health screening |
| K15 | Understand human development from conception to death, to enable delivery of person-centred safe and effective care |
| K16 | Understand body systems and homeostasis, human anatomy and physiology, biology, genomics, pharmacology, social and behavioural sciences as applied to delivery of care |
| K17 | Understand commonly encountered mental, physical, behavioural and cognitive health conditions as applied to delivery of care |
| K18 | Understand and apply the principles and processes for making reasonable adjustments |
| K19 | Know how and when to escalate to the appropriate professional for expert help and advice |
| K20 | Know how people’s needs for safety, dignity, privacy, comfort and sleep can be met |
| K21 | Understand co-morbidities and the demands of meeting people’s holistic needs when prioritising care |
| K22 | Know how to meet people’s needs related to nutrition, hydration and bladder and bowel health |
| K23 | Know how to meet people’s needs related to mobility, hygiene, oral care, wound care and skin integrity |
| K24 | Know how to support people with commonly encountered symptoms including anxiety, confusion, discomfort and pain |
| K26 | Understand where and how to seek guidance and support from others to ensure that the best interests of those receiving care are upheld |
| K27 | Understand the principles of safe and effective administration and optimisation of medicines in accordance with local and national policies |
| K28 | Understand the effects of medicines, allergies, drug sensitivity, side effects, contraindications and adverse reactions |
| K29 | Understand the different ways by which medicines can be prescribed |
| K30 | Understand the principles of health and safety legislation and regulations and maintain safe work and care environments |
| K37 | Understand the challenges of providing safe nursing care for people with complex co-morbidities and complex care needs |
| K38 | Understand the complexities of providing mental, cognitive, behavioural and physical care needs across a wide range of integrated care settings |
| K39 | Understand the principles and processes involved in supporting people and families with a range of care needs to maintain optimal independence and avoid unnecessary interventions and disruptions to their lives |
| K40 | Understand own role and contribution when involved in the care of a person who is undergoing discharge or a transition of care between professionals, settings or services |
| K41 | Know the roles, responsibilities and scope of practice of different members of the nursing and interdisciplinary team, and own role within it |
| K42 | Understand and apply the principles of human factors and environmental factors when working in teams |
| K43 | Understand the influence of policy and political drivers that impact health and care provision |
Skills:
| S1 | Act in accordance with the Code: Professional standards of practice and behaviour for nurses, midwives and nursing associates (NMC, 2018), and fulfil all registration requirements |
| S2 | Keep complete, clear, accurate and timely records |
| S3 | Recognise and report any factors that may adversely impact safe and effective care provision |
| S4 | Take responsibility for continuous self-reflection, seeking and responding to support and feedback to develop professional knowledge and skills |
| S5 | Safely demonstrate evidence-based practice in all skills and procedures required for entry to the register: Standards of proficiency for nursing associates Annex A & B (NMC 2018) |
| S6 | Act as an ambassador for their profession and promote public confidence in health and care services |
| S7 | Communicate effectively using a range of skills and strategies with colleagues and people at all stages of life and with a range of mental, physical, cognitive and behavioural health challenges |
| S8 | Recognise signs of vulnerability in self or colleagues and the action required to minimise risks to health |
| S9 | Develop, manage and maintain appropriate relationships with people, their families, carers and colleagues |
| S10 | Provide, promote, and where appropriate advocate for, non-discriminatory, person-centred and sensitive care at all times, reflecting on people’s values and beliefs, diverse backgrounds, cultural characteristics, language requirements, needs and preferences, taking account of any need for adjustments |
| S21 | Monitor the effectiveness of care in partnership with people, families and carers, documenting progress and reporting outcomes |
| S22 | Take personal responsibility to ensure that relevant information is shared according to local policy and appropriate immediate action is taken to provide adequate safeguarding and that concerns are escalated |
| S23 | Work in partnership with people, to encourage shared decision making, in order to support individuals, their families and carers to manage their own care when appropriate |
| S24 | Perform a range of nursing procedures and manage devices, to meet people’s need for safe, effective and person-centred care |
| S25 | Meet people’s needs for safety, dignity, privacy, comfort and sleep |
| S26 | Meet people’s needs related to nutrition, hydration and bladder and bowel health |
| S27 | Meet people’s needs related to mobility, hygiene, oral care, wound care and skin integrity |
| S28 | Support people with commonly encountered symptoms including anxiety, confusion, discomfort and pain |
| S29 | Give information and support to people who are dying, their families and the bereaved and provide care to the deceased |
| S30 | Recognise when a person’s condition has improved or deteriorated by undertaking health monitoring, interpreting, promptly responding, sharing findings and escalating as needed |
| S31 | Act in line with any end of life decisions and orders, organ and tissue donation protocols, infection protocols, advanced planning decisions, living wills and lasting powers of attorney for health |
| S32 | Work collaboratively and in partnership with professionals from different agencies in interdisciplinary teams |
| S33 | Maintain safe work and care environments |
| S34 | Act in line with local and national organisational frameworks, legislation and regulations to report risks, and implement actions as instructed, following up and escalating as required |
| S35 | Accurately undertake risk assessments, using contemporary assessment tools |
| S36 | Respond to and escalate potential hazards that may affect the safety of people |
| S37 | Participate in data collection to support audit activity, and contribute to the implementation of quality improvement strategies |
| S38 | Prioritise and manage own workload, and recognise where elements of care can safely be delegated to other colleagues, carers and family members |
| S39 | Recognise when people need help to facilitate equitable access to care, support and escalate concerns appropriately |
| S40 | Support and motivate other members of the care team and interact confidently with them |
| S41 | Monitor and review the quality of care delivered, providing challenge and constructive feedback when an aspect of care has been delegated to others |
Behaviour:
| B1 | Treat people with dignity, respecting individual’s diversity, beliefs, culture, needs, values, privacy and preferences |
| B2 | Show respect and empathy for those you work with, have the courage to challenge areas of concern and work to evidence based best practice |
| B3 | Be adaptable, reliable and consistent, show discretion, resilience and self-awareness |