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Welcome to Main Theatres Ophthalmology Added to NU Placements Website May 2011 Welcome to Main Theatres – Ophthalmology We hope you enjoy your placement in the department and benefit from your experience. We aim to provide a learning environment that is challenging and enables students to fulfil outcomes set by the university. A mentor is allocated to each student to guide you through your learning outcomes and will regularly review your progress. Please don’t hesitate to provide any feedback or concerns you may have regarding your placement. Department Profile Our department consists of two operating theatres which cater for both in-patient and day case surgery. Both theatres operate Monday to Friday from around 8:30 am to 5:30 pm. All types of ophthalmic surgery are performed within the department including :- vitreo-retinal surgery paediatric ophthalmic surgery strabismus (squint) surgery lid surgery corneal surgery cataract surgery oncology surgery emergency surgery e.g. penetrating injury , lid laceration Added to NU Placements Website May 2011 PHILOSOPHY OF CARE We believe each individual should receive a holistic approach to care which accounts for physical, psychological and cultural needs. Care should be offered in a clean, safe environment and delivered in a courteous, professional manner. Confidentiality, privacy and dignity should be respected at all times through practice within the professional code of conduct. We aim to improve patient care through life-long learning, audit and evidence based practice and so offer patients informed choices in their care. Each patient will have his or her own Named Nurse responsible for assessing, implementing and coordinating care within the multi-disciplinary team. By use of a problem solving, patient focused approach to care, we hope to build a partnership of care that aims to help patients attain, maintain and restore health. We aim to develop our role as educators and provide a supportive environment where learning is encouraged for all staff, patients and carers. Added to NU Placements Website May 2011 There are 11 different consultant ophthalmologists who operate regularly in our department and their specialities include : - Vitreo-retinal surgery Corneal surgery Eyelid and plastic surgery Paediatric ophthalmic surgery Strabismus (squint) surgery Glaucoma surgery Ophthalmic oncology surgery There are other surgeons who specialise in fast track cataract surgery. These surgeons are based in Cataract Treatment Centre and only operate in our theatres on emergency cases. Added to NU Placements Website May 2011 Most patients operated on within the department are in-patients from Haygarth Ward and usually require a general anaesthetic. We also perform day case surgery under local anaesthetic, usually for patients requiring lid surgery e.g. for an in-turning eyelid (entropian). Some of our staff have an ophthalmic nursing qualification and training for those who don’t is encouraged when opportunities arise. Research is also encouraged from both nursing and medical staff to improve and update current practice. Primary Nursing Patients visiting theatre from Haygarth ward are allocated their own primary nurse on arrival. This nurse will then be responsible for the patients care during their entire stay in the department. The same method is adopted for patients attending the department as day case patients. Each consultant is also allocated their own primary nurse who is responsible for co-ordinating the care and nursing team when they operate in the department. The consultant also liases directly with their primary nurse to ensure all requests , equipment etc are satisfied. Added to NU Placements Website May 2011 MAIN THEATRE : Nursing Staff There is one department manager (band 7) and one junior sister (band 6) The are also 12 band 5 staff nurses mainly full time with various levels of experience and qualifications. There are currently 2 theatre support workers (health care assistants. The department also employs one full time Operating Department Practitioner (ODP) who mainly works with the anaesthetic staff. Theatre Sterile Supplies Unit Attached to the Theatre Department is a sterile supplies department. All equipment requiring sterilisation is pre-washed on site then sent to TSSU at Sunderland Royal Hospital for Autoclaving. All equipment on return is checked and either stored in the department or distributed to the departments throughput the hospital - Theatres Cataract Treatment Centre Casualty and Outpatient Departments Haygarth Ward Excimer Unit Diagnostic Unit Added to NU Placements Website May 2011 Theatre Timetable 2010 Monday Am Th. 1 Th. 2 Monday Pm Th. 1 Th. 2 Tuesday Am Th. 1 Th. 2 Tuesday Pm Th. 1 Th. 2 Wednesday Am Th. 1 Th. 2 Wednesday Pm Th. 1 Th. 2 Thursday Am Th. 1 Th. 2 Thursday Pm Th. 1 Th. 2 Friday Am Th. 1 Th. 2 Friday Pm Th. 1 Th. 2 Added to NU Placements Website May 2011 Mr Tiffin Mr Morgan Mr Fraser Vitreo-retinal Mr Steel Miss Chapman Mr Wride Mr Boyce Mr Inglesby Mr Allchin Mr Steel Mr Allchin Mr Steel Mr Gnanaraj Mr Boyce Mr Morgan Mr Inglesby Mr Osborne Miss Chapman Mr Osborne Paediatrics Corneal/Mix Cataract/Glaucoma Emergency List Vitreo-retinal Lids/Plastics Cataract/Glaucoma Lids/Plastics Vitreo-retinal Strabismus Vitreo-retinal Strabismus Macular Paediatric/Mix Lids/Plastics Corneal/mix Vitreo-retinal Lids/Plastics Lids/Plastics Lids/Plastics Hours of Duty Full time staff are required to work Monday to Friday and do three 8 – 5:30 shifts and two half days. Start and finish times are flexible when necessary either staff or the department. Normal shift times are as follows : - full day, 08:00 til 17:30 - half day, 0800 til 13:00 or 13:30 - reverse half day, 12:30 til 17:30 As we are a Monday to Friday area only, there are usually no difficulties in working your minimum of 50% of shifts with your mentor. If you are off sick at any time, remember to inform both us and your university. There are also always two members of staff on-call for out of hours emergency cases. Useful Telephone numbers Office Extension 49156 Direct Line 0191 569 9156 Line Extension 46280 Coffee Room 46283 Sister’s Office 46295 Added to NU Placements Website May 2011 Emergency Alarm Calls And Numbers Fire Alarm Every Thursday morning the fire alarm sounds an intermittent tone at around 11:45 am. This is the test procedure. If this sounds at any other time it indicates a real fire alarm and action must be taken. All doors and windows are to be closed and remain so until the all clear is given. A continuous tone indicates a fire alarm in your area and immediate investigation is required and possible evacuation of all patients, relatives and staff. Crash Call In the event of a cardiac arrest in the department the first action is to put out a crash call and shout for assistance. The crash trolley is located in the recovery area of theatres. Cardiac Arrest : 2222 Fire : 333 Security : 777 Added to NU Placements Website May 2011 Ophthalmology Definition The study of the eye and its associated parts. Ophthalmology deals with diseases of the eye and their treatment. The word ophthalmology has greek roots derived from the greek words ophthalmos meaning eye and logos meaning science. So its literal meaning is ‘the science of eyes’. Anatomy of the Eye Ophalmology is constantly changing and updating as research and technology offer continually improving treatments and equipment. During your placement you will have the opportunity to observe a wide variety of ophthalmic surgery in our department. The following is a brief introduction to the types of surgery performed in this department. Added to NU Placements Website May 2011 Cataract A cataract is a misting or opacity of the lens. It prevents light entering the eye properly and causes dimness of vision and eventually blindness if left untreated. Most cataracts are caused by the body’s normal ageing process but occasionally are caused by trauma, diabetes or drugs.The cataract can be removed by an operation called phacoemulsification (see below). The lens is broken down using ultrasonic vibrations then aspirated. A plastic lens implanted inside the eye (IOL - intra ocular lens) then replaces the cataract (see below). Added to NU Placements Website May 2011 Sutures are not usually needed and the patient can return to a normal lifestyle immediately afterwards. Trabeculectomy Indicated for patients with glaucoma. The operation is performed where prophylactic treatment fails to control the intra ocular pressure (IOP). The aqueous fluid of the anterior chamber, in the front part of the eye, is unable to drain sufficiently away due to a blockage in the drainage channel, the trabecular meshwork, located at the junction between the sclera and the cornea. Trabeculectomy involves creating a thin scleral flap and internally cutting two small holes, one in the iris (an iridectomy) and the other in the drainage channel, usually at 12 o’clock to be less noticeable under the eye lid. This allows the aqueous fluid to flow freely and gradually be absorbed by the bloodstream and so lowering the intra ocular pressure. Added to NU Placements Website May 2011 Lid Surgery Ptosis A ptosis is a drooping of the upper lid. It can be caused by: - Abnormal weight on the lid due to oedema, tumour or scarring - trauma or disease to the muscle - paralysis of nerves supplying the upper lid - congenital causes A ptosis can be corrected by lid surgery during which the levator muscle in the lid is resected. Entropian Is a turning in over of the eyelid due to weakness of the lid retractors (the muscles which open and close the eyelids). Usually occurs in the lower eye id causing eye to water and eyelashes to rub against the cornea causing pain and discomfort. There are many different operations to correct entropian but all usually involve removing part of the eyelid therefore tightening the retractor muscle and shortening the lid. Ectropian Is a turning out over of the eyelid due to a weakness of the orbicularis muscle. Usually occurs in the lower eye lid and causes the eye to water constantly because the drainage hole (punctum) is not in the correct position. Added to NU Placements Website May 2011 The most common operation is to shorten the eyelid and to enlarge the punctum to reduce watering. Lid Lesions - Removal Usually performed to remove a lesion for diagnostic purposes. If results indicate a carcinoma further surgery will be required to remove it and re-construct the eyelid. Some lid lesions may also be removed for cosmetic reasons. Chalazion The Meibomian glands are found in the eyelids and produce a sebaceous substance, which creates the oily layer of the tear film. A chalazion occurs when one of the Meibomian glands swell due to a blockage of its duct. If the swelling does not subside the chalazion can be removed by incision and curettage. A clamp is placed on around the chalazion and the eyelid everted. A small incision is made and the contents scooped out using a curette. The clamp is then removed and some antibiotic ointment and a firm pad are applied. Evisceration Removal of the contents of the eye, usually after an infection has left the eye blind. A small amount of eye Added to NU Placements Website May 2011 movement is retained after this surgery giving a more cosmetically pleasing result. Enucleation Removal of the whole eyeball leaving the extra ocular muscles. The socket is fitted with a conformer to enable a good cosmetic result with a prosthesis (fitted at a later date). It is often performed as a last stage of treatment for a painful, blind eye following malignant melanoma. Dacryocystorhinostomy (DCR) Epiphora, or watery eyes, occurs because of a blockage in the normal lacrimal drainage system, which impairs normal tear channelling into the nasal cavity. Recurrent infection or dacryocystitis may occur as a result of stagnation. DCR may alleviate symptoms and Added to NU Placements Website May 2011 involves surgical creation of a new passage of drainage for tears into the nasal cavity. Added to NU Placements Website May 2011 Vitrectomy and Detachment Surgery These operations are performed for patients who have problems with their retina often associated with diabetes, short-sightedness (myopia) or trauma. The operations are often intricate and lengthy procedures. Vitrectomy (internal approach) involves removing the jelly part of the eye (vitreous) and replacing it with a fluid containing minerals and salts and is about the same consistency as the aqueous fluid of the anterior chamber. Microsurgery is then performed to attempt to rectify the specific problem such as retinal holes, tears or membranes. Added to NU Placements Website May 2011 Detachment (external approach) is performed on the outside of the eye (sclera) and involves suturing a silicone explant onto the sclera to create an indentation of the detached area of retina. A freezing process (cryotherapy) is then applied over the sclera to induce an inflammation over the retinal problem. The inflammation will gradually subside taking the retina back to its normal position and up against the indentation of the explant. Added to NU Placements Website May 2011 Occasionally a gas bubble is (SF6 or C3F8) mixed with filtered air is injected into the eye to tamponade problem retinal areas. The gas bubble will expand a little inside the eye and push up against the retina and help keep it in place. The gas bubble is gradually absorbed. Patients may need to posture postoperatively to help with the success of the operation i.e. lie in a certain position so gas bubble tamponades the right area of retina. The posturing can be said to be as important as the surgery itself. Corneal Graft A corneal graft is a transplant operation involving removal of the central part of the cornea and its replacement with a cornea from a donor. The donor cornea comes from someone has expressed a wish that their corneas be used to help someone else see after their death. The donor cornea is sutured to the host using either a series of interrupted sutures or one continuous suture. The sutures may be left in place for up to two years. Although rare, corneal rejection is a post op complication and can occur even years after surgery. Rejection occurs most commonly in the first year after surgery. Added to NU Placements Website May 2011 LEARNING ZONES Pre-admission Assessment Clinic Almost all elected patients are assessed prior to admission within one month of their surgery date, investigations are undertaken, eg tonometry, venepuncture, electrocardiograph, focimetry. Physical and social needs are taken into consideration and social services, occupational therapists or district nurses may be required for input on discharge from hospital. These services can be organised before admission,. The patient can receive information about their forthcoming surgery here. Haygarth Clinic Specialised nurse-led clinics are undertaken here, eg blood monitoring, oculoplastics. Patients attend as outpatients. Consultant Ophthalmologists also hold regular clinics here. Cataract Treatment Centre Patients are assessed prior to day case surgery, nurses prepare the patient for surgery and surgery such as cataracts under local anaesthetic and other eye operations are carried out and the patient is usually discharged the same day. Added to NU Placements Website May 2011 Nurses carry out a post-operative telephone assessment on the first post-operative day. Patients are also seen as outpatients by Consultants and listed for surgery as well as reviewed one-two weeks post-operatively. Main Theatre / Day Case Unit Again, patients are assessed prior to day case surgery. Patients undergo surgery for all manner of eye problems under general and local anaesthetic, eg vitrectomy, squints, cataracts, trabeculectomies. Nurses carry out a post-operative telephone assessment on the first post-operative day. Accident and Emergency Patients attending the department are triaged into one of three categories. 1 = ocular emergency 2 = urgent 3 = non-urgent The patient will be seen by the nurse practitioner, the nurse consultant, or the doctor, who can carry out the ocular examination and treatment. Conditions can include chemical injury, embedded corneal foreign body, arc eyes, eyelid lacerations, penetrating injuries, conjunctivitis etc. A minor operating theatre exists Added to NU Placements Website May 2011 for small repairs/excision of chalazions and injection of botulinum toxin injections. Diagnostic Unit Ocular ultrasound is undertaken, as well as laser treatment and fluorescein angiograms on in-patients and out-patients as needed. Medical physics investigations can be done also. The glaucoma unit also carries out tests here Excimer Laser Unit Patients undergo refractive surgery here carried out by the Corneal Consultants. Out-patients Visual acuity is checked at each visit and doctor in the clinic sees the patient. Adult and paediatric clinics are held here. Orthoptic Department - Orthoptists measure for straight eyes. Pharmacy Dispensing of in and out patient prescriptions. Opportunity to observe the working of the pharmacy department and the various types of medications available. Added to NU Placements Website May 2011 Profile of Learning Opportunities Learning Opportunity Use - Of Telephone making calls answering calls ring back facility awareness who to report to - bleep system Resource / Relevant Personel / Department Theatre Nursing Staff Using HISS / Computers - patient admission profiles / information Theatre Nursing Staff - order entry - retrieve results - internet Library Staff - email access Participation - patient care - MDT Patient Care - prioritising patient needs - different methods of care delivery e.g. Added to NU Placements Website May 2011 Nursing and medical staff MDT members - - - - primary nursing, named nursing, nursing caseload observation skills e.g. BP, temeperature, pulse, ECG, blood glucose, INR, urinalysis accurate documentation e.g. early warning scores, theatre register instillation eyedrops A-scanning IOP measurement Scrubbing for ophthalmic surgery Circulating (floor) nurse Recovery of patients including airway management, monitoring oxygen saturation, administration of oxygen, IV therapy Pain relief Infection Control - policies - source and spread of Added to NU Placements Website May 2011 Theatre Nursing Staff Anaesthetist Medical Staff ODP’s Theatre Nursing Staff Infection Control infection - aseptic technique - appropriate equipment,clothing Oncology - epidemiology / aetiology - treatment - surgery – radioactive plaque - isolation nursing Ophthalmology - anatomy of eye - diseases e.g.cataract - treatment - surgery - ophthalmic pharmacy - pre-assessment - oculoplastics - nurse led post op clinics - nurse led glaucoma clinics - outreach clinics Health Promotion - patient education - health promotion literature Added to NU Placements Website May 2011 Department Infection control link nurse Theatre Nursing Staff Ward Nursing Staff Ophthalmic Oncology Specialist – Mr Wood Eye Infirmary Nursing Staff Learning Zones e.g. CTC, Haygarth, OPD, A+E Medical Staff Pharmacist Outpatient B : preassessment All Nursing and Medical Staff Smoking Cessation Advisor - smoking cessation - low visual aids Communication Skills - assessment / discussion / education patients and relatives - interviewing / questioning skills during assessment LVA unit Theatre Nursing Staff Pre-assessment Nursing Staff in CTC and Haygarth Ward Managing care - nursing process - philosophy of care - admission day case patients - assessment e.g. who assesses, how, what and where Nursing Staff - planning of care - computerised care plans - implementation of care - evaluation of care - discharge patients - referrals to members MDT - risk assessment tools e.g. EWS Added to NU Placements Website May 2011 GLOSSARY OF OPHTHALMIC TERMS Abduction Acanthamoeba Accommodation Adduction Amblyopia Alpha, Gamma and Kappa Aniridia Aphakia Applanation tonometry Arcus senilis Argon laser Added to NU Placements Website May 2011 Turning the eye outwards. A genus of free-living amoeba. The ability of the lens to change shape to allow near objects to be focused on the retina. Turning the eye inwards. Reduced vision usually due to interference with the eye’s development. Different angles in the eye measured between the optic axis and the visual axis. Absence of the iris. Absence of the lens. Measurement of the intra-ocular pressure by flattening the cornea. Degenerative change in the cornea resulting in a white ring around the corneal circumference. Laser that uses photocoagulation. Astigmatism Uneven curvature of the cornea. Binocular vision Co-ordinated use of both eyes resulting in a single vision. Measurement of the axial length of the eye. Inflammation of the lid margin. Painful involuntary spasm of the eyelids. Optic disc where there are no nerve endings, only nerve fibres. Oedema of the cornea causing ‘blister’ formation in the epithelium. Outer and inner areas where the upper and lower lids meet. Opening of the capsule of the lens. Plastic shield to protect the eye. Small fleshy area in inner corner of the eye. Opacity of the lens. Area of vision when looking straight ahead. Biometry Blepharitis Blepharospasm Blind spot Bullous keratopathy Canthus Capsulotomy Cartella shield Caruncle Cataract Central field/vision Added to NU Placements Website May 2011 Chalazion Chemosis Chlamydia Commotio retinae Concave lens Concretion Convex lens Cycloplegia Cylindrical lens Dacryoadenitis Dacryocystitis Added to NU Placements Website May 2011 Meibomian gland cyst. Internal hordeolum. Oedema of the conjunctiva. Chronic conjunctivitis caused by serotypes D-K of Chlamydia trachomatis. Oedema of the retina following trauma. A lens which diverges light rays, used to correct myopia: a ‘minus’ lens. Lipid deposit in the conjunctiva. A lens which converges light rays, used to correct hypermetropia: a ‘plus’ lens. Paralysis of the ciliary muscles. A lens of cylindrical shape, which refracts light rays in various directions in different meridians, used to correct astigmatism. Inflammation of the lacrimal gland. Inflammation of the lacrimal sac. Dacryocystorhinostomy Dendritic ulcer Descemetocele Dioptre Diplopia Disciform keratitis Distichiases Drusen Ectropion Electroretinogram Emmetropia Added to NU Placements Website May 2011 An operation to make a passage from the lacrimal sac into the nose to overcome obstruction. A branching ulcer of the cornea caused by the herpes simplex virus. Protrusion of Descemet’s membrane through the stroma and epithelium of the cornea. Unit of measurement of strength of the refractive power of the eye, or lenses, expressed as a fraction of a metre. Double vision. Inflammation of the cornea as a complication of herpes simplex virus. Double row of eyelashes. Small yellow nodule in Bruch’s membrane or optic nerve. Turning out of the eyelid. A recording of electrical activity of the retina. Absence of refractive error. Endophthalmitis Endophthalmos Entropion Enucleation Epicanthus Epilation Epiphora Episcleritis Evisceration Excimer laser Exenteration Exophthalmometer Exophthalmos Added to NU Placements Website May 2011 Inflammation/infection of inner structures of the eye. Displacement of the eyeball downwards. Turning inwards of the lid margin. Removal of eyeball and length of optic nerve. Broad fold of skin in inner canthus. Removal of an eyelash. Watering eye. Inflammation of the episcleral vessels. Removal of the contents of the eyeball, leaving the sclera intact. Laser used for corneal surgery, eg for correcting refractive errors or removing corneal scars. Removal of the contents of the orbit, including the eyeball and lids. Instrument for measuring the degree of protrusion of an eye. Protrusion of one or both eyes - usually refers to Field of vision Fields of gaze Fixation Floaters Fundus Fusion Glaucoma Gonioscope Guttae (G.) Hemianopia Heterochromia Added to NU Placements Website May 2011 that caused by thyroid eye disease. The entire area that can be seen without moving the eye. The different areas that can be seen when moving the eye in all directions. The eyes are fixed on an object centrally at a chosen distance. Small, dark particles in the vitreous. Posterior aspect of the retina including the optic disc and the macula. Co-ordinating the images seen by both eyes into a single image. Increased intra-ocular pressure sufficient to damage vision. A contact lens mirror used to view the anterior chamber angle. Eyedrops. Half-vision - unilateral or bilateral. Difference coloured irises in one person. Hordeolum - internal See Chalzion - external See Stye Hypermetropia Long sight. Hyphaema Blood in the anterior chamber. Hypopyon Pus in the anterior chamber. Injection Degree of redness of the conjunctiva. Interpupillary distance(IPD) The distance between the two pupils. Interstitial keratitis Inflammation of the cornea due to syphilis. Iridectomy Removal of a piece of the iris. Iridodyalysis Severance of the iris from the ciliary body. Iridodonesis Quivering of iris following intra-capsular cataract extraction. Iridotomy A hole in the iris, usually performed by the laser beam. Iris bombe Bulging forward of the iris. Iris prolapse A section of the iris prolapsing through a wound, either surgical or traumatic. Iritis Inflammation of the iris. Added to NU Placements Website May 2011 Ishihara colour plates Keratitic precipitates Keratitis Keratoconus Keratometer Lacrimation Lagophthalmos Lamellar graft Laser Microphthalmos Miotic Mydriatic Myopia Oculentum (Oc.) Operculum Added to NU Placements Website May 2011 Multi-coloured charts for testing colour vision. Plaques of protein adhered to the corneal endothelium in uveitis. Inflammation of the cornea. Conical-shaped deformity of the cornea. Instrument for measuring the curvature of the cornea. Production of tears. Incomplete closure of the eyelids. Partial thickness corneal graft. Light Amplification by Stimulated Emission of Radiation. Energy transmitted as heat. Small eyeball. Drug that constricts the pupil. Drug that dilates the pupil. Short sight. Eye ointment. A semi-circular tear in the retina, covered with a flap of retina. Ophthalmia neonatorum Ophthalmoplegia Ophthalmoscope Optic axis Palpebral Pannus Panophthalmitis Penetrating graft Perimeter Peripheral vision/field Phacoemulsification Phasing Phlyctenule Added to NU Placements Website May 2011 Severe conjunctivitis of the newborn. Paralysis of the extraocular muscles. Instrument for examining the retina. The line through the centre of the optical structures of the eye. Pertaining to the eyelids. Neovascularisation of the cornea. Inflammation of the whole eyeball. Full-thickness corneal graft. Instrument for measuring the field of vision. Area of vision outside central field of vision. Removal of a cataract by ultrasound, breaking down lens matter prior to it being aspirated. Regular frequent measurements of intraocular pressure over a few days. Small vesicle of allergic origin on limbal area of conjunctiva and/or cornea. Photophobia Photopsia Phthsis bulbi Pinguecula Placido’s disc Presbyopia Preseptal callulitis Prism Proptosis Pterygium Ptosis Refraction Refractive surgery Added to NU Placements Website May 2011 Sensitivity to light. Sensation of flashing lights. Shrunken eyeball. A yellowish overgrowth of conjunctiva. A disc with alternating black and white rings for reflecting onto the cornea to detect any irregularity in its curvature. Inability to focus for near sight due to hardening of the lens nucleus after the age of 40 years. Inflammation of preseptal portion of the eyelids. A triangular-shaped lens used to correct diplopia. Protrusion of the eyeball. A triangular proliferation of conjunctival tissue that can invade the cornea. Drooping eyelid. (1) Bending of light rays. (2) Measurement of and correction of refractive errors of the eye. Corneal surgery to correct refractive errors. Retinal detachment Separation of the epithelial layer of the retina from its neural layers. Retinitis pigmentosa An hereditary degeneration of the retina. Retinoblastoma Highly malignant tumour of the retina in infancy. Retinopathy Non-inflammatory disease of the retina. Retinopathy of prematurity A vasoproliferative retinopathy occurring in premature infants. Retinoscope Instrument for objective assessment of refractive errors. Retrobulbar Behind the eyeball. Retropunctal cautery Cautery applied behind the punctum to cause fibrosis and inturning of the lower lid. Rhodopsin Light-sensitive pigment of the rods in the retina ‘visual purple’. Rodding of fornices Passing a glass rod in either fornix. Rubeosis irides Neovascularisation of the iris. Scleritis Inflammation of the sclera. Added to NU Placements Website May 2011 Scleromalacia Degeneration of the sclera. Scotoma An area of visual loss in the visual field. Seidel test A test to ascertain leakage of aqueous through a section or perforative wound using fluorescein drops. Sjorgen’s syndrome Syndrome comprising arthritis, dry eyes, dysphagia and achlorhydria. Snellen chart A chart consisting of graded letters, symbols or numbers for testing central vision. Squint Strabismus - deviation of one eye. Staphyloma A protrusion of the cornea or sclera. Stereopsis Perception of depth with binocular vision. Stevens-Johnson syndrome Acute mucocutaneous vesiculobullous disease. Strabismus See Squint. Stye Inflammation of one lash follicle. External hordeolum Superficial punctuate keratitis Superficial spots of inflammation of the Added to NU Placements Website May 2011 Symblephron Sympathetic ophthalmitis Synaechiae Tarsorrhaphy Tear film Tenon’s capsule Tomography Tonometer Topography Toric contact lens Trachoma Added to NU Placements Website May 2011 cornea which stain with G.fluorescein. Adhesion of the bulbar and palpebral conjunctiva. Severe uveitis in one eye following trauma involved the uvea of the other eye. Adhesion of the iris (a) to the lens - posterior synaechiae; (b) to the cornea - anterior synaechiae. Suturing together of the eyelids. The film of liquid covering the eyeball. Membrane encircling globe from limbus to optic nerve overlying the sclera. Computerised scan of the optic disc. Instrument for measuring intra-ocular pressure. A contour map of the curvature of the cornea. Contact lens to correct astigmatism. Potentially blinding infection of the conjunctiva and cornea caused by the TRIC virus. Trichiasis Uveitis Visual acuity Visual axis Visual field Vitrectomy Xanthelasma Xerophthalmia Yag laser Added to NU Placements Website May 2011 Ingrowing or inturning of eyelashes. Inflammation of the uveal tract. Detailed central vision. The line between a point viewed and the macula. Area of vision. Removal of vitreous. Fatty deposits on the eyelids. Lack of vitamin A resulting in corneal and conjunctival disease. Laser that cuts holes in structures. Main Theatre / Day Case Unit Ophthalmology Placement Evaluation Form Date of placement :_____________________ Mentor Name :_______________________ 1. Were you allocated a mentor on arrival to the department ? 2. Were you orientated to the area ? 3. Did you work at least 50% of your shifts with your mentor ? 4. Did you feel adequately supported during your placement ? Added to NU Placements Website May 2011 5. Did you achieve the competencies required by the university ? 6. Did you access any of the learning zones during your placement ? 7. If not , can you explain why not ? 8. Was the portfolio of learning opportunities helpful ? 9. Do you feel the placement has taught you any new skills ? 10. How could we have improved your placement ? Added to NU Placements Website May 2011 Student Induction Checklist (Ward and Department Areas) Student Name……………………………………………………………………………………………………. Mentor Name........................................................................................................................................... Ward/Department....................................................................................................................... ............. This document is to ensure that the students accessing your ward/department are inducted and orientated appropriately- within the first week of placement. This is an NMC requirement for student support and learning in practice (NMC, 2008). Students must be allocated a trained and updated mentor and must work a minimum of 50% of the time in placement with their mentor. This is necessary in order to meet the NMC requirements and to achieve a continuous and comprehensive assessment of the student. The student’s off duty should be recorded alongside their mentor’s shifts. Please take the level/year/experience of your student into consideration when discussing some of the topics listed (eg. first yr, first placement student will only require a very basic awareness about some of the identified topics) Please complete this form and retain a copy within the Evidence File (the student should also retain a copy as evidence of achievement. Initial Interview Issue POLO document or advised to access via NU website Discuss student responsibilities while on placement Discuss strategy to achieve learning outcomes & schedule to review progress Ward Orientation Introduction to ward/department staff (including MDT) Hierarchy of trust staff explained Tour around ward/department environment Nurse Call system explained Bleep system explained Location of ward/department useful contact numbers identified Off duty requests explained Shift patterns explained Security door code given (if applicable) POD system explained Explain the roles of the lead/link nurses Familiarise yourself with lead/link nurses within the ward/department Fire Procedure Identify ward/departments fire alarm points Location of fire fighting equipment and fire exits on ward/department Explain the fire procedure and contact number (333) to alert switchboard of fire. Identify ward/departments assembly point in the event of a fire Location of Fire Safety Policy identified Cardiac Arrest Procedure Location of resuscitation equipment: Resuscitation Trolley Suction Equipment (wall mounted/portable) Defibrillation Machine/cardiac monitor Oxygen points and cylinders Added to NU Placements Website May 2011 Mentor signature & date Student signature & date Mentor signature & date Explain the contents of the resuscitation trolley Demonstrate how to check and record the resuscitation trolley & Defibrillator check and frequency of checks according to policy Explain procedure for Cardiac arrest and contact number (2222) to alert switchboard to send cardiac arrest team Location of Resuscitation Policy identified Manual Handling Location of ward/departments Moving and Handling equipment Health and Safety Emergency Security bleep number (777) explained Location of Health and Safety Policies (COSHH, Risk Management, Medical Devices & Decontamination policies) identified Explain the difference between Oxygen and Air cylinders Demonstrate how to set up oxygen (tubing/masks/valves) &suctioning equipment as appropriate to the level of the student Medical equipment library explained Infection Prevention and Control Location of Infection Prevention and Control Policies identified (Disinfectant, hand washing, sharps and commode cleaning) MRSA Screening explained Explain the importance of the three times a day cannulae/line checks Explain the importance of the daily catheter checks Policies Location and awareness of Uniform, Mobile Phone, Sickness reporting, Complaints, Data Protection & Equality and Diversity Policies Communication/Record Keeping The importance of consent explained Telephone etiquette / communication skills explained Demonstrate and explain the use of relevant patient assessments: Observation charts and EWS Fluid Balance charts/Fluid Balance Summary Charts Diabetic Charts Nutrition/Food Charts Discharge Checklists Property lists MUST Tool Pressure Sore Assessment Accident/Incident Reporting Procedural Checklists Audits Additional information discussed/explained:- Added to NU Placements Website May 2011 Student signature & date