Ward 5

Information pack

For

Student Nurse’s

Review date February 2011

Contents

Contents List

Ward profile

Team Structure

Induction List

Ward Philosophy of Care

Coronary Heart Disease

Investigations

Medications

Chest Pain

12 Lead ECG

P.O.L.O

Learning Zones

Ward Profile

Ward 5 is a twenty -five bedded medical ward, which specialises in

cardiology, but also accommodates general medical patients. The

ward operates on a team nursing system of care, however whenever

possible we try to incorporate primary nursing principles. The ward

is divided into two teams the A team and the B team. The ward has

four, four bedded bays, generally theses are two male and two

female, a seven bedded bay, which is always male and two side

rooms, they are then divided between the two teams so that one

team has twelve beds and a side room and the other eleven beds

and a side room.

The nursing staff work in shifts, these consist of early shifts (7.5 hrs), late shifts

(7.5 hrs), a twelve-hour (11.30 hrs) or night shifts (10.71).

Early shift 07.45 – 14.45

Late shift 13.15 – 20.15

Twelve hour 07.45 – 20.15

Night shift 20.00 – 08.00

Ward 5 encourages learning at all levels and welcomes learner nurses at all

stages of their training on to the ward and we aim to give an informative and

enjoyable experience. During your placement on Ward 5, you will be working

along side staff that are highly skilled and motivated who will provide you with

knowledge, skills and support to facilitate the best possible care for our patients.

While placed on the ward we encourage you to ask questions and to ask for

help when needing assistance or in a situation of uncertainty.

Ward Team

1 Ward Manager/Ward Sister

1 Junior Sister Educational lead (full time)

1 Junior Sister Staff development (part time)

13 Staff nurses (Band 5)

7 Health Care Assistants

1 Ward Clerk

1 Physiotherapist (and aide)

1 Pharmacist

1 Housekeeper

Cardiology Medical Team

4 Consultant Cardiologists

2 Registrar’s

3 Senior house officers

1 House officer

Cardiology Team

Modern Matron

Coronary Care Unit

Cardiac Catheterisation Lab

Nuclear Physics Department

Cardiology Nurse Practitioners

Heart Failure Nurse Practitioners

Cardiac Rehabilitation Team

Electrocardiograph Department

Induction Checklist

Orientation Date

Shown around working environment

Introduced to staff members

Off duty organized

Procedure for reporting in sick

Discuss dress code

Explanation of POLO and Learning Zones

Location of Educational resource box identified

Location of hospital policies and Marsden manual

Emergency phone numbers

Emergency exists

Fire drill

Fire extinguishers

Mentor Name…………………………. Signed……….…………………..

Learner Name………………………… Signed…………………………..

WARD 5 PHILOSOPHY

We believe that our main focus is the patients’ right to receive nursing and medical care in a safe and therapeutic environment provided by caring, educated and proficient practitioners. Our belief is that each patient is an individual and as such we will endeavour to ensure that they are safeguarded from discrimination, that their ethnic origin, sexuality and religious beliefs are respected. It is important that people retain their dignity and self respect, being able to control their own lives and health needs. Our role cares greatly for the well-being of the patient and has recognised that the delivery of care must be holistic in nature; therefore involving the family (in its broadest term) encouraging those to take part in the delivery of care. Thereby allowing the patients and their relatives to express their concerns, fears, hopes and desires and allowing us as a team through development of relations promote caring partnerships where patients feel comfortable enough to express their inner feelings. The nursing team will provide support, education and advice so that the patient and their carers are able to make informed choices. As nurses we will strive to promote excellent standards of care and communication with patients and their carers. The care will reflect current research outcomes and also audits carried out by the Gateshead Health NHS Foundation Trust. To ensure ward 5 give the care as reflected in the philosophy we will ensure that as practitioners our skills and knowledge are kept updated and that we reflect upon our practice to maintain and explore new ways in delivering quality and timely care. We will pass these onto students who have learning requirements so that continuity of care is maintained.

February 2010

Coronary Heart Disease

While on ward 5 you will come across some terms or abbreviations that are

linked to the diagnosis and treatment of patients with coronary heart disease.

This section will try and cover such information.

Myocardial infarction (MI) Otherwise known as a heart attack. This occurs when

a blood clot blocks an artery in the heart stopping the flow of blood containing

oxygen to an area of the heart. If this is prolonged this area of muscle will die

resulting in an MI.

Non ST Elevation MI (NSTEMI) This is an MI, that when an electrocardiograph

(ECG) is taken, shows no elevated changes on the ECG within the ST segment.

However, the MI is diagnosed from the raise in Troponin T (Trop T) a specific

blood test that looks for proteins released from the heart when damage occurs.

ST elevation MI (STEMI) This is an MI which when the ECG is taken shows a

raise in the ST segment of the ECG which indicates an MI.

Angina This is used to describe pain, or discomfort in the chest and can radiate

to the neck, jaw and left shoulder and arm. It is brought on by exercise and is

caused through a lack of blood getting to the heart due to narrowing of the

arteries.

Unstable Angina This is the same as above, but the pain will develop at rest,

which can indicate the arteries are even narrower.

Coronary Heart Disease This is the narrowing of the arteries in the heart,

resulting in conditions such as hypertension (raised blood pressure) and angina.

Acute Coronary Syndrome (ACS) This is a term that is used to describe a

collection of conditions caused through a dislodged hardened clot.

1. unstable angina

2. NSTEMI

3. STEMI.

Heart Failure This is a collection of fluid around the lungs, through reduced

pumping of the heart, which will cause the patient to feel breathless and

develop swollen feet and legs (oedema).

Arrhythmias These are abnormal heart rhythms, which can be life threatening.

Common conditions are bradycardia (slow), tachycardia (fast) and Atrial

Fibrillation (AF).Arrhythmias can be caused by disease, by damage to the heart

or an imbalance in electrolytes.

Cardiogenic shock This is caused by inadequate blood supply to vital organs

due to heart failure, resulting in metabolic disturbances.

Investigations

Electrocardiograph (ECG) This is a printed interpretation of the electrical

activity in the heart, it shows the hearts rate and rhythm and can pick up

changes caused by an MI (e.g. ST segment).

Echocardiogram (Echo) This is a test that can identify if there has been any

damage to the heart following an MI, it mainly looks at the function of the

ventricles (the bottom chambers of the heart) and the valves in the heart. The

way in which it is performed is similar to that of a scan of an unborn baby.

Myocardial Perfusion Scan (MIBI) This looks at how well the heart receives

blood and can indicate areas that are damaged as a result of an MI. It is done in

two parts, a stress test and a rest test which are done on two different days.

When patients are having the stress test they are not allowed caffeine for 12

hours before.

Angiogram (Angio) This is performed in the cardiac cath lab and patients need

to be nil by mouth for 4 hours before the procedure. This procedure looks at the

condition of the arteries and identifies the location of any blockages or

narrowings. It is done by passing a tube (the catheter) through the groin which

goes up into the heart, dye is then injected up which highlights the pathway of

the blood when filmed by x-ray and identifies any problems.

Angioplasty (PCI) This is performed in the same way as the angiogram, but

where the blockages are a balloon is passed down the catheter and inflated

which opens the artery up, sometimes it is necessary to put a stent in, which is

a device that stops the artery from closing again.

Coronary Artery Bypass Grafts (CABG) This is an operation to bypass

narrowed sections of coronary arteries to improve blood supply to the heart.

Veins are taken from the legs and grafted onto the blocked artery to make the

new path for the blood flow.

Commonly Drug Groups

Nitrates

Nitrolingual Spray (GTN), Suscard buccal, Isosorbide Mononitrate (ISMN) and

Isoket (isosorbide dinitrate). These medications are used to relieve angina pain

or prevent angina attacks, they can also be used to reduce left ventricular

workload in heart failure. Nitrates have a vasodilatory effect which relaxes the

muscle wall of the arteries and veins allowing more oxygenated blood to flow to

the heart. Because of the nature of this medication it can cause headaches,

flushing, dizziness and hypotension.

Beta-Blockers

Atenolol, Bisoprolol and Metoprolol. These medications are used to control the

symptoms of angina, control hypertension and to prevent the incidence of

reinfarction and can also be used within the management of arrhythmias. The

medication blocks hormones that raise the heart rate, therefore lowering the

heart rate and the amount of oxygen needed by the heart. Beta blockers should

be used with caution with patients who have chronic obstructive pulmonary

disease and avoided with patients who have heart block and severe

hypotension. Beta blockers can cause patients to feel fatigued, have sleep

disturbances and cold extremities.

Ace Inhibitors

Lisinopril, Ramipril and Perindopril. These medications are used to treat heart

failure and hypertension, they aim at improving symptoms, improving exercise

tolerance and mortality. This medication works by inhibiting the angiotensin

enzyme, which has a narrowing effect on the arteries, therefore when taken the

production of the enzyme is reduced allowing the arteries to relax and widen.

This medication can cause severe hypotension and can effect the function of

the kidneys, patients can experience tachycardia, cough, sore throat, nausea

and vomiting.

Anti – Platelets

Aspirin and Clopidogrel. These medications are given to prevent the formation

of thrombus (clots) within the arteries. The medication works by reducing

platelet aggregation inhibiting the formation of thrombus. Care should be given

to patients who are at risk of haemorrhage and should be avoided in those who

have a haemorrhagic disorder or are actively bleeding.

Statins

Simvastatin, Pravastatin and Atorvastatin. Theses medications are used to help

aid the lowering of blood cholesterol levels by inhibiting the enzyme involved,

resulting in a slower progression of coronary artery atherosclerosis. They

should be used in caution with patients who have liver disease or a high alcohol

intake. Patients can experience nausea and vomiting, headaches and

diarrhoea.

Diuretics

There are 3 different main types of diuretics thiazides:- bendrofluamethazide

and metolazone, loop:- frusemide and bumetanide and potassium sparing:-

amiloride and spironalactone. These medications are used to relieve different

types of oedema by promoting the excretion of water and salt from the body,

lowering arterial pressure and correcting pulmonary and systemic congestion.

This type of medication can cause imbalances in electrolytes in particular

causing low levels of potassium (hypokalaemia), they should be used with

caution in patients with severe renal impairment.

Chest Pain Assessment Who can get chest pain? What causes chest pain? What symptoms might the patient have?

What would you do?

12 Lead ECG

An ECG is the recording of the electrical activity within the heart.

The heart is a muscle and like all muscles it contracts, when it contracts it sends

off impulses which are then picked up through the electrodes (the stickers)

which are placed on the body.

However, as the ECG picks up all muscular activity such as that in the arms and

legs, it is very important that the patient is as still as possible while the machine

is picking up the data. If the patient starts talking this will also be picked up by

the ECG so it is therefore necessary to explain to the patient that he/she should

be as still and relaxed as possible and not to talk.

It is also very important for the electrodes to have good skin contact, if a patient

has dry, wet or greasy skin then the electrodes have difficulty in sticking, so the

area needs to be prepared prior to attaching the electrodes. If the patient has

excessive hair on their chest, the area where the electrodes are to be placed

will need to be shaved. Permission is needed from the patient before shaving

them.

Position of the electrodes

One electrode needs to be placed on each of the wrists and on the ankles,

however the electrode can be placed anywhere on the respective limbs for the

ECG to work. If the patient happens to have either a missing limb or limbs the

electrodes can be placed on the shoulders or the hips.

There are six electrodes that are to be placed on the chest, these however are more specifically applied as they need to surround the heart.

Ward 5’s

POLO and

Learning Zones

CARDIOLOGY

• Coronary Care • Thrombolysis Nurse • Rehabilitation Nurse • Cardiology Nurse Practitioner • MIBI • Cath Lab • ECG Department • RACPAC • T.O.E. • Resuscitation Officer • Medical Team • Cardiology at FRH

SPECIALITIES

• Respiratory Nurse • Lung Cancer Nurse • Macmillan Nurse • Tissue Viability Nurse • Vascular Nurse • Infection Control Nurse • MAU • Physiotherapist • Pharmacy

INVESTIGATIONS • Medical Physics • Radiology • Gastroscopy • Colonoscopy

NUTRITION • Dietician • Diabetic Nurses • S.A.L.T. • Nutritional Specialist Nurses

SOCIAL

• Discharge Liaison Nurse • Elderly Care Practitioner • CROP/ICIS • Bed Managers

Ward 5

LEARNING

ZONES

LEARNING OPPORTUNITIES RESOURCE/PERSONNEL

CLINICAL OPPORTUNITIES CARDIOLOGY

Myocardial Infarction

Staff/

CCF/LVF

nurses

Angina

Arrhythmias/Telemetry

dpt/Radiology

Cardiac Rehabilitation

Cardiac Investigations: MIBI, Angiography,

Echo, TOE, ECG.

Haemostasis /Disturbances

Cardiac Drugs/Thrombolysis

Smoking cessation

RESPIRATORY

COPD/Asthma

Nurses/Respiratory Nurses

Drugs/Oxygen/Nebuliser Therapy

technicians/

Infections

Chest X-rays

specialist

Investigations: CT scan/VQ

scan/bronchoscopy

Pulmonary Function Tests

Treatments

Lung Cancer

Trained Nurses/Medical

CCU/Cardiology Specialist

Resource Room/Library/ Pharmacy/ECG

Clinical pathology services

Trained

Medical Staff/ECG

Pharmacy/Radiology

Lung cancer nurse

GASTRO-INTESTINAL SYSTEM

Investigations: Endoscopy/Colonoscopy

Nurses/Dieticians

Nutrition: Food Charts/Weight

nurses

Monitoring

Dietician

Naso-gastric/PEG tubes and feeding

Trained /Untrained

Nutritional specialist

ENDOCRINE SYSTEM Diabetes staff

Thyroid function

Trained nurse/Medical

Diabetic nurse specialist

NERVOUS SYSTEM CVA

Epilepsy nurse

Parkinson’s Disease research

Medical staff/Parkinson’s

Dysphagia nurse/Stroke Team

HAEMATOLOGY Blood disorders Staff Haemorrhage Nurse

Trained Nurses/Medical Blood Transfusion Nurse/Haematology

NURSING CARE Hygiene Nurses Mouthcare Continence /Elderly Pressure area care Falls Catheter Care Privacy and Dignity Principles of Self Care Communication

Trained/Untrained Tissue Viability Nurse Continence Advisor

Care Team

CARE MANAGEMENT

RISK MANAGEMENT

Risk Assessments/Tools Leads Clinical Incident Recording Health and Safety Policies and Procedures Medical Devices Infection Control Moving and Handling Falls

Trained Nurses/ Ward

Resource Room

RESOURCES Resource Room Manager Cardiology Workbooks Library Staff Rota Drugs/Stock/Equipment Ordering Budgets Internet/E-mail

Trained Nurses/Ward

Pharmacist

NURSING PROCESS Assess Plan Implement Evaluate

Trained/Untrained Nurses

STAFF SERVICES/DEVELOPMENT Clinical Supervision Philosophy of Care Essence of Care NSF’s CONTACT’s Training Files/Training Opportunities Preceptorship Portfolio Rotational Posts Staff Library NVQ Resource Room Cardiology Workbooks

Trained Nurses/Ward Managers

EMERGENCY SITUATIONS Cardiac/respiratory arrests Clinical incident Fire

Trained nurses/Ward manager

Fire officer/Resuscitation officer

TEAM MANAGEMENT Organisation Delegation Prioritising Leadership Managing change Standards of care Quality Time/Workload management

Trained nurses/Ward manager

12 Lead ECG

A 12 lead ECG is a recording of the

electrical activity occurring in the heart

each time the heart contracts.

12 different views of the same activity are

demonstrated on the ECG graph paper.

Each separate view of the heart is called a

“lead”.

Electrodes are placed on both wrists and

the left ankle forming a triangle, known as

Einhovens triangle.

The fourth electrode, which is on the right

ankle is to stabilize the ECG but takes no

part in the formation of the ECG.

These leads are the limb leads and form 6

of the 12 leads on the ECG. The other 6

leads are placed over the chest. (See

Diagram Below)

V1 (red) – Is positioned at the fourth

intercostals space at the right of the

sternal margin.

V2 (yellow) - Is positioned at the fourth

intercostals space at the left of the

sternal margin.

V3 (green) – Is at the fifth intercostals

space between V2 & V4.

V4 (brown) – Is at the fifth intercostals

space mid clavicular line

V5 (black) - Is mid way between V4 & V6.

V6 (purple) - Is at the fifth intercostals

space mid auxillary line