Date of Learning Log: 19/07/2024

Time: 09:30-16:00

Learning Activity 1: Cardiac Monitoring and ECG

In this learning activity, I gained an understanding of the indications for cardiac monitoring. During this session, the course convenor demonstrated how to set up cardiac monitoring and ECG. Furthermore, interpretation of ECG readings to identify normal and abnormal heart rhythms.

The electrocardiogram (ECG or EKG) is a non-invasive medical test that measures the heart’s electrical activity. It records the heart’s rhythm and electrical signals, providing valuable information that helps doctors identify various heart conditions. The ECG is a versatile tool used to detect arrhythmias, which are irregular heartbeats, and to assess potential damage following a heart attack. Additionally, it plays a crucial role in diagnosing conditions such as coronary artery disease. Moreover, the ECG is utilised to monitor the effects of heart medications as part of routine health checks, especially for individuals at risk of heart disease.

This test measures the number of times the heart beats per minute and determines whether the heart’s rhythm is regular or irregular. It also provides insight into the strength and timing of the electrical signals as they pass through different parts of the heart. It consists of waves: P wave, QRS complex, and T wave. The P wave represents atrial contraction (upper chambers). The QRS complex represents ventricular contraction (lower chambers), and the T wave represents the recovery phase of the ventricles.

The process of using electrodes involves placing small, adhesive patches on specific areas of the chest, as well as sometimes on the arms or legs. These patches are connected to a computer via wires, which then prints or displays the results of the electrical activity of the heart. The electrical activity of the heart originates from a specialised group of cells called the sinus node, which generates an electrical stimulus at a regular rate of 60 to 100 times per minute under normal conditions. This electrical stimulus initiates the contraction of the atria, the upper chambers of the heart. The electrical impulse then travels down through the heart’s conduction pathways and causes the ventricles, the heart’s lower chambers, to contract and pump out blood to the rest of the body.

Learning Activity 2: Neurological Assessment

In this learning activity, I gained an understanding of the principles of neurological assessment, how to use it in a clinical simulation environment and identify why these assessments are important in patient’s care.

Neurological observation serves two primary functions within the healthcare setting. First, it involves assessing a patient’s current neurological function. This entails evaluating various aspects of the nervous system, such as sensory and motor responses, reflexes, and overall neurological status. Second, neurological observation involves monitoring for any changes in a patient’s neurological status, which may indicate either improvement or deterioration in their condition.

The primary tool used for conducting neurological observation is the Glasgow Coma Scale (GCS), which provides a standardized and objective assessment of a patient’s level of consciousness. This scale evaluates eye opening, verbal responses, and motor responses, and the combined score helps in determining the severity of a patient’s neurological impairment.

A neurological exam, also known as a neuro exam, is a comprehensive evaluation of a person’s nervous system that can be performed in a healthcare provider’s office or clinical setting. It involves a range of assessments, including sensory perception, coordination, reflexes, and cognitive function. Healthcare professionals may utilize various instruments, such as lights and reflex hammers, to conduct specific tests as part of the neuro exam. Importantly, these examinations are designed to be non-invasive and generally do not cause any discomfort or pain to the patient.

During a neurological examination, a healthcare provider will assess sensory neuron and motor responses, including reflexes, to determine the integrity and functionality of the patient’s nervous system. This evaluation typically involves a thorough physical examination and a comprehensive review of the patient’s medical history. However, it only encompasses deeper investigations such as neuroimaging studies, which may be conducted separately based on the findings of the initial neurological assessment.

The primary purpose of the assessing pupil gauge should be to compare the size of the patient’s pupils to a quantitated size of a black circle. In this case, the pupils measure approximately 3.5 mm in diameter. A Finoff transilluminator is then used to determine the reaction of the patient’s pupils to light. Penlight assesses pupil response, or how fast the pupils constrict when suddenly exposed to a bright light.

Normal pupil size ranges between 1/16 to 5/16 of an inch (2.0 to 8.0 millimetres), depending on the lighting. 1. The size of your pupil can tell your healthcare provider quite a bit about your health. It’s essential to unlocking possible medical conditions you might not otherwise know about.

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Date of Learning Log: 12/07/2024

Time: 09:30-16:00

Learning Activity 1: Supporting Mental Health Patients

During this learning activity, I acquired knowledge about working with mental health crises, psychotic disorders, and mood disorders. The goal of this session was to understand the concept of deterioration and the various manifestations of psychological distress. We also discussed different tools and techniques for assessing the needs of individuals in a mental health crisis, as well as effective communication strategies for interacting with people in distress.

The mental health conditions we looked at are:

Depression

• Depression is a low mood that lasts for weeks or months and affects your daily life.

The symptoms of depression include feeling unhappy or hopeless, having low self-esteem, and finding no pleasure in activities you usually enjoy. Treatment for depression typically involves a combination of lifestyle changes, talking therapies, and medication.

Self-care: Many people with depression benefit from making lifestyle changes, such as getting more exercise, reducing alcohol consumption, quitting smoking, and eating healthily.

Medical Treatment: Treatment for depression can involve a combination of lifestyle changes, talking therapies, and medication. The recommended treatment will be based on whether you have mild, moderate, or severe depression. If you have mild depression, your doctor may suggest “watchful waiting” to see if it improves on its own while monitoring your progress. They may also suggest lifestyle measures such as exercise and self-help groups. Talking therapies, such as cognitive behavioural therapy (CBT), are often used for mild depression that is not improving or for moderate depression. Antidepressants are also sometimes prescribed.

Psychosis

• Psychosis is where you see or hear things that are not there (hallucinations) or believe things that are not true (delusions)

The main symptoms of psychosis are hallucinations and delusions.

The two main symptoms of psychosis are:

1. Hallucinations: A person may hear, see, and in some cases, feel, smell, or taste things that do not exist outside their mind. These experiences can feel very real to the person affected by them. A common hallucination is hearing voices.
2. Delusions: Some people have strong beliefs that are not shared by others. A common delusion is believing there’s a conspiracy to harm them.

The combination of hallucinations and delusional thinking can cause severe distress and a change in behaviour. Experiencing these symptoms is often referred to as having a psychotic episode.

MEDICAL TREATMENTS

Treatment for psychosis involves a combination of approaches:

Antipsychotic medicine can help relieve the symptoms of psychosis.

Psychological therapies, such as one-on-one cognitive behavioural therapy (CBT), have been successful in helping people with psychosis. Family interventions, which involve partners, family members, and close friends, have also been shown to reduce the need for hospital treatment in people with psychosis.

Social support is important for addressing social needs like education, employment, or accommodation.

Some individuals may need to take antipsychotics long-term, while others may be able to gradually reduce their dosage and eventually stop taking them if their symptoms improve significantly. It’s important not to abruptly stop taking any prescribed medicines, as this could trigger a relapse of symptoms. In severe cases, hospitalization may be necessary during psychotic episodes.

Schizophrenia

Schizophrenia is a mental health condition where you may see, hear or believe things that are not real.

Symptoms of schizophrenia include:

• Hallucinations – hearing or seeing things that do not exist outside of the mind.
• Delusions – unusual beliefs not based on reality.
• Muddled thoughts based on hallucinations or delusions.
• Losing interest in everyday activities.
• Not caring about your hygiene.
• Wanting to avoid people, including friends.

MEDICAL TREATMENTS

Schizophrenia is a complex mental health condition that is typically treated using a multifaceted approach tailored to everyone’s needs. Treatment normally involves a combination of medication and therapy, with antipsychotic medications and cognitive behavioural therapy (CBT) being commonly used. People with schizophrenia often receive support from a community mental health team, which provides ongoing assistance and treatment to help manage their condition. While many individuals can recover from schizophrenia, it’s important to note that there may be periods when symptoms resurface, known as relapses. However, with the appropriate support and treatment, the condition’s impact on daily life can be minimised.

Learning Activity 2: Decision-Making in GI Emergencies + Pre-and Post-operative Care.

In this learning activity, I learned about the causes and progression of appendicitis. Appendicitis is an inflammation of the appendix, which is a small pouch connected to the large intestine. The condition often starts with a blockage in the appendix, which can be caused by hardened stool (fecaliths), foreign objects, or tumours. This blockage increases pressure, reduced blood flow, and bacterial overgrowth. The body’s immune response triggers inflammation, causing swelling and further blockage. If not treated, the increased pressure can lead to a lack of blood flow (ischemia), tissue death (necrosis), and potential perforation, which can result in peritonitis.

The symptoms of appendicitis are:

• Abdominal Pain: Initially vague around the belly button, it typically migrates to the right lower quadrant (McBurney’s point).
• Nausea and Vomiting: Often follow the onset of pain.
• Loss of Appetite: Commonly reported.
• Fever: Mild to moderate fever may occur.
• Rebound Tenderness: Pain upon releasing pressure in the abdomen.
• Constipation or Diarrhoea: This can occur but is less common.

Treatment available for appendicitis are:

1. Surgical Intervention:
   • Appendectomy: The standard treatment is the surgical removal of the appendix, either through open surgery or laparoscopically.
2. Antibiotics: Preoperative antibiotics are typically administered to reduce infection risk.
3. Postoperative Care: Includes pain management and monitoring for complications.

When experiencing symptoms such as sudden pain in the lower right abdomen, loss of appetite, nausea, vomiting, and fever, it’s important to promptly seek medical attention from a healthcare professional. Early diagnosis and timely treatment of appendicitis are crucial to prevent potential complications such as perforation of the appendix or the formation of an abscess. Therefore, it is imperative not to delay seeking medical care if appendicitis is suspected.

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Date of Learning Log: 05/07/2024

Time: 09:30-16:00

Learning Activity 1: Common Mental Health Conditions

In this learning activity, I gained an understanding of the pathophysiology of mental health issues and how they impact individual lives, including psychological/emotional distress, self-harm and suicide. Using evidence-based methods to support the analysis of the development of practical nursing care, the experience of integrated care for individuals with complex needs, strategies in decision-making and obtaining independence, and the ethical and legal perspectives associated with complex and long-term conditions were discussed.

Self-harm refers to the deliberate act of causing physical injury or pain to oneself, typically to cope with overwhelming emotions, stress, or psychological distress. People who engage in self-harm often do so to express, manage, or control feelings that are otherwise too difficult to handle. It is not necessarily a suicide attempt, but it can be a sign of emotional distress and a potential risk factor for more serious mental health concerns.

Self-harm can take many forms, including cutting- using sharp objects to cut the skin, most commonly on the arms, legs, or wrists. Burning oneself with hot objects or substances (e.g., lighters, cigarettes). Hitting – punching oneself or banging parts of the body against a surface. Scratching – repeatedly scratching the skin to the point of injury. Hair-pulling: Known as trichotillomania, pulling out one’s hair. Interfering with wounds – picking at or reopening healing wounds to prevent them from healing properly. Poisoning – ingesting harmful substances, though this is more associated with suicidal intent.

Several factors increase the likelihood of self-harming behaviours. Mental Health Issues – Conditions such as depression, anxiety, borderline personality disorder, eating disorders, and post-traumatic stress disorder (PTSD) are associated with a higher risk of self-harm. Trauma and Abuse – Past experiences of physical, sexual, or emotional abuse, as well as neglect or trauma, can contribute to self-harming behaviours. Low Self-Esteem – Individuals with feelings of worthlessness or self-hatred are more prone to self-harm. Substance Abuse – Drug or alcohol misuse can increase impulsivity and lower inhibitions, making self-harm more likely. Social Isolation – Lack of strong social support or feelings of loneliness can contribute to self-harm. Difficult Relationships -Conflict with family members, friends, or partners can be a significant trigger.

Treatment and Support for Self-Harm:

Seeking professional help is crucial for individuals who self-harm. Treatments may include:

1. Therapy:
   • Cognitive Behavioural Therapy (CBT): Helps individuals identify and challenge negative thought patterns and develop healthier coping mechanisms.
2. Medication: Antidepressants or other psychiatric medications may be prescribed to address underlying mental health conditions, such as depression or anxiety.
3. Support Groups: Peer support groups can provide a safe space to share experiences and learn from others who have similar struggles.
4. Crisis Support: In severe cases, immediate help from crisis lines, therapists, or emergency services may be necessary.

Prevention and Coping Strategies:

• Building Emotional Awareness: Recognising and understanding emotions can help develop healthier coping strategies.
• Distraction Techniques: Using alternative behaviours like drawing, journaling, or exercising when feeling the urge to self-harm can reduce the intensity of the impulse.
• Relaxation Techniques: Breathing exercises, mindfulness, and progressive muscle relaxation can help alleviate emotional stress.
• Improving Social Support: Connecting with friends, family, or support groups can reduce feelings of isolation and provide emotional outlets.

Self-harm is a serious issue that reflects underlying emotional pain or mental health difficulties. It’s essential to approach those who self-harm with empathy, understanding, and no judgment, encouraging them to seek professional help and develop healthier coping mechanisms.

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Date of Learning Log: 24/05/2024

Time: 09:30-16:00

Learning Activity 1 and 2: Preparation for Practice on Placement

As part of our nursing commitment, we are focused on empowering Nursing Associates to take accountability as professionals. We aim to promote health and prevent ill health by providing comprehensive care and monitoring patient well-being. By working collaboratively, we strive to enhance patient safety, improve the quality of care, and contribute to everyone’s integrated care.

Nursing Associates are expected to practice independently with minimal supervision, providing and monitoring care while continuously demonstrating growth in knowledge, skills, and confidence. The assessment criteria are designed to evaluate whether individuals have already achieved the necessary competencies, can identify the appropriate knowledge based on patient needs, and can utilise the requisite skills to deliver person-centred care. Additionally, the assessment considers whether individuals can demonstrate professional values and positive engagement with their learning.

Proficiencies must be completed through episodes of care and medicines management as a mandatory requirement for progression within the nursing associate role. Reflective accounts are expected to provide insights into professional development and understanding of the Nursing Code. Reflections should not merely be descriptive but follow a structured approach of “What? So What? Now What?” while ensuring that clinical evidence supports the reflection and maintaining confidentiality.

Professionalism is expected to underpin all aspects of practice and conduct during placement. This includes completing the required hours for allocated placement, accurately logging attendance (including sickness/absence hours) in the ePAD and following the proper procedures for reporting sickness/absence in the placement area on the timesheet.

To ensure that concerns raised in a practice learning environment are consistently, effectively, and appropriately addressed, students must understand their duty to report any dangerous, abusive, discriminatory, or exploitative behaviour during their practice. This encompasses a wide range of situations, including but not limited to physical abuse, domestic abuse, sexual abuse, psychological abuse, financial abuse, discriminatory abuse, organisational abuse, neglect, and acts of omission, such as ignoring medical, emotional, or physical care needs. It is crucial for students to be aware of these possibilities and to report any such instances to maintain a safe and supportive learning environment.

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Date of Learning Log: 17/05/2024

Time: 09:30-16:00

Learning Activity 1: Essay Support/ Draft Checking/ Revision (Self-learning)

In this learning activity, the formative assignment is due to feedback from peers and lecturers. This is an opportunity to clarify doubts about the summative assignments and discuss them more in-depth.

I was not able to present my formative assignment in class as I was not able to attend the session. However, the case study I focused on was Cancer, in which I discussed Rosemary’s diagnosis of muscle-invasive bladder cancer. The background of her disease was discussed, as well as previous treatments, the pathophysiology of cancer, presentation, treatment and management.

Learning Activity 2: Paediatric Emergencies and Decision-Making

Recognising paediatric emergencies involves assessing varying age groups and understanding the causes, pathophysiology, management, and decision-making processes involved. Anaphylaxis, which is a severe allergic reaction, necessitates understanding its triggers, physiological processes, and the appropriate management techniques. When discussing foreign body ingestion, it’s critical to delve into the types of foreign bodies commonly ingested by children, the potential complications, and the appropriate interventions. Poisoning and overdose in paediatric patients require an understanding of the common toxic substances, their effects on the body, and the specific management strategies.

Cardiac arrest in children necessitates a comprehensive understanding of the causes, immediate management, and the decision-making process in this critical situation. Additionally, discussing paediatric life support and CPR involves covering both basic life support (BLS) and advanced life support (ALS) interventions for common paediatric medical emergencies.

Assessing young children, especially in paediatric care, requires a special approach considering their developmental stage, ability to communicate, and physical needs. Here’s a guide on effectively assessing young patients, focusing on children.

1. Create a friendly environment for the assessment. Use colourful decorations, toys, and a gentle tone to help the child feel comfortable.
2. Involve Parents/Caregivers: Include the parents or caregivers in the assessment process, as they can give important information and provide comfort.
3. Use Language Suitable for the Child’s Age: Adjust your language and approach based on the child’s age. For babies, use soothing tones and simple words. For toddlers and pre-schoolers, use playful language and interact with toys or dolls.
4. Get on Their Level: Lower yourself to the child’s eye level to make interactions less intimidating.
5. Observe Developmental Milestones: Check for important milestones relevant to the child’s age, such as motor skills (crawling, walking), language development, and social interactions.
6. Use Developmental Screening Tools: Use age-appropriate tools like the Denver Developmental Screening Test or Ages and Stages Questionnaires to assess developmental progress.
7. Start with Less Distressing Procedures: Begin with less distressing procedures, like measuring height and weight, and then move on to more invasive assessments as needed.
8. Use a Head-to-Toe Approach: Perform the physical exam systematically, checking infant fontanelles, assessing head shape, and evaluating the neck’s range of motion. Use age-appropriate tools for eye, ear, nose, and throat exams, and listen to heart and lung sounds. Gently palpate the abdomen and check limb movements, muscle tone, and reflexes for younger children.
9. Adapt Techniques: Use appropriate methods and equipment for young children, such as measuring the brachial or femoral pulse for infants and radial pulse for older children. Observe breathing patterns and use non-invasive methods like temporal artery thermometers for quick temperature readings.
10. Observe Behaviour: Note any signs of distress, anxiety, or unusual behaviour, as these can provide insights into the child’s overall health and well-being.
11. Assess Emotional State: Determine how the child responds to the environment and interactions and consider any factors affecting their emotional health.
12. Use Age-Appropriate Tools: For young children, use observational tools like the FLACC scale (Face, Legs, Activity, Cry, Consolability) or the Wong-Baker FACES Pain Rating Scale, which uses pictures to help children express their pain. Also, watch for non-verbal cues such as facial expressions, body language, and changes in behaviour that may indicate pain.
13. Gather History: Get a detailed medical history from parents or caregivers, including information about birth history, vaccinations, growth and development, and any current concerns.
14. Discuss Findings: Share assessment results and any concerns with the caregivers in a clear, supportive manner and provide guidance on the next steps.

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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.

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Date of Learning Log: 03/05/2024

Time: 09:30-16:00

Learning Activity 1: Complex CVS conditions

In this learning activity, I learned about the anatomy and physiology of the heart/cardiovascular system and gained knowledge about common cardiovascular conditions and congenital heart defects. The management and treatment were also discussed during this learning activity.

The cardiovascular system performs several vital functions to maintain homeostasis and overall health. Its main roles include transporting blood through the heart and blood vessels to circulate blood throughout the body. Blood carries oxygen, nutrients, and hormones to cells while removing waste products such as carbon dioxide and urea. The cardiovascular system delivers oxygen from the lungs and nutrients from the digestive system to tissues and organs that require them for energy production and growth. It aids in waste removal by collecting carbon dioxide and metabolic waste products from cells and transporting them to the lungs and kidneys for filtration and excretion. Blood vessels help regulate body temperature by controlling blood flow to the skin. Additionally, the cardiovascular system transports white blood cells and antibodies to sites of infection or injury, playing a crucial role in immune defence. It also delivers hormones secreted by glands, facilitating communication between different body parts. Furthermore, the cardiovascular system regulates blood pressure, fluid balance, and pH levels, helping to maintain internal stability and ensuring optimal conditions for cellular functions.

Acute coronary syndrome (ACS) encompasses a range of conditions characterized by sudden, diminished blood flow to the heart muscle. This decrease in blood flow often stems from the rupture of atherosclerotic plaque within the coronary artery, resulting in partial or complete blockage. ACS is a medical emergency that, if not promptly addressed, can lead to heart damage or even death. Common signs and symptoms of ACS include chest pain or discomfort, shortness of breath, nausea or vomiting, sweating, and light-headedness or dizziness. Cardiovascular risk factors associated with ACS include high cholesterol, high blood pressure, smoking, diabetes, obesity, and a sedentary lifestyle. Treatment for ACS focuses on restoring blood flow to the heart, alleviating symptoms, and preventing further heart damage. This may involve medication such as blood thinners, beta-blockers, or statins, and in severe cases, surgical procedures like angioplasty or coronary artery bypass grafting.

Learning Activity 2: Venepuncture

In this learning activity, I undertook venepuncture for our care delivery module. I explored the range of equipment and techniques used for venepuncture and identified the indications, contraindications and risks. The anatomy and physiology of peripheral vasculature, identify veins appropriately and obtain blood samples using the correct vacutainer system from a mannequin.

We covered the essential principles of safe phlebotomy techniques and provided hands-on demonstrations using a clinical simulator. While venepuncture and phlebotomy involve drawing blood, they are used in slightly different contexts. Venepuncture refers to puncturing a vein, typically with a needle, to draw blood or administer fluids or medications. This term encompasses a broader range of medical procedures involving accessing veins, commonly used for blood sampling, intravenous therapy, and other medical interventions. On the other hand, phlebotomy specifically pertains to drawing blood for diagnostic or therapeutic purposes, focusing primarily on obtaining blood samples for testing.

Understanding the technique and patient care during venepuncture and phlebotomy ensures a safe, efficient process with minimal discomfort from the patient. The pre-procedure is as vital as the post-procedure, essentially within infection prevention control to prevent complications such as infections or injuries.

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Date of Learning Log: 26/04/2024

Time: 09:30-16:00

Learning Activity 1: Complex Genomics: Cancer

In this learning activity, I learned about the pathophysiology of cancer, genetic considerations, and how to manage the illness. We explored the different types and conditions of cancer, cellular mutations, the differences between benign and malignant tumours, metastasis, and coping with living with cancer.

Cancer is a broad term encompassing a range of diseases characterised by the uncontrolled growth and spread of abnormal cells within the body. Typically, cells undergo a regulated growth, division, and death process. However, cancer arises when this process malfunctions, resulting in the formation of tumours—abnormal masses of tissue—or, in some instances, cancers that affect the blood and spread through the bloodstream without forming tumours.

Metastasis occurs when cancer cells infiltrate surrounding tissues and spread to other body parts through the bloodstream or lymphatic system. Cancer often stems from genetic mutations that alter the function of specific genes, leading to abnormalities in cell growth, repair, and death. Solid cancers typically result in the development of tumours, which can be either benign (non-cancerous) or malignant (cancerous). Malignant tumours can invade nearby tissues and organs.

The signs and symptoms of cancer can vary depending on the type, location and stage of the cancer. Typically, when cancer begins the signs and symptoms are absent. A mass grows, and ulceration may appear; unexplained weight loss, fatigue, and persistent pain can be an imitator of other conditions and may frequently occur in individuals with other conditions.

Cancer can be caused by various factors including environmental exposures – these are exposures to radiation, chemicals and pollutants, lifestyle factors – smoking, poor diet, lack of physical activity, and excessive alcohol consumption. Studies have shown that some cancer deaths are related to infectious diseases, including viruses, bacteria and parasites, e.g. HPV – cervical cancer.

Diagnosing cancer typically involves a combination of several tests and procedures aimed at identifying the presence of cancer, determining its type, and assessing its extent or stage. Most cancers are initially recognised from clinical signs and symptoms screening. Investigations such as tissue biopsy, blood tests, x-rays, CT and MRI scans.

There are different types of cancer treatment available, which also depends on the type of cancer, its location and its stage. Treatments such as surgery – removing tumour or cancerous tissue, radiation therapy – using high-energy radiation to kill cancer cells, chemotherapy – using drugs to kill or slow the growth, immunotherapy – boosting the body’s immune system to fight cancer, targeted therapy – specifically target cancer cells, and hormonal therapy – used for cancers that are influenced by hormones such as breast and prostate cancer.

Living with cancer presents a challenging journey, encompassing both physical and emotional hurdles. It involves navigating the disease, coping with treatments, and seeking ways to uphold quality of life. This experience is intricate, but with the appropriate support, resources, and care, many individuals find methods to manage the disease and sustain a meaningful life. The significance of a support network, transparent communication within the healthcare team, and encouragement and support for individuals cannot be overstated.

Learning Activity 2: End-of-Life Care

In this learning activity, I learned about end-of-life care in the context of a dying person’s last days of life. We discussed the importance of communication, recognising when a person is entering their last days, gaining awareness of symptom management, the role of NA and understanding advance care planning.

End-of-life care necessitates a comprehensive approach that encompasses the physical symptoms and the emotional, spiritual, and psychological needs of patients and their families. Having this understanding enables nursing assistants to deliver thorough care. Effective communication skills are vital in end-of-life situations, which frequently involve challenging discussions about prognosis. It is crucial to be proficient and empathetic, ensuring that patients and families are well-informed and supported. End-of-life care often entails intricate ethical considerations, such as decisions regarding life-sustaining treatment and patient autonomy. Familiarising oneself with these ethical considerations equips me to engage in ethical decision-making processes as an NA.

Advanced care planning (ACP) involves individuals deciding about their future healthcare, mainly when they cannot communicate or make decisions. ACP ensures that a person’s healthcare preferences and values are recognised, understood, and honoured by family members, caregivers, and healthcare providers.

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Date of Learning Log: 19/04/2024

Time: 09:30-16:00

Learning Activity 1: Renal Patients and Decision-Making (Acute Kidney Injury – AKI)

In this learning activity, I learned about the anatomy and physiology of the kidney, classified stages of acute kidney injuries (AKI), the pathophysiology of AKI and its clinical features, treatments and common implications of AKI.

The kidneys perform several bodily functions, including filtering waste products and excess substances such as salt, water, and urea from the blood, which are then excreted as urine. The kidneys are responsible for regulating the body’s overall homeostasis by regulating blood pressure, blood pH, blood volume, electrolyte balance, blood osmolarity, and blood glucose.

An acute kidney injury is a sudden and rapid loss of kidney function over hours, which encompasses structural damage and impairment. According to NICE 2019, people who are at risk of developing AKI are individuals with chronic kidney disease, heart failure, liver failure, diabetics, abnormal low output of urine and individuals with neurological injury or cognitive deficit. AKI is diagnosed through blood tests, urine tests, imaging studies and sometimes kidney biopsies. Measuring creatinine, creatine, and urine output levels can help detect AKI.

Various factors can cause AKI, which is generally categorised into three types based on the location of the issue. Pre-renal causes are conditions that reduce blood flow to the kidneys, such as severe dehydration, blood loss, heart failure or shock, and severe burns. Intra-renal causes involve direct damage to the kidneys, such as acute glomerulonephritis, acute tubular necrosis, infections, and nephrotoxic medications. Post-renal causes are conditions in which there is an obstruction in the urine flow, such as kidney stones, enlarged prostate, tumours and urethral strictures.

The signs and symptoms of AKI include increased heart rate, arrhythmias, low BP if shocked or dehydrated, high BP if overloaded with fluid, decreased urine output, oedema, reduced level of consciousness, confusion and tremors. Managing AKI involves giving fluids – if BP is low and signs of shock, frequent vital sign monitoring, ECG, fluid balance chart, central venous catheter and central venous pressure monitoring, oxygen therapy, and treating hyperkalaemia. Early detection and treatment are crucial in managing AKI to prevent permanent kidney damage and other complications. Therapy addresses the underlying cause, such as rehydrating the patient, treating infections, or relieving obstructions.

Learning Activity 2: Medication Management/Drug Calculation/Safe Medicate Practice

During this learning activity, we delved into our Care Delivery module and discussed the learning and module outcomes, focusing on thoroughly examining the timetable and ePads medication management. Additionally, I gained insight into the significance of mental capacity assessment with administering medications and critically considered scenarios based on clinical practices.

This learning activity discusses the procedural competencies required for administering medications. It mentions that continuous assessment of the patient’s ongoing ability to self-medicate is crucial to identifying concerns, including when and how to escalate. It is important to undertake accurate drug calculations for various medications and exercise accountability in ensuring the safe administration of medicines to those receiving care. It is essential to learn about different routes when administrating medications, as this could be via oral, topical, inhalation, subcutaneous and intramuscular injections, etc. Safe medication involves assessing and managing the effectiveness of symptom relief medication, recognising and responding to adverse or abnormal reactions, knowing when to escalate concerns, and storing, transporting and disposing of medicinal products properly. Safe medication also includes acting according to the NMC, the code and standard of proficiencies, and understanding the ten rights of medication administration.

Consent is crucial in medication management; consent respects the person’s autonomy, which focuses on the patient’s right to make informed decisions about their own body and health. This acknowledges patients’ authority over what treatments they receive, including medications. Obtaining consent is a fundamental ethical principle that ensures that the patients are not subjected to treatments against their will, which upholds their dignity and personal rights. A valid consent can be verbal or written, which must be voluntary and informed, and the person consenting must be able to make the decision. In summary, consent in medication management ensures that the treatments are ethical, legal and aligned with the patient’s health goals and values.

The term “mental capacity” refers to a person’s capability to make decisions, especially regarding their health, finances, or personal affairs. It entails grasping, analysing, and appraising information to make well-informed choices. Mental capacity is not fixed; it can change based on the difficulty of the decision, the timing of the decision, and any temporary or long-term conditions impacting the individual. Mental capacity is essential in determining whether someone can consent to medical treatments, manage their own affairs or make other significant decisions. If a person lacks mental capacity, decisions may need to be made on their behalf, usually through legal or medical representatives and always with their best interests in mind.

A lasting power of attorney (LPA) is a legal document that allows a person to appoint one or more people to help them make decisions or to make decisions on their behalf. There are two types of LPA: health and welfare and property and financial affairs. The independent mental capacity advocate (IMCA) supports and represents the person in the decision-making process. Essentially, they ensure that the person’s mental capacity is being followed. The IMCA safeguards individuals who lack the capacity to make some important decisions.

Mental capacity is crucial for safely managing medications as it influences a person’s ability to provide informed consent, follow treatment plans, prevent errors, and take part in decision-making. Confirming that patients possess the capacity to handle their medication properly is essential for safeguarding their health and well-being.

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Date of Learning Log: 12/04/2024

Time: 09:30-16:00

Learning Activity 1: Introduction to HF and managing risks and theory of decision making and clinical judgement.

In this learning activity, we explored the importance of the human factor, defined HF/ergonomics, understood the role of clinical decision-making and clinical judgment, and analysed the policies regarding decision-making.

Human factors are crucial in enhancing clinical performance, and ergonomics involves studying people in their working environments. Understanding human factors is essential for identifying potential errors in healthcare settings, thus improving patient safety by minimising the risks of mistakes. Furthermore, it improves communication among healthcare providers by ensuring accurate conveyance and understanding of information, which is crucial for effective patient care.

During our session, we delved into three distinct safety models, each offering a structured framework for identifying, analysing, and mitigating risks to ensure patient safety. These models are defined as follows:

1. Model of Safety 1: Ultra Safe
2. Model of Safety 2: High Reliability
3. Model of Safety 3: Embracing Risks

It is incorporating human factors into nursing practice. This will result in patients receiving safer, more efficient, and more compassionate care and provide nurses with a better working environment.

Learning Activity 2: Sepsis

In this learning activity, we explored the definitions of sepsis and its pathophysiology, discussed the long-term and short-term management plans, and learned about its complications.

Sepsis is a severe medical condition when the body’s response to an infection triggers an overwhelming and systemic inflammatory reaction. This can result in extensive tissue damage, organ failure, and potentially even death. Sepsis is considered a severe and critical complication that requires immediate and intensive medical attention. The National Institute for Health and Care Excellence has issued guidelines emphasising treating sepsis with the same urgency as a heart attack. Healthcare professionals should always consider the possibility of sepsis in patients with infections.

Numerous risk factors are associated with sepsis, including environmental influences and organ sensitivity, such as respiratory infections, skin infections, urinary catheters, urinary infections, and IV lines causing skin infections. Recent trauma, surgery, or invasive procedures are all contributors to the development of sepsis. Sepsis is also anticipated in individuals with impaired immune responses or those with long-term illnesses such as diabetes, immunodeficiency, HIV/AIDS, neutropenia, splenectomy, and iatrogenic conditions. Additionally, factors such as age, improper management of infection, and genetic predispositions should be considered.

I acquired valuable knowledge during the educational session about the treatment, pathophysiology, indicators, and symptoms of sepsis. The principles of treating sepsis patients remain the same regardless of the cause. Initial evaluation and resuscitation should follow the ABCDE format and involve the appropriate Sepsis Screening Tool. Patients should be treated using the Sepsis 6 approach, and it’s crucial to promptly engage with Critical Care, particularly in cases of septic shock or multi-organ failure. The largest group of sepsis patients typically consists of those with pneumonia, though other presentations may involve gastrointestinal, urinary tract, biliary tract, and skin infections. It is crucial to approach the evaluation of a patient presenting with sepsis with an open perspective. Most organisations now have their recommended first-line empiric treatments for common infections.

Learning Activity 3: Sickle Cell Anaemia

In our recent learning activity, we delved into sickle cell disease. We explored the intricate genetic factors that contribute to this condition, gaining a deep understanding of how it is passed down through generations. We examined the various signs and symptoms of sickle cell, delved into the treatments available, and discussed the potential complications associated with this challenging condition.

Sickle Cell Disease (SCD) is caused by inheriting the sickle cell gene, typically when both parents have the disease or are carriers. Carriers do not have the disease, but they can pass it on to their children if their partner is also a carrier. SCD is a group of inherited blood disorders with insufficient healthy red blood cells (RBC) to carry adequate oxygen throughout the body. This is caused by an abnormal production of haemoglobin (protein in RBC) known as haemoglobin S. The haemoglobin molecules in people with SCD tend to form rigid and sticky, causing RBC to become shaped like a crescent or sickle. The irregular cell shape can block small blood vessels, reducing or stopping blood and oxygen flow to body parts.

The signs and symptoms of SCD vary from person to person and have a wide range of symptoms. The main symptoms are fatigue, anaemia, and pain. Painful episodes known as sickle cell crises are common and most distressing symptoms of SCD. They can be severe and last several days or weeks. Pain is developed when sickle-shaped RBCs block blood flow through vessels to the chest, abdomen, bones, and joints. This can damage the spleen, which fights infection. Therefore, frequent infections can occur. Other symptoms, such as delayed growth due to a shortage of RBC, can slow growth in infants, children and teenagers. SCD can also affect vision; blood vessels that supply the eyes will damage the retina, which leads to vision problems. The complications of SCD include stroke, seizure, limb weakness, speech difficulties and loss of consciousness. SCD can be diagnosed by a blood test, which tests haemoglobin S. If the test is positive, further tests will be done to determine whether the person has sickle cell trait or sickle cell disease. A low haemoglobin is a sign and can prove SCD and other blood tests.

The treatment for SCD aims to avoid crises, relieve symptoms, and prevent complications. Regular doctor visits are needed to review medications. Treatments such as blood transfusion, bone marrow transplant, antibiotics, analgesics, assessment of stroke risks, and vaccinations are available for SCD patients. Experimental treatments, such as gene therapy and turning off the defective gene while reactivating another gene, are also available.

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