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Ward 19 Student Orientation Package June 2010. Ward 19 Orthopaedics Ninewells Hospital, Dundee Ward 19 is one of four busy orthopaedic wards. Ward 16 is primarily concerned with joint replacements. Ward 17 & 18 receive orthopaedic trauma from A&E. The main roles for ward 19 are the rehabilitation of lower limb amputees and the treatment of wound infections with I.V. antibiotics. Ward 19 also has a number of orthopaedic trauma injuries from A&E. We care for patients of mixed gender and wide age ranges, in a 24 bedded acute nursing setting. During your clinical placement here you will have the opportunity to learn many new skills and consolidate previous learning experiences, linking learning to practice. Designated experienced staff nurses will act as your preceptors throughout this learning period. Your education is of paramount importance – please request to attend focus visits listed in the programme and any other tutorial/lecture/training sessions that are scheduled for the Orthopaedic unit. The staff here hope you enjoy this clinical placement and that you gain advantage of the knowledge, experiences and skills that are available for you. June 2010. ORIENTATION 1. Introduction to members of staff and Preceptor / Associate Preceptor. 2.Tour of the practice setting. 3.Receipt of teaching package, handout on Orthopaedic Terminology and abbreviations. 4.Introduction to ward routine. 5.Discuss the role of the multi-disciplinary team. 6.Location of Policies, protocols and textbooks. 7.NMC Documents held in the clinical area: NMC Code of Conduct Code of Conduct for Students Scope of Professional Practice Confidentiality Standard for the safe Administration of Drugs Standard for Records and Record Keeping Exercising Accountability Signature of Student Signature of Preceptor Signature of Associate Preceptor Date June 2010. AIMS 1. Our aim is to integrate the theory you have obtained in the School of Nursing and Midwifery by providing instruction within an Orthopaedic environment. 2. You will have your educational experience planned with your Preceptor / Associate Preceptor. 3. You will meet with your Preceptor / Associate Preceptor for a planned mid placement evaluation. 4. You should identify what your educational needs are and we will endeavour to provide the learning opportunity for you. June 2010. PRECEPTOR/ASSOCIATE PRECEPTOR During your placement on the ward you will be allocated a Preceptor and Associate Preceptor. You and your Preceptor/associate Preceptor should discuss the objectives you require to achieve whilst allocated to the ward. The roles of your Preceptor/Associate Preceptor are to act as an educator, assessor, counsellor and confidante to you. Their responsibilities in partnership with you are, 1. To assist you in achieving identified learning outcomes. 2. To provide on going feedback to you on your progress. 3. To assess your performance. 4. To facilitate you in acquiring knowledge and skills in order to Deliver optimal patient care. 5. To demonstrate integration of theory and practice. 6. To maximise learning opportunities which will assist you to Develop competencies. 7. To provide individual support and guidance to you. 8. To create a supportive learning climate by maintaining Effective interpersonal relationships. June 2010. ORTHOPAEDIC VOCABULARY [Look these up in any good Orthopaedic book or medical dictionary] ABDUCTION CREPITUS SCOLIOSIS ADDUCTION IMPLANTS SEQUESTRUM AMPUTATION CALLUS SPASTICITY ARTHRODESIS INTERTROCHANTERIC SPONDYLOSIS ARTHROPLASTY INTRAMEDULLARY SPONDYLITIS ACHONDROPLASIA INTRATHECAL STABILITY ANKYLOSIS ISCHAEMIA STRESS # APPROXIMATE IDIOPATHIC SUBLUXATION ARTHRITIS INVERSION SUPINATION ARTHROTOMY KYPHOSIS TRAUMA ATAXIA MYELITIS TOMOGRAM SPASTICPARALYSIS0TALIPES MEDIAN LINE UNILATERAL APPARENT SHORTENING METAPHYSIS OSTEOTOMY ARTHROGRAM MOBILISATION OSTEOMYELITIS BURSA MEDIAL ROTATION OSTEOPOROSIS COXA SHORTENING NEUROMA CAVUS SCLEROSIS NECROSIS June 2010. SURGICAL PROCEDURES AND FIXATION OF JOINTS Abduction To pull a way from the median line of the body. Acetabulum Cup like socket which head of femur sits in. Active Flexion Bending a joint by oneself, e.g. knee. Apparent Shortening Abnormal position of limb (adduction) makes limb appear short. Arthritis Inflammation of joint. Arthrogram X-ray of joint space using radio-opaque dye. Arthrodesis Fusion of a joint by surgery. Arthroplast Formation of a new joint by surgery. Artificial. Arthroscopy Examination of joints via fibre optic scope. Avulsion Forcible separation of two joints. Back Slab Half bandage half plaster of Paris. Bennett’s Fracture Fracture of proximal end of thumb, metacarpal. Camp Splint Removable splint used to give leg support to prevent bending of the knee. Charnley Wedge Triangular shaped piece of foam used for total hip replacement to keep legs abducted. Placed between the knees to prevent dislocation. Colles’ Fracture Fracture to lower radius. Callus Formation of new bone. Dislocation Dislocation of Articular surface of a joint. Movement of part of joint out of usual position. E.g. Head of Femur from Acetabulum. External Rotation Limb is turned outwards. (Can be a sign of dislocation). Fasciotomy To relieve tension or pressure of the fascia. Treatment for Compartment Syndrome. Gait Manner of posture and walking. Haemarthrosis Bleeding into a joint. Internal Rotation Limb is turned inwards. (Can be a sign of dislocation). Log Roll Nurses required to roll patient in a straight line, mainly used when patient has had a total hip replacement to prevent dislocation with legs in abduction. Or when spinal injury suspected or confirmed. Neuroma Benign tumour involving a nerve. Osteochondritis Inflammation of bone and cartilage. Osteoporosis Form of brittle bones. Osteomalacia Soft bones. Osteotomy Division of bones by surgery. Passive Flexion Someone/something bending a joint e.g. knee Pendular Exercises To move limb in a pendular motion, like a pendulum in a clock Poly Sling Foam sling commonly used for people following shoulder injuries. Potts Fracture Fracture of lower ends tibia and fibula. Prosthesis Artificial part used as replacement i.e. hip joints. Pseudo - Arthrosis False joint e.g. girdlestone. Straight Leg Raise To be able to lift leg off a bed without assistance. COMMONLY USED ABBREVIATIONS DHS Dynamic Hip Screw EOSD Early Orthopaedic Supported Discharge CPT Collarless, Polished and Tapered SLR Straight Leg Raise ABP Angle Blade Plate ACL Anterior Cruciate Ligament CSM Circulation, Sensation and Movement BAS Broad arm sling CPM Continuous Passive Movement RA Rheumatoid Arthritis FWB Full Weight Bearing OA Osteo Arthritis PWB Partial Weight Bearing # Fracture TWB Touch Weight Bearing L or R Left or right IM Nail Intra – Medullary Nail K – Wire Kirschner Wire TBW Tension Band Wiring DCS Plate Dynamic Cannula Screw T.A. Tendon Achilles NOF Neck of Femur ORIF Open Reduction Internal Fixation POP Plaster of Paris M.U.A. Manipulation Under Anaesthetic E.U.A. Examination Under Anaesthetic R.O.S Removal of Stitches SLR Straight Leg Raise OTHER TERMS USED IN WARD REPORTING PMH Past Medical History CVA Cerebral Vascular Accident COAD Chronic Obstructive Airways Disease IDENTIFIED LEARNING OPPORTUNITIES The following list is of possible learning opportunities for you during your placement. The list is not prescriptive and you do not have to participate in all the activities identified, the list is not all encompassing. There may be other opportunities for learning available that are not identified in this list. 1. Admission procedure of the patient. Discuss and familiarise with Integrated Care Pathways (ICP). 2. Discharge of patients. 3. Attend and participate in ward patient report sessions. 4. Observe the role of the Physiotherapist in the care of the Orthopaedic patient. 5. Observe the role of the Occupational Therapist in the care of the Orthopaedic patient. 6. Preparation of patient for theatre. 7. Post-operative care of patient following surgery: * Orthopaedic Surgery Poly - Trauma # Neck of Femur Dynamic Hip Screw Hemiarthroplasty * Intermediate Surgery Anterior Cruciate Ligament Reconstruction Removal of Metal Work O.R.I.F Ankle/Wrist # * Minor Orthopaedic Surgery Release of Dupytrens Arthroscopy of knee Carpal Tunnel Decompression 1 1 June 2010. OBSERVE AND PARTICIPATE IN PATIENT CARE WHERE APPROPRIATE 1. Maintain a safe environment for the patient. 2. Assist where appropriate with patient hygiene: * Bathing/ bed bath / assisted wash * Oral hygiene-care of dentures * Eye care * Hair care, nails etc. 3. Monitoring temperature, pulse respiration and blood pressure:* With manual and electronic monitoring equipment 4. Maintaining patients comfort:* Bedmaking * Pain Control * Positioning pillows etc. 5. Assisting where appropriate with elimination needs: * Toileting * Catheterisation * Administration of prescribed aperients 6. Control of Infection: * Cross Infection * Wound care * Aseptic technique * Specimen collection 7. Monitoring fluid intake and output: * Administering and recording oral fluids * Care of patient undergoing an intravenous infusion /transfusion * Care of patient with urinary catheter * Care of patient with wound drain 1 2 June 2010. 8. Monitoring patient’s nutritional status. 9. Mobilising patients * Non-weight bearing * Weight bearing * Bedfast patients * Using aids i.e. Zimmer frame, crutches etc. 10. Ensuring adequate rest and sleep. 11. Care of patient undergoing oxygen therapy: * Via venti-mask * Nasal prong 12. Supervised administration of medications * Oral medicines * Inhaled medicines * Subcutaneous injections * Intra-muscular injections June 2010. 1 3 EMERGENCY PROCEDURES For Fire or Cardiac Arrest Phone EMERGENCY NUMBER 2222, state ward number and if Cardiac Arrest or Fire. E.g. “Cardiac Arrest Ward 19” or “Fire (area) Ward 19”. Page System i.e. to 1. Dial 88 and wait for response. 2. Dial required page number, wait for response. 3. D ial your extension number followed by # sign, wait for response 4. Replace receiver and wait for reply. To call page holder 3010 from phone extension 33819, Dial 88, then 3010, then 33819#, hang up and wait for 3010 to call back 33819. It is vital you are aware of the location of the following Date Student sig. Preceptor sig. Sign Cardiac Arrest Trolley Portable Oxygen/Suction Emergency Box Emergency Buzzers Defibrillator Fire Points Fire Extinguishers Nurse Call System All of the above must be shown to the student on the first day in the ward June 2010. 1 4 EVALUATION QUESTIONNAIRE We are interested in obtaining your views on Ward 17 as a learning environment. Please complete the following questionnaire before you leave the placement by placing a (X) in the column that most accurately reflects your views. Columns vary from 5 = Strongly Agree to 1 = Strongly Disagree STATEMENTS 1. 5 You received an introduction/orientation Package on arrival to the ward, was this of benefit? 2. You were allocated an Associate Preceptor During this placement. 3. Your Preceptor and you discussed and identified learning objectives and opportunities at initial meeting. 4. You were given the opportunity identify your own specific personal learning objectives. 5. You worked with your Preceptor/ Associate more than two shifts per week during placement. 6. You had a planned midway placement Evaluation with your Preceptor. 6. You achieved your set objectives by the end of this placement. 8. You found this ward placement an environment conducive to learning. June 2010. 1 5 4 3 2 1 Ward 19 Ninewells Hospital We recognise our patient’s needs to be cared for in an approachable, professional and courteous manner. We believe that privacy for our patients is of paramount importance and give great consideration to all communications regarding values, beliefs and customs. We appreciate the need to maintain a safe environment for our patients, staff and visiting members of the public. We realise research is important for the promotion and transference of safe clinical nursing practice with which we aim to continue. We endeavour to remain adaptable to change and to enjoy new challenges We understand and appreciate that education and development of our clinical practice is essential in remaining progressive. We endeavour to maintain a harmonious relationship with our professionals within the multi-disciplinary team. Our aim is to continually improve the quality of care delivered and provide a service of excellence for the patients of Tayside June 2010. 1 6 1 7 And finally….Enjoy your placement! June 2010. 1 8