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Understanding before content: 4/10

Understanding after content 8/10

Watching this video on Naloxone helped deepen my understanding, of how this medication works to rapidly reverse the effects of opioid overdose. I learned about its mechanism of action (blocking opioid receptors) the routes of administration (e.g intramuscular, intranasal) and the importance of rapid response to prevent respiratory depression and death.

Reflecting this information into my future practice, I will feel more confident in recognising the signs of opioid overdose. By knowing when and how to safely administer Naloxone, I also plan to ensure I follow up with education for patients and families around overdose prevention. Examples of education include: medication safety, and accessing ongoing care, especially in communities at higher risk such as people experiencing homelessness, Aboriginal and Torres Strait Islander peoples, individuals with a history of substance use or mental illness, people recently released from correctional facilities, and young people experimenting with illicit drugs.

6.3 – Documents, evaluates and modifies plans of care to facilitate the agreed outcomes.

After administering Naloxone, I will monitor and reassess the patient, update the care plan, and prepare for potential rebound symptoms linking to safe documentation and ongoing evaluation.

6.5 – Practises in accordance with relevant policies, guidelines, standards, regulations and legislation.

Naloxone use is governed by specific resuscitation and medication safety guidelines. Being informed and following these in practice aligns with this sub standard.

4.1 – Conducts assessments that are holistic and culturally appropriate.

Recognising overdose signs and acting swiftly, while also being sensitive to cultural considerations around substance use, supports a person-centred and respectful response.

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Transcript
How Naloxone Saves Lives in Opioid Overdose
NALOXONE SAVES LIVES.

No time to sit idly by. More and more people are dying of overdose from the likes of heroin, fentanyl, and prescription pain medications like oxycodone and hydrocodone. These are all examples of opioids.

Opioids are drugs derived from the opium poppy plant or made in the lab. They can treat pain, cough and diarrhea. But opioids can also be addictive and even deadly.

The number of opioid overdose deaths has escalated more than 400% since the turn of the century, with tens of thousands of lives now being lost every year.

But many deaths can be prevented with a life-saving treatment: naloxone.

When given right away, naloxone can work in minutes to reverse an overdose. Naloxone is safe, has few side effects, and some forms can be administered by friends and family.
When is naloxone used?
You can save a life. First, recognize signs of overdose:

Limp body

Pale, clammy face

Blue fingernails or lips

Vomiting or gurgling sounds

Inability to speak or be awakened

Slow breathing or heartbeat

If you see these symptoms, call 911 immediately and consider the use of naloxone if available.
How is naloxone given?
Home preparations include a nasal spray given to someone while they lie on their back or a device that automatically injects medicine into the thigh. Sometimes more than one dose is needed.

The person's breathing also needs to be monitored. If the person stops breathing, consider rescue breaths and CPR if you are trained until first responders arrive.
How does naloxone work?
Naloxone is an opioid antagonist, which means that it blocks opioid receptors from being activated. It is so strongly attracted to the receptors that it knocks other opioids off. When opioids are sitting on their receptors, they change the activity of the cell.

Opioid receptors are found on nerve cells all around the body:

In the brain, opioids produce feelings of comfort and sleepiness.

In the brainstem, opioids relax breathing and reduce cough.

In the spinal cord and peripheral nerves, opioids slow down pain signals.

In the gastrointestinal tract, opioids are constipating.

These opioid actions can be helpful! The body actually produces its own opioids called "endorphins," which help calm the body in times of stress. Endorphins help produce the "runner's high" that helps marathon runners get through grueling races.

But opioid drugs, like prescription pain medications or heroin, have much stronger opioid effects. And they are more dangerous.

Over time, frequent opioid use makes the body dependent on the drugs. When the opioids are taken away, the body reacts with withdrawal symptoms such as headache, racing heart, soaking sweats, vomiting, diarrhea, and tremors. For many, the symptoms feel unbearable.

Over time, opioid receptors also become less responsive and the body develops tolerance to the drugs. More drugs are needed to produce the same effects...which makes overdose more likely.

Overdose is dangerous especially for its effect in the brainstem, relaxing breathing. Breathing can be relaxed so much that it stops...leading to death.

Naloxone knocks opioids off their receptors all around the body. In the brainstem, naloxone can restore the drive to breathe. And save a life.

But even if naloxone is successful, opioids are still floating around, so expert medical care should be sought as soon as possible. Naloxone works for 30-90 minutes before the opioids return to their receptors.

Naloxone may promote withdrawal because it knocks opioids off their receptors so quickly. But otherwise naloxone is safe and unlikely to produce side effects.

Naloxone saves lives. From 1996 to 2014, at least 26,500 opioid overdoses in the United States were reversed by laypersons using naloxone.

While naloxone is a potentially life-saving treatment, more needs to be done to solve the opioid overdose epidemic.

The National Institutes of Health launched the HEAL Initiative in 2018, expanding research across multiple NIH Institutes and Centers to speed scientific solutions to the national opioid crisis. Research is underway to improve treatments for opioid misuse and addiction, and to enhance pain management. The National Institute on Drug Abuse, or NIDA, is the leading NIH institute for research on opioid misuse and addiction, and its support helped the development of the user-friendly naloxone nasal spray.

For more information, see NIDA's website at drugabuse.gov and search "naloxone," or visit nih.gov and search "NIH heal initiative." General opioid information can also be found at MedlinePlus.gov.

This video was produced by MedlinePlus, a trusted source of health information from the National Library of Medicine.

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MedlinePlus: How Naloxone Saves Lives in Opioid Overdose

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How Naloxone Saves Lives in Opioid Overdose NALOXONE SAVES LIVES. No time to sit idly by. More and more people are dying of overdose from the likes of heroin, fentanyl, and prescription pain medications like oxycodone and hydrocodone. These are all examples of opioids.

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Todays lesson we were re introduced to our patient Avery seventeen year old non binary patient who weighs 50kg with a history of type 1 diabetes mellitus.

This lesson in groups of three we were asked to perform a full A-G assessment on a hard to rouse patient involving three students one as a primary nurse, second as the secondary nurse, and third to provide clarification of the patient symptoms.

I was the secondary nurse for the activity, as I observed I helped assist with listening to chest sounds, putting the sats probe on the patients finger and asking the third nurse for our BGL results.

4.1 - 'Conducts assessments that are holistic as well as culturally appropriate'

Going through our understanding we took note that our patient had a low blood sugar in an episode of DKA the role of dextrose can help prevent Hypoglycaemia.

4.2 - Uses a range of assessment techniques to systematically collect relevant and accurate information and data to inform practice

Once we received the ok from our instructor we moved onto administering IV dextrose 2ml/kg = 100ml/hr then checking BGL after thirty mins to see if treatment had worked.

4.4 - 'Assesses the resources available to inform planning

After this lesson I felt very confident to hang and prime IV primary lines

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As a future Registered Nurse, I am deeply passionate about providing compassionate, high-quality care that aligns with the Nursing and Midwifery Board of Australia (NMBA). Throughout my studies and clinical experiences, I have built a strong foundation in holistic, evidence-based care. This involved always prioritising patient safety, cultural awareness, and heartfelt communication.

My love for nursing stems from a deep desire to support individuals during the most vulnerable and transformative moments of their lives. As I transition into my new graduate practice, I am eager to further develop my clinical skills, critical thinking, and leadership abilities within a supportive healthcare environment. I look forward to embracing lifelong learning, engaging in interdisciplinary collaboration, and continually refining my practice to provide the highest standard of care.

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Labelled diagram of integumentary system

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Understanding before content: 7.5/10

Understanding after content: 9/10

Basics of the integumentary system notes:

Epidermis – The outermost layer, primarily composed of keratinocytes, which produce keratin, a protein essential for waterproofing and structural integrity. The epidermis also contains melanocytes (responsible for skin pigmentation) It undergoes continuous renewal, with new cells forming at the basal layer and migrating upward.

Dermis – This middle layer provides strength and elasticity due to its rich network of collagen and elastin fibres. It contains blood vessels, nerve endings, hair follicles, and sebaceous and sweat glands. The dermis plays a crucial role in temperature regulation, wound healing, and immune responses.

Hypodermis (Subcutaneous Tissue) – This deepest layer consists mainly of adipose tissue, which provides insulation, cushioning, and energy storage. It also houses larger blood vessels and lymphatic structures that contribute to immune function and circulation (Rn), (2021)

What it means to me in my practice:

Reflecting on this module I am learning to differentiate between superficial, partial-thickness, and full-thickness burns as this helps me develop a systematic approach to estimating Total Body Surface Area (TBSA) using validated tools such as the Wallace Rule of Nines and the Lund and Browder chart. In line with NMBA substandard 6.1 – 'Provides comprehensive safe, quality practice to achieve agreed goals and outcomes that are responsive to the nursing needs of people'.

Accurate TBSA estimation is crucial for fluid resuscitation calculations and ensuring adequate organ perfusion, especially in paediatric patients, who are at a higher risk of fluid loss and shock due to their greater body surface area-to-mass ratio.

Understanding how to calculate fluid replacement based on burn severity shows the importance of early and adequate resuscitation to prevent hypovolemic shock and organ dysfunction. Practicing fluid calculations during clinical simulations gave me confidence in performing accurate weight-based medication calculations.

5.4 plans and negotiates how practice will be evaluated and the time frame of engagement, and

6.2 practises within their scope of practice

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During my placement at a hospice a few months ago, I cared for an elderly man in the final stages of terminal cancer. This experience challenged me emotionally and professionally, pushing me to reflect on my attitudes, values, and beliefs surrounding palliative care. Mr T was diagnosed as end of life, I was assisting with providing comfort care along with two other nurses this involved personal care, feeding, medication administration.

His family members were present, expressing a mix of grief, acceptance, and distress. I felt their grief, unsure if my words helped. Under the supervision of my RN while administering end-of-life medications also made me uneasy. I often wondered if they were enough to make him comfortable, as his pain levels were very high sometimes even after administration.

This experience was incredibly emotional, and I felt distraught for the family as he was a very loved family member who had grandchildren who were also present at bedside. I felt a sense of pressure to provide the best care possible as I would want that for my family. I questioned my ability to handle such delicate moments, especially when he had passed.

The family members had thanked me and the staff for making his final moments so special and I felt truly privileged to be part of such an intimate moment in his life knowing that my presence and actions mattered.

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In line with Nursing Standard 1: Critically Thinks and Analyses Nursing Practice (Nursing and Midwifery Board of Australia, 2016), I demonstrated the ability to think critically and seek evidence-based knowledge by proactively accessing the healthcare facility’s online policy regarding syringe driver usage.

Before caring for Mr. T, I recognised I had very little knowledge regarding the safe and effective use of syringe drivers, which are essential for administering continuous subcutaneous infusions in palliative care settings.

I approached senior nursing staff on the ward and requested five minutes to review the policy, ensuring I had a clear understanding of the correct setup, dosage adjustments, and monitoring requirements associated with syringe driver use. This self-directed learning was an application of critical thinking, as I identified the lack of understanding and took immediate steps to address it using the best available evidence.

In my future practice, I will continue expanding my knowledge by attending workplace workshops and in-services training to further educate myself about medication administration techniques and fully understanding them before caring for my patient. Palliative Care Australia (2018)

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Engaging in therapeutic and professional relationships focuses on establishing, sustaining, and concluding relationships that are respectful, person-centered, and culturally responsive. This experience aligns with this standard through building trust and rapport with my patient by acknowledging his family's grief and distress as well as demonstrating empathy and sensitivity. My awareness of their emotions and uncertainty about what to say highlights the intent to provide compassionate, patient-centered care. My emotional awareness allowed me to engage with the family which validated their feelings while maintaining a professional and compassionate demeanour. Trust is fundamental in palliative care, as patients and their families rely on healthcare providers for emotional support and guidance during end-of-life transitions. In such moments, non-verbal communication, such as maintaining a calm presence, listening attentively, and offering gentle reassurance can be, just as meaningful as spoken words. National Institute on Aging (2022)

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NMBA Standard 3 emphasises the responsibility of nurses to ensure they maintain, develop, and apply their knowledge and skills to provide safe, high-quality, evidence-based care (Nursing and Midwifery Board of Australia (NMBA), 2016).

Providing end-of-life care for Mr. T was emotionally challenging, particularly witnessing his family’s grief. However, I recognised the importance of maintaining professional boundaries and managing my emotions to continue delivering high-quality care. By reflecting on this experience, I have developed a greater awareness of the emotional impact of palliative care and the necessity of self-care strategies, such as seeking peer support and clinical supervision, to sustain my emotional resilience in future practice.

Research suggests that structured debriefing sessions and reflective practice are essential in helping nurses cope with grief and avoid burnout, ultimately promoting long-term emotional resilience. Additionally, self-care strategies such as mindfulness, maintaining work-life balance, and engaging in professional development can mitigate emotional exhaustion and enhance long-term well-being in palliative care nurses. Moving forward, I aim to actively integrate these strategies into my practice, ensuring I can provide consistent, compassionate, and sustainable care while safeguarding my emotional well-being. Alanazi et al. (2024)

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Specific: I will enhance my clinical proficiency in managing complex care by improving patient assessments, medication management, and communication with multidisciplinary teams, with a focus on interpreting diagnostic results and responding to emergencies.

Measurable: I will complete 10 comprehensive patient assessments within three months, receive feedback from preceptors, and participate in 3 emergency response simulations.

Achievable: I will attend workshops on emergency care, pharmacology, and patient assessments, and shadow experienced Registered Nurses in critical care settings to strengthen my decision-making.

Relevant: Mastering patient assessment and medication management is essential for providing high-quality, safe care as I transition into the Registered Nurse role.

Time-bound: By the end of six months, I aim to consistently demonstrate competency in patient assessments and managing emergency situations independently.

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The day started with a warm welcome from our lecturers, who introduced themselves and provided an overview of the simulation-based learning areas. They emphasised the importance of active participation, teamwork, and applying theoretical knowledge to practical scenarios. We were reminded of our responsibilities, including adhering to infection control practices, maintaining professionalism, and actively engaging in debriefing sessions.

We were then given a tour of the clinical skills lab, which helped ease some initial nerves. The team showed us the different stations, including the mannequins, medication administration areas, and emergency response equipment.

As well as the simulation room where an audience would watch as two participants of our class would be recorded in an immerse environment. Reflecting on today I am very excited to start learning for INC six as we near the end and become future registered nurses to our community, how exciting!

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Please see key within word doc

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Sign in to your OneDrive cloud storage and Office Online.

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Please be advised there are 4 separate columns, for each part of the modules including:

1. Pre module notes

2. Seminar reflection

3. Clinical skills reflection

4. Simulation reflection

Some tiles will also consist of excess notes and helpful resources that contributed to my learning.

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The Lund and Browder (LB) chart is currently the most accurate and widely used chart to calculate total body surface area affected by a burn injury.

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Epidermis – Outermost layer, provides a barrier.

Dermis – Contains blood vessels, nerves, and sweat glands.

Subcutaneous Tissue – Fat and connective tissue for insulation and shock absorption.

Thermal Burns (Heat-related) – Flame, Scald (hot liquids), or Contact (hot surfaces).

Electrical Burns – From electrical currents; can cause deep tissue damage.

Friction Burns – Caused by rough surfaces, e.g., road rash.

Chemical Burns – Due to strong acids, alkalis, or solvents.

Radiation Burns – From UV rays (sunburn) or radiation therapy.

Depth Classification:

Superficial (1st-degree): Red, painful, no blisters.

Partial-thickness (2nd-degree): Blistering, very painful.

Full-thickness (3rd-degree): White/charred, no pain due to nerve damage

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By creating an electrolyte table, I was able to enhance my understanding of electrolyte imbalances, which is crucial for providing comprehensive and safe care to patients experiencing DKA. This table helped me understand how each electrolyte impacts the patient's overall health and recovery, allowing me to deliver more targeted care for my future practice.

6.1 - 'provides comprehensive safe, quality practice to achieve agreed goals and outcomes that are responsive to the nursing needs of people'

Nursing and Midwifery Board of Australia registered nurse standards for practice (2016)

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Fluid and Electrolytes explained simply for Nursing Students 

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This educational video helped me understand electrolytes and their uses in the body

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Fluid and Electrolytes Imbalances for Nursing Students - NCLEX Review

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Diabetic patient finding out about diabetes diagnosis

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During the clinical skills class we were separated into groups of three. As a group we were given the ACT Health guideline for DKA diagnosis and management.

This guideline helped to inform our practice and using it to develop a plan for Avery who is experiencing DKA.

5.1 - 'Uses assessment data and best available evidence to develop a plan' this links with my information given to inform my practice:

Blood Glucose Level (BGL)

Ketone level

pH level

Electrolytes - Sodium level

Patient Weight (essential for calculating insulin infusion rate)

Medical History - Diabetes mellitus

Our plan involved using Avery’s weight-based insulin dose we prioritised safety by verifying our calculations with our lecturer, who acted as a second checker before proceeding.

This action reflected real-life high risk medications especially IV infusions like insulin where this requires double checking to prevent errors and adverse effects.

By taking this extra step, we adhered to our rights of medication administration and shows both NMBA sub standard 5.5 -'Coordinates resources effectively and efficiently for planned actions' and

NMBA sub standard - 6.5 Practises in accordance with relevant policies, guidelines, standards, regulations and legislation.

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Image above shows my seminar handwritten pre work: 

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Understanding before content = 5.5/10

Understanding after content = 7/10

During our seminar the topics covered were:

Revising DKA pathophysiology

The role of key electrolytes (potassium, magnesium, phosphate & sodium) specifically during DKA.

Discharge planning considerations for DKA patients and impact on families.

Consider the role of health literacy & nurses roles to assess DKA in paediatric patient:

As I went into our seminar I felt a bit nervous, I understood the basics of such as DKA symptoms, but previous to this I cared for a patient who was a diabetic, poorly managed and often had episodes of DKA. So this module really helped gain a deeper understanding of:

pathophysiology

critical interventions

electrolyte imbalances

managing blood glucose levels

6.1 - 'provides comprehensive safe, quality practice to achieve agreed goals and outcomes that are responsive to the nursing needs of people'

As a class we briefly discussed what those electrolyte changes would look like and applying them to the pathophysiology of DKA

Sodium

Often appears low (hyponatremia) due to osmotic shifts caused by high glucose levels.

Correction: As glucose levels are normalised, sodium levels may rise.

Potassium

Typically elevated (hyperkalaemia) due to acidosis and insulin deficiency which inhibits potassium uptake into cells.

Phosphate

Often decreased (hypophosphatemia) during treatment due to shifts into cells and renal losses. This can lead to complications if not monitored.

As a class we covered health literacy & nurses roles to assess DKA in paediatric patient such as

Teach back/talk back method:

For example, using teach back method with the patient’s family can be helpful to gauge an understanding of knowledge that they gained through your explanation of the health condition.

Visual aids

Written instructions

Culturally appropriate resources can enhance comprehension.

Open ended questions

Asking open-ended questions with simple language avoiding jargon or complex medical terminology, such as "Can you explain how you would manage this situation at home?" or "What would you do if this (symptom) occurs?" This encourages the family to actively engage with the information and, apply it to real-life scenarios.

We were then split into groups of 4 to discuss a topic decided by our lecturer we were given Ketosis we were asked to research and then present our findings to the rest of the class after completion. When I heard this word it made me automatically think of the 'keto diet' for weight loss.

Upon reading more about ketosis, I have learned that this metabolic state is when there is insufficient carbohydrate intake or insulin deficiency meaning, the body then burns fat for energy instead of glucose.

This process produces ketones acids that can be measured in the blood and urine. This learning will definitely be used in my future practice as I will be better equipped to recognise early signs of metabolic imbalance and intervene promptly to prevent complications following NMBA standards:

5.1 uses assessment data and best available evidence to develop a plan

6.2 practises within their scope of practice

7.1 evaluates and monitors progress towards the expected goals and outcomes

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Reflecting on this experience I think my partner and I did a really good job going through A-G assessment.

Our actions were very quick and concise upon realising that this patient is hard to rouse due to opioid overdose.

I also found watching Nathan putting in an airway for our patient really interesting to watch. Our actions today showed

6.2- practises within their scope of practice

5.5- coordinates resources effectively and efficiently for planned actions.

4.2 - uses a range of assessment techniques to systematically collect relevant and accurate information and data to inform practice

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My handwritten notes cover our module prep work - this includes the

1. Legislative considerations

2. Voluntary patients

3. Involuntary patients

4. Decision making capacity

Voluntary patients:

4.1 – Uses a person-centred approach:

This sub-standard highlights the importance of respecting patient autonomy by ensuring that voluntary patients are fully informed and actively involved in decisions regarding their care. It reinforces that when patients have decision-making capacity, they should be empowered to consent to or refuse treatment.

7.2 – 'Engages in ethical decision-making'

This sub-standard involves upholding the rights and dignity of patients by ensuring that ethical principles guide care. For voluntary patients, this means respecting their choices and ensuring their consent is informed and voluntary.

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This seminar was a more self directed learning class. We were asked to review two digital QR codes and make notes. This seminar covered Trauma and how this can manifest in nursing.

Trauma is an emotional and physiological response to deeply distressing or disturbing experiences such as abuse, neglect, loss, violence, or serious illness.

Trauma can manifest in patients in many ways, including:

Heightened anxiety or hypervigilance

Fear or mistrust of healthcare providers

motional withdrawal or dissociation

Challenging behaviours that may be misunderstood as non-compliance or aggression

Poor communication or reluctance to disclose important health information

It’s important to remember that trauma is not always visible and can be historical, intergenerational, or cultural particularly in Aboriginal and Torres Strait Islander communities, where trauma may stem from colonisation, the Stolen Generations, and systemic racism.

As a nurse, recognising trauma means shifting our approach from asking "What is wrong with you?" to "What has happened to you?"

In my future practice, I will aim to:

Build trust through respectful, non-judgemental communication

Offer choices to empower patients and restore control

Create safe environments that reduce re-traumatisation

Acknowledge cultural needs and support traditional healing practices when appropriate

Collaborate with multidisciplinary teams, including mental health and social work

Relevant NMBA Standards:

Standard 6.2: Practises within their scope and understands when to seek specialist support

Standard 7.3: Engages in self-reflection and development to improve practice, especially in complex situations

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Reflecting on this simulation, I realised how unpredictable and challenging real-life clinical situations can be especially when de-escalation is required. I was slightly nervous before the session because I wasn’t sure if we would have to de-escalate a situation or remove ourselves from it.

The pre-recorded simulation depicted two nurses during handover, where one nurse expressed concerns about Robin’s medication adherence, noting that he had been "fine yesterday." The second nurse (Bec) probed further, asking if Robin was confused, agitated, or both. As the scenario unfolded, Robin became visibly distressed responding to unseen stimuli, displaying agitation, and pushing objects around the room in an aggressive manner. Both nurses then prioritised their own safety by removing themselves from the immediate vicinity to the other side of the room ensuring that everyone including Robin remained unharmed. I also deeply appreciated hearing Bec’s perspective afterwards, which provided valuable insights into the emotional and practical challenges faced by nurses in high-stress situations.

Standard 4.1: Comprehensive and Collaborative Practice

The simulation considered both the patient’s physical and emotional needs. Despite Robin’s agitation Bec did try and attempt to understand his distress which is using person-centred approach.

Standard 4.2 (Effective communication): The handover discussion, particularly the questioning about whether Robin was confused or agitated, shows how it is so important for clear and thorough communication between health professionals, This aspect reminded me that accurate and empathetic information sharing is essential in ensuring continuity of care.

Standard 7.2 (Advocacy for safe practice): The simulation illustrated how essential it is to advocate for both patient and staff safety, and to be prepared to make difficult decisions rapidly. This will guide me to always prioritise safety and ethical decision making in my future practice.

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Reflecting on today's lesson I took my theoretical knowledge from my pre learning calculations based on TBSA (Total body surface area) and applied this to today's case. Although this is normally a group activity this was a makeup session, so I performed individually with the lecturer in attendance for assistance. Today's clinical skills involved a paediatric patient who was burned on her face similar to Anthea's daughter Quinn.

Within this experience I learned how to implement the fluid resuscitation order as well as what to monitor once administered for example; input and output of the patient and how these results may differ from an adult to a paediatric patients according to weight.

For example for a child we are aiming for a urine output of 1–2 mL/kg/hr where as for an adult we are aiming for a urine output of at least 0.5 mL/kg/hr. Children often have more water in their bodies up to 70–80% of their body weight is water, compared to 50–60% in adults most of this water is extracellular, which makes them more vulnerable to rapid fluid shifts and dehydration.

Daley and Avva (2024)

Due to the patient having a burn on her face in an area close to her mouth could be an airway be at risk. I learned how to administer pain analgesia through a metered atomised device (MAD) and some considerations surrounding administration for a paediatric patient - Some considerations included gaining consent from the parents as sometimes this can be an uncomfortable feeling in the nasal passage and the child may become distressed and anxious.

As a registered nurse I would help educate the parents on the medication being given and what signs and symptoms to look out for such as respiratory depression/distress, bradycardia, Hypotension especially with IV administration, Nausea and Vomiting, Sedation or Drowsiness. This directly relates to NMBA standards:

6.2 practises within their scope of practice

6.1 provides comprehensive safe, quality practice to achieve agreed goals and outcomes that are responsive to the nursing needs of people

7.2 revises the plan based on the evaluation, and

7.3 determines, documents and communicates further priorities, goals and outcomes with the relevant persons.

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While attending a placement on a cardiothoracic ward, I wanted to gain a bit more information surrounding management of patients with temporary epicardial pacers. A few of my patients had these following some cardiac procedures such as coronary artery bypass grafting (CABG) and valve replacement surgeries. I learned that these pacers are often inserted intraoperatively to support the heart's conduction system in the immediate postoperative period, particularly if there's a risk of bradyarrhythmia's or heart block.

Although understanding that management of a pacer is out of my scope at this stage of study and once graduated would still need to go for another short course depending on workplace. For my education I took initiative by printing off this workplace's policy surrounding epicardial pacing.

This informed my future practice by answering questions of who was allowed to pace, what kind of equipment I would need for the procedure, commencement of epicardial pacing, capping of epicardial wires and removal of wires. By doing so I not only educated myself but actively engaged in material to understand how epicardial pacers work and why they are used.

In line with NMBA substandard 4.1 - assesses the resources available to inform planning and 6.2 - practises within their scope of practice , As a future registered nurse I can understand if there were to be abnormalities with the pacer, I can now know what to look out for and let the appropriate personnel know and escalate as needed within my scope of practice and training.

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prep notes

1. Primary assessment notes

• Direct trauma – Facial fractures, Laryngeal injury, Oesophageal injury

Suicide attempts (from hanging), domestic violence compression of neck

Falls from heights, motor vehicle accidents

• Contamination – Vomit, blood, teeth, foreign body

Older population – Dentures

Younger population – Lego/ craft objects

• Loss of airway tone – Head injury, Drugs/alcohol, Hypoglycaemia, Lowered GCS

• Airway positioning – Infants -Neutral, Children - Sniff position this is due to different size, shape and development.

Airway management: C spine immobilisation

• Suction if there’s contamination

• Gravity to drain out blood or fluids

• Careful with spinal cord injuries and recovery position as it can worsen the injury

• Jaw thrust/chin lift – C spine injury or unknown cause

• OPA, NPA, LMA, ETT – Oral pharyngeal airway, Nasal pharyngeal airway, laryngeal mask airway, endo tracheal tube

• Breathing assessment:

• Inspection – Chest symmetry, Work of breathing, Recession, tracheal tug, accessory muscle use.

• Auscultation – Equal air entry, Wheeze, Rhonci, Muffled sounds

• Palpitations – Asymmetry, Tenderness

• Percussion – Air, fluids, solids

Breathing management:

• Patient positioning

Tripod, paediatrics

Application of supplemental oxygen

• NP – HM- NRB

• NIV(CPAP, BiPAP)

• Intubation/Ventilation

Circulation assessment

1. Pulse – Rate, Strength, Regularity

2. Skin colour

3. Capillary refill time

4. BP -

5. Causes of blood loss – Torniquet, pressure dressings, pelvic binders

6. IV access – How many do we have? How many do we need?

7. Intraosseous access – Into bone

8. Xray – Pelvis and Chest as these bones will cause significant haemorrhage

9. Pressure on anything bleeding to stop the losses

10. Blood products

11. If you haven’t gained control of your bleeds DO NOT move onto disability assessment (AVPU)

12. A- Eyes open, Conversing

13. V – Responds to vocal stimulation

14. P- Responds to pain – Trap squeeze don’t use sternal rub (risk of haematoma and injury

15. U – Nil response to any stimulus

• GCS – Record pupil size

• Assessment of all 4 limbs

Exposure –

• Record temp

• Limit time patient is exposed

• Quickly assess and actively warm – Warm IV fluids, Warm blankets, Space blankets, Hot air blanket (Bear hugger)

• Actively cool – Cool fluid bags to neck, armpits and groin, Encourage cool oral fluids

THM –

• Document before and after your interventions and investigations

• E.g if you’re giving pain relief include the pain assessment score for your why- this closely links with NMBA standard 7

• Consider family presence in resuscitation in efforts

• Look after yourself

Secondary Survey

When do we perform this?

After resus and stabilised, after MET fix the immediate problem

History – Ample A- Allergies, Medication, Past history, last eat/drink, events to injury e.g fall from horse, fall from roof etc

Collect collateral – By stander accounts, paramedic, scene photos, family members, Patient may wear medi alert or QR code jewellery

Document findings – Interventions and findings

HEAD TO TOE

General – Lacerations, Deformity, Muscle tone, Asymmetry

EYES – Pupil size, reactivity, Racoon eyes (Orbital bruising base of skull fracture), Foreign body, subconjunctival haemorrhage, irregularity of iris, Presence of contact lenses

EARS – Blood or spinal fluid, Battle sign (bruising of mastoid process

NOSE – Deformity, Epistatis, Sepital haematoma, Leaking cerebralspinal fluid

MOUTH- loose/ broken teeth, Laceration to gums, lips, tongue or palate, Malocclusion of bite, Tongue swelling

VOICE – Hoarseness

HEAD palpitation – Examine the particular focus on skull, Depressions/irregularities, Bon surfaces, Crepitus, Tenderness, Subcutaneous emphysema

NECK – Cervical spine immobilisation must be maintained through secondary survey, Examine cervical collar should be opened and supported with manual immobilisation then reapply collar ASAP, Normal cervical spine x ray does not clear from potential injury.

CHEST – Breathing rate, Paradoxical movement, accessory muscle movement, Lacerations, deformity, bruising (seatbelt marking), auscultation of chest

ABDOMEN – Laceration, bruising, distention, Priapism, Seatbelt marks, external genitalia, palpating tenderness, guarding, rigidity, masses, Bowel sounds

PELVIS - Laceration, bruising, deformity, tenderness, pain- applying pelvic binder

LIMBS - Laceration, bruising, deformity, Open fractures, shortening rotation in hips, tenderness, joint movement and stability, muscular power + neurovascular observations

Log roll patient

Laceration, bruising, deformity, abrasions, if spinal injury is suspected rectal exam should be performed, examine buttocks and perineum for bruising and laceration. (Maintain C spine )

Disposition planning – Early referrals, Aboriginal liaison, Non English-speaking patients, speech therapy, OT, Physio, Social work

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Reflecting on today's seminar we first reviewed a case study involving Michelle who fell 2.5 meters backwards off a truck and hit her head while at work. Michelle had seizure like movements and vomited 3 times post fall.

During our seminar, we discussed more about which members of the multidisciplinary team (MDT) would be involved in Michelle’s care. We also watched a video interviewing professionals such as physiotherapists, occupational therapists, and social workers. They each outlined their concerns for Michelle and highlighted how collaborative care is essential to ensure holistic and safe discharge planning.

From the video and discussion, I began to understand how important the nurse’s role is in supporting the MDT by providing timely, clear, and comprehensive information that can guide assessment and review. For example, in Michelle’s case she is not just a patient she is also a carer to her husband who lives with Multiple Sclerosis. As a nurse, I would need to advocate for her needs by raising questions such as:

Is Michelle the primary source of income in the household?

Will her current condition affect her ability to drive?

Will she have the physical capacity to continue her caregiving role at home?

These are not only clinical questions but social and functional concerns that can significantly impact her recovery and quality of life. By understanding these aspects, we can refer appropriately to social work, OT, or arrange for a carer assessment. This supports safe and person-centred discharge planning.

Nursing 'Top Tips' Given by MDT:

Written communication is key – ensure documentation is specific, objective, and reflects any changes or concerns clearly.

Don't be vague when describing changes in a patient's condition — clear descriptions help other team members understand the urgency or nature of the issue and guide appropriate intervention.

Future Practice & NMBA Links:

In my future practice, I will aim to be a strong communicator and effective team player within the MDT, ensuring that my assessments are detailed and accurate, and that I advocate for the patient’s wider social needs.

NMBA Standard 6.1: Provides comprehensive, safe, quality practice to achieve agreed goals and outcomes that are responsive to the nursing needs of people.

Standard 4.2: Communicates effectively and is respectful of a person’s dignity, culture, values, beliefs and rights.

Standard 5.3: Uses evidence-based practice to develop plan of care that supports the individual’s goals and context.

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Our clinical skills class in we were asked to get into groups of three and there would be one facilitator, one primary nurse and another secondary nurse.

We went through our A-G thoroughly documenting our findings against the trends of the patient.

After we had done this the patients condition changed, and we had to change our interventions and reasoning to fit the new trends showing for our patient.

The case given was 47 yr old male who fell from a roof, he was complaining about pain on deep breathing. My automatic thoughts when presented with this case was thinking since he'd fallen on his side there is was a possibility he has broken a rib and may have punctured his lung to explain the pain on inhalation. The the plan to assist his breathing and maintaining airway was by putting him on a Hudson mask non breather on 10L, the reason behind this intervention is so the patient isn't doing all breathing on his own and causing unnecessary pain. When looking at the BP, it was falling 102 systolic this made me think that there is some possible internal bleeding going on. By linking this to my pathophysiology to reason, if blood is lost the effective circulating volume decreases. This results in a drop in blood pressure, the reduction in preload compromises cardiac output.

This decision aligns with NMBA Standard 6.1, which highlights the importance of providing safe, quality, evidence-based care that responds to the patient’s condition. Recognising early signs of deterioration and applying appropriate interventions such as oxygen therapy demonstrates this standard in action.

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Before going into this scenario I was a bit hesitant as I have not had a lot of exposure to burns in my clinical experiences or PEP's so this was very interesting to hear from a mother's perspective

For this simulation I reviewed a scenario interview with (Anthea) who is the mother of patient Quinn who sustained a burn injury, 3 months ago at 05:30 in the morning she grabbed a cup of boiling water and spilled on her right side of her body sustaining burns on her body including her face, fingers, back, shoulders, chest, neck and upper arm. Anthea and her husband quickly sprung into action took off Quinn's clothes and rushed her into a cold shower for 20 mins and called an ambulance due to concern of swelling

6.1 - 'Provides comprehensive safe, quality practice to achieve agreed goals and outcomes that are responsive to the nursing needs of people'.

During this scenario, I observed how crucial early intervention is in burn care. Anthea’s immediate actions removing Quinn’s clothing, cooling the burn, and seeking urgent care demonstrated evidence-based practice. While I understood the clinical importance of these steps, I hadn’t previously considered the emotional aspect of providing care in an emergency, especially as a parent.

In my future practice, I will ensure I respond not only clinically but also holistically by providing reassurance and clear communication to both patients and families in distress. I will also focus on family-centred care, acknowledging the emotional toll on caregivers when treating children with burns.

6.2 - 'Practises within their scope of practice'.

Despite being a nurse, Anthea had to recognise that specialist burn care was necessary. This was a moment that made me reflect on the limitations of my own scope of practice. As a student, I sometimes feel the pressure to "know everything," but this scenario highlights that safe practice involves recognising when to escalate care and seek senior support.

In future practice, I will actively engage with multidisciplinary teams and be comfortable acknowledging when specialist input is required. During my placement, I have also observed how indigenous patients may have different perspectives on burn care, including the use of traditional healing practices. I want to develop my cultural competence by learning how to have respectful conversations around integrating these practices into clinical care.

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Prioritisation of care is a fundamental aspect of nursing, requiring nurses to assess and determine the urgency of patient needs to deliver safe and effective care. This process involves:

Assessing patient conditions to identify immediate needs.

Delegating tasks appropriately within the healthcare team.

Managing time efficiently to address multiple patient needs.

Rationalisation of care refers to the allocation of limited resources, which may lead to difficult decisions about which care activities to perform or defer.

This can result in:

Moral distress when nurses feel unable to provide the level of care they deem necessary.

Moral injury, a deeper psychological harm occurring when nurses participate in or witness actions that conflict with their moral or ethical beliefs.

It is essential seniors and other staff:

Provide support systems for nurses, including counselling and peer support.

Encourage open communication within healthcare teams to discuss ethical dilemmas.

Implement policies that support ethical decision-making and resource allocation.

New registered nurses in leader roles

Challenges:

Navigating team dynamics and establishing authority.

Balancing clinical responsibilities with leadership duties.

Aligning personal values with professional expectations.

Reflecting on one's attitudes, values, and beliefs is crucial in developing effective leadership skills.

Justine Jeanelle Ting, Babenko-Mould and Garnett (2024)

Strategies to support new nurse leaders include:

Mentorship programs to provide guidance and support.

Leadership training focused on communication, conflict resolution, and decision-making.

Regular feedback to foster growth and confidence.

By embracing these strategies, newly registered nurses can develop into competent and compassionate leaders.

Justine Jeanelle Ting, Babenko-Mould and Garnett (2024)

Infection Control notes-

Effective infection control during a gastroenteric illness outbreak is vital to prevent the spread of infection. According to Australian guidelines:

Isolation: Patients with suspected or confirmed gastroenteritis should be isolated with dedicated bathroom facilities.

Rigorous hand hygiene practices must be enforced among staff, patients, and visitors.

Regular and thorough cleaning of surfaces with appropriate disinfectants is essential.

Staff exhibiting symptoms should be excluded from work until 48 hours after symptoms resolve.

Prompt reporting to public health authorities and clear communication within the facility are crucial for outbreak management.

Implementing these measures helps control outbreaks and protect both patients and healthcare workers.

Australian Commission on Safety and Quality in Health Care (2019)

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Our seminar today included a strong focus on preparing for our upcoming Viva assessment. One of the most beneficial components of this session was when our lecturer presented an example of a previous student's responses. We were asked to take on the role of assessors and “mark” the response using the marking rubric provided.

This activity was incredibly insightful, as it not only clarified the expectations for the level of depth and detail required, but also challenged me to think critically about what makes a response strong or lacking. I realised that it’s not just about having knowledge it’s about clearly articulating your clinical reasoning, linking theory to practice, and demonstrating safe, evidence-informed care.

Seeing how another student structured their response helped me reflect on how I plan to approach my own assessment.

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In today's clinical skills class we were provided our case for a patient who is a 100 yr old female, she has a history of hypertension, chronic kidney disease and osteoarthritis. She has symptoms of cramps 7/10 and a dull back ache 5/10.

RR - 20

SP02 - 99

HR - 102

BP- 101/75

Cap refill - 3 secs

Feels dizzy

Temp - 37.8

Vomiting over 48hrs - last vomit 30 mins ago green fluid only teacup amount

Last bowel motion 3 hours ago loose

From Margaret's presentation, I recognised the importance of rapid assessment and prioritisation of care. My nursing focus would be on:

Fluid resuscitation and electrolyte monitoring

Strict input/output charting

Monitoring for signs of acute kidney injury, given her chronic kidney disease and risk of further fluid loss

Pain management considering her age and history of osteoarthritis, while being cautious with medications that may worsen kidney function.

This scenario challenged me to critically think through the interconnected systems affected by her symptoms, particularly the renal, cardiovascular, and gastrointestinal systems. It also highlighted the importance of considering how age-related physiological changes (e.g., reduced renal reserve, skin elasticity, and immune function) impact assessment and treatment planning.

NMBA links:

6.1 – Provides comprehensive, safe, quality practice to achieve agreed goals and outcomes: I had to think comprehensively about how the patient’s chronic conditions, current symptoms, and vital signs interconnected and how to form a safe care plan.

4.2 – Assess, plan, implement and evaluate nursing care: This scenario allowed me to apply the A-G assessment, respond to clinical cues (like cap refill and vomiting), and begin formulating appropriate interventions.

6.5 – Practises to achieve person-centred outcomes: In future practice, I would consider her individual values, such as her age, cognitive state, and support system when developing a care plan.

7.3 – Understands and applies evidence-based practice: By recognising signs of fluid deficit and using best practice to guide management (e.g., early fluid replacement, electrolyte replacement, monitoring for signs of shock), I ensured safe, evidence-informed care.

Future Strategy:

To improve, I will revise fluid balance calculations and electrolyte correction strategies for older adults. I also want to practise more case based scenarios involving more frail patients and multimorbidity to strengthen my confidence in prioritising care for complex patients.

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Today's simulation was a real eye opener for me as a future nurse and will be a valuable lesson in the field when I start working with other like minded people.

We were put in groups of four and given four patients with different symptoms and problems to prioritise in order of concern as a group to discuss and debate. The results were put on the board and we saw how our answers often differed from others from different considerations for example:

The first round we said John, Mary, Rose, Paul where as every other group in the class said John, Rose, Mary, Paul - there are no correct answers but to understand there are different considerations of concern was interesting to see. For example the reason why everyone said Rose before Mary was due to COPD automatically putting her as more of a priority than Rose due to airway and breathing worries however, my group stated what if that is her baseline of being short of breath due to COPD? We did this a few times and all priorities across all groups were the same.

Some considerations for notification and changes in these patients are:

NOK

Dr

Family

Report to manager

PPE

Scope of practice