B26 STUDENT INFORMATION AND LEARING OPPORTUNITIES PACK

Your mentor is ……………………………… Your Associate mentor is……………………………

THE RENAL WARD B26

Welcome to the Renal ward B26 we are an inpatient area for people with long-term renal problems and acute episodes of renal failure.It is a 23-bed ward with an acute dialysis bay.The ward is divided into two teams. We use the Named Nurse and Team Nursing concepts together

Patients are admitted to the ward for various reasons; those with long-term renal problems include admission for dialysis access or current access problems and infection. Patients are admitted for renal investigations and biopsies, via Gp, s when blood results come back abnormal.Patients admitted with acute renal failure are often severely unwell therefore require urgent specialist care.

On the ward we provide a wide variety of care and treatments.We hope you find your time with us productive and enjoyable, allowing you to gain inside knowledge into how people are looked after within our department

Who’s Who?

WARD SISTER JUNIOR SISTER MATRON

Navy Uniform. Navy Uniform White Uniform Red trim Navy trousers

STAFF NURSES PDN AUXILLARY NURSES RENAL SUPPORT

NURSES Pale Blue Uniform. White Uniform Beige Uniform. White Tunic. With navy trim White Tunic. (With Pale Blue Epaulettes) Navy trousers (With Beige Epaulettes)

STUDENT NURSES. SPRINGBOARD.

White Tunic. Pale Green Uniform Black Trousers.

DOMESTIC STAFF. PHYSIOTHERAPISTS.

Yellow Tunic/Dress. Navy Trousers. Navy Trousers/ Top White Tunic.

OCCUPATIONAL RADIOGRAPHERS WARD CLERKSTHERAPISTS.

Green Trousers Burgundy Trousers White Tunic

White Tunics. White Tunics. Black trousers

RENAL AMBULATORY CARE DEPARTMENT

The Team consists of 4 staff• Department Manager/Anaemia Specialist Nurse• CAPD Nurse• Transplant / Pre D nurse• HCA

This is a very busy Nurse led department covering various requirements and aspects of patient care. These include;

• Training patients for dialysis• Reviewing home dialysis patients• Educating patients• Preparing patients for dialysis and transplant • Clinics• Reviews from discharges and Clinics• Planned treatments/day cases• Theatre

The CAPD Nurse is a primary nurse for her caseload of patients. Her work involves training the patients to do home dialysis in various forms. This training and follow up care maybe carried out in the home, which allows a patient, centred approach to their care. The CAPD Nurse is also involved in the preparation, insertion and after care of the patient and their access. To ensure we are offering the best standard of care. The Nurse is involved in the monitoring and reviewing of standards and protocols.

The Transplant and Pre Dialysis Nurse is also the primary nurse for her caseload of patients. This role is primarily educational and offering information so as the patient can make an informed choice about their treatment and options. Communication skills are essential and the ability to deliver the information at a level and with a content that is appropriate for the patient. The Nurse is also involved in the organisation of investigations and tests required for transplant work up and dialysis. This

May involve liaison and referral with members of the multidisciplinary team in and out of the renal department.

The Role of the Renal Anaemia Nurse specialist is to work within the renal team and enhance the treatment of anaemia to achieve the British Renal standards. This requires a motivated and enthusiastic facilitator. The Nurse works under their own initiative and is able to plan their own workload. They must also have knowledge and ability to make decisions about treatment and any changes required in accordance with patient group directives.The role of the anaemia nurse is very much educational not only towards the patients and relatives but to fellow colleagues and staff. This maybe within the renal department, other areas or the community. The ability to disseminate information using various effective communication skills and recourses enables a safe and efficient practice.ROLE OF THE ANAEMIA NURSE

• Nurse led clinics working within guidelines• Intravenous iron clinics• Acts on referrals from nephrologists• Co-ordinated the prescriptions and supply of erythropoietin• Educates patients/relatives/staff/GP/ community nurses• Forwards regular audits• Liaises with company suppliers of Erythropoietin• Organises educational sessions and updates• Monitors patients practice and wellbeing

The Health care assistant works with both members of the department, she has gained extended skills and knowledge from working in the department. These skills include theatre work, clinics and venepuncture

LEARNING OPPORTUNITIES

ORGANSATIONAL AND MANAGERIAL ISSUE

LEARNING OPPORTUNTIES

RESOURCE/RELEVANT/PERSONNEL/DEPT

Managing a team: Organisational skillsDelegation skillsPrioritising skillsTime managementLeadershipOff dutyManaging patient workloadQualityStandards of careImplementing change Giving information to: StaffDoctorsPatientsRelativesMulti-disciplinary team membersOther departments

Resources: Stock controlDrugsTSSUMaterials managementNon-stockStationaryEstablishment/skill mixBudget control

Registered nurse/team leaders/manager Registered nurse/team leaders/managerRegistered nurse/team leaders/managerRegistered nurse/team leaders/managerRegistered nurse/team leaders/managerTeam leaders/managerRegistered nurse/team leaders/managerRegistered nurse/team leaders/managerRegistered nurse/team leaders/manager

Registered nurse/team leaders/managerRegistered nurse/team leaders/managerRegistered nurse/team leaders/managerRegistered nurse/team leader/managerRegistered nurse/team leaders/managerRegistered nurse/team leaders/manager

Registered nurse/team leaders/managerRegistered nurse/pharmacist storesRegistered nurse/pharmacistRegistered nurse/TSSURegistered nurse/storesRegistered nurse/storesRegistered nurse/ward clerkWard manager

Managing risk: Policies and proceduresEquipment safety checksQuality controlEnvironment checksInfection controlMoving and handlingCOSHHHealth and safety

Emergency situations Cardiac arrestViolent incidentsFirePatient fallsBed alerts

Staff development Clinical supervisionReflective practice

Ward managerRegistered nurseHealth and safety officer/electronicsHealth and safety officer and link nurseDomestic supervisorControl of infection sisterMoving and handling co-ordinatorLink nurseLink nurse

Registered nurse/arrest teamRegistered nurse/security officerRegistered nurse/fire officerRegistered nurse/health and safety officerRegistered nurse/bed manager

Registered nurse/HCARegistered nurse/HCA

LEARNING OPPORTUNITIES

PATHOPHYSIOLOGICAL PROCESS

LEARNING OPPORTUNITIES RESOURCES/RELEVANT/PERSONNEL/ DEPARTMENT

Infection:Inflammatory processSourceNatural spreadTreatment

Immunological factors:AntigensAutoantigensSuppression of the immune systemDrugs Disorders

Disturbances in electrolytes and water balance:Anatomy and physiologyNormal electrolyte balanceReading and understanding blood resultsDehydrationFluid overloadAcidosisInvestigations

Oncology:AetiologyEpidemiologyPathologyTreatmentsChemotherapy/Radiotherapy/Drugs

Registered nurse/Doctor/PharmacistBook/Articles

Registered nurse/Doctor/PharmacistBooks/Articles

Registered nurse/Doctor/Pharmacist/Renal team/DietitianBooks/Articles

Registered nurse/Pharmacist/Macmillan nurse/Hospice/Chemotherapy unit/Radiotherapy departmentBooks/Articles

Cardiovascular system:Anatomy and physiologyECGInvestigationsTreatmentsMyocardial infarctionAnginaHeart failure, CCF, LVFCardiac ArrestHypertensionCardiac ArrhythmiasDrugs

Respiratory system:Anatomy and physiologyInvestigationsInfectionTreatmentsChest infectionCOPDAsthmaEmphysemaDrugs, nebulizers, inhalers, oxygen therapy

Kidney and genitourinary system:Anatomy and physiologyInfections DrugsInvestigationsTesting urinePyelonephritisFluid BalanceGlomerulnephritisPolycystic kidney diseaseAuto immune diseaseDiabetic nephropathyRenal vascular diseaseNephrotic syndromeKidney stones/Obstructive nephropathyAcute renal failure

Disease of the Blood:Blood formation and destruction processRed blood cells

Registered Nurse/Thrombolysis nurse/Doctor/ECG department/Angiograph nurse/Heart failure nurse/Books/Articles

Registered nurse/Respiratory nurse/Doctor/Pulmonary technician/physio therapistBooks/Articles

Registered nurse/ Doctor/ Renal nurse/ incontinence nurse/Radiology/Pharmacist/Renal department/ DietitianBooks/Articles

Doctor/Registered nurses/ Anaemia nurse specialist/Haematology unit/Pathology labBooks/Articles

LEARNING OPPORTUNITIES

INTERPERSONAL SKILLS

Learning Opportunities Resources/Relevant personnel/department

Use of telephone; Answering callsMaking calls Ring backBleep system

Use of computer to obtain; Patient investigationsPatient information

Talking to;PatientsRelativesDoctorsOther nurses including specialist nursesMulti-disciplinary team referralsAncillary staffMDT meetingsDoctors ward rounds Consultant ward roundsBooking transportFacilitating investigationsNurses handoversManagerial structure in TrustTeam workingPatient transfer within TrustPatient transfer outside the Trust

Ward clerk/ward staff Ward clerk/ward staffWard manager/clinical lead

Registered /Auxiliary nurse

Doctors/Multi-disciplinary teamRegistered nurses/OT/Physio/Social worker/Specialist nursesDomesticsRegistered nursesDoctors/Registered nurses/PharmacistsWard clerks/Ambulance control/hospitalTransport DeptRegistered nurses/doctors/ward clerkRegistered nursesWard managerObservation of rolePatient/relative/registered nurse/bedManager/porter/ambulance crew

LEARNING OPPORTUNITIES .

MANAGEMENT OF CARE

Learning Opportunities Resources/Relevant Personnel/Department

Use of nursing model Philosophy of careDocumentation used

Nursing Process;AssessmentHow is assessment carried out/open or closed questions?What is assessed?Where does it take place?

PlanningCare plansRisk assessment toolsCare pathwaysMulti-disciplinary plan/workingDischarge plan

Referral to other agencies; OT PhysioSocial workerDistrict nurseDischarge liaisonSpecialist nurseCritical care outreach nurseMacmillan nurse

Implementation/Evaluation Ward roundsMDTDocumentationStandardsProtocols/Policies

Registered nurse Registered nurseRegistered nurse

Registered nursesSources of informationPatient/relatives/doctor/pharmacist/notes/district nurses/specialist nurses.

Registered nursesRegistered nurse/Link nursesRegistered nurse/specialist nurseMDTDischarge liaison nurse

Registered nurseRegistered nurse/DoctorRegistered nurseRegistered nurseRegistered nurseRegistered nurseRegistered nurseRegistered nurse

Registered nurse/DoctorRegistered nurse/General officeRegistered nurse/DoctorRegistered nurse/hospital Chaplin/priest

Communication/patients/relativesTime managementPlanning prioritiesDealing with difficult situationsDeceased patientsPatient property/ValuablesSelf dischargeReligious needs/arranging priests

LEARNING OPPORTIUNITIES

CLINICAL SKILLS

LEARNING OPPORTUNITIES

RESOURCE/ RELEVANT/PERSONNEL/DEPARTMENT

CORE SKILLS: Patient hygieneMouth careHair/nail careSkin carePressure care prevention [Braden Scale]Recording of physiological observations:Blood PressureTemp, Pulse, RespsWeightBlood GlucoseUrine OutputMaintaining accurate chartsGiving medications:OralIntravenous IntramuscularSubcutaneous RectalIntravenous infusionsCannulation/care of venflonsMedical devicesInfusion pumpsSyringe driversPhlebotomy/venepunctureAdministration of blood/blood productsAseptic techniques i.e.

Registered/HCA/occupational therapist Registered/HCARegistered/HCA/DoctorRegistered nurse/Diabetic nurse specialistRegistered /HCA

Registered nurse

Registered nurse Pharmacist/DoctorRegistered nurse

Registered nurse/Medical electronics

Registered nurse/HCA

Registered nurse/Dietitian

dressingsRisk assessmentNutritional intakeBMIFalls assessmentMoving and handlingUse of aidsHoistsI

Infection controlIsolation of patientsCatheter insertion and care Test urineCentral venous pressure linesPatient safetyChecking equipmentPreparation for investigations:ConsentInformationInvasive radiologyNon-invasive radiology

SPECIALIST SKILLSAnaemia nurseErythropoeitin s/cStorage of EPOIron infusionsMonitor bloodsFollow up appointments/clinicsVenepunctureCannulationE.C.GHaemodialysisC.AP, D/APDClinics/Pre-d/transplantation/ReviewAmbulatory care Department

Registered nurse/physiotherapist/moving and handling advisor

Registered nurse/Infection control nurseRegistered nurse/ HCA

Registered nurse

Registered nurse/physiotherapist/moving and handling advisorRegistered nurse/HCARegistered nurse/DoctorRegistered nurseRegistered nurse/radiology nurse/DoctorRegistered nurse/radiology nurse/Doctor

Registered nurseRegistered nurseRegistered nurseAuxiliary /registered nurseRegistered nurse/Doctor/Secretaries/ward clerkRegistered nurse/doctor/ HCARegistered nurseRegistered nurse/Doctor/HCA/TechnicianRegistered nurse/DARegistered nurse/patient/carerRegistered nurse/doctor/consultantRegistered nurse/HCA/doctor

WHERE ARE THE KIDNEYS

The kidneys are two bean-shaped organs about the same size as a fist. They are located near the middle of the back, one on either side of the spine.

system filters waste products out of the blood and makes urine. It is made up of the

• Kidneys • Ureters • Bladder • Prostate (in men) • Urethra

Kidneys, waste products and unneeded water are collected and turned into urineThe urine is gathered in an area called the renal pelvis at the centre of each kidney. From there it drains into the bladder down a tube called the urethra. There are two ureters – one from each kidney.Another tube called the urethra carries urine from the bladder out of the body.

Inside the kidney, the blood is filtered through very small networks of tubes called nephrons. Each kidney has about 1 million nephrons.Inside the nephrons, waste products in the blood move across from the bloodstream (the capillaries) into the urine-carrying tubes inside the nephron. These tubes are called tubules. As the blood passes through the vessels of the nephron, all unwanted waste is taken away. Any chemicals needed by the body are kept and returned to the bloodstream by the nephrons. In this way, the kidneys help to regulate the levels of chemicals in the blood such as sodium and potassium. So the right levels are maintained to keep the body healthy.

WHAT THE KIDNEYS DO?

• Fluid Balance

• Electrolyte Balance – K, CA,P, NA, CL

• Acid Base Balance

• Hormonal – RAAS, Erythropoitein, Vitamin K

• Removal of waste Creatinine and Urea

• Removal of some Drugs and Toxins

WHAT FUNCTIONS CAN DIALYSIS REPLACE

• Fluid Balance

• Electrolyte Balance

• Some Drug Removal

• Acid Base Correction

• Removal of Metabolic Waste

PHYSIOLOGICAL PRINCIPALS OF RENAL REPLACEMENT THERAPY:

Osmosis: The movement of water across a semi -permeable membrane to achieve equilibrium. Dissolved particles cannot pass the membrane nevertheless the concentrations tend to equal out, thus waters moves from the high concentration to a low concentration across the membrane.

Diffusion; The random movement of solutes from higher concentration to a lower concentration dependant on the concentration gradient, molecular weight, membrane resistance.

Ultra filtration: The movement of fluids through a semi permeable membrane due to a pressure gradient. Ultra filtration is erected by the amount of pressure applied (TMP) and the permeability of the membrane to water (KUF)

Convection: The movement of water by hydrostatic forces, therefore solutes are removed by solvent drag that is they are carried along with the passage of water through the pores

Principles behind HD: Diffusion, Ultra filtration Principles behind HF: Ultra filtration, Convection Principles behind HDF: Diffusion, Ultra filtration, Convection

HEAMODIALYSIS ACCESS

There are three forms of vascular access

• Permanent Line

• Temporary Line - Internal/ external jugular Femoral Subclavian

dialysis catheter is a catheter used for exchanging blood to and from the hemodialysis machine from the patient.

The dialysis catheter contains two lumens:

• Venous • Arterial

This is a confusing terminology for layperson, because both lumens are in the vein. The arterial lumen (typically red) withdraws blood from the patient and carries it to dialysis machine, while the venous lumen (typically blue) returns blood to the patient (from the dialysis machine). Flow rates of dialysis catheters range between 200 to 500 ml/min.

• Graft and Fistula – permanent internal

For both fistulas and grafts, the connection between your artery and vein increases blood flow through the vein. In response, your vein stretches and becomes strengthened. This allows an even greater amount of blood to pass through the vein and allows your dialysis to proceed efficiently.

The Heart

The heart is a dual pump, circulating blood through two separate closed systems. Oxygen-carrying blood leaves the left ventricle through the aorta. It circulates through the body and returns, deoxygenated, to the right auricle via the superior and inferior vena cava. The right ventricle pumps this blood through the pulmonary artery to the lungs, where it exchanges carbon dioxide for oxygen. Oxygenated blood then returns to the left auricle of the heart, ready for arterial circulation, through the pulmonary veins.

Circulatory System

The circulatory system functions in the delivery of oxygen, nutrient molecules, and hormones and the removal of carbon dioxide, ammonia and other metabolic wastes. Capillaries are the points of exchange between the blood and surrounding tissues. Materials cross in and out of the capillaries by passing through or between the cells that line the capillary,

HUMAN LUNGS

Though the right lung has three lobes, the left lung, with a cleft to accommodate the heart, has only two. The two branches of the trachea, called bronchi, subdivide within the lobes into smaller and smaller air vessels. They terminate in alveoli, tiny air sacs surrounded by capillaries. When the alveoli inflate with inhaled air, oxygen diffuses into the blood in the capillaries to be pumped by the heart to the tissues of the body, and carbon dioxide diffuses out of the blood into the lungs, where it is exhaled.

The Nervous System

The Nervous System is the most complex and delicate of all the body systems. At the centre of the nervous system is the brain. The brain sends and receives messages through a network of nerves. The spinal cord is a thick bundle of nerves, which runs down the centre of the spine. This is like a freeway. Along the spinal cord smaller bunches of nerves branch out. From these bundles, smaller bundles of nerves branch out again. Finally individual nerves branch out to every part of the body.This network allows the brain to communicate with every part of the body.Nerves transmit information as electrical impulses from one area of the body to another.

The Endocrine System

The endocrine system is a control system of ductless glands that secrete hormones that circulate within the body via the bloodstream to affect cells within specific organs. It is also instrumental in regulating mood, growth and development, tissue function, and metabolism, as well as sexual function and reproductive processes. (1) Endocrine glands secrete their products immediately into the blood or interstitial fluid, without storage of the chemical. Hormones act as "messengers," and are carried by the bloodstream to different cells in the body, which interpret these messages and act on them. Typical endocrine glands are pituitary, thyroid, and adrenal glands, but not exocrine glands such as salivary glands, sweat glands and glands within the gastrointestinal tract

1. Pineal gland2. Pituitary gland3. Thyroid gland4. Thymus5. Adrenal Gland6. Pancreas7. Ovary8. Testis

THE DIGESTIVE SYSTEM

Normal SystemThe human digestive system, otherwise known as the gut or gastrointestinal tract, is essentially a continuous muscular tube about 7-8 metres long in adults running from the mouth to the anus (back passage). It is designed to process food and fluids, which are consumed on a daily basis; the main processes involve ingestion, digestion, absorption and elimination.

SKELETAL SYSTEM

1. It protects our vital organs such as the brain, the heart and the lungs.

2. It gives us the shape that we have. Without our skeleton, we would just be a blob of blood and tissue on the floor.

It allows us to move. Because our muscles are attached to our bones, when our muscles move, they move the bones, and we move.

WARD INFORMATION/ORIENTATION

Date Signature of mentor

Orientation to the renal department

Introduce to fellow staff and mentorLocation of all policies and procedure filesLocation of resuscitation equipmentBleep system

Visiting times

Drug rounds

Ward rounds

Patient telephone calls

Meal breaks

Hand washing policy

Uniform policy

Infection control basic policyProcedure for arranging repairsComplaints policy

Initial interview

Students responsibilitiesDiscussed

ADMISSION TO DISCHARGE - HISS

Date Signature of mentor

Greeting patients and significant others

Introduction to facilitiesIntroduction to appropriate staff and patientsHiss training

Admissions

Nursing care

Devise a plan of nursing care based on assessment with the patient

Set realistic goals

Delivers care in accordance with Trust policiesAdapt care appropriately to individual requirements

Liaise with multidisciplinary team, accurately maintain recordsApply correct methods when referring to and liaise with members of the MDTEvaluate care using required methodsDischarge in accordance to Trust policies

PATIENT CARE

Date Sign

Applies correct procedures when monitoring vital signs

Accurate recordings

Understands recording charts/check listsRecognises deviations from normal or unusual findings and reports these appropriatelyConducts assessments sensitively

Uses all appropriate recourses to complete a comprehensive assessmentAccurately records information using the correct documentation

Recognises physical, psychological social and environmental factors which may adversely affect health and well being of the patient Identify appropriate legislation policies and procedures in place to protect patient health Takes appropriate action to minimise risk

INVESTIGATIONS/PROCEDURES

Date Signature of mentor

Clinical procedures- the student nurse will be able to observe /participate with medical staff

Renal biopsy

Central line insertion

Permanent neck line insertionRemoval of neck line

Fistula formation

Tenckhoff insertion and removal

Theatre preparation

Discuss the rational for a clean environment within theatre area

Discuss the basic principals of handling and disposing of clinical waste correctlyDiscuss the rational preparation of each individual caseDiscuss the role of the assistance in theatre

DIALYSIS

Date Signature of mentor

Observe the cleaning of the exit site and dressingDiscuss the rational of observation of exit siteDiscuss the different types of peritoneal dialysis CAPD (continuous ambulatory peritoneal dialysis)APD (automated peritoneal dialysis)

IPD (intermittent peritoneal dialysis)

Discuss the principles of haemodialysisDiscuss the different types of haemodialysis access

Neck line (temporary and permanent)

Fistula

Graft

DRUGS

Date Signature of mentor

Storage of drugs

Knows where medications are storedUnderstands the control of dangerous drugsRenal prescriptions

Discuss the dangers of potassium in renal patientsDiscuss gentamycin and vancomycin therapies Discuss the administration of O2 and nebs with accurate monitoring of O2 sats

Discuss the administration of intravenous drugs via volumetric and syringe devices

EPO therapyDiscuss why we use EPO therapy

Discuss the method of administrationIron therapyDiscuss what blood results to look at i.e. ferritin & HRBCDiscuss the risks involved giving iron therapy

MISCELLANEOUS

Date Sign

Nutrition and fluid balance

Discuss renal diet

Discuss importance of fluid restrictionsDiscuss the administration of supplements i.e. drinks and total parental nutrition(renal regime)Ordering patients meals

Discuss the importance of daily weight

Student Evaluation Form

Were you allocated a mentor?…………………………………………………………………………………………………………………………………………………………………………………………………………………………

Were you introduced to staff upon the ward upon your 1st day or before you commence your placement…………………………………………………………………………………………………………………………………………………………………………………………………………………………

Were you orientated to the ward environment upon your 1st day or before you commenced your placement…………………………………………………………………………………………………………………………………………………………………………………………………………………………

Have you worked alongside your mentor through out your placement with us?………………………………………………………………………………………………………………………………………………………………………………………………………………………

Were you allocated an Associate mentor in your mentor’s absence?…………………………………………………………………………………………………………………………………………………………………………………………………………………………

Have you gain the competencies you set out to achieve?…………………………………………………………………………………………………………………………………………………………………………………………………………………………

If not, can you explain the reasons why?…………………………………………………………………………………………………………………………………………………………………………………………………………………………

Have you enjoyed your placement with us?…………………………………………………………………………………………………………………………………………………………………………………………………………………………

Were you made welcome throughout the placement?………………………………………………………………………………………………………………………………………………………………………………………………………………………

Did you gain enough learning opportunities?…………………………………………………………………………………………………………………………………………………………………………………………………………………………

What could we do to improve learning opportunities for students?………………………………………………………………………………………………………………………………………………………………………………………………………………………

Were you made aware of the Polo File, and learning zones?………………………………………………………………………………………………………………………………………………………………………………………………………………………

Is there anything else you could suggest to improve learning for students coming onto our ward environment?…………………………………………………………………………………………………………………………………………………………………………………………………………………………

Were you given the Student information pack at the commencement of you placement?

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