WOUND CARE: SUTURE / CLIP/DRAIN REMOVAL             26/07/2024.

The lesson started with the introduction of the topic, the learning outcomes, and the structure of the skin.

The skin is divided into three:

• Epidermis ( this is further described as the epidermis – it is composed of 5 layers, it has a protective barrier, contains melanin, and a new epidermis every 25 – 45 days).
• Dermis (this layer contains – hair follicles, capillaries, sweat glands, nerve endings, iol glands, collagen and elastin)
• Hypodermis – this is also known as a subcutaneous layer ( this acts as a shock absorber, regulates temperature, connective tissue connects bone and muscle to the layer of the skin, nerves and blood vessels here connect to those in the dermis layer).

Note: the skin protects our bodies. The skin is a physical barrier,  when the skin wounds the barrier is open to infection. The PH of the skin is 5.5 and it is acidic to kill bacterias. The skin is sensitive to pain.

We described a wound as an injury that breaks the skin or other body tissue. Or a wound is a break in the continuity of the skin, through injury or surgery.

The stages of wound healing is as follows:

• Hemostasis
• Inflammatory
• Proliferative
• Remodelling.

Hemostasis ( vascular constriction, platelet aggregation, fibrin formation to create thrombus.

The inflammatory – inflammation attempts to rid the wound area of any foreign material, microbes or toxins. This prepares the site for tissue repair.

This phase is characterised by:

• Swelling
• Redness
• Heat
• Pain.

The proliferation (angiogenesis, collagen synthesis, reepithelialization, extracellular matrix formation).

The maturation and remodelling ( collagen remodelling, vascular maturation, edge contraction, scar tissue.

The following are abnormal healing. Failure to heal at least 40% within the 4 weeks:

• Infection.
• Devitalised tissue.
• Chronic wounds.
• Overgranulation.

We continued with wound assessment and the TIMES model. The learning outcomes were also discussed.  The types of wounds are as follows:

• Traumatic injury, eg skin tear, laceration, burn, abrasions.
• Pressure ulcer
• Legs ulcer/ diabetic ulcer
• Surgical, eg incisional, skin graft, ostomy, flap reconstruction.

TIME(S) is an acronym used to support a standardised approach to wound assessment and outline key considerations in the process.

T – tissue

I – inflammation/infection

M – moisture

E – edges. And the additional ‘s’ is to assess surrounding skin.

Note: we should make TIME to assess and manage a wound effectively.

The tissue can be: 

• Necrosis,
•  slough, 
• granulated, 
• hypergranulated.

Infection, the location.  

• (Wound bed only – treat the wound topically).

• Systemic (swab to be taken if a patient is  presenting with a systemic infection or a deteriorating condition. In these cases, oral antibiotics may be advised.

• odour

moisture(exudate) 

• Volume (low, moderate, high)
• Type /consistency (serous, haemoserous, purulent)

Edge 

• Rolled, fragile, hypergranulated

Surrounding skin

• Excoriated, macerated, oedematous.

                             KSB ADDRESSED

                       KNOWLEDGE.

K1: Understand the Code: Professional standards of practice and behaviour for nurses, midwives and nursing associates (NMC, 2018), and how to fulfil all registration requirements. 

K2: Understand the demands of professional practice and demonstrate how to recognise signs of vulnerability in themselves or their colleagues and the action required to minimise risks to health.

K4: Understand the principles of research and how research findings are used to inform evidence-based practice. 

K5: Understand the meaning of resilience and emotional intelligence, and their influence on an individual’s ability to provide 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.

K8: Understand how discriminatory behaviour is exhibited.

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 .

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. 

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 

K25: Know how to deliver sensitive and compassionate end of life care to support people to plan for their end of life 

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 

K31: Understand how inadequate staffing levels impact on the ability to provide safe care and escalate concerns appropriately 

K32: Understand what constitutes a near miss, a serious adverse event, a critical incident and a major incident 

K33: Understand when to seek appropriate advice to manage a risk and avoid compromising quality of care and health outcomes 

K34: Know and understand strategies to develop resilience in self and know how to seek support to help deal with uncertain situations 

K35: Understand own role and the roles of all other staff at different levels of experience and seniority in the event of a major incident 

K36: Understand the roles of the different providers of health and care 

K37: Understand the challenges of providing safe nursing care for people with complex co-morbidities and complex care needs.

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.

                                       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 

S11: Report any situations, behaviours or errors that could result in poor care outcomes 

S12: Challenge or report discriminatory behaviour 

S13: Apply the aims and principles of health promotion, protection and improvement and the prevention of ill health when engaging with people 

S14: Promote preventive health behaviours and provide information to support people to make informed choices to improve their mental, physical, behavioural health and wellbeing 

S15: Identify people who are eligible for health screening 

S16: Promote health and prevent ill health by understanding the evidence base for immunisation, vaccination and herd immunity 

S17: Protect health through understanding and applying the principles of infection prevention and control, including communicable disease surveillance and antimicrobial stewardship and resistance 

S18: Apply knowledge, communication and relationship management skills required to provide people, families and carers with accurate information that meets their needs before, during and after a range of interventions 

S19: Recognise when capacity has changed recognise and how a person’s capacity affects their ability to make decisions about their own care and to give or withhold consent 

S20: Recognise people at risk of abuse, self-harm and/or suicidal ideation and the situations that may put them and others at risk 

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 

S42: Support, supervise and act as a role model to nursing associate students, health care support workers and those new to care roles, review the quality of the care they provide, promote reflection and provide constructive feedback.

S43: Contribute to team reflection activities to promote improvements in practice and services.

                                 BEHAVIOURS

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.

Principles of A – E Assessment

The lesson started with an introduction of the module, the learning outcomes and the learning objectives. We looked NEWs2 2017, and how it works. The NEWs 2 is used for all adult patients in hospitals and ambulance trusts.

• It is also used as a choice scales to record Sp02
• Use of ABCDE structure
• For better documentation of oxygen flow and delivery device
• As a parameter ranges for each clinical variable
• ACVPU -new confusion added as a trigger.

In monitoring the Early Warning Systems (EWS), the is track and trigger by monitoring 6 physiological parameters and they are as follows:

• Respiratory rate 
• Oxygen saturation (Sp02)
• Temperature
• Systolic Blood Pressure
• Heart rate
• Level of consciousness.

For Airway and Breathing (A & B)

• Respiratory Rate
• Oxygen saturation (Sp02)

For Circulation ( C )

• Systolic Blood pressure
• Heart rate

For Disability (D)

• Level of consciousness

For Exposure (E)

• Temperature.

The total NEWs score generated from the physiological parameters prompts specific actions:

• Frequency of monitoring 
• Urgent clinical review (escalation)
• Competencies of responding to clinical teams.#
• For each physiological parameter a normal healthy range is defined.
• Measured valves outside of this range are allocated a score that is weighted and colour coded.
• The size of the score gives an indication of how abnormal the parameter is and reflects the severity of physiological disturbance.
• The individual scores are added together.
• The total score indicates the level of clinical risk (also colour coded)

The following are the clinical responses to the NEWs 2 triggers and thresholds.

• If the score is = 0, minimum 12 hours, the clinical response to continue routine  monitor.
• If scoring = 1 – 4, monitor minimum 4 -6 hours, the clinical response to inform the RN, who must assess the patient.
• In scoring 3 in a single parameter, 1 hourly, the clinical response, Rn to inform the medical team caring for the patient.
• If scoring 5 or more urgent response thresholds, minimum 1 hour, the clinical response, the RN immediately informs the medical team caring for the patient.

The RN to request urgent assessment by the clinician or team with core competence with the care of acutely ill patients.

• If scoring 7 or more, RN immediately informs the team caring for the patient, this should be at least a specialist registrar level. Clinical care in an environment with a monitoring facility.

We looked at blood pressure interpretation and they are as follows:

• Blood pressure is the force or pressure that the blood exerts on the walls of the vessels.
• The systolic Blood Pressure (SBP) this represents the peak pressure generated by the left ventricular contraction
• Diastolic Blood Pressure (DBP) represents the degree of contraction within the vascular system. This fluctuates less than systolic pressure.

Hypertension is a high blood pressure caused by:

• Pain, stress
• Significant risk factor for cardiovascular disease
• Major cause of stroke
• Can indicate renal disease or tumour of adrenal medulla.

Hypotension is a low blood pressure that indicates circulatory compromise or heart failure.

• Sepsis
• Hypovolaemia
• Cardiac failure (pump problem)
• Cardiac arrhythmia
• CNS depression

Pulse pressure (PP) – the difference between systolic and diastolic pressure indicating vascular tone.

• Narrow pulse pressure (<30mmHg) = vasoconstriction.
• Wide pulse pressure (> 50mmHg) = vasodilation.

Mean Arterial Pressure (MAP) this represents the average pressure on blood vessel walls throughout the cardiac cycle.

• Should be above 65mmHg – 70mmHg to maintain perfusion to organs.

Pulse interpretation is as follows: 

Bradycardia (low heart rate):

• Physical conditioning (athletes)
• Medications
• Heart block
• Hypothermia (low temperature)
• CNS depression

Tachycardia (high heart rate)

• Sepsis
• Hypovolaemia
• Pyrexia
• Cardiac failure
• full/bounding (vasodilation).

Consciousness represents the brain’s overall level of function. impaire d consciousness indicates:

• Serious brain dysfunction- head injury, CVA, drugs-opiates
• Severe systemic disease and loss of homeostatic protections( hypoxia, hypercapnia, hypo/hyperglycemia, uraemia, hypovolaemia, cardiac arrhythmia, peri/cardiac arrest)

Note – patients assessed as ‘P’ or ‘U’ are at risk of airway compromise.

Patient assessed as ‘C’ – new onset confusion is a worrying sign – could indicate sepsis.

Patient refusing observation – acute confusion is a sign of deterioration with the following:

• Explore – the reasons for refusal
• Explain – dangers of not having observations performed.
• Eye -ball – non contact physical health observation (NCObs) including Respiratory rate and A-E.
• Escalate – to the medical team and consider Critical Care Outreach Team (CCOT).

The following are the underlying principles:

• To use the Airway, Breathing, Circulation, Exposure (ABCDE) approach to assess and treat the patient.
• To do a complete initial assessment and re-assess regularly.
• To treat life-threatening problems before moving to the next assessment.
• Assess the effects of treatment.
• Recognise when you will need extra help. Call for appropriate help early.
• To use all members of the team. This enables interventions (eg, assessment, attaching monitors, intravenous access) to be undertaken simultaneously.
• Communicate effectively – use the situation, Background, Assessment, Recommendation (SBAR).

                                                   KSBs ADDRESSED

                                                    KNOWLEDGE

K1: Understand the Code: Professional standards of practice and behaviour for nurses, midwives and nursing associates (NMC, 2018), and how to fulfil all registration requirements.

K4: Understand the principles of research and how research findings are used to inform evidence-based practice.

K6: Understand and apply relevant legal, regulatory and governance requirements, policies, and ethical frameworks, including any mandatory reporting duties, to all areas of practice.

K8: Understand how discriminatory behaviour is exhibited. 

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 

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.

K25: Know how to deliver sensitive and compassionate end of life care to support people to plan for their end of life. 

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. 

K32: Understand what constitutes a near miss, a serious adverse event, a critical incident and a major incident.

K35: Understand own role and the roles of all other staff at different levels of experience and seniority in the event of a major incident.

K36: Understand the roles of the different providers of health and care. 

K37: Understand the challenges of providing safe nursing care for people with complex co-morbidities and complex care needs. 

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.

K43: Understand the influence of policy and political drivers that impact health and care provision Skills. 

                                             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. 

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.

S30: Recognise when a person’s condition has improved or deteriorated by undertaking health monitoring, interpreting, promptly responding, sharing findings and escalating as needed.

S38: Prioritise and manage own workload, and recognise where elements of care can safely be delegated to other colleagues, carers and family members.

                                       BEHAVIOURS

B1: Treat people with dignity, respecting an 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.

UNDERSTANDING  COMPLEX CARE NEEDS 

COMPLEX ENDOCRINE CONDITIONS LIVING WITH DM      10/05/2024.

The lesson started with an introduction of the module learning outcomes, followed by the learning outcomes, the aims and objectives of the module. An introduction of the topic was also done. The gastrointestinal tract (GIT).

• The GIT is basically one long muscular tube from mouth to anus.
• The digestive system breaks down food and drink through the process of digestion into nutrients, specifically carbohydrates, proteins and fats.
• These nutrients are absorbed  into the bloodstream and transported to cells throughout the body.
• Once in the cells they provide fuel for cell function and the building blocks required for cell growth and repair.

The digestive system starts from the mouth through the following parts:

• Oropharynx
• Stomach
• Small intestine (duodenum, jejunum and the ileum)
• Large intestine (caecum, colon ascending, transverse, descending, sigmoid)
• Rectum & the 
• Anus 

The walls of the GIT is made up the following:

• The mucosa (innermost layer)
• Sub-mucosa (outside the mucosa)
• Serosa (outermost layer)

The process of digestion is as follows: 

• An enzymatic process which converts complex foodstuffs into smaller absorbable units.
• The primary process used is hydrolysis (breakdown by addition of water)
• Some components such as water, mineral salts, vitamins and glucose are already in a suitable form for absorption.

There are basically three forms of food molecules, and they are as follows:

• Carbohydrates. (simple sugar and starch)
• Proteins ( dietary protein is required to supply the amino acids for formation of body protein, any surplus is used as a source of heat and energy).
• fats.( the main useful components of ingested fats are the triglycerides or triacylglycerols, because fats are not soluble in water, digestion of fats is complicated, detergents produced in the liver – the bile salts – emulsify the fat and render it susceptible to the action of lipases secreted by the pancreas which hydrolyse it to form monoglycerides and free fatty acids.

We looked at Diabetes Management (DM), ia a condition in which the body does not produce enough insulin, and / or the body does not properly respond to insulin. Insulin is a hormone produced in the pancreas. Insulin enables cell to absorb glucose in order to turn it into energy.

The role of insulin required for transport of glucose into : muscle, adipose, liver. The absence of insulin can lead to: glucose accumulates in the blood use amino acids for gluconeogenesis, converts fatty acids into ketone bodies ;like acetone, acetoacetate, beta hydroxybutyrate.

The following are the complications of DM:

• Hypoglycaemia
• Hyperglycaemia
• Ketosis
• Acidosis
• DKA (hyper + ketosis + acidosis)
• HHS

DKA is a state of absolute or relative insulin deficiency aggravated by ensuring hyperglycaemia, dehydration, and acidosis-producing derangements in intermediary metabolism, including production of serum acetone.

Hyperosmolar hyperglycemic state (HHS) is an acute metabolic complication of DM characterised by impaired mental status and elevated plasma osmolality in a patient with hyperglycemia. 

• Occurs predominantly in type 2 DM ( a few reports of cases in type 1 Dm)
• The presenting symptom for 30-40% of type 2 DM
• Not commonly associated with ketonuria and acidosis.

DM is classified based on the severity of the acidosis.

• Mild:  PH less than 7.3 and /or HCO3<15 mmol/L
• Moderate : PH less than 7.2 and /or HCO3<10 mmol/L
• Severe : PH <7.1 and/ or HCO3<10 mmol/L

The following are people at risk of diabetes:

• Age <12
• Those with low socioeconomic status.
• People with poor access to medical care.
• Stress (increased ketotic metabolism).
• Glucocorticoids, atypical antipsychotics, diazoxide, and some immunosuppressive drugs.

A question: why ketone? This is because:

• No carbohydrate intake  (fasting, gastroenteritis, Atkins diet, neonate fed -fat milk)
• Prolonged exercise, pregnancy.
• Lack of insulin activity (onset of DM, interruption of insulin delivery in patients with established DM).
• Increased in insulin resistance (infection, surgery, stress, illness)

The following are the signs and symptoms of hyperglycemia, ketosis and acidosis:

• Deep rapid breathing.
• Fruity breath odour.
• Dry mouth.
• Nausea and vomiting.
• Lethargy.
• Drowsiness.
• Thirst
• Tachycardia/shortness of breath
• hypotension/dehydration

In preventing DM, consider the following:

• Diabetic education.
• BM monitoring.
• Easily digestible liquid diet when sick.
• Supplement short acting insulin.
• Reducing , rather than eliminating, insulin when patients are not eating.
• Guidelines for when patients should seek medical attention.
• Case monitoring of high risk patients.
• Special education on patients on pump Mx

                                              KSB ADDRESSED.

                                               KNOWLEDGE

K1: Understand the Code: Professional standards of practice and behaviour for nurses, midwives and nursing associates (NMC, 2018), and how to fulfil all registration requirements.

K4: Understand the principles of research and how research findings are used to inform evidence-based practice .

K6: Understand and apply relevant legal, regulatory and governance requirements, policies, and ethical frameworks, including any mandatory reporting duties, to all areas of practice. 

K8: Understand how discriminatory behaviour is exhibited. 

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. 

K25: Know how to deliver sensitive and compassionate end of life care to support people to plan for their end of life. 

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. 

K30: Understand the principles of health and safety legislation and regulations and maintain safe work and care environments.

K36: Understand the roles of the different providers of health and care.

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. 

K43: Understand the influence of policy and political drivers that impact health and care provision Skills.

                                             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.

S13: Apply the aims and principles of health promotion, protection and improvement and the prevention of ill health when engaging with people. 

S14: Promote preventive health behaviours and provide information to support people to make informed choices to improve their mental, physical, behavioural health and wellbeing.

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. 

S30: Recognise when a person’s condition has improved or deteriorated by undertaking health monitoring, interpreting, promptly responding, sharing findings and escalating as needed.

S38: Prioritise and manage own workload, and recognise where elements of care can safely be delegated to other colleagues, carers and family members.

                                    BEHAVIOURS

B1: Treat people with dignity, respecting an 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.

LONG TERM/COMPLEX CONDITIONS (LTC)                      11/04/2024

The learning outcomes and the learning objectives were discussed. A question, what is long term condition was asked. These are conditions or chronic diseases are conditions for which there is currently no cure, and which are managed with drugs and other treatment.

It was said that these LTC are more prevalent in older people and in more deprived groups. 

The NHS long term plan for LTC 2019 is as follows:

• More people are living with cancer or dementia largely due to increase in life expectancy and falls in the rate of premature death.
• The United Kingdom mortality rate from heart and circulatory diseases has declined by more than three quarters in the last 40 years.
• Mental health, respiration and musculoskeletal conditions are responsible for a substantial amount of poor health.

The following are the LTC we have heard of:

• Asthma
• Cancer
• CKD
• COPD/Pulmonary fibrosis
• Diabetes
• Coronary heart disease
• Hypertension
• Heart failure 
• Dementia
• Depression
• crohn’s / ulcerative colitis
• Epilepsy
• Hypothyroidism
• Stroke
• Multiple sclerosis(MS)
• Parkinson’s disease
• Motor Neurone disease (MND)
• Chronic fatigue syndrome
• Arthritis.

The  following are the increase risk of LTCs:

• Genetics
• Lifestyle choices( smoking, diet, alcohol,recreational drugs taking, lack of exercise)
• Socioeconomics status (class)
• Obesity
• Stress
• Environmental factors -triggers.

The following can be the impact of living with LTCs:

For the physical;

• Mobility – independence
• Personal care/hygiene
• nausea/vomiting
• Pain
• Bowel disturbance
• Sleeping
• Breathing
• eating/diet restrictions
• Hair loss/amputation
• Acutely unwell episodes (hospitalisation).

With regards the psychosocial aspect:

• Financial 
• stress/anxiety/depression
• Employment/study
• Body image
• Role model within family
• Relationships
• Social life/sports
• Sexuality
• Grief

We looked at assessment as the process that identifies and defines the service user’s problems.

• Evaluates the service user’s wishes, mental, physical, social, cultural, spiritual and personal needs.
• Finding out what the service user’s can or cannot do.
• A multi-stage procedure.
• True likeness of the service user as an individual, highlighting their needs( present and near future) and the resources that they have  available to them.

The reason why assessment is important, failure to recognise and respond to an individual’s needs can result in them not being met and in a failure of care.

The following are the reasons assessment can be complex in service user’s with LTCs:

• Multiple LTCs.
• Symptoms may change over time.
• Often experience more than one symptoms
• May be taking multiple medications
• Complex need.
• Holistic assessment.
• Person-centred care.

In assessing people with LTCs, these are the assessment tools used:

• APIE
• ADPIE
  ASPIE.

The following are the skills required for assessment:

• Interviewing
• Observation
• Taking measurements.
• Review documents.
• Communication
• Listening.

In assessing  for service user’s with LTCs, the following should be considered:

• Understand the pathophysiology of the condition.
• Services for people with LTCs must take into account the emotional and psychological impact of being diagnosed or living with a LTCs.
• For many their condition will be relatively stable over a period of time with only irregular flare-ups.
• For people with more complex needs or with more than one LTC, their situation may be less stable and as a result more intensive or ongoing periods of care and support will be required.
• Integrated working.
• Consider the needs of carers/family members.

People with LTCs may need the following in their care:

• They may want to be involved in decisions about their care – they want to be listened to.
• They want access to their information to help them make those decisions.
• They want support to understand their condition and confidence to manage –  support to self care.
• They want to be joined up, seamless services.
• They want proactive care.
• They do not want to be in hospital unless it is absolutely necessary and then only as part of a planned approach.
• They want to be treated as a whole person and for the NHS to act as one team. (King’s Fund, 2014).

The following are the models of nursing:

• Give direction to the nurse when assessing the needs of the service user.
• There are many models which are selected for their appropriateness to the care setting and service user.
• Help to add consistency and continuity to person-centred care, because everyone will be working the same underpinning philosophy.
• Provide a framework to direct practitioners in their assessment and care- planning process.

The RLT model stresses the importance of cultural, environmental and economic factors affecting both health and well-being and encourages a nursing role in preventing, alleviating or coping with illness.

The important ideas that can be found within the model are:

• Individuality
• The activities of living
• A dependence – independence continuum
• The progression of a person along a life-span
• Influencing factors

                                    KSBs ADDRESSED.

                                                              KNOWLEDGE  

K1: Understand the Code: Professional standards of practice and behaviour for nurses, midwives and nursing associates (NMC, 2018), and how to fulfil all registration requirements. 

K4: Understand the principles of research and how research findings are used to inform evidence-based practice 

K6: Understand and apply relevant legal, regulatory and governance requirements, policies, and ethical frameworks, including any mandatory reporting duties, to all areas of practice.

K8: Understand how discriminatory behaviour is exhibited 

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 

K25: Know how to deliver sensitive and compassionate end of life care to support people to plan for their end of life 

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 

K36: Understand the roles of the different providers of health and care 

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 

K43: Understand the influence of policy and political drivers that impact health and care provision Skills 

                                             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 

S13: Apply the aims and principles of health promotion, protection and improvement and the prevention of ill health when engaging with people 

S14: Promote preventive health behaviours and provide information to support people to make informed choices to improve their mental, physical, behavioural health and well being 

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 

S30: Recognise when a person’s condition has improved or deteriorated by undertaking health monitoring, interpreting, promptly responding, sharing findings and escalating as needed 

S38: Prioritise and manage own workload, and recognise where elements of care can safely be delegated to other colleagues, carers and family members 

                                          BEHAVIOURS

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

PRE & POST OPERATIVE CARE.

LEARNING LOG                                                  12/07/24

The lesson started with an introduction of the module, followed by the learning outcomes, its aims and objectives. There were questions asked in class, regarding the tools used to identify a sick person and why? What are some of the challenges when assessing a patient using A – E framework?

The question regarding the challenges when assessing a patient using A- E. the following are some thing we identify in class. 

• Learning disability
• Language barrier
• Mental health.

In the pre-operative care, we look at the airway. It is a comprehensive evaluation that looks for upper airway pathologies or anatomical anomalies. We consider the mouth opening, dentition, thyromental distance and neck circumference etc. LEMON is an acronyms use by anaesthetics to assess before operation.

For breathing, –

• Obstructive Sleep Apnea (OSA), 
• Any previous history
• Any respiratory diagnosis
• Recent chest infections
• Immunisation history
• Chest x-ray to name but a few.

For circulation –

• We look for any infection risk.
• Ask about drug history(anticoagulants, insulin)
• Any cardiac history including cardiac surgeries
• Pacemaker, ICD.
• Chest x-ray, ECG, and routine blood tests.
• Surgical site prep.

The post- operative nausea and vomiting (PONV), we look for 

• History of PONV
• History of motion sickness
• Age 
• Sex
• Non-smoker
• Post op opioids(side effects)

With regards the post operative care , we continue monitoring :

• Airway
• Breathing
• Circulation
• Disability
• Medications

Postoperative nausea and vomiting:

• Nauseous or nauseated.

For the anaesthesia related causes:

• Opioids
• Nitrous oxide
• Duration of anaesthesia
• Induction drugs eg propofol

The following are the common complications:

• Infection
• GI complications
• Respiratory complications
• Renal
• CVS(cardiovascular)
• Neuro
• haematological(bleeding, clotting)
• Others (wound dehiscence eg open wound)

With regards the missed opportunities:

• Poor monitoring of vital signs
• ABC not recognised
• Not acting on clear documentation
• Failure to use systematic approach
• Poor team work and communication
• Late referrals.

                                    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 

K4: Understand the principles of research and how research findings are used to inform evidence-based practice 

K6: Understand and apply relevant legal, regulatory and governance requirements, policies, and ethical frameworks, including any mandatory reporting duties, to all areas of practice 

K8: Understand how discriminatory behaviour is exhibited 

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 

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 

K25: Know how to deliver sensitive and compassionate end of life care to support people to plan for their end of life 

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 

K32: Understand what constitutes a near miss, a serious adverse event, a critical incident and a major incident 

K35: Understand own role and the roles of all other staff at different levels of experience and seniority in the event of a major incident 

K36: Understand the roles of the different providers of health and care 

K37: Understand the challenges of providing safe nursing care for people with complex co-morbidities and complex care needs 

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 

K43: Understand the influence of policy and political drivers that impact health and care provision Skills 

                                                          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 

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 

S30: Recognise when a person’s condition has improved or deteriorated by undertaking health monitoring, interpreting, promptly responding, sharing findings and escalating as needed 

S38: Prioritise and manage own workload, and recognise where elements of care can safely be delegated to other colleagues, carers and family members 

                                                  BEHAVIOURS

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

LEARNING LOG          19/07/2024.

CARDIAC MONITORING  &  ELECTROCARDIOGRAM (ECG).

The lesson started with an introduction of the topic, the lesson outcome. The aims and objectives of the lesson were also discussed.  

Cardiac monitoring is a system that allows healthcare professionals to continuously monitor a patient’s heart activity to assess their condition.

An ECG is a non-invasive test that records the electrical activity of the heart, including its rate and rhythm. 

The following are the reason for an ECG:

•  To detect any abnormality of the heart.
• The heart rhythm or conduction problems.
• Damage to the heart muscle caused by heart attack. 
• Enlarged heart.
• Heart inflammation.
• Imbalance of blood chemicals
• Effects of some medication on the heart.

When the cell is not active, it is negatively charged. And when positively charged, it is called DIPOLARISE.

REPOLARISE it returning to its normal state (relaxation).

I learnt some of the limitations of ECG: 

• The normal ECG does not rule out a problem with the heart.
• Not all heart attacks can be picked up by ECG.
• Not all angina attacks can be picked up by an ECG.
• Individuals with heart rhythm that is not stable, this is not picked up by the ECG.

There are six(6) methods for ECG interpretation:

• What is the heart rate?

Normal rate = 60 – 100 bpm

Bradycardia (too slow) = <60 bpm

Tachycardia (too fast) = > 100 bpm

• Is the rhythm regular or irregular?

R-R interval is constant 

• Is there ventricular activity?

QRS waves present

• Are the QRS narrow or broad?

If the QRS is narrow the impulse has originated from the atria (which is where it should come from).

If the QRS is broad, there is a delay in the conduction system and the impulse may have originated from the ventricles (which isn’t where it should come from).

• What is the relationship between the P waves(atrial activity) and the QRS complexes (ventricular activity)?

One P wave for each QRS complex

Is the PR interval too short, too long or just right?(too short means that the impulses has originated from the wrong place – either AV node / accessory pathway, too long means that there is a delay in conduction – heart block).

The rate determinant, six (6) second method (30 boxes)

• The ECG paper is marked at 3 seconds intervals (15 large boxes).
• Count the R waves in 6 seconds (30 large boxes), 3 seconds intervals.
• Multiply the number of complexes by 10 to determine the rate (in this example 7 * 10 =70)

                           KSB ADDRESSED.

                          KNOWLEDGE:

K1: Understand the Code: Professional standards of practice and behaviour for nurses, midwives and nursing associates (NMC, 2018), and how to fulfil all registration requirements. 

K2: Understand the demands of professional practice and demonstrate how to recognise signs of vulnerability in themselves or their colleagues and the action required to minimise risks to health.

K4: Understand the principles of research and how research findings are used to inform evidence-based practice.

K5: Understand the meaning of resilience and emotional intelligence, and their influence on an individual’s ability to provide 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.

K8: Understand how discriminatory behaviour is exhibited. 

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. 

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.

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. 

K25: Know how to deliver sensitive and compassionate end of life care to support people to plan for their end of life. 

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. 

K31: Understand how inadequate staffing levels impact on the ability to provide safe care and escalate concerns appropriately. 

K32: Understand what constitutes a near miss, a serious adverse event, a critical incident and a major incident. 

K33: Understand when to seek appropriate advice to manage a risk and avoid compromising quality of care and health outcomes. 

K34: Know and understand strategies to develop resilience in self and know how to seek support to help deal with uncertain situations. 

K35: Understand own role and the roles of all other staff at different levels of experience and seniority in the event of a major incident. 

K36: Understand the roles of the different providers of health and care. 

K37: Understand the challenges of providing safe nursing care for people with complex co-morbidities and complex care needs. 

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.

                                                           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. 

S11: Report any situations, behaviours or errors that could result in poor care outcomes. 

S12: Challenge or report discriminatory behaviour. 

S13: Apply the aims and principles of health promotion, protection and improvement and the prevention of ill health when engaging with people. 

S14: Promote preventive health behaviours and provide information to support people to make informed choices to improve their mental, physical, behavioural health and wellbeing. 

S15: Identify people who are eligible for health screening. 

S16: Promote health and prevent ill health by understanding the evidence base for immunisation, vaccination and herd immunity. 

S17: Protect health through understanding and applying the principles of infection prevention and control, including communicable disease surveillance and antimicrobial stewardship and resistance. 

S18: Apply knowledge, communication and relationship management skills required to provide people, families and carers with accurate information that meets their needs before, during and after a range of interventions. 

S19: Recognise when capacity has changed recognise and how a person’s capacity affects their ability to make decisions about their own care and to give or withhold consent. 

S20: Recognise people at risk of abuse, self-harm and/or suicidal ideation and the situations that may put them and others at risk. 

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. 

S42: Support, supervise and act as a role model to nursing associate students, health care support workers and those new to care roles, review the quality of the care they provide, promote reflection and provide constructive feedback. 

S43: Contribute to team reflection activities to promote improvements in practice and services.

                            BEHAVIOURS:

B1: Treat people with dignity, respecting an 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.

LEARNING LOG                        12/07/2024

UNDERSTANDING PEOPLE STRUGGLING WITH MENTAL HEALTH.

The lesson started with an introduction to the topic. The lesson’s outcome, aims and objects were also discussed. 

We looked at:

•  managing or assessing people with mental health. 
• The tools in assessing people with mental health.
• Causes/ understanding 
• remedies/ treatment
• How mental health services are structured.

We also noted that people with mental health crisis are: 

• Uncomfortable
• Confused
• stressed/distressed
•  Worried
• Isolated / alone
• Upset / low
• powerless
• Frustrated
• Withdrawn

I also noted that people working with mental health patients are also:

• Worried
• Terrified
• Unsure
• Concerned
• Empathy
• Supported.

We looked at the stress vulnerability model, stress vulnerability model is the tool professionals used to explain the causes of psychosis. Stress vulnerability has been instrumental in helping us better understand psychiatric ailment, it hasn’t been without crisis.

The stress bucket was created to help people measure their stress tolerance.

A group work was done in class and to present in class.

The topics to present on were:

1. Bipolar disorder.
2. Depression.

• identify the condition 
• Behaviour
• Thoughts , speech
• Treatment options

My group was to present on bipolar disorder.

The condition according to (NHS,UK,2023) is a mental health condition that affects your moods, which can swing from one extreme to the other known also as manic depression.

(mental health foundation, 2023) states that bipolar disorder is:

• full of energy
• Self important(have a lots of ideas and plans)
• No desire to sleep
• Make decisions or say things out of character, risky or harmful.
• Changes in mood or emotions 
• Elevated or extreme change.

The Behaviour of bipolar patients are listed below:

• (NHS, 2023) feeling sad
• (mind,2022) not doing things they normally enjoy
• Misuse of drugs
• withdrawn/ avoid social 
• Difficulty in concentrating and remembering things.

The other group presented on depression. (WHO,2024)They defined depression as a condition that can happen to anyone. It is characterised by low mood, loss of pleasure or interest in active ties for a prolonged period of time.]

They discussed the signs and symptoms

 (NIH,2024) A person with depression can experience:

• Feeling of hopelessness, pessimism
• Persistent sadness, anxious or empty mood.
• Feeling of guilt worthlessness, helplessness
• Loss of interest in activities
• Difficulty in sleeping, thoughts of suicide and death.

Treatment options(NHS,2024) are:

• Psychotherapist
• Counselling
• Medication

                                   KSB ADDRESSED.

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 

K2: Understand the demands of professional practice and demonstrate how to recognise signs of vulnerability in themselves or their colleagues and the action required to minimise risks to health 

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 

K4: Understand the principles of research and how research findings are used to inform evidence-based practice 

K5: Understand the meaning of resilience and emotional intelligence, and their influence on an individual’s ability to provide 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 

K8: Understand how discriminatory behaviour is exhibited 

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 

K25: Know how to deliver sensitive and compassionate end of life care to support people to plan for their end of life 

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 

K31: Understand how inadequate staffing levels impact on the ability to provide safe care and escalate concerns appropriately 

K32: Understand what constitutes a near miss, a serious adverse event, a critical incident and a major incident 

K33: Understand when to seek appropriate advice to manage a risk and avoid compromising quality of care and health outcomes 

K34: Know and understand strategies to develop resilience in self and know how to seek support to help deal with uncertain situations 

K35: Understand own role and the roles of all other staff at different levels of experience and seniority in the event of a major incident 

K36: Understand the roles of the different providers of health and care 

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 

S11: Report any situations, behaviours or errors that could result in poor care outcomes 

S12: Challenge or report discriminatory behaviour 

S13: Apply the aims and principles of health promotion, protection and improvement and the prevention of ill health when engaging with people 

S14: Promote preventive health behaviours and provide information to support people to make informed choices to improve their mental, physical, behavioural health and wellbeing 

S15: Identify people who are eligible for health screening 

S16: Promote health and prevent ill health by understanding the evidence base for immunisation, vaccination and herd immunity 

S17: Protect health through understanding and applying the principles of infection prevention and control, including communicable disease surveillance and antimicrobial stewardship and resistance 

S18: Apply knowledge, communication and relationship management skills required to provide people, families and carers with accurate information that meets their needs before, during and after a range of interventions 

S19: Recognise when capacity has changed recognise and how a person’s capacity affects their ability to make decisions about their own care and to give or withhold consent 

S20: Recognise people at risk of abuse, self-harm and/or suicidal ideation and the situations that may put them and others at risk 

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 

S42: Support, supervise and act as a role model to nursing associate students, health care support workers and those new to care roles, review the quality of the care they provide, promoting reflection and providing constructive feedback 

S43: Contribute to team reflection activities to promote improvements in practice and services 

S44: Access, input, and apply information and data using a range of methods including digital technologies, and share appropriately within interdisciplinary teams  

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

LEARNING LOG                                          17/05/2024

PAEDIATRIC EMERGENCIES  (ASSESSING CHILDREN AND YOUNG PEOPLE) 

The lesson started with an introduction of the module, followed by the learning outcomes, with the lesson’s aims and objectives.

We looked at the paediatric (paeds) assessment ranging from newborn to teenagers, (birth to 19 years). Paeds initial assessment can be done or carried out before touching the patient. Visual clues can be done to determine if the child is sick or not.

With regards the appearance, the muscle tone, interaction with the environment, alertness, eye contact, consolability.

There are different types of assessment : 

• Clinical assessment – A-E
• Social / emotional assessment
• Physical assessment  
• Environmental assessment
• Family assessment 

Ensure you look at the present(reason for attending)  and past history. 

• The reason for attending 
• The health concerns
• Symptoms
• Pain.

For the past history:

• The relevant to take birth history 
• Previous illness
• Family history

Also consider the –

• age, 
• sex, 
• religion, 
• language. 

• Parental responsibility
• immunisation(are they up to date)
• Medication
• Any allergies

With regards family history,

• employed/ financially stable
• Where do they live
• parents/ sibling(any concerns)
• school/nursery
• Any other healthcare professional, social worker
• Any parental concerns.

I learnt that in using the Paediatric Early Warning Sign (PEWS) form, always ensure or consider the Drs/Nurse/Patient concerns. The respiratory rate, and the heart rate. And be mindful of the acronyms wet flag, (weight, energy, tube, fluids, lorazepam, adrenaline and glucose). 

The following are the signs and symptoms of allergies:

• Itching
• Urticaria 
• Angioedema,
• Washing,
• Coughing
• Dyspnoea
• Stridor
• Hypotension
• Nausea
• Vomiting
• Tachycardia.

The treatment is ABC, 

Oxygen/ventilation,

 inhaler to name but a few.

With regards foreign bodies choking, the signs and symptoms are as follows;

• Difficulty in breathing, speaking, or coughing.
• A red puffy face
• Signs of distress, they may point to their throat or grasp their neck.

The treatment includes:

• Cough out- encourage them to cough and remove any obvious obstructive from their mouth
• Slap it out- if coughing fails to work
• Call 999

Shock – is the failure of circulation of oxygen to tissues resulting in lactic acidosis.

The following are the types of shock:

• Hypovolemic – this is due to loss of blood or fluid
• Distributive(septic) – maldistribution of blood.
• Obstructive – reduce to vascular size and limit the blood flow.
• Anaphylactic – shock due to allergies.
• Cardiogenic – primary heat problems.

Seizures – seizure is a sudden, uncontrolled burst of electrical activity in the brain that temporarily affects the consciousness.

Febrile convulsion – children cannot maintain their temperature due to underlying conditions.

NOTE- document everything that you see, do not rely on their parents. 

The signs and symptoms are as follows:

• Altered mental status,
• Nystagmus
• Convulsion
• Secondary trauma. 

The treatments are as follows:

• Oxygen therapy
• Monitor glucose
• Vital signs
• Iv acess
• Administrator benzodiazepines
• Administer midazolam / diazepam
• Suction if necessary
• Recovery position.

Cardiac arrest – this is when the heart stops beating suddenly. The lack of blood flow to the brain to other organs can cause a person to lose consciousness, become disabled, or die, if not treated immediately. Therefore it is a medical emergency.

The signs and symptoms of cardiac arrest are as follows:

• Sudden collapse
• No pulse
• No breathing
• Loss of consciousness

Sometimes other symptoms occur before a sudden cardiac arrest:

• Chest discomfort
• Shortness of breath
• Weakness to name but a few.

                     KSB ADDRESSED.

K1: Understand the Code: Professional standards of practice and behaviour for nurses, midwives and nursing associates (NMC, 2018), and how to fulfil all registration requirements. 

K4: Understand the principles of research and how research findings are used to inform evidence-based practice.

K6: Understand and apply relevant legal, regulatory and governance requirements, policies, and ethical frameworks, including any mandatory reporting duties, to all areas of practice. 

K8: Understand how discriminatory behaviour is exhibited. 

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. 

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. 

K25: Know how to deliver sensitive and compassionate end of life care to support people to plan for their end of life..

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.

K32: Understand what constitutes a near miss, a serious adverse event, a critical incident and a major incident.

K35: Understand own role and the roles of all other staff at different levels of experience and seniority in the event of a major incident. 

K36: Understand the roles of the different providers of health and care. 

K37: Understand the challenges of providing safe nursing care for people with complex co-morbidities and complex care needs. 

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.

K43: Understand the influence of policy and political drivers that impact health and care provision Skills.

                                                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.

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. 

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 your own workload, and recognise where elements of care can safely be delegated to other colleagues, carers and family members.

                                             BEHAVIOURS

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

     LEARNING LOG         19/04/2024

 RENAL PATIENTS.                

The lesson started with an introduction of the module with the learning objectives.  We looked at the anatomy and physiology of the renal system. I learnt that all the oxygenated bloods are connected to the Venal Cavity.  

The right artery carries oxygenated blood to the kidney, while the right ventricle carries blood to the heart and  the kidney is situated between T12 and L 3.

The following are the functions of the kidney:

• To eliminate waste and excess fluid.
• For reabsorption
• To control BP
• To maintain haemoglobin (low HB)
• Signals to produce red blood cells.

We say the nephron is the functional unit of the kidney. The function of the nephron is as follows:

• Glomerular Filtration Rate (GFR) 

Normal = 90 – 120

            Abnormal = 15 – 30

            Early abnormality = 60 – 90

• Tubular Reabsorption
• Tubular Secretion.

I learnt that crantin is the main blood test carried out to prove the weakness of the kidney.

Acute kidney injury (AKI) is an abrupt disease in the kidney function that compromises  both injury (structural damage) and impairment (loss of function).

AKI is often a complication of another illness (10 – 15% of hospital admission).

Deterioration in renal function leads to the accumulation of waste products on the body.

This can lead to permanent injury to kidneys and sometimes DEATH.( 25 – 30% impatient mortality rate).

I learnt that patients with renal failure should not take anything with potassium (banana, spinach, avocado to name but a few). Medications like spironolactone, furosemide to name but a few. Meds to reduce potassium levels are insulin, sodium sulphate, salbutamol……

             These are some of the causes of AKI, and there are three different groups namely:

• Pre-renal – inadequate perfusion. Not enough blood at sufficient pressure to allow filtering.
• Renal – Cellular damage/intrinsic. Damage to the cells that make filtering mechanism possible
• Post -renal- obstruction. Urine unable to drain adequately-system back up.

                                                                 KSB ADDRESSED.

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 

K4: Understand the principles of research and how research findings are used to inform evidence-based practice 

K6: Understand and apply relevant legal, regulatory and governance requirements, policies, and ethical frameworks, including any mandatory reporting duties, to all areas of practice 

K8: Understand how discriminatory behaviour is exhibited 

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 

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 

K25: Know how to deliver sensitive and compassionate end of life care to support people to plan for their end of life 

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 

K32: Understand what constitutes a near miss, a serious adverse event, a critical incident and a major incident.

K35: Understand own role and the roles of all other staff at different levels of experience and seniority in the event of a major incident. 

K36: Understand the roles of the different providers of health and care.

K37: Understand the challenges of providing safe nursing care for people with complex co-morbidities and complex care needs. 

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. 

K43: Understand the influence of policy and political drivers that impact health and care provision Skills.

                                                  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.

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. 

S30: Recognise when a person’s condition has improved or deteriorated by undertaking health monitoring, interpreting, promptly responding, sharing findings and escalating as needed.

S38: Prioritise and manage own workload, and recognise where elements of care can safely be delegated to other colleagues, carers and family members.

                                                    BEHAVIOURS.

B1: Treat people with dignity, respecting an 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.