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ORIENTATION OF WARD 11.
Ward 11 is a paediatric ENT ward at The Freeman Hospital.
We are situated on level 5.
Sister Jacqueline Gunn is the nursing team leader.
Ward 11 welcomes student nurses at various stages in their
training and hopes that you will find the experience enjoyable
and informative. You will be allocated a mentor and an associate
mentor prior to commencing your placement.
MENTOR: ________________________________
ASSOCIATE MENTOR:______________________
We work the following shift patterns: -
Day shift 07.30 – 20.00
Night shift 19.30 – 08.00
You will have off duty prepared for you. If you require any
special requests please speak to your mentor.
Ward 11 cares for children from 0-16 years with ENT
conditions.
We have 20 beds on the ward, 6 of these are daycare.
We admit children for planned surgery Monday to Friday.
Common operations include tonsillectomy, adenoidectomy,
insertion of grommets, mastoidectomy, myringoplasty and
septoplasty.
We also admit emergency admissions. Common conditions
accepted onto the ward are patients who are suffering from
tonsillitis, ear infections and glandular fever.
At weekends, usually by Saturday evenings, we close Ward 11
and join Ward 23 (a Paediatric cardiothoracic ward). We open
again on Monday mornings. This provides students with
further learning opportunities, working alongside staff from
both Ward 23 and their mentor from Ward 11.
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A multi-disciplinary approach is taken when planning care to
ensure effective care delivery. You will be able to work with all
team members to achieve your clinical competencies.
Emergency Telephone Numbers
Fire 333
Security 333
Cardiac Arrest 2222
When you call 2222 for the cardiac arrest team you need to
state that there is a paediatric respiratory and/or cardiac
arrest on Ward 11 Freeman Hospital.
The Paediatric Resuscitation Trolley is situated in the
treatment room, make sure you know where it is and how to
move it in the event of an emergency.
Switchboard 0
The main switchboard is located here at Freeman however it is
a central switchboard for the entire trust, therefore can be
very busy. When telephoning an outside line not in the „0191‟ or
„01670‟ area codes or mobile phone numbers, switchboard must
be contacted and an operator will connect you to the required
number.
DECT phones
Many medical and nursing professionals now carry DECT phones
which usually have five digit contact numbers and can be called
directly from the ward telephones.
The internal number for Ward 11 is: 37011
The external number for Ward 11 is: 0191 2137011
Fire Safety
Your mentor will make you aware of the fire procedure for
ward 11 and where the fire extinguishers are located.
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Patient buzzer system
Each patient has a hand held, wall mounted buzzer to gain our
assistance. The patient presses the buzzer and an intermittent
sound will be heard all over the ward.
Emergency buzzer system
If a member of staff requires urgent assistance, they will
sound the nearest emergency buzzer (situated at various
points on the ward). This tone is similar to the patient buzzer
system but is a continuous sound.
Your mentor will go through the two systems with you in more
detail.
There are a variety of learning opportunities in addition to all
the ward based nursing activities that can be discussed and
arranged with your mentor.
Theatre visits
Out-patient clinics
The role of the nursery nurse
Observing the nurse practitioner‟s role
The Portfolio of learning opportunities (P.O.L.O) supplied in
this booklet provides a more thorough exploration of these
opportunities.
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COMMON CONDITIONS & PROCEDURES
You will become a lot more familiar with the ENT terminology
used on ward 11 as your placement progresses, but as a starting
point these are most common procedures children have whilst
in our care.
Tonsillectomy- the removal of the tonsils, which are a pair of
lymphatic tissue, situated at the back of the throat.
Adenoidectomy- the removal of the adenoids, which are also
areas of lymph tissue, situated in the postnasal space.
Myringoplasty- the repair of a perforated eardrum.
Septoplasty- surgery to correct or improve the position of a
deviated nasal septum.
Glue ear- the Eustachian tube in the middle ear becomes
blocked with fluid that is thick and glue-like. This can
significantly reduce the child‟s level of hearing and can cause
ear infections.
Grommets- if glue ear persists then grommets may be advised.
They are tiny plastic tubes that are inserted into the eardrum
to prevent the build up of any further fluid. They are only a
temporary measure usually lasting 6-12 months.
Mastoiditis- the inflammation of the mastoid antrum and cells.
Mastoidectomy- the removal of diseased bone and drainage of
the mastoid antrum in severe purulent mastoiditis.
Quinsy- a peritonsillar abcess, acute inflammation of the tonsil
and surrounding cellular tissue.
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Tracheostomy- a surgical opening made into the trachea
(windpipe) through the neck into which a curved tube is
inserted. Tracheostomy is indicted in the following instances: -
possible or actual upper airway obstruction.
ventilatory assistance.
to protect the airway and provide pulmonary suctioning.
Other terminology you may hear used include;
Apnoea- cessation of respirations.
Apyrexial- the absence of fever.
Asepsis- the process of performing a sterile procedure to
minimise the risk of infection.
Audiology- the evaluation and measurement of hearing.
Aural- referring to the ear.
BSERA- brain stem evoked response audiometry.
Cholesteatoma- a sac containing cholesterol which can occur in
the middle ear.
Diathermy- used to coagulate blood vessels or dissect tissue.
Dysphagia- difficulty in swallowing.
Emla- a local anaesthetic cream used to numb the skin prior to
cannulation.
Epistaxis- bleeding from the nose.
Haemostasis- the arrest of bleeding.
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Otalgia- earache.
Otorrhoea- discharge from the ear.
Rhinitis- inflammation of the mucus membranes of the nose.
Rhinorrhoea- nasal discharge.
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All staff nurses on Ward 11 have various areas of interest. We
have designated link nurses for different areas of nursing
practice.
Area of interest Staff Name(s)
Asthma Heather Kennedy Pain Nicola Peacock
Karen Elliott Health and Safety Nicola Readman Education Nicola Peacock
Margaret Bulmer “Improving Working Lives” Margaret Bulmer Tissue Viability Karen Elliott Moving and Handling Stephanie Collins/ Deb Tulip Risk Management Nicola Readman Clinical Supervision Jacqueline Gunn Tracheostomy Care Jacqueline Gunn COSHH Nicola Readman Pre-assessment Sharon Bradley Infection Control Karen Elliott
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COMMON DRUGS USED ON WARD 11.
Analgesia: -
Paracetamol
Codeine phosphate
Diclofenac
Ibuprofen
Antibiotics: -
Augmentin
Penicillin
Amoxicillin
Cephalexin
Metronidazole
Ear drops: -
Sofradex
Gentisone
Audicort
Others: -
Hydrogen peroxide gargles
Naseptin cream
Information regarding all of these drugs and others you see
used on the ward can be found in the „Alder Hay Medicines for
Children‟ book and the British National Formulary (BNF), both
of which can be found at the back of the nurse‟s station.
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Drug Calculations REMEMBER THE FORMULA…….
What you want x what it’s in (volume) What you’ve got 1) A dose of 125mg Ampicillin is prescribed for a child. It
is prescribed in syrup with 250mg in 10ml. How much would you give the child?
2) An initial dose of 375mg of Ampicillin is prescribed. The
syrup is the same suspension as question 1. How much would you administer?
3) A child is prescribed 15mg Phenobarbitone which is
dispensed in a solution of 25mg in 5ml. How much would you give the child?
4) Carbamazepine liquid is dispensed as 100mg in 5ml. A
child is prescribed 150mg. How much would you give? 5) A child is prescribed 40mg of the same drug as question
4. How much would you give? 6) Drug X is manufactured in 50mg tablets. The
prescription is for 150mg. How many tablets are needed? 7) A child is prescribed 450microgs of Atropine Sulphate,
which is dispensed in vials containing 600microgs in 1ml. How much would you give?
8) Flucloxacillin 62.5mg is prescribed. It is dispensed as
125mg in 5ml. How much would you give?
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9) A child is prescribed 50mg of Phenytoin this is dispensed as 30mg in 5ml. How much would you give?
10) A baby is prescribed 35microgs of Digoxin this is
dispensed as 30microgs in 1ml. How much would you give? 11) Paracetamol paediatric syrup (Calpol) is available in 2
consistencies-
‘INFANT’= 120mg paracetamol in 5ml suspension ‘SIX PLUS’= 250mg paracetamol in 5ml suspension
How much would you require for the following doses? a) 500mg (six plus) b) 360mg (infant) c) 720mg (six plus) d) 80mg (infant) e) 1g (six plus)
12) Diclofenac is commonly administered in two forms-
50mg enteric coated tablets 50mg dispersible tablets
A dose of 40mg is prescribed. How would you suggest administering this amount?
25mg? 15mg?
13) Codeine phosphate can be administered as 25mg in 5ml
syrup. How much in mg is 7.5mls? 14) A dose of 15mg codeine is required. How many mls
would you give?
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15) You have to give 150mg of Metronidazole, which comes in a 100ml solution containing 500mg of Metronidazole. How much would you give?
16) Ondansetron is dispensed in 4mg ampoules with a
volume of 2mls. A dose of 3mg is required. How much would you give?
Further information regarding all these medications can be
found in the British National Formulary (BNF) on the ward.
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LEARNING OPPORTUNITIES
The following few pages identify the learning opportunities
open to you whilst on placement with us in Ward 11. We hope
you find this useful in helping to structure your placement.
KEY ELEMENT
INTERPERSONAL SKILLS
LEARNING OPPORTUNITIES RELEVANT RESOURCE
Use of the telephone
Answering calls
Making calls
Transferring calls
Contacting other wards
/departments
Use of bleep system
ward clerk/ward staff
Use of the computer
Patient investigation results
Patient information
Use of Trust intranet
E mail access
ward clerk/ward staff
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Talking to
Patients
Relatives
Doctors
Other nurses including specialist
nurses Doctor
Members of multi-disciplinary team
All nursing staff
Other ward staff
Other hospitals
Ancillary staff
MDT meetings
Doctors ward rounds
Booking transport
Facilitating investigations
Nursing hand-over
Managerial structure in Trust
Patient transfer outside the trust
(As appropriate)
Registered nurse
Doctor
Health Care Assistant
Domestic
Multi-disciplinary team
Domestics
Registered nurses
Doctors/registered nurses
Ward clerk/ambulance control
Registered nurses/doctors/ward
clerk
Registered nurses
Specialist nurses/sisters
Parents/registered
nurses/ambulance service/ward
clerk
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KEY ELEMENT CLINICAL SKILLS
LEARNING OPPORTUNITIES RELEVANT RESOURCE
Physiological Observations
Temperature
Pulse
Respirations
Blood pressure
Oxygen saturations
Weight
Blood glucose
Urine output
PAIN assessment tool
(As appropriate)
Registered nurse
Doctor
Health Care Assistant
Administration of medicines
Oral
Intravenous
Intravenous therapy
Topically
Cannulation/venepuncture
Inhalation
(As appropriate)
Registered nurse
Anaesthetist
Pharmacist
Doctor
Pre operative care
Pre admission preparation
Admission onto ward
Consent
Anaesthetic review
Check list
Establish NBM times
Distraction therapy
(As appropriate)
Nurse Practitioner
Registered nurse
Operating surgeon
Anaesthetist
Health care assistant
Nursery Nurse/Play specialist
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Post operative care
Safety Checks
Taking and recording of vital signs
Administration of analgesia
Establishing diet and fluids
Registered Nurse
Patient discharge
Discharge advice (verbal/written)
Registered nurse
Consultant
Doctor
Nurse Practitioner
Knowledge/nursing care of patient
ENT procedures:-
Tonsillectomy
Adenoidectomy
Insertion of grommets
Mastoidectomy
Myringoplasty/tympanoplasy
BSERA
Tracheostomy
Septoplasty
Registered nurse
Consultant
Doctor
Nurse practitioner
ENT conditions
Tonsilitis
Glandular Fever
Ear infection
Orbital cellulitis
(as above)
Cardiac and respiratory conditions
Medical and surgical management of
pneumonia/empyema
Lung transplant assessments
Pre and post operative cardiac
surgery care
Registered nurse
Paediatric respiratory doctors
Cardiothoracic surgeon
Observation and assistance with:-
Suture removal
Aseptic technique
Drain removal
Registered Nurse
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KEY ELEMENT MANAGEMENT OF CARE
LEARNING OPPORTUNITIES RESOURCE/RELEVANT
PERSONEL/DEPARTMENT
Assessment
Pre-assessment
Documentation used
Nurse practitioner
Registered nurse
Trust website (intranet)
Planning
Pathways of care
Risk assessment tools
Patient/carer involvement
Registered nurse
Implementation/evaluation
Ward rounds
Standards/protocols/policies
Communication/relative/patient
Time management/Planning
priorities
Dealing with difficult situations
Patient property/valuables
Religious needs
Self discharge/parent self
discharge
As above
Organisational skills
Role of ward sister
Delegation
Off duty
Standards of care
Quality issues
Sister
Registered nurse
Management of ward/resources
Ordering drugs
Stock control
Moving and handling
Risk management
Health and safety
Staff development/appraisal
(as appropriate)
Registered nurse
Sister
Trust website (intranet)
Moving and handling facilitator
Risk assessment facilitator
Emergency situations
Post tonsillectomy bleed
Cardiac/respiratory arrest
Fast bleep system
Violent incidents
Fire
Registered nurse/doctor
Cardiac arrest team/registered
nurses
Switchboard
Fire officer/registered nurse
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NORMAL TEMPERATURES, PULSES, RESPIRATIONS AND
BLOOD PRESSURES FOR CHILDREN AND ADOLESCENTS.
Temperature: -
Newborn 36-37.2 c
3 yrs 36.4-37 c
10 yrs 36.4-37 c
16 yrs 36.4-37 c
Pulse:-
Newborn 120-160
3 yrs 80-125
10 yrs 70-110
16 yrs 55-90
Respirations:-
Newborn 30-60
3 yrs 20-30
10 yrs 16-22
16 yrs 15-19
Blood pressure:-
Newborn Systolic 46-92 Diastolic 38-71
3 yrs Systolic 72-110 Diastolic 40-73
10 yrs Systolic 83-121 Diastolic 45-79
16 yrs Systolic 93-131 Diastolic 49-85
Reference:-
Mallet J, Bailey C. (1998).
The Royal Marsden NHS Trust Manual of Clinical Nursing
Procedures. (Fourth Edition
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We hope you find this booklet useful. Please feel free to ask
any of us any questions you have. All the staff on ward 11 wish
you a insightive, interesting, productive and enjoyable
placement!!
SPACE FOR YOUR OWN NOTES
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Your mentor will complete this form with you on your
first day. Please ensure you are familiar with important
safety issues on the ward
Student Name……………………………………
Mentor name……………………………………..
Year/group……………………………………….
Guidance facilitator………………………………
Ward Layout Date Mentor
Signature
Student
Signature
Location of Break glass,
Fire Points and Exits
Welfare (location of
toilet, washing, changing
and dining areas).
Regulation Procedures
Fire safety
Hygiene / Infection
Control
Reporting illness and
absence
Harmful substances
(COSHH)
Electrical Equipment
Resuscitation Trolley
location
Green / red bag location
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Emergency buzzers
Oxygen and Suction
Patient Line television
Policy Documents
Policy document locations
Security –patient and
staff valuables
Telephone System
Emergency Numbers
Answering calls
Making Calls
Transferring Calls
Use of bleep and dect
system
Specific Infection control
procedures
Uniform Policy
Food Handling
Waste disposal
Needle stick injuries /
sharps
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BIBLIOGRAPHY.
Baillieres Nursing Dictionary (1990)
Weller & Wells.
Ear, Nose & Throat (1994)
Dhillon R S, East C A
Churchill Livingston.
Ear, Nose & Throat Disorders (1993)
Sigler B A, Schuring L T
Mosby Clinical Nursing Series.
The Royal Marsden NHS Trust Manual of Clinical Nursing
Procedures (1998)
Mallet J, Bailey C.
Blackwell Science Ltd, Fourth Edition.
Produced by Nicola Peacock and Heather Kennedy September 2004 Updated March 2011 Update due March 2014
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PROFILE OF LEARNING OPPORTUNITIES
Children’s hearing clinic General ENT clinics
Nurse Practitioner Pre-assessment Clinic
Audiology ENT outpatients dept. Casualty Clinic
Cardiac borders
Hospital play specialist
Pre assessment and
Play preparation _________
Distraction therapy Sleep Study Lab
Theatres Specialist sleep study nurse
Operating theatre Ward based sleep studies Clinic
Recovery Anaesthetic room Child and family care
Admissions
Nursery Nurse/Play specialist
Respiratory care Play Basic infant care Pre-operative care
Bronchiolitis/ Pneumonia Discharge Post-operative care
Medical surgical
management management
Ward 11