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SP 02/12 1
WELCOME TO THE CARDIOLOGY DEPARTMENT
PROFILE OF LEARNING OPPORTUNITIES (POLO)
AND
INDUCTION CHECKLIST
EDUCATIONAL LEAD:
Student:
Mentor:
Co - Mentor:
Date:
SP 02/12 2
CONTENTS
Page
Introduction 3
Service Profile 4
Staff –Nursing 4 - 5
Lead / Link Nurses 6
Medical Staff 7
Allied Health Professionals 7
Philosophy of care 8
Hours of duty 9
Referrals / Admission 10
Ward rounds 11
Glossary of terms 12
Learning Opportunities 13 - 38
Learning Zone 39
Induction Checklist 40
SP 02/12 3
INTRODUCTION
Welcome to the Cardiology Department at Sunderland Royal Hospital.
Whilst on placement in the Cardiology Department Student Nurses will be allocated a
Mentor, and will work with their Mentor during a variety of shifts across a 24 hour
period. By working days, nights, and weekends it will allow quality time to be spent with
their Mentor, providing great opportunities for learning, to ensure all aspects of
Cardiology Care are experienced.
Learning during the placement is the Student’s responsibility, their Mentor will facilitate
this learning to help them achieve the objectives set.
Any problems or recurring issues experienced by the Student Nurse should be expressed
to their Mentor, or Ward Manager during the placement so they can be resolved before
the end of the placement. Hopefully, this will create an atmosphere conducive to
learning, and make the experience an enjoyable one.
SP 02/12 4
SERVICE PROFILE
DIRECTORATE: Emergency Care
SPECIALITY: Cardiology
BEDS: 7 Coronary Care
18 Cardiology Step-down
10 Chest Pain Assessment Unit
STAFF
Nursing:
Ward Manager B22
Ward Manager CCU/CPAU
Cath Lab Manager
Cardiac Rehabilitation Nurse
Nurse Consultant
Matron
Research Nurse
Emergency Care Practitioners: X 10
SP 02/12 5
Junior Sisters: X 4
Staff Nurses: X 35
Auxilary Nurses: X 15
Ward Clerks CPAU/CCU
B22
SP 02/12 6
Lead Nurses
Wound management
Educational Lead
Budget
Lifting / Handling
CPR
Research
Clinical Supervision
Angio
Health and Safety
Rehab
Stock Management
COSHH
Nutritional Link
Diabetes
Infection Control
Clinical Governance
Essence of Care
Mandatory Training
SP 02/12 7
Medical Staff
Cardiologists: X 6
Registrar: Changes every 6 - 12 months
Junior Doctors: Based on B22,
Change every 3 months
Allied Health Professionals
Pharmacist
Dietician
Physiotherapist
Occupational Therapist
SP 02/12 8
CARDIOLOGY DEPARMENT PHILOSOPHY OF CARE
The staff of the Cardiology Department will endeavour to deliver the highest standard of
nursing care to patients under their care.
This will be achieved by creating an optimum environment in which skilled nurses using
a recognised model of nursing will address issues of individual and holistic care without
prejudice.
Each Practitioner will be accountable for delivering nursing care that promotes and
maintains the optimum health of individuals. Constantly seeking to improve quality of
care and implementing evidence-based care. Continually updating skills to ensure the
advancement of knowledge, skills and practice.
Ultimately providing an effective and efficient Cardiology Service.
SP 02/12 9
HOURS OF DUTY
Whilst on placement Student Nurses will be allocated a Mentor, and will work with their
Mentor during a variety of shifts across a 24 hour period. By working days, nights, and
weekends it will allow quality time to be spent with their Mentor, providing great
opportunities for learning, to ensure all aspects of Cardiology Care are experienced.
Learning during the placement is the Student’s responsibility; their Mentor will facilitate
this learning to help them achieve the objectives set.
Any problems or recurring issues experienced by the Student Nurse should be expressed
to their Mentor or Ward Manager during the placement so they can be resolved before the
end of the placement. Hopefully, this will create an atmosphere conducive to learning,
and make the experience an enjoyable one.
Thirteen Hour 7.30 am - 8.30 pm
Early (if working 2x13hrs) 7.30 am – 2pm
Early (if working old over 5 days) 7.30 am – 4.15 pm
Early half day 7.30 am - 1pm
Late (if working 2x13hrs) 2pm – 8.30pm
Late (if working over 5 days) 12.30 pm - 8.30 pm
Reverse half day 3 pm - 8.30 pm
Night Duty 8.15 pm - 7.45 am
SP 02/12 10
REFERRALS / ADMISSIONS
Referrals To CPAU:
Direct admissions from Ambulance Service
Accident and Emergency Department
Referrals to CCU/ B22:
Direct admissions from Ambulance Service (Not B22)
Accident and Emergency Department
Clinical Decisions Unit
Admission Wards
Any other ward or patient area within CHS
SP 02/12 11
WARD ROUNDS
CPAU:
At least twice daily by the Cardiologist on call.
CCU:
At least daily by the Cardiologist on call.
B22:
Daily by Various Cardiologists.
Cath Lab:
Daily by Cardiologist
SP 02/12 12
GLOSSARY OF ABBREVIATION USED WITHIN
CARDIOLOGY DEPARTMENT
ACS Acute Coronary Syndrome IV Intra Venous
AF Atrial Fibrilation LBBB Left Bundle Branch Block
Ant MI Anterior Myocardial Infarction LVF Left Ventricular Failure
Ant-Lat Anterior Lateral Myocardial MI Myocardial Infarction
Infarction
APTT Activated Partial Thromboplastin MSU Mid Stream Urine
Time
AV Atrio-Ventricular MSW Medical Social Worker
BP Blood Pressure NAD No Abnormality Detected
BM Boeehringer Mannheim NBM Nil By Mouth
Mellitus (Blood Glucose) NIDDM Non-Insulin Dependent
Diabetes
CABG Coronary Artery Bypass Graft NPU Not Passed Urine
CCU Coronary Care Unit NSAID Non-Steroidal Anti
Inflammatry Drug
CE’s Cardiac Enzymes OT Occupational Therapist
CHB Complete Heart Block PAWP PulmonaryArtery Wedge
Pressure
CO Cardiac Output PE Pulmonary Embolism
COPD Chronic Obstructive Pulmonary PEA Pulseless Electrical Activity
Disease
CPAU Chest Pain Assessment Unit Post MI Posterior Myocardial
Infarction
CPR Cardio-Pulmonary Resuscitation PU Passed Urine
CVP Central Venous Pressure PVD Peripheral Vascular Disease
C&S Culture and Sensitivity Px Prescribed
CXR Chest X-ray RBBB Right Bunble Branch Block
DC Direct Current SVT Supra-Ventricular
Tachycardia
DU Duodenal Ulcer Sync Synchronised
ECG Electrocardiograph TNK Teneceplase
ECHO Echocardiogram U/A Unstable Angina
ETT Exercise Tolerance Test U&E’s Urea and Creatinine
FBG Fasting Blood Glucose VE Ventricular Ectopics
FWT Full Ward Test VF Ventricular Fibrillation
GTN Glycerine Tri Nitrate VT Ventricular Tachycardia
HR Heart Rate V/R Ventricular Rate
Inf MI Inferior Myocardial Infarction VSD Ventricular Septal Defect
Inf-Lat Inferio-Lateral WPW Wolff-Parkinson-White
MI Myocardial Infarction
IM Intra Muscular
SP 02/12 13
LEARNING OPPORTUNITIES
Frequent physiological conditions
M I
Angina
Heart Failure
Arrythmias
Cardiomyopathy
Pericarditis
Endocarditis
Cardiogenic Shock
Clinical Procedures
Insertion of Central Venous Pressure Line / Femoral Line
Insertion of Temporary Pacing Wire
Pericardiocentesis
Insertion of Intra Aortic Balloon Pump
Synchronised Cardioversion
CPAP
SP 02/12 14
Diagnostic Tests
Cardiac Enzyme Troponin T
Exercise Tolerance Test
Echo
Angiography
Myocardial Perfusion Scan
Cardiomemo
24 Hour Tape
Journals, Books etc
A selection of Cardiac Journals can be found in the Research Office on B22
Selected titles of recent Cardiology Books are available - see Sr Bell / Roper
SP 02/12 15
LEARNING OPPORTUNITIES
THE SCOPE OF CARDIOLOGY DEPARTMENT
DISCUSS DATE SIGN Aim and objectives of the Cardiology Dept
City Hospital operational policy file
The philosophy of care practised in the Cardiology
Department
Nursing policies appropriate to the care of the patient in
Cardiology Department
Role of the Nurse in the Cardiology Department
Advantages of nursing patients within the Cardiology
Department
RESOURCES
Policy file
Cardiology protocol file
Procedure file
NB: All Student Nurses when on placement must adhere to the policies of City
Hospitals Sunderland NHS Trust.
SP 02/12 16
ADMISSION OF PATIENTS TO CCU/CPAU
DISCUSS DATE SIGN
Criteria for the admission of patients to CCU/CPAU
Means and methods by which patients are admitted
into CCU/CPAU
Preparation of patients room and equipment prior to
admission
Application of electrodes and use of monitoring
equipment
Recording of 12 lead ECG (dealt with in greater detail
session 6)
Priorities in immediate patient care
Type of analgesia used giving examples of drug, dose
and route (dealt with in greater detail session 11)
Psycological support necessary for patients and
relatives eg initial and ongoing explanations of
patient’s condition and care of both medical and
nursing staff
Documentation
RESOURCES
CCU/CPAU admission books, charts etc.
Visiting leaflet
ECG machine and monitors
SP 02/12 17
ORIENTATION TO THE EQUIPMENT IN USE
DISCUSS/DEMONSTRATE DATE SIGN Central console and bed side monitoring
system/modules
Defibrillators
ECG machine
Cardio memo machines/Receiver
Baxter and Ivac controllers
Oxygen Saturation Modules/Monitoring
Image intensifier
Pacing boxes
External pacing machine
Swan Ganz Module, Transducer and giving set
Cardiac output module/giving set
Monitors and link up from CPAU and Cath Lab
Equipment decontamination procedure and document
RESOURCES
All the above equipment
Instruction/Operational manuals
Decontamination forms used when equipment for repair
Contact address/Tel No of equipment maintenance specialists
SP 02/12 18
MANAGEMENT OF CARDIAC ARREST
DISCUSS DATE SIGN Definition of cardiac arrest
Recognition of lethal arrhythmias
Drugs used in the management of cardiac arrest
(dealt with in greater detail session 11)
Equipment used in cardiac arrest situation
The summoning of aid in the cardiac arrest situation
The technique of external cardiac massage and
assisted ventilation
Advanced life saving techniques
RESOURCES
Video
Resuscitation manikin
Defibrillator
Intubation equipment
Wall chart
Rhythm strip
SP 02/12 19
CARDIOVASCULAR SYSTEM
DISCUSS/DEMONSTRATE DATE SIGN Structure and function of the heart
Structure and function of the conduction system
The physiology of cardiac contraction
Cardio Vascular parameters
RESOURCES
Video
Model of heart
O.H.P
SP 02/12 20
CARDIAC ARRHYTHMIAS
DISCUSS DATE SIGN The physiology of cardiac contraction (Recap
session
Factors contributing to arrhythmias
Sinus rhythm
Bradycardia
Tachycardia
Arrhythmia
Arrest
Ventricular Tachycardia
Fibrillation
Ectopic
Asystole
Junction Ectopic
Tachycardia
Bradycardia
Upper
Middle
Lower
Atrial Ectopic
Flutter
Fibrillation
Paroxysmal Atrial Tachycardia
Super Ventricular Tachycardia
1 Block
2 Block
3 Block
atrioventricular-dissociation
Ventricular standstill
RESOURCES
ECG File
SP 02/12 21
ECG Simulator
CATH LAB
DISCUSS/DEMONSTRATE DATE SIGN Indication for Angiography/Angioplasty
Risks associated with Angiography/Angiolplasty
Pre Assessment in clinic / ward area
Angiogram/Angioplasty observed
Recovery procedure and after care
Complications and their management
RESOURCES
Angio Nurses
Cardiac Physiologists
Radiographers
Medical Staff
SP 02/12 22
ANGINA PECTORIS
DISCUSS DATE SIGN Definition of Angina Pectoris
Causes of Angina Pectoris
Presentation of Angina Pectoris
Treatment of Angina Pectoris; medical methods,
surgical intervention
Investigations performed to diagnose Angina
Pectoris
ECG changes due to Angina Pectoris
Nursing care of patient suffering from Angina
Pectoris
RESOURCES
ECG Recordings
Visit to ECG department
SP 02/12 23
MYOCARDIAL INFARCTION
DISCUSS DATE SIGN Definition of Myocardial Infarction
Cause of Myocardial Infarction
Presentation of Myocardial Infarction
Investigations needed to diagnose Myocardial
Infarction
Treatment of Myocardial Infarction
ECG changes due to Myocardial Infarction
Nursing care of a patient suffering from Myocardial
Infarction
Complications of Myocardial Infarction
RESOURCES
Video
ECG recordings
SP 02/12 24
DRUGS USED IN THE CARDIOLOGY DEPARTMENT
DISCUSS DATE SIGN
Instruction in use, classification, dosage,
action and side effects of a wide range of
drugs used including
Anti – arrhythmias
Beta – blocking
Inotropic agents
Diuretics
Narcotic analgesics
Vasodilators
Anti – hypertensive
ACE Inhibitors
Thrombolytic therapy and anticoagulants
Glycoprotein 2b 3a inhibitors
RESOURCES
B.N.F.
Data Compendium
Drug Policy
CCU Drug Regimes
Cardiology Treatment Guidelines
SP 02/12 25
CENTRAL VENOUS PRESSURE MONITORING
DEMONSTRATE/DISCUSS DATE SIGN Indication of the insertion of CVP line
Equipment needed for insertion of CVP line
including description and use of:
CVP monitoring line
CVP module
The technique for CVP insertion and measurement
The complications and hazards associated with CVP
line insertion and measurement
RESOURCES
CVP manometer
CVP monitoring line
OHP
SP 02/12 26
CARDIAC REHABILITATION
DISCUSS/DEMONSTRATE DATE SIGN Discussion with the cardiac rehabilitation nurse
Accompany the cardiac rehabilitation nurse on:
a) Ward visit
b) Clinic Visit
c) Visit the physio exercise class
RESOURCES
Advice leaflets, booklets
Videos
SP 02/12 27
SYNCHRONISED CARDIOVERSION
DISCUSS/DEMONSTRATE DATE SIGN Indications for synchronised Cardioversion
Difference between non-synchronised cardioversion
and synchronised Cardioversion
Equipment required for synchronised Cardioversion
Patient preparation
Technique used for synchronised Cardioversion
Hazards associated with synchronised Cardioversion
Patient aftercare
RESOURCES
Nurse Consultant
Cardioversion ECP’s
SP 02/12 28
LEARNING OPPORTUNITIES
KEY ELEMENT
INTERPERSONAL SKILLS
LEARNING OPPORTUNITIES RESOURCE / RELEVANT
PERSONNEL / DEPARTMENT
Use of the telephone:
Answering calls
Making calls
Ring back etc
Bleep system
Use of computer to obtain: Patient investigation results
Patient information
Talking to: Patients
Relatives
Doctors
Other nurses including specialist nurses
Multi-disciplinary team referrals
Ancillary staff
MDT meetings
Doctors ward round
Consultant ward rounds
Booking transport
Facilitating investigations
Nurses handovers
Managerial structure in Trust
Team working
Patient transfer in Trust
Patient transfer outside the Trust
Ward clerk / ward staff
Ward clerk / ward staff
Ward manager / Clinical Lead
Registered / Auxiliary nurse
Doctors, Multi-disciplinary team
Registered nurses / OT / Physio / Social
worker / Specialist nurses
Domestics
Registered nurses
Doctors / registered nurses / pharmacists
Ward clerk / Ambulance control / Hospital
transport Dept
Registered nurses / Doctors / ward clerk
Registered nurses
Ward manager
Observation of role
Patient / relative / registered nurse / bed
manager / porter / ambulance crew.
SP 02/12 29
KEY ELEMENT
CLINICAL SKILLS
LEARNING OPPORTUNITIES RESOURCE / RELAVANT
PERSONNEL / DEPARTMENT
CORE SKILLS:
Patient hygiene
Mouth care
Hair / nail care
Skin care
Pressure care prevention (Braden Scale)
Recording of physiological observations:
Blood Pressure
Temp, Pulse, Resps
Weight
Blood Glucose
Urine Output
Maintaining accurate charts
Giving medications -
Oral
Intramuscular
Subcutaneous
Intravenous
Rectal
Intravenous infusions
Cannulation / Care of venflons
Medical devices -
Infusion pumps
Syringe drivers
Phlebotomy / venepuncture
Administration of blood / blood products
Aseptic techniques, i.e. dressings
Risk assessment
Nutritional intake
BMI
Falls assessment
Registered / auxiliary nurse / occupational
therapist
Registered / auxiliary nurse
Registered / auxiliary nurse / Doctor
Registered nurse / Diabetic nurse specialist
Registered / auxiliary nurse
Registered nurse / Pharmacist / Doctor
Registered nurse / Infection control nurse
Registered nurse / Medical electronics
Registered nurse / Phlebotomists / path lab
Registered nurse
Registered nurse
Registered nurse
SP 02/12 30
Moving and handling
Use of aids
Hoists
Infection Control
Isolation of patients
Catheter insertion and care
Test urine
Central venous pressure lines
Patient safety
Checking equipment
Preparation for investigations
Consent
Information
Invasive radiology
Non-invasive radiology
SPECIALIST SKILLS
Nurse Thrombolysis
Temporary Pacing wires
Synchronised Cardioversion
Pericardiocentesis
Intra Aortic Balloon Pump
CPAP
Investigations:
Cardiac enzymes - Troponin T
Exercise Tolerance Test
Echocardiography
Angiography
Myocardial Perfusion Scan
Cardiomemo
24 hour tape
Registered nurse / Physiotherapist /
Moving and Handling Advisor
Registered / Auxiliary nurse / Control of
Infection nurse
Registered nurse
Registered Auxiliary / nurse
Registered nurse
Registered nurse
Registered nurse / Medical electronics /
works dept
Registered nurse / Doctor
Registered nurse / Radiology nurse /
Doctor
Emergency Care Practitioner (ECP)
Registered nurse / Doctor
Registered nurse / Nurse Consultant
Registered nurse / Doctor
Registered nurse / Nurse Consultant
Registered nurse / Nurse Consultant
Registered nurse
Registered nurse / Doctor / ECG Dept
Registered nurse / Doctor / ECG Dept
Registered nurse / Angiography nurse
Registered nurse / Medical Physics nurse /
Doctor
Registered nurse / ECG Dept
Registered nurse / ECG Dept
SP 02/12 31
KEY ELEMENT
HEALTH DEVELOPMENT OPPORTUNITIES
LEARNING OPPORTUNITIES RESOURCE / RELEVANT
PERSONNEL / DEPARTMENT
Healthy lifestyle strategies in relation to:
Smoking cessation
Alcoholic Liver Disease
Bowel disorders
Cancer
Obesity
Diabetes
Eating for a healthy heart
Drug and alcohol abuse
Promotion of exercise
Stroke rehabilitation
Healthy heart
Pulmonary rehabilitation
Health education and health promotion
literature
Models of health promotion/ education
Interface between hospital and community
care
Counselling
Smoking cessation advisor / pharmacist
Dietician / Gastroenterology nurse
Dietician / Upper GI nurse
Macmillan nurse / Hospice
Dietician / Practice nurse
Dietician / Diabetic nurse specialist
Dietician / Registered nurse / rehab nurse
Drug and alcohol team
Physiotherapist
Stroke unit / Physio / OT
CHD nurse / Heart failure specialist nurse
Respiratory specialist nurse
Health Promotion Unit
City Hospitals Web site
Internet
Specialist nurse clinics
Discussion with mentor
HAZ
Health Promotion Unit
Specialist nurses
CHD Community nurse
Macmillan nurse specialists
Hospice
Clinical psychology
SP 02/12 32
KEY ELEMENT
MANAGEMENT OF CARE
LEARNING OPPORTUNITIES RESOURCE / RELEVANT
PERSONNEL / DEPARTMENT
Use of nursing model
Philosophy of care
Documentation used
Chest Pain Assessment
Nursing process:
Assessment -
Who assesses?
How is assessment carried out / open or
closed questions?
What is assessed?
Where does it take place?
Planning -
Care plans
Risk assessment tools
Care pathways
Multi-disciplinary plan / working
Discharge planning
Referrals to other agencies -
OT
Physio
Social worker
District nurse
Discharge liaison
Specialist nurses
Critical Care Outreach nurse
Macmillan nurse
Hospice
Relevant departments
Registered nurse
Registered nurse
Registered nurse
Emergency Care Practitioner
Registered nurse
Sources of information
Patient, relatives, doctor, pharmacist, notes,
district nurses, specialist nurses
Registered nurse
Registered nurse / Link nurses
Registered nurse / specialist nurses
MDT
Discharge liaison nurse
Registered nurse
SP 02/12 33
Implementation / Evaluation -
Ward rounds
MDT
Documentation
Standards
Protocols
Policies
Patient Group Directions
Communication / patient / relatives
Time management
Planning priorities
Dealing with difficult situations
Deceased patients
Patient property / Valuables
Self discharge
Religious needs / arranging priest /
communication etc
Registered nurse / Doctors
Registered nurse
Registered nurse
Registered nurse
Registered nurse
Registered nurse
Registered nurse
Registered nurse
Registered nurse
Registered nurse
Registered nurse
Registered nurse / Doctor
Registered nurse / General office
Registered nurse / Doctor
Registered nurse / hospital chaplain / priest
SP 02/12 34
KEY ELEMENT
ORGANISATIONAL AND MANAGERIAL ISSUES
LEARNING OPPORTUNITIES RESOURCE / RELVANT
PERSONNEL /DEPARTMENT
Managing a team:
Organisational skills
Delegation skills
Prioritising skills
Time management
Leadership
Off duty
Managing patient workload
Quality
Standards of care
Implementing change
Giving information to:
Staff
Doctors
Patients
Relatives
Multi-disciplinary team members
Other departments
Resources:
Stock control
Drugs
TSSU
Materials management
Non - stock
Stationary
Establishment / skill mix
Budget control
Managing risk:
Policies and procedures
Equipment safety checks
Quality control
Registered nurse / team leaders / manager
Registered nurse / team leaders / manager
Registered nurse / team leaders / manager
Registered nurse / team leaders / manager
Registered nurse / team leaders / manager
Team leaders / manager
Registered nurse / team leaders / manager
Registered nurse / team leaders / manager
Registered nurse / team leaders / manager
Registered nurse / team leaders / manager
Registered nurse / team leaders / manager
Registered nurse / team leaders / manager
Registered nurse / team leaders / manager
Registered nurse / team leaders / manager
Registered nurse / team leaders / manager
Registered nurse / team leaders / manager
Registered nurse / Pharmacist / stores
Registered nurse / Pharmacist
Registered nurse / TSSU
Registered nurse / stores
Registered nurse / stores
Registered nurse / ward clerk / stores
Ward manager
Ward manager
Registered nurse
Health and safety officer / electronics
Health and safety officer and link nurse
SP 02/12 35
Environment checks
Infection Control
Moving and Handling
COSHH
Health and Safety
Emergency situations:
Cardiac arrest
Fast bleep system
Violent incidents
Fire
Bed alerts
Patient falls
Staff Developments:
Clinical supervision
Reflective practice
Domestic supervisor
Control of infection sister
Moving and handling co-ordinator
Link nurse
Link nurse
Registered nurse / arrest team
Registered nurse / switchboard
Registered nurse / Security officer
Registered nurse / Fire officer
Registered nurse / Bed manager
Registered nurse / health and safety officer
Registered nurse
Registered nurse
SP 02/12 36
KEY ELEMENT
PATHOPHYSIOLOGICAL PROCESSES
LEARNING OPPRTUNITIES RESOURCE /RELEVANT
PERSONNEL / DEPARTMENT
Infection:
Inflammatory process
Source
Nature spread
Treatment
Immunological factors:
Antigens
Autoantigens
Suppression of immune system
Drugs
Disorders
Disturbances in water and electrolyte
balance:
Normal electrolyte balance
Reading and understanding blood results
Dehydration
Water excess (ADH)
Acidosis
Oncology:
Epidemiology
Aetiology
Pathology
Treatments chemotherapy, radiotherapy,
Drugs
Registered nurse / Doctor / Pharmacist /
books / articles
Registered nurse / Doctor / Pharmacist /
books / articles
Registered nurse / Doctor / Pharmacist /
Renal team / books / articles
Registered nurse / Doctor / Pharmacist /
books / articles / Macmillan nurse /
Hospice
Chemotherapy unit / Radiotherapy dept
SP 02/12 37
Cardiovascular system:
Anatomy and physiology
Conduction system and ECG
Investigations
Treatments
Myocardial infarction
Angina
Heart failure, CCF, LVF
Cardiac arrest
Hypertension
Cardiac Arrhythmias
Cardiogenic shock
Drugs
Respiratory system:
Anatomy and physiology
Investigations
Infections
Treatments
Chest infections
COPD
Asthma
Emphysema
Fibrosis
Drugs Nebulisers, inhalers, oxygen therapy
Liver and Biliary system:
Anatomy and physiology
Jaundice
Tumours
Alcoholic liver disease
Nutrition
Treatments
Kidney and Genitourinary system:
Anatomy and physiology
Infections
Drugs
Investigations
Testing urine
Pyelonephritis
Fluid balance
Registered nurse / ECP / Doctor / ECG /
books / articles
Registered / Angiography nurse
Registered / ECP / Doctor
Registered / ECP / Rehab nurse
Registered / ECP / Doctor
Heart Failure nurse
Registered nurse / Doctor
Registered nurse / Doctor
Registered nurse / Doctor
Registered nurse / Doctor
Registered nurse / Doctor / Pharmacist
Registered / Respiratory nurse / Doctor
Pulmonary technician
Doctor / Pharmacist
Registered nurse / Doctor / GI nurse /
Endoscopy unit
Macmillan nurse
Drug and alcohol unit
Dietician
Registered nurse / Doctor / Continence
nurse / Radiology
SP 02/12 38
Diseases of the blood:
Blood formation and destruction process
Red blood cells
White blood cells
Platelets
Anaemia's
Blood transfusions
Malignant disorders
Lymphomas
Leukaemia's
Myeloma
Haemorrhage
Thrombosis
Endocrine and Metabolic disease:
Diabetes mellitus
Thyroid problems
Long term use of steroids
Pituitary problems
Nervous system:
Epilepsy
Tumours
Headaches
CVA
Infections
Connective tissue, joints, bones:
Arthritis
Lupus
Osteoarthritis
Osteoporosis
How bones heal
Infection
Acute poisoning:
Causes
Treatments
Drugs
Registered nurse / Doctor / books / articles
Haematology unit
Registered nurse / Doctor / Diabetic nurse /
Endocrine nurse / Pharmacist
Registered nurse / Doctor / Pharmacist
Stroke unit / Specialist nurse
Control of Infection nurse
Registered nurse / Doctor / Pharmacist /
Specialist nurse / Physio / books / articles
Registered nurse / Doctor / Pharmacist /
Poison unit
SP 02/12 39
LEARNING ZONES FOR CARDIOLOGY DEPARTMENT
N.B. It is important that when considering a visit to a learning zone that the
competencies a student will have achieved have been clearly identified and discussed
with the Mentor and Student. The Student must following the visit compile a
Testomy of Witness that must be countersigned by the practitioner with whom the
competencies have been undertaken in order for the Mentor to verify the
competence has been achieved.
ICCU
Heart Start
AMU Freeman and James Cook Hospitals
Emergency Care Physiotherapy Dietician
Radiology CCU B22 CPAU A&E
Cath Lab Research
Nurse
Cardiac
Rehab Heart Failure
Nurse
Nurse
Consultant RACPAC
Genetics Nurse
Community
CHD Nurses ETT/ECG/Echo Warfarin
CARDIOLOGY
DEPARTMENT
SP 02/12 40
Student Induction Checklist
Student Name……………………………………………………………………………………………………. Mentor Name........................................................................................................................................... Ward/Department.................................................................................................................................... This document is to ensure that the students accessing your ward/department are inducted and orientated appropriately- within the first week of placement. This is an NMC requirement for student support and learning in practice (NMC, 2008). Students must be allocated a trained and updated mentor and must work a minimum of 50% of the time in placement with their mentor. This is necessary in order to meet the NMC requirements and to achieve a continuous and comprehensive assessment of the student. The student’s off duty should be recorded alongside their mentor’s shifts. Please take the level/year/experience of your student into consideration when discussing some of the topics listed (eg. first yr, first placement student will only require a very basic awareness about some of the identified topics) Please complete this form and retain a copy within the Evidence File (the student should also retain a copy as evidence of achievement.
Initial Interview
Mentor signature & date
Student signature & date
Issue POLO document or advised to access via NU website Discuss student responsibilities while on placement Discuss strategy to achieve learning outcomes & schedule
to review progress
Ward Orientation
Introduction to ward/department staff (including MDT)
Hierarchy of trust staff explained
Tour around ward/department environment
Nurse Call system explained
Bleep system explained
Location of ward/department useful contact numbers identified
Off duty requests explained
Shift patterns explained
Security door code given (if applicable)
POD system explained
Explain the roles of the lead/link nurses
Familiarise yourself with lead/link nurses within the ward/department
Fire Procedure
Identify ward/departments fire alarm points
Location of fire fighting equipment and fire exits on ward/department
Explain the fire procedure and contact number (333) to alert switchboard of fire.
Identify ward/departments assembly point in the event of a fire
Location of Fire Safety Policy identified
Cardiac Arrest Procedure
Location of resuscitation equipment: Resuscitation Trolley
Suction Equipment (wall mounted/portable)
Defibrillation Machine/cardiac monitor
Oxygen points and cylinders
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Mentor signature & date
Student signature & date
Explain the contents of the resuscitation trolley
Demonstrate how to check and record the resuscitation trolley & Defibrillator check and frequency of checks according to policy
Explain procedure for Cardiac arrest and contact number (2222) to alert switchboard to send cardiac arrest team
Location of Resuscitation Policy identified
Manual Handling
Location of ward/departments Moving and Handling equipment
Health and Safety
Emergency Security bleep number (777) explained
Location of Health and Safety Policies (COSHH, Risk Management, Medical Devices & Decontamination policies) identified
Explain the difference between Oxygen and Air cylinders
Demonstrate how to set up oxygen (tubing/masks/valves) &suctioning equipment as appropriate to the level of the student
Medical equipment library explained
Infection Prevention and Control
Location of Infection Prevention and Control Policies identified (Disinfectant, hand washing, sharps and commode cleaning)
MRSA Screening explained
Explain the importance of the three times a day cannulae/line checks
Explain the importance of the daily catheter checks
Policies
Location and awareness of Uniform, Mobile Phone, Sickness reporting, Complaints, Data Protection & Equality and Diversity Policies
Communication/Record Keeping
The importance of consent explained
Telephone etiquette / communication skills explained
Demonstrate and explain the use of relevant patient assessments:
Observation charts and EWS Fluid Balance charts/Fluid Balance Summary Charts Diabetic Charts Nutrition/Food Charts Discharge Checklists Property lists MUST Tool Pressure Sore Assessment Accident/Incident Reporting Procedural Checklists
Audits
Additional information discussed/explained:-
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ADDITIONAL INFORMATION
How to record a 12 lead ECG
Explain the procedure to the patient. Patient will have to remove the shirt to
expose the chest. Reassure that it will be painless and will only take a few
minutes. Patient should then be helped on the couch and asked to lie with legs
and arms uncrossed.
• Clean areas of electrode placement with alcohol wipes. • Place pads for limb and chest electrodes. • Limb leads are colour coded. Pneumonic Ride Your Green Bike will help
you remember how to place the leads. Start with the red lead and attach it to the right wrist. Yellow is attached to the left wrist, green to the left leg and black to the right leg.
• Position of chest leads o V1: Fourth intercostal space at the right sternal border. (First
palpable intercostals space, below the clavicle is the 2nd
intercostal space.
o V2: Fourth intercostal space at the left sternal border o V3: Midway between V2 and V4 o V4: Fifth intercostal space in the midclavicular line o V5: Anterior axillary line at the same horizontal level as V4 o V6: Mid-axillary line at the same horizontal plane as V4 and V5
Switch on the machine, if it has a filter button press it to erase previously
recorded ECG. Record ECG.
How to read ECG
I will try to explain the important points in ECG as briefly and simply as I can. For
the OSCE you will obviously need to check the patient’s name, date of birth and
date when ECG was done.
ECG machines pick up electrical activity through 4 limb electrodes and 6 chest
electrodes and covert it into 6 limb leads (I, II, III, aVR, aVL and aVF) and 6 chest
leads (V1-V6)
• Leads I and aVL look at the left side of the heart
• Leads II, III and aVF look at the inferior surface of the heart
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• aVR is always negative as it looks at the heart from the position of the right
shoulder and electrical current moves away from it. The negative waves
confirm that the electrodes have been connected correctly
The 6 chest leads look at the heart in the horizontal plane, from the front and
around
• V1 and V2 give information about the right heart
• V3 and V4 about the interventricular septum
• V5 and V6 give information about the left side of the heart
Waves
• P wave: represent atrial systole
• QRS complex: ventricular systole
• T wave: ventricular relaxation or diastole
• Atrial systole gets buried in the ventricular systole and therefore does not
produce a wave form
• Q waves: When heart muscles are damaged the electrical current does not
pass through them and instead of upright R waves, downwards Q waves
are produced
Intervals
When ECG is recorded the paper speed is 25 millimetres/second so in 1 second
ECG tracing covers 5 large squares or 1 large square is equal to 0.2 seconds
and one small square is equal to 0.04 seconds.
• PR interval is measured from the start of the P wave to the beginning of the
QRS complex. The normal PR interval is 0.12 to 0.2 seconds or 3-5 small
squares
• Duration of QRS complex is normally 0.12 seconds or 3 small squares
• QT interval is the time between the onset of depolarization to repolarization.
It is affected by diet, gender, alcohol, time of the day, menstrual cycle and
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heart rate. QTc is the QT interval which has been corrected for the heart
rate
o QTc = QT msec/square root of RR
I don’t know about you but I have limited mathematical skills and cannot
calculate QTc with the above formula. An easier way is to calculate the
RR interval (number of large squares) and if QT interval is longer than
50% of the RR interval (again check the number of large squares between
beginning of Q and end of T) it is an indication that it is prolonged. You
can then take out your calculator and do it properly
Potential consequences of QT prolongation include torsade de pointes
(syncope), ventricular fibrillation and sudden death. If QTc prolongation is
associated with T wave changes refer to the cardiologist.
Heart rate
Hear rate can be easily determined by counting the number of large squares
between 2 consecutive QRS complexes (R-R interval). Normally the heart rate is
between 60 and 100/min.
• 1 large square: rate is 300/m
• 2 large squares: rate is 150
• 3 large squares: rate is 100
• 4 large squares: rate is 75
• 5 large squares: rate is 60 (1 QRS per second)
• 6 large squares: rate is 50
Patient is said to be bradycardiac if under 60 and tachycardic if heart rate is more
than 100.
How to determine axis?
Axis can be checked by looking at the direction of wave forms in leads I, II and
III. A normal (11’o clock to 5 o’ clock axis means that current is flowing towards
leads I, II and III and results in upward deflections in all 3.
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• In right axis deviation the deflections in I will become negative with positive
waves in II and III.
• In left axis deviation waves are negative in II and III
• If deflections are negative in all 3 it is extreme left axis deviation
How to read a rhythm strip?
Have gone trough the basics lets move on to reading a rhythm strip. 6 questions
need to be answered.
1. Is electrical activity present? (Does the tracing have any wave forms)
2. What is the heart rate?
3. Is atrial activity present? (Are p waves present)
4. Is the ventricular rhythm regular or irregular? (QRS complexes equally
spaced or not)
5. Is QRS complex width normal or prolonged? (3 small squares or more)
6. How is atrial activity related to ventricular activity? (Every p wave should be
followed by a QRS complex)
Important rhythm abnormalities
• Atrial flutter (I.H.D/Digitalis toxicity): Saw tooth appearance of p waves. It is
due to re-entry within the atria. As compared to A Fib rhythm is relatively
regular. Often presents with 2:1 or 4:1 AV blocks
• Atrial fibrillation: A chaotic rhythm, which originates from multiple sites in
atria. Only some impulses get through to the ventricles. Atria contract
rapidly and ventricular response is generally variable so every p wave will
not be followed by QRS complex
• Ventricular tachycardia: H.R > 100, QRS complexes wide (> 3 small
squares). P waves may or may not be present.
• Ventricular fibrillation: Irregularly irregular heart rate. No p waves. Wide QRS
complexes. Medical emergency treated with cardioversion.
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Myocardial infarction and Acute coronary syndrome
• Acute MI is characterised by ST elevation of 2 mm (2 small squares) in the
chest leads or 1 small square in the limb leads.
• T wave inversion denotes ischaemic changes (acute and chronic)
• ST depression signifies acute coronary syndrome or unstable angina
• Elevation/depression in a single lead is insignificant
Hyperkalemia
• Tall T waves or tenting of T waves.
• If associated with QRS prolongation it can lead to life threatening ventricular
arrhythmia
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SP08/10
ECG CHEST LEAD PLACEMENT
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