welcome to the cardiology department · welcome to the cardiology department at sunderland royal...

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WELCOME TO THE CARDIOLOGY DEPARTMENT

PROFILE OF LEARNING OPPORTUNITIES (POLO)

AND

INDUCTION CHECKLIST

EDUCATIONAL LEAD:

Student:

Mentor:

Co - Mentor:

Date:

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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

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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.

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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

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Junior Sisters: X 4

Staff Nurses: X 35

Auxilary Nurses: X 15

Ward Clerks CPAU/CCU

B22

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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

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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

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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.

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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

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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

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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

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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

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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

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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

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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.

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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.

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KEY ELEMENT

CLINICAL SKILLS

LEARNING OPPORTUNITIES RESOURCE / RELAVANT


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

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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 / 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

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KEY ELEMENT

HEALTH DEVELOPMENT OPPORTUNITIES



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

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KEY ELEMENT

MANAGEMENT OF CARE



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

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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 / General office


Registered nurse / hospital chaplain / priest

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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





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

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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


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


books / articles


Renal team / books / articles


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:


Investigations

Infections

Treatments

Chest infections

COPD

Asthma

Emphysema

Fibrosis

Drugs Nebulisers, inhalers, oxygen therapy

Liver and Biliary system:


Jaundice

Tumours

Alcoholic liver disease

Nutrition

Treatments

Kidney and Genitourinary system:


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 / 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


Specialist nurse / Physio / books / articles


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

SP 02/12 41

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



• 5 large squares: rate is 60 (1 QRS per second)


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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