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Student Learning Opportunities Radiology 1 Student Nurses - Welcome to the Radiology Department We are an extremely busy unit providing an imaging service to Sunderland City and the surrounding districts. Our service covers a wide range of diagnostic and interventional procedures to a vast population suffering from various injuries, illnesses and diseases. The department of Radiology can offer the student nurse a wide range of experience, knowledge and skills, which can enlighten them towards procedures which patients regularly undergo as both in-patients and out-patients. There is many opportunities to develop knowledge and understanding of anatomy and physiology, as well as developing a greater understanding of disease and disease process. You will be assigned to a mentor for your time spent in the department. Your learning outcomes and competencies will provide direction during your placement and be facilitated where possible by your mentor. Please remember that you are responsible for your own learning and your mentor/associate mentor is only there to advice and facilitate your learning (Student/mentor file section 2 Roles & Responsiblities of the Learner). If you have any queries please feel free to ask your mentor or any other staff member. The sister is also available to assist you with any difficulties you may experience. The modalities within the department are: Computer Tomography (CT) Fluoroscopy Ultra Sound Plain film radiography Magnetic Renaissance Imaging (MRI) 2 The Directorate The Directorate of Radiology comes under the Division of Clinical Support This includes clinical directorates: Anaesthetics Pathology Radiology Pharmacy Paramedics Directorate of Radiology Clinical Director Mr G McNab Directorate Manager / Imaging Service Manager Mr P Stephenson Nursing Staff Matron Anita Hagon Joy Champion Barbara O’Shaughnessy mentor) Shirley Butler Catherine Launder Julie Brown Margaret Lash Jean Rogers Consultants Dr England Dr Marsh Dr Shirbhate Dr Featherstone Dr Schierle Dr Karasek Dr Bunea Dr White Dr Florek Dr Powaska Dr Connor - Sister (mentor, Educational link) - Staff Nurse (stores & supplies co-ordinator, associate - Staff Nurse (mentor, infection control link) - Enrolled Nurse - Staff Nurse (mentor) - Staff Nurse Deputy infection control link,) - Auxiliary Nurse Fluoroscopy Vascular/ CT Fluroscopy non vascular/CT Bariums/CT MRI/CT CT/Ultrasound/Bariums Fluroscopy Vascular/CT CT/Ultrasound/Bariums CT/Paediatrics/urology Ultrasound/ CT Ultrasound /CT Ultrasound/ CT 3 Departmental Philosophy The radiology department aims to provide an efficient and effective diagnostic imaging and interventional service. We accept referrals from Sunderland City and the surrounding districts. Our immediate multidisciplinary team consists of: Clerical staff, Domestic technicians, Nurses Porters, Radiographers, Radiographic assistants, Radiologists Furthermore, we strive to work in active partnership with our other colleagues throughout the trust. ‘We Believe’ The Environment: Whilst your stay in the department may be short, the atmosphere will be friendly. We aim to be welcoming and approachable to all visitors. The department will be clean, comfortable, safe and tidy, catering for your needs. For our Patients: Individual choices coupled with privacy, dignity and confidentiality. An identified practitioner will be responsible for your care during your visit and an explanation of each procedure undertaken will be offered to ensure you are well informed. Relatives and Friends: When a patient chooses to invite a friend or relative to participate in their care, we will aim to accommodate, support and inform them where appropriate. How we provide care: Standards are constantly monitored to meet the changing needs and expectation of our clients. Education is recognised by all staff as being essential for continuous professional development and to keep abreast with research based practice. We respect that all members of our team play a part in the delivery of care and the maintenance of standards. As a team we strive to supports each other to reach our goals. In order to improve our standards of care and our service to you we welcome your constructive comments. Please use the comment boxes located around the department or speak to a member of staff. 4 GENERAL INFORMATION Off Duty The department operates Monday to Friday students are expected to work from 8.30am until 5pm, with exception of one 2pm early finish. Uniforms Uniforms should only be worn within the hospital therefore; changing facilities will be arranged. Patient Allocation Primary nursing is in operation within the Radiology department. The primary nurse will be responsible for the patient’s total welfare during the stay in the unit. Daily Routine Start 8.30 08.30 – 9.00 09.00 13.00 – 13.30 13.30 – 14.00 14.00 Set up rooms Commence lists Lunch Set up rooms Commence lists Finish 17.00 5 COMMUNICATION SKILLS LEARNING OPPORTUNITIES SUGGESTIONS OF RESOURCE PERSONNEL& INFORMATION SOURCES. Communicating with: Patients and relatives Members of the multi disciplinary team The whole departmental team VERBAL COMMUNICATION: Telephone skills The Emergency System (Fire & Cardiac Arrest) The Bleep System Giving and receiving information Observing confidentiality Answering patient enquires Patient Transportation Liaising with the clinical team Nurse hand over Nursing staff, radiographers Nursing staff, radiographers, doctors Nursing staff, all department staff, patients and relatives. All departmental staff, CHS polices Nursing staff, radiographers, doctors, secretarial staff, patients Ambulance liaison, portering service Observation of roles Registered nurses WRITTEN DOCUMENTATION & COMPUTER SKILLS: Care plans Hiss system Patient information Investigation results Daily lists etc. CHS protocol and policies, Nursing staff, radiographers, doctors, secretaries, administration staff. 1 PRACTICAL NURSING SKILLS LEARNING OPPORTUNITIES Practical nursing skills: Recording physiological observations e.g. Pulse, Blood pressure, Oxygen Saturations, Blood Glucose Giving medication i.e. Oral/Intravenous/Controlled Drugs Skin care/pressure area care IV infusions/Medical devices Checking equipment/Emergency Crash Trolleys Risk assessment/Patient safety Moving and Handling/use of aids and hoists SUGGESTIONS OF RESOURCE PERSONNEL& INFORMATION SOURCE S. Books, articles, courses, library resources and various literature, Registered Nurses. Books, articles, courses, library resources and various literature Registered Nurses, Drug Administration Protocols, Radiographers, Trust Protocols, moving and handling facilitator, Doctors Aseptic technique Setting Trolleys/Preparing for Investigations Assisting Radiologists with investigation/treatment process eg. Angiographic catheter and wire manipulation Cannulation/care of intravenous cannulas Infection Control issues: Hand washing technique as part of investigation process giving barium/water soluble contrast:- orally intravenously arterially rectally Infection control link nurse. Registered Nurses. Infection Control File, Infection Control Link Nurse. Poster Campaigns. 2 ANATOMY, PHYSIOLOGY AND PATHOLOGY LEARNING OPPORTUNITIES SUGGESTIONS OF RESOURCE PERSONNEL& INFORMATION SOURCES. PROCEDURES/INVESTIGATIONS: CT Scan MRI Angiography (vascular/coronary) Angiography for the Biliary and Renal Systems Angioplasty /Stent insertion/Thrombolysis Balloon dilatation and stenting of oesophageal strictures Percutaneous Transhepatic Cholangiogram (PTC) Ultrasound examinations Fine needle aspiration (FNA) Biopsies Drainages Intravenous Urograms (IVU) Micturating Cystograms Barium Examinations (swallows/meals/enemas/follow-through) Books, articles, courses, library resources and various literature Radiologists, Radiographers, Registered Nurses, Ultrasound Stenographers, Doctors, Radiology Procedure File INFECTION: Books, articles, courses, library resources and various literature Observation of Infection Control Policies i.e. when acting as scrub Registered Nurses, Doctors, Infection Control Nurse Infection Control Nurse, nurse. Causes, spread & prevention 3 ANATOMY, PHYSIOLOGY AND PATHOLOGY LEARNING OPPORTUNITIES NORMAL ANATOMY AND PHYSIOLOGY SUGGESTIONS OF RESOURCE PERSONNEL& INFORMATION SOURCE S. Books, Library Resources, Posters/visual aids, x-rays ABNORMAL ANATOMY. PHYSIOLOGY AND PATHOLOGY (Examples you may encounter on the department) DISORDERS OF THE CARDIOVASCULAR SYSTEM Coronary Heart Disease Congestive Heart Failure Cardiac Valve Disease Hypertension Atherosclerosis/Peripheral Vascular Disease Aortic Aneurysm DISORDERS OF THE NERVOUS SYSTEM Traumatic Brain Injury Stroke Subarachnoid Haemorrhage Brain Tumour Spinal Injury Books, articles, courses, library resources and various literature Radiologists. Cardiologists. Registered Nurses. Specialist Vascular Nurse. CCU. Literature. Investigations/Diagnostic Procedures e.g. CT, Angiography, Ultrasound/Doppler, Electrocardiography (ECG)' Books, articles, courses, library resources and various literature Doctors. Registered Nurses. Radiographers. Specialist Nurses, Literature, Rehabilitation Nurses, Investigations/Diagnostic Procedures E.g. CT. MRI. X-RAY 4 ANATOMY, PHYSIOLOGY & PATHOLOGY LEARNING OPPORTUNITIES SUGGESTIONS OF RESOURCE PERSONNEL& INFORMATION SOURCES. DISORDERS OF THE RESPIRATORY SYSTEM: Books, articles, courses, library resources and various literature Chronic Bronchitis/Emphysema Asthma Cystic Fibrosis Lung Cancer Chest Trauma Pulmonary Embolism Pneumothorax Chest Drainage Doctors, Registered Nurses, Specialist Respiratory Nurse, Chest Clinic, Respiratory Ward, laboratory, Macmillan Nurse, Investigations/Diagnostic Procedures e.g. CT, X-Ray , Ultrasound, CT /Ultrasound guided Biopsies, Drainage DISORDERS OF THE RENAL AND URINARY SYSTEM Acute/Chronic Renal Failure Polycystic Kidney Disease Renal Cancers Urinary Tract Infections Bladder Cancers Acute/Chronic Pyelonephritis Books, articles, courses, library resources and various literature Doctors, Registered Nurses, Renal Ward, Renal Dialysis Unit, Literature, Laboratory , Investigations/Diagnostic Procedures e.g. CT, X-RA y , Angiography, Stenting, Ultrasound, Ultrasound guided biopsies/ drainages 5 ANATOMY, PHYSIOLOGY & PATHOLOGY LEARNING OPPORTUNITIES SUGGESTIONS OF RESOURCE PERSONNEL& INFORMATION SOURCES. DISORDERS OF THE GASTROINTESTINAL SYSTEM: Nausea and Vomiting Dysphasia Diarrhoea/Constipation Gastrointestinal Bleeding Bowel Obstruction/Colorectal Cancer Diverticular Disease Crohn's Disease/Ulcerative Colitis Eating Disorders/Obesity Gastric Cancer Oesophageal Cancer Books, articles, courses, library resources and various literature Doctors, Registered Nurses, Specialist Colorectal Nurse, Library Resources, Surgical Team, Speech Therapist, Dietician, Investigations/ Diagnostic Procedures e.g. CT, Barium investigations, Endoscopic Procedures, X-Ray, Angiography, Stenting DISORDERS OF THE ENDOCRINE SYSTEM : Hypo thyroidism/ Hyperthyroidism Goitres Thyroid Cancer Diabetes Mellitus Pancreatitis Pancreatic Cancer Books, articles, courses, library resources and various literature Doctors, Registered Nurses, Diabetic Specialist Nurse, Laboratory, Specialist GI Nurse, Literature, Investigations/Diagnostic Procedures E.g. Ultrasound, Ultrasound guided Biopsy/FNA, Angiography, ERCP, Blood Tests 6 ANATOMY, PHYSIOLOGY & PATHOLOGY LEARNING OPPORTUNITIES SUGGESTIONS OF RESOURCE PERSONNEL& INFORMATION SOURCES. DISORDERS OF THE LIVER AND BILIARY SYSTEM: Alcoholic Liver Disease Cirrhosis Hepatic Failure Tumors/Metastatic Liver Cancer Jaundice Clotting Disorders Books, articles, courses, library resources and various literature Doctors, Registered Nurses, Specialist Nurses, Laboratory, Literature, Investigations/Diagnostic Procedures e.g. CT, Angiography, Stenting, Ultrasound, Ultrasound Guided Biopsies, Blood Tests i.e. Clotting Studies DISORDERS OF THE REPRODUCTIVE SYSTEM: Testicular/Prostate Cancer Ovarian Cysts/Ovarian Cancer Cervical Cancer Breast Cancer Books, articles, courses, library resources and various literature Doctors, Registered Nurses, Oncology Team. Breast Care Nurse. Screening Clinics, Literature. Library Resources. Investigations! Diagnostic Procedures e.g. CT, MRI. Ultrasound. Ultrasound Guided Biopsy Fine Needle Aspiration (FNA) DISORDERS OF THE SKELETAL SYSTEM : Osteoarthritis/Osteoporosis Trauma/fractures Metastatic Bone Disease Books, articles, courses, library resources and various literature Doctors. Nurses, Radiographers, Accident and Emergency Dept., Literature. Investigations/Diagnostic Procedures e.g. CT. MRI, XRay 7 HEALTH EDUCATION AND PROMOTION LEARNING OPPORTUNITIES SUGGESTIONS OF RESOURCE PERSONNEL& INFORMATION SOURCES. LIFESTYLE ISSUES IN RELATION TO COMMONLY PRESENTED CONDITIONS: Smoking Obesity Alcoholic Liver Disease Diabetes Heart Disease Peripheral Vascular Disease Accidental Injury Gastrointestinal Disorders Books, articles, courses, library resources and various literature Registered Nurses, Mentor, Library Resources, Department of Health Document, Government Target Initiatives. Health Action Zones. Trust Strategies and Documents INFLUENCED BY: Government Target Initiatives The role of the X-Ray Department e.g. Fast-Track Services The Nurses Role in Health Education/Promotion Giving Appropriate Advice Leaflets/Poster Displays Books, articles, courses, library resources and various literature Mentor. Registered Nurses. Trust Strategies and Documents Health Promotion and Health Education Literature, Specialist Nurses 8 THE PATIENT JOURNEY AND THE NURSING PROCESS LEARNING OPPORTUNITIES Many of the procedures and investigations within radiology involve nursing care. On the patient ‘s journey through Radiology nurse contact may be brief but this should never interfere with the standard of care given. SUGGESTIONS OF RESOURCE PERSONNEL& INFORMATION SOURCES. Policies and procedure files. Sister, Mentor, Registered Nurses Sister, Mentor, At all times the following things should be unheld: Philosophy of care Nursing models Nursing policies Standards Protocols Documentation Books, articles, courses, library resources and various literature Policies and procedure files. Registered Nurses, Specialised Nurses, Sister, Mentor. Managing Patient Care: Prioritising The nursing process – assessment, planning implementation & evaluation. Nurse handovers/discharge home. Books, articles, courses, library resources and various literature Policies and procedure files. Sister, Mentor. Registered Nurses. 9 MANAGERIAL AND ORGANISATIONAL SKILLS LEARNING OPPORTUNITIES SUGGESTIONS OF RESOURCE PERSONNEL& INFORMATION SOURCES. ORGANISATIONAL SKILLS RESOURCE PERSONNEL~INFORMATION SOURCE Prioritising Time Management Organising Procedure Lists Organising Patient Transportation/Portering Services Team Preparation Organising Appropriate Skill Mix Patient Preparation for Procedures e.g. Clotting Studies Leadership Skills Books, articles, courses, library resources and various literature. Registered Nurses, Sister, Mentor, Radiographers, Doctors, etc QUALITY ISSUES Policies Clinical Governance Standards of Practice Clinical Audit Changing Practice Handling Complaints Research Books, articles, courses, library resources and various literature. Registered Nurses, Policy File, Performance and Governance Dept, Library Resources, Mentor, Sister 10 MANAGERIAL AND ORGANISATIONAL SKILLS LEARNING OPPORTUNITIES RESOURCE MANAGEMENT Stock Control Ordering Pharmacy Budget Management RISK MANAGEMENT Standards, Policies and Procedures Infection Control Clinical Supervision Moving and Handling Equipment/Environment Safety Check HANDLING EMERGENCY SITUATIONS Fire Cardiac Arrest Security Incidents Accidents/Near Miss Register SUGGESTIONS OF RESOURCE PERSONNEL& INFORMATION SOURCES. Books, articles, courses, library resources and various literature Policy and Procedure Files Sister, Mentor, Registered Nurses Books, articles, courses, library resources and various literature Registered Nurses. Policy Files, Infection Control Link Nurse, Moving and Handling Facilitator, Radiographers, Relevant literature Fire Officer/Safety Department, Mentor, Registered Nurses Security Officer, IM&T Security Officer. Sister, Senior Radiographers 11 FAST –TRACK BREAST ASSESSMENT CLINIC BREAST CARE SPECIALIST NURSE CORONARY CARE UNIT MRI SURGICAL DAY CASE UNIT BARIUM EXAMINATIONS RADIOLOGY DEPARTMENT LEARNING ZONE ADMISSION UNIT CT SCANNERS SPECIALIST VASCULAR NURSE ULTRASOUND INTERVENTIONAL PROCEDURES ANGIOGRAPHIC PROCEDURES RENAL UNIT MEDICAL DAY-CASE UNIT COLORECTAL SPECIALIST NURSE 12 Terminology Abscess Localised collection of pus. Aneurysm A sac formed by local enlargement of a weakened artery wall. Angiography The radiographic study of vessels. Angioma A benign tumour associated with blood vessels. Angioplasty An angiographic procedure where a balloon is passed into a stenosed artery And inflated with contrast medium; it presses the artheroma against the Vessel wall, thereby increasing the lumen. Anterior Forward part of the body or organ. Artefact An area of information on a reconstructed image that does not exist in reality. It may be caused by operator, patient motion or equipment peculiarities. Artheriography The radiographic examination of arteries after the injection of a radiopaque contrast medium. Atherosclerosis Fibrous and fatty deposits on the luminal wall of an artery that may cause an obstruction of the vessel. Benign Non malignant, simple tumour. Bifurcation The place where an artery divides into two branches. Calculus A stone. Carcinogen Any cancer producing substance or material such as nicotine, radiation, ingested uranium. Cerebrovascular Pertaining to the blood vessels of the brain. Crohn’s Disease Chronic non-specific inflammation of any part of the intestine. CT Computed Tomography – computer constructed imaging technique of thin slices through the body, derived from x-ray absorption data collected during a circular scanning motion. Cyst Hollow sac containing fluid or semi-solid material. Distal Refers to parts of the body farthest from the centre, midline or trunk. Diverticulitis Inflammation of the diverticulae of the bowel. Dysphasia Difficulty in swallowing. Despoil Difficulty in breathing. Embolus Thrombus that detaches and moves freely in the bloodstream. 13 Extravasation The escape of fluid from a vessel into the surrounding tissue. Film Badge A piece of photographic film in a lightproof holder worn to measure the amount of radiation to which an individual is exposed. Fistula Abnormal communication between organs. Haematemesis Vomiting of blood. Haematology The science of dealing with the formation, composition, functions and diseases of the blood. Haematoma A local swelling filled with blood. Haematuria Blood in the urine. Haemoptysis The coughing up of blood. Haemorrhage The escape of blood from a vessel. Hydronephrosis Distension of the kidney pelvis with urine caused by urethral obstruction. Hypertension Abnormally high blood pressure. Hypotension Abnormally low blood pressure. Hysterosalpingogram Radiological examination of the uterus and the uterine tubes used to investigate the patency of fallopian tubes. IVU Intravenous urography – radiographic visualisation of the renal pelvis and ureter by injection of a radiopaque liquid into the blood stream. Leaded Apron Protective apron worn to shield the trunk of the wearer from scattered radiation. Laryngoscope Instrument for exposure and visualisation of the larynx. Lateral At or belonging to the side away from the median line. Malignant Life threatening tumour producing secondary effects. Mastectomy Surgical removal of the breast. Medial Pertaining to or near the middle. Metastasis The spread of tumour cells from one part of the body to another. MRI Magnetic Resonance imaging – a technique of imaging by computer using a strong magnetic field and radiofrequency signals to examine thin slices through the body. Nephrostomy Surgical drainage of the kidney. Pancreatitis Inflammation of the pancreas. Percutaneous Effected or introduced through the skin. 14 Pneumothorax The presence of air in the pleural cavity. Proximal Refers to a part closest to the centre, midline or trunk. Radiograph A photographic image formed by exposure to x-rays. (The correct term for a x-ray). Radiographer A person qualified in the techniques of diagnostic or therapeutic radiography. Radiography The use of x – radiation to create images of the body from which medical diagnosis can be made (diagnostic), or to treat a person suffering from a malignant disease, according to a prescribed regime (therapeutic). Radiologist A medical specialist in diagnosis by using x-rays and other allied imaging techniques. Radiopaque Having the property of significantly absorbing x-rays, therefore becoming visible on a radiograph. Barium and iodine compounds are used as a contrast media to produce artificial radiopacity. Stenosis Constriction or narrowing of a passage or orifice. Thrombosis Formation of a clot within a blood vessel. U.S. Ultrasonography – production of a visible image from the use of ultrasound. A controlled beam is directed into the body. The echoes of reflected ultrasound are used to build up an electronic image of various structures in the body. Varices Dilated veins. Venogram The radiographic study of veins after the injection of radiopaque contrast medium. References Ballinger, P.W. (1986) Merrill’s Atlas of Radiographic positions and Radiological Procedures. 6th ed. The C.V. Mosby Company. Brown, G. (1998) A Radiographer’s Handbook. W.B. Saunders Company Ltd. Roper, N. Ed. (1987) Pocket Medical Dictionary. 14th ed. Churchill Livingstone VERSION HISTORY Version Date Issued Brief Summary of Change Owner’s Name Live 2001 First Version Judy Smith Staff Nurse Radiology Live Jan 2004 Revised Version Claire Elwell Staff Nurse Radiology Updated Aug 2005 In line with Ed audit Joy Champion sister Radiology 15