I have recognised areas where I need working on and I have recognised areas where I am good at. The struggles that I face are mainly my knowledge of medications, calculations and lots of health conditions. When I was doing up the antibiotic it took me a bit longer than others to work out what rate the pump should be running at. This simulation particularly made me think about what ways can help me remember and calculate. I am currently in the process of making a medication table that is more specifically laid out the way I can understand and memorise the information - I will upload my progress on my medication table.

This is what I've discovered about diabetic ketoacidosis. It's when the body doesn't have enough insulin and can't receive the sugar it needs for energy. When the body can't use sugar for energy, it turns to fat, which turns into fatty acids called ketones. The ketones are built up within the blood and change the chemical balance in your body. The blood becomes acidic when a high amount of ketones is in the bloodstream and causes the pH levels to decrease (the normal range is 7.35 and 7.45).

Normal Blood Glucose Range: Type 1 Before meals - 4.0 to 6.0mmol/L

2 hours after meals - 4.0 to 8.0 mmol/L

Normal Blood Glucose Range: Type 2

Before meals - 4.0 to 8.0mmol/L

2 hours after meals - 5.0 to 10mmol/L

Normal Ketone Range:

Less than 0.6mmol/L - normal

0.6 to 1.5mmol/L - trace or small

1.5 to 3.0mmol/L - moderate/large

Over 3.5mmol/L - large

Note for nurses: if a patient's glucose levels are extremely high, this is why it is important to check ketone levels

The symptoms that can indicate potential DKA are;

Symptoms of DKA:

• Fruity-smelling breath

• High blood sugar

• Low blood pressure

• Increased respiratory rate

• Rapid breathing

• Frequent urination

• Nausea/Vomiting

What to do if your patient is in DKA?

• Take a set of blood

• Do a urine analysis

• Conduct an ECG

• Once DKA is confirmed, perform biochemical monitoring - Hourly BGL and Ketone testing, at 2 hours and 2-4 hours after that - VBG, UEC, Ca, Mg, PO4

• Maintain hydration

• Reverse ketosis, correct acidosis and glucose

• Monitor complications of DKA and treatments: Cerebral oedema, hypo/hyperglycaemia

• Identify and treat any precipitating cause

DKA can be life-threatening and requires urgent medical attention.

Standard 1.4 - Complies with legislation, regulations, policies, guidelines and other standards or requirements relevant to the context of practice when making decisions

I found it helpful when we split the different electrolytes into sections on the whiteboard and wrote out the relevance of each. As a visual learner, this supported my learnings on a deeper pathological level.

• A heart rate between 120-160 is normal

• How to calculate TPN and Lipids (shown below)

• I learnt about what an isolette does - it's a clear crib that maintains a warm environment for a newborn and protects them from germs

• Swaddling a premature baby replicates the mother's womb and provides them comfort

• I learnt about Jaundice - a yellow discolouration of the body tissue resulting from the accumulation of excess bilirubin

• Phototherapy - used to treat newborn jaundice by making it easier for the baby's liver to break down and remove the bilirubin from the baby's blood.

• They keep fabric-shaped love hearts that are scented with their mother's breast milk around the babies to provide comfort when unsettled

• CPAP is used for neonatal to maintain or increase the functional residual capacity of the lungs, help prevent the alveolar to collapse, reduce the work of breathing and improve gas exchange in infants

• I helped provide cares that included - nappy changing, applying cream around the bottom, CPAP cares (if required), swaddled them and changed the sats probe to the opposite foot

• I learnt how to read a histogram -

• Observing and understanding the importance of individualized care for each baby, recognising their unique needs and family dynamics.

• Witnessing the collaboration between various healthcare professionals, including nurses, doctors, and therapists, to create comprehensive care plans.

• Learning to navigate the emotional challenges of working with critically ill infants and their families, developing empathy and support strategies.

• Recognising the crucial role of family presence and participation in the care process, and how it contributes to the baby's well-being and development.

• Understanding the application of current research and best practices in neonatal care, emphasising the importance of staying informed in a rapidly evolving field.

• Reflecting on personal growth in confidence, critical thinking, and decision-making skills, preparing me for future challenges in nursing.

HEEADS provides a systematic approach to developing rapport with young people and performing a holistic, psychological resilience and risk assessment across the areas that involve their home, education, eating (and/or employment), activities, drugs and alcohol, sexuality, suicide, mental health and safety.

CRAAFT is another risk assessment designed to identify substance use, substance-related abuse or use that is between 12-21 years.

Voluntary admission is when someone admits themselves to a public mental health facility in circumstances where they can give consent to receive mental health care and treatment.

Involuntary admission is when someone receives compulsory assessment/treatment from mental health services without the person's consent.

Here's what I learnt about the Integumentary System.

What is the Integumentary System?

The integumentary system is the body’s largest organ, acting as a physical barrier between the external environment and the internal systems it protects and sustains. This system comprises the epidermis, dermis, and hypodermis, along with associated glands, hair, and nails.

Skin is the largest and heaviest organ in your body. Your skin is made up of three layers.

Epidermis: The outermost layer of your skin, visible and tactile. It consists of three types of cells: melanocytes, keratinocytes, and Langerhans cells. This layer provides skin colour and forms a waterproof barrier.

Dermis: The middle and thickest layer of your skin, containing sweat and oil glands as well as hair follicles.

Hypodermis: The innermost layer of your skin, composed of fatty tissue that aids in insulating your body.

Nails provide protection to the ends of your fingers and toes. The nail anatomy consists of:

Nail plate: The visible, hard surface of your nail.

Nail bed: The skin beneath the nail plate.

Cuticle: The delicate skin at the base of the nail plate.

Matrix: The “root” of the nail that is responsible for its growth.

Lunula: The white, crescent-shaped area at the base of the nail plate.

Hair on your head provides heat to your body and your eyelashes and eyebrows help protect your eyes from dirt and water. The three parts of your hair consist of:

Hair shaft: The visible portion of your hair that you can see, touch, and style.

Hair follicle: The tubular structure that anchors your hair within the skin.

Hair bulb: Situated beneath the skin, this is the part responsible for hair growth.

Glands are distributed throughout your skin, releasing substances such as water, salt, and oil from beneath the skin to its surface. Your integumentary system includes the following types of glands:

Sudoriferous glands: These glands secrete sweat through your skin

Sebaceous glands: produce sebum, also known as oi and give your face its oil

Ceruminous glands: These glands are in your ear that secrete ear wax

Mammary glands: These glands are on a person's chest. When females give birth, that's when these glands produce milk

What is the purpose of the Integumentary System?

Your integumentary system safeguards your body from infections and injuries that may arise from the external environment. It acts as a protective barrier, serving as the first line of defence against viruses, bacteria, and other microbes. Additionally, it protects against harmful light and aids in regulating body temperature. This system also stores fat, water, glucose, and vitamin D, while supporting your immune system to help guard against diseases.

How to Conduct a Primary Survey:

Airway:

- Check if the airway is clear. Look for any obstructions, such as foreign bodies, vomit, or swelling. If the patient is unconscious or unable to maintain their airway, consider interventions like positioning or suctioning.

Breathing:

- Assess the patient's breathing by observing the rise and fall of the chest and listening for breath sounds. Check for adequate ventilation and oxygenation. If the patient is not breathing or has inadequate breathing, provide supplemental oxygen or assist ventilation as necessary.

Circulation:

- Evaluate the patient's circulation by checking their pulse, skin colour, and temperature. Look for signs of shock, such as low blood pressure or altered mental status. Control any visible bleeding and initiate intravenous access if required for fluid resuscitation.

Disability:

- Perform a quick neurological assessment using the AVPU scale (Alert, Voice, Pain, Unresponsive) to determine the patient's level of consciousness. Check pupil response and limb movement to assess neurological function.

Exposure:

- Expose the patient to identify any hidden injuries while maintaining their dignity and warmth. This may involve removing clothing carefully and assessing the entire body for burns, fractures, or other injuries.

Glucose:

- Check BGL and Ketones if relevant to patient symptoms or finding any major concerns.

After completing the primary survey, reassess the patient's condition and provide necessary interventions based on your findings. Continuous monitoring and documentation are vital, as the situation may change rapidly. Conducting a primary survey efficiently ensures that critical issues are addressed promptly, laying the foundation for further assessment and management.

Secondary Survey is a thorough and systematic assessment performed after the primary survey in nursing and emergency care. It aims to identify any additional injuries or medical conditions that were not immediately life-threatening but still require attention. This detailed evaluation is crucial for comprehensive patient care.

Performing an Assessment:

Head and Face

Examine the face and scalp for:

- Signs of injury: Look for bleeding, lacerations, bruising, depressions, or irregularities in the skull. Check for behind the ear, which may indicate a skull base fracture.

Assess on areas such as;

- Eyes: Inspect for foreign bodies, subconjunctival hemorrhage, hyphema, irregularities in the iris, penetrating injuries, and the presence of contact lenses.

- Ears: Check for bleeding and blood behind the tympanic membrane, which can suggest a skull base fracture.

- Nose: Look for deformities, bleeding, nasal septal hematoma, or cerebrospinal fluid (CSF) leaks.

- Mouth: Assess for lacerations on the lips, gums, tongue, or palate.

- Teeth: Examine for subluxation, looseness, missing teeth, or fractures.

- Jaw: Check for pain, trismus, or malocclusion, which may indicate a fracture.

Palpate the:

• Bony edges of the orbit, maxilla, nose, and jaw.

• Scalp and skull to identify any fractures.

Test eye movements, pupillary responses, vision, and hearing.

Neck

Examine the neck, ensuring to open the collar while maintaining manual in-line stabilisation. Assess the anterior neck for:

• Tracheal deviation

• Wounds or bruising

• Subcutaneous emphysema

• Tenderness over the larynx

• Distension of neck veins

• Carotid pulsations and any hematoma; listen for a bruit.

Assess the cervical spine by palpating the cervical vertebrae

Chest

Inspect the chest and observe its movements, looking for:

• Bruising (especially from seatbelts)

• Asymmetric or paradoxical chest wall movement

• Potential penetrating wounds, which are rare in children; check for "hidden" wounds in areas like the axilla and back.

Palpate for tenderness in the clavicles and ribs, and auscultate the lung fields and heart sounds.

Abdomen

Examine the abdomen, perineum, and external genitalia, specifically looking for:

• Seatbelt bruising or handlebar injuries

• Distension

• Blood at the urinary meatus or introitus

Palpate for tenderness, especially over the liver, spleen, kidneys, and bladder, and auscultate bowel sounds.

Pelvis

Inspect the pelvis for any abrasions over the iliac crest. Check for bruising, deformities, pain, or crepitus during movement.

Limbs

Inspect all limbs and joints, palpating for tenderness in bony and soft tissue. Check joint movements, stability, and muscular strength. Assess sensory and motor functions of any potentially injured nerve roots or peripheral nerves.

Back

A log roll should be conducted during either the primary or secondary survey.

• Inspect the entire length of the back and buttocks.

• Palpate and then percuss the spine for tenderness.

• Palpate the scapulae and sacroiliac joints for any tenderness.

• Inspect the anus; a digital examination is rarely necessary and, if indicated, should be performed only once.

NSQHS Standards:

The Recognising and Responding to Acute Deterioration Standard is a standard that is set out for healthcare workers to follow to ensure a adequate and appropriate treatment to deteriorating patients is escalated correctly. These guidelines include information on how to assess patients, recommended actions such as an A-G assessment, guidelines on how to communicate and coordinate with the multidisciplinary team. Following these standards enables healthcare workers to provide quality care to their patients.

Simulation:

This case we got involved with a young patient named Avery, who overdosed on opioids. The simulation was to encourage the students to perform an appropriate A-G assessment and outline areas of deterioration. During this simulation it made me recognise that when a patient isn't responding and is rapidly deteriorating always escalate to the doctors and if you're feeling like it needs to be addressed urgently always call a MET.

In reflection of the NMBA Standards, more specifically Standard 6.1 provides comprehensive safe, quality practice to achieve agreed goals and outcomes that are responsive to the nursing needs of people. Providing comprehensive, safe, and quality nursing practice for an adolescent who has overdosed on opioids requires a holistic and individualised approach. Initial assessments must consider the adolescent’s medical history and psychosocial background to tailor interventions effectively. To include this in my future nursing practice I will always communicate with the appropriate healthcare workers my concerns or patient concerns to ensure good patient care is provided.

Here is my overview of an A-G assessment I thought about after practising it during my workshop.

Performing an A-G - Opioid Addition

Airway - Assessing the patient's breathing and if they're able to maintain their airway.

Keywords that can be used when documenting: patent/obstructed, clear, speaking appropriate/inappropriate sentences.

What to look for with an opioid overdose: increased respiratory can be a side effect of an opioid overdose so ensuring the airway is clear and the patient is breathing adequately is crucial.

Breathing - Assessing the patient's breathing pattern, lung sounds and oxygenation.

Keywords that can be used when documenting:

Sufficient/Insufficient work of breathing, equal rise and fall, bradypnoea, tachypnoea, asymmetrical/symmetrical, wheeze.

What to look for with an opioid overdose:

Opioids can suppress the respiratory function, leading to shallow or slow breathing. Ensuring that monitoring their saturation levels and providing adequate oxygen if needed.

Circulation - Assessing the patient's heart rate, blood pressure, and peripheral perfusion.

Keywords that can be used when documenting:

Tachycardia/bradycardia, high/low blood pressure, pallor, oedema, warm to touch, cool/sweaty/clammy, <3 cap refill, regular/irregular heart rate.

What to look for with an opioid overdose:

An overdose of opioids can decrease blood pressure and affect circulation. Monitoring these vital signs and administering relevant interventions such as fluids or medications to maintain symptoms.

Disability - Assessing the patient's level of consciousness, neurological status, and mental function and neurovascular observations.

Keywords that can be used when documenting:

Pupils are equal/unequal, non reactive/reactive, Glascow Coma Scale (GCS)

What to look for with an opioid overdose:

Assessing the patient's response and neurological function is important in determining the severity of the overdose and what interventions are needed to be considered to ensure appropriate treatment is achieved.

Exposure - Assessing the patient's skin from head to toe to find any signs of trauma or injury, and expose areas for further examination.

Keywords that can be used when documenting:

Rashes, swelling, signs of infection, bruising, catheter, surgical drains, lacerations, temperature,

What to look for with an opioid overdose:

Any injection sites on the skin, signs of scratches, bleeding, rashes and wounds.

Glucose - Assessing the patient's blood sugar levels, in cases where deteriorated mental health is present.

Keywords that be used when documenting:

BGL, Ketones

What to for with an opioid overdose:

Monitoring blood glucose levels is vital as opioids can cause hypoglycemia or hyperglycemia, which can severe concerns.

Holistic:

Have they mobilised? How do they mobilise?

Any complaints?

What's the plan?

Further information from family/friends?

Some individuals may show visible signs of being affected, while in others, the indications might not be immediately clear— but they can surface over time. A Trauma-Informed Care approach enhances well-being by ensuring that the policies, procedures, and environments in workplaces, schools, or healthcare settings are sensitive to individuals' trauma histories, prioritising the physical, psychological, and emotional safety of everyone involved. This approach acknowledges the widespread impact of trauma and fosters healing and recovery, avoiding practices and services that could unintentionally cause further trauma.

Key Principles of Trauma-Informed Care:

Trauma Awareness: It's crucial to understand the effects of traumatic experiences on individuals, families, and communities. Establishing a trauma-informed workplace involves incorporating an awareness of trauma and its effects into every aspect of your organisation and team dynamics. It’s especially important to recognize the increased likelihood of certain types of trauma exposure relevant to your organization and the implications for your team or client population.

Promotion of Safety: Within your workplace, it’s vital for both your team and the patients they're working with to experience physical and emotional safety. The aim is to create a sense of security for your team through established policies and practices.

Rebuilding Control: In a trauma-informed organisation, both team members and patients must receive clear and relevant information about their rights and have a voice in shaping trauma-informed policies and practices.

Focusing on Strengths: A strengths-based approach focuses on understanding how a person's behaviour after a traumatic event is shaped by their unique experiences and limited resources. It encourages examining and questioning assumptions about why individuals respond as they do when dealing with trauma. Viewing all behaviours, including challenging ones, through a trauma-informed lens acknowledges that these actions often reflect a trauma-affected individual’s best attempts to cope.

Promoting Connection: Fostering connections with primary support systems, including family, friends, and community resources, aids recovery from trauma by ensuring individuals receive the specific assistance they need throughout their journey.

Belief in Recovery: The focus of trauma-informed care is to instil a sense of hope and support and foster belief in recovery, acknowledging that responses to trauma range in complexity. To support recovery, an organisation must respond appropriately to all different kinds of trauma and the impacts of that trauma, including recent and past traumatic events. Supporting recovery from trauma must also take a preventative approach through managing the risk of future exposure to trauma for team members and patients.

During this week we sat in a circle and watched videos of healthcare workers not providing quality and fair care towards mental health patients. I found this topic of discussion eye-opening as I became aware that mental health is a sensitive and confronting topic, especially during our seminar where we had to make assumptions based on professional photos of both men and women. This enabled me to reflect on some of the NMBA Standards, more specifically Standard 6.6.

Standard 6.6 uses the appropriate processes to identify and report potential and actual risk-related system issues and where the practice may be below the expected standards.

Reflecting on the video of Kerry who faced neglect and judgment due to their condition highlights the critical need for adherence to Standard 6.6, which emphasises the identification and reporting of potential and actual risks related to systemic issues in care. Kerry's experience serves as a reminder of the failures that can occur when mental health care is not prioritised or when biases influence treatment. It underscores the importance of recognising when practice falls below expected standards and taking appropriate action to address these deficiencies. By implementing risk identification and reporting, healthcare professionals can advocate for patients who may otherwise be marginalised, ensuring they receive the compassionate, respectful care they deserve. This reflection reinforces the ethical responsibility of mental health practitioners to challenge systemic flaws and work towards a more inclusive and supportive healthcare environment.

The information I found helpful was retrieved from the Royal Children's Hospital Guideline.

When can you use it:

• Fractures and dislocations

• Burns

• Severe lacerations

• Painful procedures under nitrous oxide

Dose:

1. 100mcg/2mL strength fentanyl solution for intravenous use

2. First dose 1 mcg/kg dose

3. A second dose can be administered within 10 minutes after the first dose to ensure adequate pain relief is given - 0.75 - 1.5 mcg/kg

4. If the second dose of the medication doesn't work a review should be escalated for more analgesia

Administration

• Draw up the appropriate dose for weight, plus 0.1 mL extra to the first dose (to ensure dead space is filled in the device)

• Attach the Mucosal Atomiser Device (MAD) to the end of the syringe

• With the child sitting at approximately 45 degrees or with head to one side, insert the device loosely into the nostril and press the plunger quickly

• Dose should be divided between nostrils

• Do NOT draw up 0.1 mL extra for the second dose when re-using the delivery device (MAD)

Monitoring

Ensure patient monitoring is done which includes heart rate, respiratory rate, oxygen saturation, pain score & sedation score every 5 minutes after administration.

Heat/Thermal Burns:

Scald Burns - Caused by hot liquids, steam, or vapours. Common in young children and can occur from spilled beverages or cooking liquids.

Flame Burns - Result from direct contact with an open flame, often associated with fires, explosions, or ignited clothing.

Electrical Burns are caused by electrical current passing through the body. These burns can result in internal injuries, muscle damage, and complications such as cardiac arrhythmias. The entry and exit wounds may appear small but can cause significant damage internally.

Friction Burns occurs when skin rubs against a hard surface, leading to abrasion and damage. Common examples include road rash from falls or burns from ropes or belts during sports or accidents.

Chemical Burns result from exposure to corrosive substances, such as acids or alkalis. These burns can cause severe damage to the skin and underlying tissues, depending on the chemical's strength and duration of contact.

Radiation burns are caused by exposure to radiation sources, such as the sun (sunburn) or medical treatments like radiation therapy. These burns can damage skin cells and lead to long-term complications, including an increased risk of skin cancer.

First-degree (Superficial) burns affect only the outer layer of skin, known as the epidermis. They are characterized by redness, mild swelling, and pain, but do not involve blisters. Healing typically occurs within a few days without scarring.

Second-degree (Partial Thickness) burns extend beyond the epidermis into the dermis, the lower layer of skin. These burns can cause redness, swelling, and significant pain, along with blisters. Healing may take two to three weeks and can result in some scarring.

Third-degree (Full Thickness) burns penetrate through both the epidermis and dermis, affecting deeper tissues. The skin may appear white, charred, or leathery, and these burns can be painless due to nerve damage. Healing is prolonged and often requires medical intervention, such as skin grafting, and can lead to significant scarring.

Fourth-degree burns extend beyond the skin into underlying tissues, including muscle, tendons, and bone. They are often associated with severe injury, and loss of sensation, and require extensive medical treatment. Healing is complicated and usually necessitates surgical intervention, with a high likelihood of significant scarring and functional impairment. Each type of burn injury requires specific assessment and management approaches to ensure optimal healing and recovery.

Total Fluid Requirement (in mL) = 4 mL × % Total Body Surface Area (TBSA) burned × Body Weight (in kg)

Breakdown:

1. 4 mL: This is the standard factor used in the formula.

2. % TBSA burned: This is the percentage of the patient's total body surface area that has been burned.

3. Body Weight: The weight of the patient in kilograms.

Administration:

- First 24 Hours: The total calculated volume should be administered over the first 24 hours post-injury.

- First 8 Hours: Half of the total volume should be given in the first 8 hours, with the remaining half given over the next 16 hours.

Example Calculation:

For a 70 kg patient with 40% TBSA burned:

- Total Fluid Requirement = 4 mL × 40 × 70 = 11,200 mL

- First 8 hours: 5,600 mL

- Next 16 hours: 5,600 mL

This formula helps ensure that burn patients receive adequate hydration to maintain organ perfusion and support healing. Always monitor the patient closely and adjust fluid rates as necessary based on their clinical status.

The Rule of Nines is a quick method used to estimate the Total Body Surface Area (TBSA) affected by burns in adults, dividing the body into sections that each represent approximately 9% of the total surface area. Specifically, the head and neck account for 9%, each arm for 9% (18% total for both), each leg for 18% (36% total), the anterior torso for 18%, the posterior torso for 18%, and the perineum for 1%. This method allows healthcare providers to quickly assess burn extent, guiding fluid resuscitation and treatment decisions. While effective for adults, it is less accurate for children due to their different body proportions, making more precise tools like the Lund and Browder chart preferable for pediatric patients. Overall, the Rule of Nines is an essential tool in the initial assessment of burn injuries, facilitating rapid decision-making in emergencies.

Tess and I volunteered to participate in the simulation scenario with Yasmin, who was a pediatric patient who suffered from significant burns. While Tess and I entered the room, Yasmin was extremely unsettled and was clearly in a lot of pain. The mother was rocking her in her lap trying to comfort her, however, nothing seemed to be working. I felt Tess and I communicated, evaluated and assessed the situation well before making any significant decisions about what to do next. We were handed over that Yasmin's wound dressing was changed and all pain relief was given not long before we entered her space. Tess and I communicated as a team that the correct decision would be to escalate to the doctors to get a review on Yasmin and increase her pain relief. As a future nurse, I find it so important to ensure we advocate for our patients and provide quality and effective care.

During our clinical labs, we practised our IV fluid administration and got to use a Mucosal Atomisation Device (MAD). It was so interesting to learn about this device, I was surprised at how much can come out just with one squirt. I was intrigued with how the doses work and how you have to add an extra 0.1ml to ensure you fill in the dead space. I see how valuable these devices can be when a patient is struggling with severe pain and is in need of quick relief.

Standard 6.5, practises in accordance with relevant nursing and health guidelines, standards, regulations and legislation was utilised during our workshop and I ensured I was always reviewing the guidelines throughout my administration of IV fluids and fentanyl. This guided me to provide safe care and reminded me of how important it is to double-check with your buddy or a trusted colleague.

In my nursing practice, Standard 5.2 collaboratively constructs nursing practice plans until contingencies, options priorities, goals, actions, outcomes and timeframes are agreed upon with the relevant person, which will be greatly reflected in my care to my patients to ensure I collaborate my care plans will emphasise the importance of teamwork and communication with patients, families, and other healthcare professionals. Engaging with the multidisciplinary team in the planning process ensures that contingencies, options, priorities, goals, actions, outcomes, and timeframes are clearly defined and agreed upon. This collaborative approach not only foster a sense of shared responsibility but also empowers patients by incorporating their preferences and needs into their care plans. By working together, we can create more personalised and effective nursing strategies, ultimately improving patient outcomes and enhancing the overall quality of care provided. This process reinforces the value of interdisciplinary collaboration in achieving comprehensive and responsive healthcare solutions.

Using this procedure guide in my nursing practice will ensure I'm following the policy and ensuring I'm providing safe care to our patient's who could potentially be at a high risk of damage to their spin.

This week allowed me to practice my primary and secondary surveys and reminded me how important it is to be thorough in your initial assessment needs to be. I know I have a lot of practising to do and I would like to continue using the correct abbreviations when documenting my findings. I will read examples and seek advice from experienced nurses on what they do when documenting their assessment.

The Multidisciplinary Team includes:

- Nurses deliver patient care, administer medications, and monitor the condition of patients.

- Doctors and physicians offer medical expertise, make diagnoses, and develop treatment plans.

- Pharmacists ensure medications are used safely and effectively, providing management of medication therapy.

- Social workers evaluate and address the social and emotional needs of patients and their families, offering counseling and connecting them with community resources.

- Therapists include physical, occupational, speech, and respiratory therapists who deliver specialized rehabilitation services.

- Dietitians conduct nutritional assessments and provide guidance to enhance patients' overall health and well-being.

- Case managers coordinate communication and continuity of care among team members, assisting patients in navigating the healthcare system.

- Specialists, such as cardiologists, neurologists, psychiatrists, or oncologists, contribute their direct expertise to a multidisciplinary team in specific cases.

Kangaroo Pumps:

Kangaroo pumps are specialised enteral feeding pumps designed to deliver nutrition directly to patients via feeding tubes, commonly used in hospitals and home care settings for those with swallowing difficulties or specific medical needs. These pumps offer precise control over the rate and volume of feed, ensuring patients receive the correct nutritional intake. With user-friendly interfaces and safety features like occlusion detection and alarms for feeding issues, they are easy for healthcare providers and caregivers to operate. Kangaroo pumps accommodate various enteral nutrition formulas and can be portable, allowing for mobility during feeding. Overall, they are essential tools that enhance the convenience and effectiveness of nutritional support, improving patient health and quality of life.

Overall my classmates did well with their hand hygiene, I was very proud of them!

During our seminar, we got some insight into what a credit and distinction response looks like in our upcoming VIVA. Hearing these responses made me a little nervous because the responses were quite detailed. It made me feel better knowing that most of my classmates felt the same and we were all reassured that going into the VIVA with a clear mind and reassuring ourselves that we know a lot more than we think and that we just need to form a good, quality response. I found these week's classes helpful and I'm very grateful for how this unit was set out.

Relating to my allocation as the hand hygiene auditor I reflected on Standard 6.4, provides effective timely direction and supervision to ensure that delegated practice is safe and correct. This enabled me to work effectively and ensure I correctly followed the provided form to fill out while assessing my classmates to ensure there was safe and correct practice.

Thanks again, team!