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After finishing INC5 placement in ICU, I am really looking forward to start INC6 unit reflecting upon my previous workshops and placement experiences. Cannot wait to start my INC6 journey with my peers and support from teaching team.

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https://youtu.be/FxOXPVW4ZCc
I found this YouTube video on Diabetic ketoacidosis which is very helpful to broaden my knowledge on this condition.

What is diabetic ketoacidosis (DKA)?
Diabetic ketoacidosis is a serious complication of diabetes. when the body is unable to create enough insulin, the condition arises. Sugar, a main source of energy for muscles and other tissues, enters cells in the body with the aid of insulin. When insulin levels are too low, the body starts using fat as fuel. Ketone, which are acids, begin to accumulate in the bloodstream as a result. The accumulation can result in diabetic ketoacidosis if it not managed.

In this first week of workshop, we discussed about Beth's case in which we explore more about diabetic ketoacidosis and we focused on the its presentation, assessment and care priorities as a Registered nurse. We went through the CHS policy prior to commencing insulin infusion. If BGL is >15 a normal saline needs to be used and if BGL <15 a glucose intravenous infusion at a rate of 125 ml per hour must be prescribed (sideline). The rate of the insulin infusion depends on the blood glucose level.

Reflection
In this workshop and seminar I was able to learn DKA in depth and I realized that why it is more important to go through policies prior to commencing insulin infusion.  As we were two in group due to make up class, we got confused regrading calculation of actrapid  how much to administer. But we took some time and went through CHS policies of insulin infusion and we managed to administer correct dose following seven rights of medication.

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What is Asthma?
A chronic lung disorder of the airway called asthma ( the passage that transports air into our lung).  Although there is currently no treatment, it can be controlled. The airways of those who have this illness are sensitive. When exposed to triggers, these airways swell up and become inflamed (also known as having a flare-up ). As the airways narrow as a result of inflammation , there are noticeable , troublesome symptoms that last for a long time. As it is the same as inhaling through a very small tube, this frequently leads to respiratory problems. It also results in a medical emergency. A flare up can develop gradually over hours, day, or even weeks, or rapidly over a short period of time.

Different Adventitious sounds

Crackles: Crackles are slight bubbling, clicking, or rattling sounds in the lungs.

Rhonchi: Rhonchi resemble snoring. This sound can occur in expiration or both inspiration and expiration.

Wheezes: Wheezes are high- pitched sounds.

Stridor: Stridor is a wheeze-like sound. An airflow blockage in the windpipe or the back of the throat causes this sound.

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This is the first Chapter of the 'Live Well with Asthma' DVD - other chapters also available on our YouTube channel - www.youtube.com/asthmansw.

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As we were group of 5 and we divided roles for each task and worked as a team. We wrote down some bullet points on whiteboard while providing care to Thomas. I was assigned to administer medication and stat dose of salbutamol 12 puffs given as per charted. But we found out that there was overdose of salbutamol because patient already had that medication. Due to overdose of salbutamol, patient's vital signs are started to deteriorate with mews-9. We called MET team and given handover to MET team.

In this week, I learnt that effective communication is really important between the patient and nurse which helps to provide better care to patient. I have learnt in this workshop is that reassuring to patient and giving the update like what is happening, what is the next plan during the MET call is really important because it can be overwhelming to patient in such situation.

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In the seminar, we discussed the Standard 4, 6 and ULO 1,3 relating with Thomas's case and we discussed some points in the picture above during the seminar.

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Some of the points above written down while taking care of Manuel who is 89 year old man history of COPD and multiple infective exacerbations. During the workshop, we figured out concerns were SPO2 88-92%, ?infection, high temperature, respiratory rate, risk of dehydration. Early recognition of deteriorating patient and escalation to team is important and which I have learnt in this module. I practiced administering IVAB and s8 analgesia. I have realized that before administering analgesia it is very important ask patient what kind of analgesia they take, how much dose, how often they take. Because asking these questions can help patient what works better for them.

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This week's seminar in a group of 5, we explore on  Emphysema and its presentation. We drawn some pictures for better understanding of pathophysiology of emphysema. Emphysema primarily affects the air spaces distal to the terminal bronchiole and it’s a clinical diagnosis. It is distinguished by abnormal persistent expansion of lung air spaces, wall disintegration, and degradation of the lung parenchyma (with loss of elasticity).

Reflection
In a group, we were asked to practice interview using NMBA standard of practice  with relating to Manuel case. Interview practice is really helpful for our upcoming interview and will be using some tips and tricks which I have learnt in this seminar.

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This picture is really helpful in understanding of inspection palpitation, auscultation and percussion which comprehensively shows physical examination when patient present with abdominal pain.

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This week we discussed about Jemima who is 18 years old female presented with abdominal pain. In this workshop, as Vera plays an role of Jemima and we got chance to ask lot questions regarding Jemima's background, past medical history, psychosocial history which is really important when providing care of patient with being non-judgmental and priotise care accordingly. From this patient and nurse roleplay what I have realized is therapeutic relationship is important to build trust between patient and nurse and to make patient comfortable so that they can share their concerns, information without any hesitation.

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Trauma is a widespread issue. It happens when someone experiences a single incident or a strong of emotionally upsetting or life threatening events that have a lasting negative impact on their functioning and mental, physical, social, emotional, and/or spiritual well-being.
Prior to the patient's arrival, the trauma assessment is started with information gathering, trauma team, and equipment setup. The team's initial examination of the patient 's airway, breathing, circulation, disability and exposure occurs when patient first arrives. The secondary survey starts after the patient has been stabilized. To prevent missing an injury, a comprehensive history and physical examination are required.

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From this week of workshop, what I have learn is understanding your responsibilities and getting ready to fulfill them are crucial when taking care of trauma patients. Documentation, taking vital signs, inserting an intravenous catheter, checking the patient's glucose level, drawing labs, getting ECG, giving medications which are typical duties but these duties can be fulfilled with the effective communication and proper team work. Moreover, the trauma assessment should be led by a single team member and constant closed-loop communication should be used to facilitate effective communication.

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Day 4 post cyclist with multiple injuries, alert and orientated. Stated pain 9/10 but declined analgesia. Surgical wounds dry and intact. Neurovascular intact. Unable to mobilize due to pain. Sam is declining analgesia with 9/10 pain. Provided education of taking pain medications why it is beneficial for his current situation. Mobility is important for proper blood circulation and for wound healing as well.
Patient education is important when taking care of patient as it helps to maintain better relation and build trust between patient and nurse.

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In the workshop, we were three in group and we assigned different roles and while taking care of Sam and we worked as a team, help each other out. When working as team effective communication is necessary and we followed throughout the workshop which helps to achieve our assigned work done on time. At last we discussed about team de-briefing questions among the class which is really helpful to know what we did and what can be done better in future.

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My name is Pabitra Dahal one of the students from University of Canberra and going to complete my Bachelor of Nursing this mid-year. I am at end of completion of my placement.

During my two years of Nursing degree, I always looked for expanding my knowledge and skills which will make me capable enough as a nurse and to provide care to others. From my previous placement experience, I learnt and developed that therapeutic relationship and communications skills which is important when taking of care patients because these skills makes me listen to understand, advocate, and maintain a non-judgmental environment. These skills help me to fostered self-awareness, empathy, trust and authenticity on which I will be able to provide best possible care to my patients by respecting their needs and understand them, their situation and work together to achieve positive health outcomes.
I have done my placement in several areas of Nursing like Mental health, ICU, Surgical ward experiencing in various areas has enabled me to gain different skills like documentation, escalation, administration of medications, handover and collaboration with multidisciplinary team which help to broaden my knowledge and able to perform task competently.

My goal is to provide care within a safe environment and to improve effective communication skills and to achieve this, I will practice more clinical handover following ISBAR format on my upcoming placement and I will measure my achievement by seeking  feedback from CLN, preceptor and strive for opportunities, relating with Nursing standard guidelines. I will reflect on strength and weaknesses where I will focus on areas of improvement by utilizing the resources and measuring my achievement. I am looking forward to transitioning my skills and knowledge into practice as RN.

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certificate of acute adult mental health