 Hi everyone! So it is the weekend and as you know from the last video I was practicing my bandage skills. I have some little beans in the background mix and dillan and my willing victim Dully. So I can show you how to bandage how the nurse taught me even. Okay so she taught me to go this way with your bandage the opposite way to the way you put your toilet roll. That's the right way isn't it? Oh the toilet debate. Okay so she taught me to go here to the out of outer part of the toes and then just secure it tightly and then you go round again one more time in the middle of the foot and then you have to lift the foot and then you go round the ankle but just on the just oh god can you see that? Hang on. Just like that so it's not quite covering the heel it's just lining the heel and then you go up and over but this time you're gonna go over the heel so it covers the heel and then you're gonna go up the leg put your leg down. Thanks. And we're doing 50% because the bandage has to line this bit with 50% of this bit like that. If that makes sense. So you've got 50% bandaging. Is that okay patient? That's lovely thank you. There you go. 50% and then that's one layer. Gonna go over with a bandage, crepe bandage, exactly the same. So line it up with the toes and then you're gonna go over, sorry. And then just on the edge of the heel then once more over the heel to cover and then just go 50% put your leg down now. Thanks. You can come again. Then you put your tape on. So today is Monday it is a week two of my management placement which is our sign-off placement as a student nurse to say I'm safe to see patients as a newly qualified nurse. So it started off amazing again. I've had a really interesting morning I've been up at the hospital with my mentor. We had an MDT meeting to go to about a patient that's going to be sort of discharged back into the community and it was just interesting to see all of the different people and their different inputs. So we had the social worker, we had like a case manager ward nurse. I'm not 100% sure on her role. And we had someone from the mental health team as well. And then we had us as district nurses to represent the patient as a district nurse. So really interesting really really complex case by the sounds of it. I can't really go into too much detail because of confidentiality and all of that jazz as always. But it's a really interesting case. It was really good to sit into that meeting and just see how everyone worked together and everyone was actually acting as an advocate for the patient and voicing their concerns which was amazing to see that everyone the main focus was the patient and their best interest at all times was maintained. So it was really good to see that but seeing it from different angles and different perspectives of people. So that was really good. Then we had a couple of the patients that we went and did. So we had a leg dressing to do two legs on the same patient. So he had both of his legs dressed and we had an insulin patient to go to. And we had another patient with dementia who we needed to get blood from and do a temperature because she's got a few things going on. So it was really interesting to go to her and she was so lovely and she let us do everything because from what I've heard she's refused and declined care previously. She's been declining her temperature and things like that. So it was really nice that she let us do that today and she trusted us to do that. So that was really really nice and lovely to see. And apart from that I've done documentation. I've been writing down as well terminology in my book because there's some terms that I didn't quite understand and I need to print out pictures so I can visualise it as well as understand the words because it's to do with wounds and presentation of the skin and the surrounding skin. And there's all these different words that I didn't fully understand but I'm going to learn them by the end of this placement. I'm going to have these down to a T hopefully because it's really important for documentation. Really important for a sort of a set and a wound as well and deciding what to do with these wounds. So it's really important that I understand it. So I've wrote them down. I've started to make a list. I've started explaining what they are but I just want to print out and just to add to my own little placement pack that I've got just the presentations and all of that and I want some images to go with it as well. So hopefully I'm going to get on that. This is actually the first placement that I've had where I've given myself homework to do. I've never done this before. I'll write down things in my book as a go and I'll ask questions and nurses will ask questions of me and I'll find out the information if I don't know but I've never actually been so interested in something where I'm writing down the terminology. I want to print pictures. I want to understand it so I'm giving myself extra homework when I get home. So I've never had that before and I just love it. I love it so much and you know I love it because I want to do these things when I get home and I want to tell you all about it. So yeah. So it's been an interesting day. It's been amazing and yeah I'm going to stop talking now because this is already like five minutes long so I should see you all tomorrow. So today's Tuesday. I've just got back from my placement and again another completely mixed day. So today we have been in clinic and so this is for patients that can leave the house and they can come into clinic and they just need that extra care in whatever way. So today we had a mixture of patients. We had some leg ulcers. We had pressure sores. We had a catheter washouts or bladder washout. Apparently they've changed the name now but I can't quite remember what she said but apparently bladder washout is not the term to use anymore but that's pretty much what it was. You sort of remove the catheter. You get a hundred mils of saline. Push the saline in. Sometimes they use the 50 mil bag. Push the saline through the catheter up into the bladder and then it comes back out again to sort of wash it out and just make clear it if there's any obstructions. This also assesses if there's any blood. If it's dark, it's cloudy, anything like that but luckily we were good today. It was clear. It was clean. It was lovely so we didn't have to do anything further with him. We also had a Doppler assessment. So a Doppler assessment is... So there's two ways of doing a Doppler assessment. There's a manual one and there is an electronic version. So the manual one is where you put the gel. There's like a jelly that they put on first and then there's like an ultrasound so they listen to the sort of the blood flow in the legs but the electronic one is like a blood pressure cuff so they put a blood pressure cuff around the arm and then one around each foot. This just gauges the arterial pressure in each foot so if they have a good flow of blood they can compress the leg then for compression therapy. If they don't have a good flow and it's really restricted they're not going to want to compress that even more so they can't do compression therapy. So this is what a Doppler assessment is used for in this case with lymphedema. Any sort of edema in the legs. They use the Doppler as well on wounds that are taken longer than I think it was six weeks. So really sort of long-term wounds that are taken a long time to heal. They do the Doppler assessment because they think maybe compression therapy might benefit and it might just help repair the wound a lot faster. So we did that today we had another patient with extremely high blood pressure so we had to refer them back to the GP to get this monitored because it was really quite high it was quite concerning. They also had a wound as well that we had to redress. So yeah so we had quite a lot going on and mixture of things today. We also had to sort out patient care notes because there was some notes that were sort of missing things. There was notes that were all over the place and we're just making sure they're all up to date as well. So we did that sort of towards the end of the day and yeah that's it really and I'm going to end it here and I shall see you all tomorrow. Tomorrow I'm with the band 7 nurse to sort of see what she does and how she manages things and then I've got a palliative training session 2 till 4 I think at one of the hospices so that's gonna be really interesting so it should be a good day tomorrow as well. So yeah that's it from me I shall see you tomorrow. So today it is what day is it oh my god I've lost track of my days it's Wednesday thank you it's Wednesday had to remind myself Wednesday so today I've had a really busy day it's been manic I've been out with the band 7 nurse it's been really amazing we've had complex patients so we've had the really complex wounds we had a home visit with a patient where we had to go in with the tissue viability nurses so that was really interesting to see we had a new patient assessment which was really interesting again so we did all of our observations and everything pressure area checks and everything and yeah it'll be nice to follow up on that one I've discovered that I really really like new patient assessments because I like to know the patient from the beginning to end it's been really hard for me to go into a patient that I don't really know and you're sort of trying to look through the notes and find what's wrong with the patient what's been going on with the patient what you're doing for the patient and when documentation isn't quite a hundred percent clear it can be a little bit so it's just really important that I've discovered that documentation again I've said this before in previous vlogs documentation is key when you're going to see a patient document every single that last detail so that if a new nurse is picking it up they know exactly what they're doing with that patient so I've been trying to write my notes really thorough for the thorough this can't even speak thorough so that another nurse whoever's going to come in can pick it up and go this is what they did with that patient so it's really interesting the second half of my end afternoon I went to palliative care training over at the John Taylor hospice and this was actually amazing because even though I've had patients die on me I've had end of life I don't fully understand palliative care I've never dealt with palliative care I don't know what hospice hospices do I assume the hospices were mainly for the end of life stages but actually they do a whole lot more than I actually ever imagined they do so much so I've actually just arranged to go out with palliative care nurse for the day in October and hopefully learn absolutely everything about palliative care because that's something that's actually really interested me now it's really interesting training session and that will just be fantastic so when I go out for the day with her I will do a whole vlog on palliative care I think and just obviously the basics because well not basics because palliative cares so specialised but just I'm gonna just teach you whatever I learned on the day basically so yeah so that's been my day it is five o'clock now I finished a little bit earlier today so I'm going to have my dinner I don't know what I'm gonna have I'm gonna shower I'm gonna settle down for the night I'm gonna chill it's gonna be amazing because I finished early and I shall see you all tomorrow again I probably won't vlog Friday I'll just leave it as Thursday because this vlog's just gonna be way too long it's gonna be long-winded I don't want to repeat myself I just want to give you all the new information that I do rather than repeat myself so yeah I shall see you all tomorrow guys it is now Thursday I've had another amazing day it's been so so busy I finished about half past five and then my mentor dropped me home so lovely over so I didn't have to get changed to walk home out on my uniform and she dropped me literally on the street and yeah it was just so lovely over very grateful for that today we had a mixture of patients again we've had wounds we've had pressure area checks we've had skin checks we've had skin reactions to look at we've had male catheter to insert we had a diabetic patient we've had a whole range of patients today we've seen quite a lot of patients I can't even remember where we started and where we finished it's been really busy and then we had to update all of the notes and everything for the patients we usually have handover about half past one so we have our handover and the whole team come back to the office speak about the patients any problems any concerns all of that update everybody and then we go out back out and see patients afterwards so we did that I looked up some medication because there was a medication that we weren't too familiar with we'd never seen before we never heard before it was very strange so I looked that up and that was quite interesting to look that up it was called by DeRio something like that I'm gonna put the name there I'm not very good at saying names yeah you know I'm not very good at this so I'm gonna put the name there tell me how it said so I had to look up that and it was for type 2 diabetes it's this particular ones only given weekly it's not an insulin is a different type of diabetic medication it's an in-cretin memetic so it mimics the in-cretin or in creating however you want to say it I don't know how to say these words again it's the most frustrating part for me it's not been able to speak and sometimes I'll say a word about medication or something they'll just be like that's not how you say it you say it like this oh okay that makes more sense yeah sorry guys not the best at medication pronunciations they're all in Latin apparently so I'm really sorry about that but yeah I've got my book here I'm looking at it now oh god look at my scribblings look at that writing that's terrible that is not how a documenting care knows for promise it is much neater than that I swear so this one is an agonist it binds to the GP GLP1 receptor so then once it's done that it increases the insulin secretion but then it suppresses the glucagon secretions and then it slows down the gastric emptying as well so it does quite a few things it's more of a slow release long-term acting sort of injection rather than fast acting which is quite good I think for this lady this one is only to be used for type 2 diabetics not for type 1 and it's only as a last resort if other medications aren't working and the patients got uncontrollable diabetes with the blood glucose levels and all of that if they can't control it with using other medications like metformin such things it can also be used in conjunction with other medications like metformin and things it was really interesting to read upon that and have a look at that and everything that it does and looking at the nice guidelines around it because I'd never seen it before I'd never heard about it before the injection size it's like a rocket I was there like I've never seen this before and yeah so me and my mentor both a little bit stumbled by that and we had to look at the instructions on how to mix it up and give it because it was one that you had to mix up as well inside the barrel it was very strange I'd never seen it before but it was really really interesting for me to see that so yes that has been my day it's been really really interesting it's been another amazing week I'm back in tomorrow and then I'm off for the weekend and I'm back Monday as I said I'm not gonna vlog tomorrow I don't want to repeat myself so I'm gonna leave the video here and yeah I shall see you all next week for another amazing week of learning and yeah I hope you have a great day hope you have a great Sunday hope you have great week whatever you're doing whatever you're up to and see you next week