NSB233 Workbook 2019 Interactive 1 PDF

Preview

Summary

Download NSB233 Workbook 2019 Interactive 1 PDF

Description

NSB233 Integrated Practice 3 Off Campus

Clinical Practice Sessions Student Workbook 2019

Table of Contents KEY CLINICAL FRAMEWORKS

3

CLINICAL PRACTICE SESSION 1

4

NSQHS FACT SHEET MY QUESTIONS FROM THE PRE-WORK KEY CONCEPTS ACTIVITY 1.1 ACTIVITY 1.2 TODAYS SKILLS ISBAR HANDOVER WHIPPLES FACT SHEET HANDOVER DOCUMENT PATIENT PROGRESS NOTE Workbook references for session SELF-ASSESSMENT CHECK REFLECTION

5 5 5 5 6 7 8 9 10 11 11 12

CLINICAL PRACTICE SESSION 2

13

MY QUESTIONS FROM THE PRE-WORK KEY CONCEPTS ACTIVITY 2.1 ACTIVITY 2.2 TODAY'S SKILLS ISBAR HANDOVER HANDOVER DOCUMENT PATIENT PROGRESS NOTE WORKBOOK REFERENCES FOR SESSION SELF-ASSESSMENT CHECK REFLECTION

13 13 13 13 14 15 16 17 19 19 20

Student CPS Guide

CLINICAL PRACTICE SESSION 3

21

MY QUESTIONS FROM THE PRE-WORK KEY CONCEPTS ACTIVITY 3.1 TODAY'S SKILLS ISBAR HANDOVER HANDOVER DOCUMENT PATIENT PROGRESS NOTES

21 21 21 22 23 24 25

WORKBOOK REFERENCES FOR SESSION SELF-ASSESSMENT CHECK REFLECTION

27 27 28

CLINICAL PRACTICE SESSION 4

29

MY QUESTIONS FROM THE PRE-WORK KEY CONCEPTS ACTIVITY 4.1 ACTIVITY 4.2 TODAY'S SKILLS ISBAR HANDOVER HANDOVER DOCUMENT PATIENT PROGRESS NOTE WORKBOOK REFERENCES FOR SESSION SELF-ASSESSMENT CHECK REFLECTION

29 29 29 29 30 31 32 33 34 34 34

Page 2 of 34

f

Introduction

Key Clinical Frameworks During the Clinical Practice sessions (Labs) you will be using a number of Key Clinical Frameworks.

CPS 1

ISBAR Oral Communication Framework

SBAR Written Communication Framework

5 Moments of Hand Hygiene

6 Rights + 3 Checks for Safe Medication Administration

CPS 3

STARL Reflection Framework

CPS 2

Clinical Reasoning Cycle (Adapted from Levitt-Jones, 2014)

CPS 4

Student CPS Guide

Page 3 of 34

f

Introduction

NSQHS 2nd Edition

CPS 1 CPS 2 CPS 3

Student CPS Guide

Page 4 of 34

CPS 4

For information on what the standards mean for your practice click here or go to the following address: https://www.safetyandquality.gov.au/standards/nsqhs-standards

f

Introduction

Clinical Practice Session 1 My questions from the pre-work

PRE WORK ACTIVITIES Activity 1.1

CPS 1

List any questions that you have regarding the preparation for Clinical Practice Session 2 materials. Time will be allocated during the Clinical Practice Session to answer your questions.

Insulin Infusion: skills video QUT School of Nursing. https://www.youtube.com/watch?v=daV7kO4Myqg Extend your Learning

https://learn.bloodsafelearning.org.au/mod/elmo/view.php?id=2

CPS 2

Log into the following website, register and do the following modules in MODULE 4: ‘Overview’ and ‘Mistakes Can be Fatal’

CPS 3

Key concepts and today’s skills In the session today, you will consolidate the following knowledge and skills: Identify equipment needed for an IV infusion Prepare medication to be delivered via syringe driver Understand documentation associated with IV infusions Discuss patient education for relevant IV medication Understand nursing responsibilities with Blood Transfusion Understand nursing responsibilities with cytotoxics Review of ISBAR handover

Student CPS Guide

CPS 4

      

Page 5 of 34

f

Performing a set of Vital Signs on one of your peers Preparing insulin infusion Administering insulin infusions using a syringe driver Using documentation for IV infusions and insulin administration Performing Blood transfusion checks using relevant documentation Cytotoxic precautions Practicing ISBAR handover to your peers

CPS 1

• • • • • • •

Introduction

In the session today, you will be practicing the following skills:

CPS 2

NSQHS STANDARDS REFLECTED CPS 3 CPS 4

Student CPS Guide

Page 6 of 34

f

Good morning/ Good afternoon. My name is xxxxx one of the SN’s here at the QUT hospital Kelvin Grove in the Surgical Department. Our patient today is Mrs Kristine Jenkins in bed 12.

I S B A R

Introduction

ISBAR HANDOVER Week 1

dentify

CPS 1

Kristine is a 52 year old lady who has been admitted today to the surgical ward for preoperative preparation and insulin support.

ituation

CPS 2

Kristine is scheduled to undergo a pancreaticoduodenectomy also known as a Whipples Procedure. She has been diagnosed with pancreatic cancer 7 days ago. Kristine has a history of Type 1 diabetes diagnosed when she was 12 years old. She has a history of hypercholesterolemia, managed by atorvastatin. No other significant history

ackground

ssessment

Student CPS Guide

Page 7 of 34

CPS 4

ecommendation

Kristine needs to be prepared for the operating theatre, she is the first patient on the afternoon list commencing at 2pm. She is to be NBM from 0800 hours with her Insulin order to commence at 0800 hours. Perform a set of pre op vital signs. Please prepare and begin her infusion. Monitor her BGL hourly until she goes to the Operating Theatre. Please provide education to Kristine regarding her IV insulin.

CPS 3

Kristine’s blood glucose on admission is 8.6 mmol/L. She has had an IV cannula inserted ready to commence her Insulin infusion. She has IV fluids running to KVO. Pathology has attended to a Full Blood Count/ U & E’s/ Cross Match. Kristine has been cross matched for 2 units of packed cells for either intra operatively or post operatively as a precaution.

f

CPS 2

Why do patient’s need to have the Whipple’s operation? The Whipple’s operation is usually performed to treat: • cancers in the head of the pancreas • other tumours and benign lumps in the pancreas • cancers of the bile duct, duodenum or ampulla • non-cancerous (benign) disorders such as chronic pancreatitis • jaundice, which is caused by a blockage in the bile duct. If the patient is jaundiced before the operation, they may have a procedure called an endoscopy (ERCP) to place a plastic tube (stent) into the bile duct to unblock it, allowing bile to flow normally. The patient should be able to eat and drink normally (with enzyme supplements to help your digestion) and enjoy a better quality of life than you would have done without the operation

CPS 1

What is the Whipple’s operation? The Whipple’s operation was named after Dr Allen Whipple who first performed the operation during the 1930s, it is also referred to as a pancreaticoduodenectomy. During the operation, the head of the pancreas, a portion of the bile duct, the gallbladder and the duodenum are removed. Part of the stomach is usually removed too. The remaining pancreas, bile duct and stomach are then rejoined to the intestine, which allows pancreatic juice, bile and food to flow back into the gut so that digestion can continue normally. In this variation the end of the stomach is preserved to try to maintain the stomach’s valve mechanism. Both procedures have been found to be equally good in taking away cancers from the head of the pancreas or from the end of the bile duct. The diagrams below show the normal anatomy of the pancreas and its relationship to nearby organs. The areas marked by the red highlight the parts of organs removed during the Whipple’s or PPPD procedure.

Introduction

WHIPPLE’S (PANCREATI CO DUO DECTOMY) SURGERY QUICK FACT SHEET-SNAPSHOT BEFORE CLASS

CPS 3 CPS 4

Acknowledgements to University Hospital Southampton NHS Foundation Trust www.uhs.nhs.u

Student CPS Guide

Page 8 of 34

f

CPS

BED No 12

Name URN Kristine Jenkins QUT 22065 52yo

Introduction

HOSPITAL Victoria Park Road KELVIN GROVE QLD 4154

Handover document Diagnosis

Investigations

Treatments

Comments

CPS 1 CPS 2 CPS 3 CPS 4

Student CPS Guide

Page 9 of 34

f

Date/ Time

PATIENT PROGRESS NOTE Room: 310 URN: QUT22065

CPS 1

HOSPITAL Victoria Park Road KELVIN GROVE QLD 4154

complete a set of progress notes for Kristine Jenkins

Introduction

Activity 1.3 Using

PATIENT: Kristine Jenkins DOB: 23/6/66 (52yo)

Notes

CPS 2 CPS 3 CPS 4

Student CPS Guide

Page 10 of 34

f

Introduction

Workbook references for session 3rd Ed. (2017). Administering Medication. Skill 27-1 2nd Ed. (2014) Medication therapy Skill 31-11

CPS 1 CPS 2

Self-Assessment check 1 ter your Clinical Practice Session, reflect on your learning by evaluating your level of knowledge and skills. Knowledge and skills

Proficient

Needs further development

Gathering equipment for infusion Understanding correct PPE

CPS 3

Maintaining ANTT during preparation

Student CPS Guide

CPS 4

Drawing up insulin Calculations for infusion doses and rates Connecting up infusion Using documentation for infusions Using IV Drug Guidelines Outlining patient education Understanding cytotoxic precautions and responsibilities Understanding Blood Cross Match and Patient ID Checks Understanding Blood Observation Page 11 of 34

f

sing the STARL Reflective Framework, take a few minutes to reflect on your experiences and learnings from the session today.

Introduction

Reflection

CPS 1 CPS 2 CPS 3 CPS 4

Student CPS Guide

Page 12 of 34

f

Introduction

Clinical Practice Session 2 My questions from the pre-work

PRE WORK ACTIVITIES Activity 2.1 Patient Controlled Analgesia (PCA): Skills Video QUT School of Nursing https://www.youtube.com/watch?v=lHR0yz7z4Oo

CPS 1

List any questions that you have regarding the preparation for Clinical Practice Session 2 materials. Time will be allocated during the Clinical Practice Session to answer your questions.

Activity 2.2

Review your Basic Life Support Knowledge and defibrillation safety

CPS 2

Review the video on Epidural insertion via your link in week 2 CPS on Black Board. Also look at the Patient Education handout embedded in into week 2 CPS.

https://resus.org.au/guidelines/flowcharts-3/# https://resus.org.au/guidelines/

CPS 3

Key concepts and today’s skills

   

CPS 4

In the session today you will consolidate the following knowledge and skills: accurately identify the indication and equipment required to prepare a PCA infusion understand the safety concerns related to PCA’s and epidural infusions be able to prepare a medication (including formulas and all calculations) to be delivered via a PCA/epidural understand the documentation relation to PCA and epidural administration

udent CPS Guide

Page 13 of 34

f be able to explain nursing responsibilities in relation to PCA’s, CVAD (central venous access devices) and epidural infusions.

Performing or receiving a handover of your patient. Performing a set of vital signs on your patient. View PCA order form and cross check PCA medication in the machine Perform setting checks on the PCA machine. View Epidural Form and cross check Epidural machine settings Observe and discuss the Central Lines on display in the Labs. Review the Resus Trolley contents

CPS 2

• • • • • • •

CPS 1

In the session today, you will be practicing the following skills:

Introduction



CPS 3

NSQHS STANDARDS REFLECTED CPS 4

Student CPS Guide

Page 14 of 34

f

Introduction

ISBAR HANDOVER Week 2

CPS 1

I S B A

Good morning/ Good afternoon. My name is xxxxx one of the SN’s here at the QUT hospital Kelvin Grove in the Surgical Department. Our patient today is Mrs Kristine Jenkins in bed 12.

dentify

ituation

CPS 2

Kristine Jenkins is Day 1 post the Whipples procedure RTW from OT at 2000 hours last evening. Vital signs stable overnight. Kristine has a peripheral IV line insitu. Epidural infusion running at 5 mls an hour controlling pain that is to be weaned off this morning. She has a PCA of morphine and IV fluids as she remains NBM.

She has undergone a Whipples due to a recent diagnosis of pancreatic cancer. Kristine has a history of Type 1 diabetes diagnosed when she was 12 years old. She has a history of hypercholesterolemia, managed by atorvastatin. No other significant history.

Her current vital signs are stable. IV fluids of Sodium Chloride 0.9% running at 125 mls per hour. Epidural site dry and intact. CVC site intact with no evidence of redness. Insulin infusion ceased this am and BGL stable 4-8 mmols/L overnight.

Student CPS Guide

CPS 4

ssessment

CPS 3

ackground

Page 15 of 34

f

ecommendation

BED No 12

Name URN Kristine Jenkins QUT 22065 52yo

CPS 1

HOSPITAL Victoria Park Road KELVIN GROVE QLD 4154

CPS

Introduction

R

Hourly vital signs as per PCA and Epidural policy. Review PCA Education for Kristine as she has been unclear on how to use the PCA. Wean and cease epidural infusion today. Monitor BGL’s and commence s/c insulin as ordered.

Handover document Diagnosis

Investigations

Treatments

Comments

CPS 2 CPS 3 CPS 4

Student CPS Guide

Page 16 of 34

f

Introduction CPS 1

Activity 2.2 Using

please document your patients notes for Kristine Jenkins for your shift

CPS 2

PATIENT PROGRESS NOTE Room: 310 URN: QUT22065 HOSPITAL Victoria Park Road KELVIN GROVE QLD 4154 Notes

CPS 3

Date/ Time

PATIENT: Kristine Jenkins DOB: 23/6/66 (52yo)

CPS 4

Student CPS Guide

Page 17 of 34

f

Introduction CPS 1 CPS 2 CPS 3 CPS 4

Student CPS Guide

Page 18 of 34

f

Introduction

Workbook references for session 3rd Ed. (2017). Administering Medication. Skill 27-1 2nd Ed. (2014) Medication therapy Skill 31-11

CPS 1

Self-Assessment check 2 ter your Clinical Practice Session, reflect on your learning by evaluating your level of knowledge and skills. Proficient

CPS 2

Knowledge and skills accurately identify the equipment required to prepare a PCA infusion

Needs further development

CPS 3

be able to prepare a medication (including formulas and all calculations) to be delivered via a PCA/epidural understand the documentation relation to PCA and epidural administration

CPS 4

Explain nursing responsibilities in relation to PCA’s, CVAD (central venous access devices) and epidural infusions Understand the safety concerns related to PCA’s and epidural infusions

Student CPS Guide

Page 19 of 34

f

Introduction

Reflection sing the STARL Reflective Framework, take a few minutes to reflect on your experiences and learnings from the session today.

CPS 1 CPS 2 CPS 3 CPS 4

Student CPS Guide

Page 20 of 34

f

Introduction

Clinical Practice Session 3 My questions from the pre-work

PRE WORK ACTIVITIES Activity 3.1 IDC insertion and Removal: Skills video QUT School of Nursing. https://www.youtube.com/watch?v=kewObzOQucE

CPS 1

List any questions that you have regarding the preparation for Clinical Practice Session 3 materials. Time will be allocated during the Clinical Practice Session to answer your questions.

CPS 2

Key concepts and today’s skills CPS 3

In the session today you will consolidate the following knowledge and skills: Identify indications for IDC insertion and potential complications. Identify correct equipment required for insertion Demonstrate insertion of an indwelling catheter using aseptic, non-touch techniques. Complete relevant documentation Have knowledge of complications of insertion Provide patient education in relation to indications and expectations pre/post insertion

Student CPS Guide

CPS 4

     

Page 21 of 34

f

Introduction

In the session today you will be practicing the following skills: o o o o

Taking and documenting Vital Signs on your patient Preparation and insertion of an Indwelling Catheter Connecting an IDC drainage bag Documenting insertion in nursing notes

CPS 1 CPS 2

NSQHS STANDARDS REFLECTED CPS 3 CPS 4

Student CPS Guide

Page 22 of 34

f

Good morning/ Good afternoon. My name is xxxxx one of the RN’s / SN’s here at the QUT hospital Kelvin Grove in the Surgical Department. Our patient today is Mrs Kristine Jenkins in bed 12.

I S B A R

Introduction

ISBAR HANDOVER Week 3

dentify

CPS 1

Kristine is a 52 year old lady who is day 3 post Whipples Procedure.

ituation

CPS 2

She has undergone a Whipples due to a diagnosis of pancreatic cancer. Kristine has a history of Type 1 diabetes. Managed with subcut insulin. She has a history of hypercholesterolemia. No other significant history. Epidural removed day 1. PCA removed this am, with IM morphine controlling pain PRN. IDC removed but unable to pass trial of void overnight.

ackground

ssessment

CPS 3

Bladder scan 700 mls of urine. She is uncomfortable and experiencing pain with the bladder distention. Vital signs stable but slightly hypertensive query secondary to pain? Reviewed by surgeon just now.

IDC to be inserted and left insitu overnight. Observe wound dressing Monitor vital signs

CPS 4

ecommendation

Student CPS Guide

Page 23 of 34

f

CPS

BED No 12

Name URN Kristine Jenkins QUT 22065 52yo

Introduction

HOSPITAL Victoria Park Road KELVIN GROVE QLD 4154

Handover document Diagnosis

Investigations

Treatments

Comments

CPS 1 CPS 2 CPS 3 CPS 4

Student CPS Guide

Page 24 of 34

f

Introduction

Activity 3.2 Using

please document your patient notes for Kristine this shift

PATIENT: Kristine Jenkins DOB: 23/6/66 (52yo)

Notes

CPS 2

Date...