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Review date:

March 2014

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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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Anatomy and

physiology of

ENT

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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