Ocean Ward and Land Ward
Student Induction Pack
and Workbook
September 2013
Student Induction Pack and Workbook – Ocean and Land Wards – September 2013
Dynamic Statement
The information given in this pack is correct at the time of issue. Due to the evolving nature
of the medical unit, information is subject to change. Therefore this pack will be updated
every two years.
The aim of this pack is to introduce you to the paediatric medical unit as well as provide
more theoretical information. We have aimed the workbook sections at all levels so there
are sections that are basic and others that are more challenging – disregard what you
don’t need.
Any comments or suggestions will be gratefully received.
Jan Delamere, Julie Rowe, Cheryl Probert. Claire Briggs
September 2013
Ocean Ward &
Land Ward’s Philosophy
To care for children and their families with
compassion, knowledge and skill.
To provide family centred care in a safe
and happy environment.
To help children and their families to
understand and take part in their care.
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Student Induction Pack and Workbook – Ocean and Land Wards – September 2013
Contents
Welcome Page
1
Your First Week on the Ward
2
Useful Things to know and find out
3
People on the Ward
4
Ward Rules
5
Standards for Personal Appearance
6
Infection Control
7
Medical Conditions
8
Paediatric Normal Values
9
Administration of Medicines on the Ward
10
Commonly Used Drugs
11
Admission and Discharge
14
“Fundamentals of Care” and the Admission Booklet
16
Specialist Nurses
17
Parents and the Ward
18
Abbreviations
19
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Student Induction Pack – Ocean & Land Wards – September 2013
Contents (continued)
Nursing Calculations
20
Section 1 – Unit Conversions
20
Section 2 – Drug Calculations
21
Section 3 – Estimating Weight
23
Section 4 – Fluid Requirements
23
Section 5 – Infusion Rates
25
Section 6 – Fluid Charts
26
Section 7 – Moles
27
Section 8 – Baby Feeding Requirements
27
Test Questions
28
References
30
Appendix A – Fluid & Electrolyte Therapy
31
Appendix B – Reading List
32
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Student Induction Pack – Ocean & Land Wards – September 2013
Welcome to Ocean Ward
& Land Ward
Ocean and Land are medical paediatric wards. The wards work in collaboration with each
other. Nursing Staff are allocated to work on Ocean or Land. However there are occasions
where they will be working odd shifts on the opposite ward. The manager for ocean ward
is Janice Gracie and the manager for Land ward is Susan Dinsdale.
Ocean typically cares for babies and pre-school children with Land typically caring for
older children and adolescents. During bed shortages both wards can take all ages.
Both wards have 20 staffed beds. Ocean consists of 8 cubicles used for barrier nursing, 1
family room and 4 bays named Octopus, Starfish, Dolphin and Turtle, each having 4 bed
spaces.
Land has 9 cubicles for barrier nursing and 3 bays named Zebra, Lion and Giraffe. Again
each has 4 bed spaces.
The medical unit also has two staffed beds for transitional care. This is based in Monkey
Bay on Land. The unit mainly cares for children with complex discharge needs. These may
include children that require neurological rehabilitation or need ventilating for all or part of
the day.
The aim is to enable the children to go home supported by a Community team when they
are stable enough. The beds are also used for sleep studies or provide ventilation support
for children already in the community when they come in for surgical procedures.
Children are admitted to Ocean or Land via A&E (Accident & Emergency), CAU
(Children’s Assessment Unit) or by OPD (Out-Patient Department) referral with a range of
conditions. Children are also admitted for investigations e.g. MRI scans under General
Anaesthetic. Children with chronic problems under the care of particular Consultants may
have Open Access and be brought to the ward out of hours without having to go to their
GP or through A&E.
We hope you enjoy your placement and find it an enriching experience in your professional
development. If you have any problems do not hesitate to talk to any of the nursing staff,
Cheryl Probert (Band 5 ocean ward), Stella Young (Band 6 SSN Land) are the lead
mentors for each ward.
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Student Induction Pack – Ocean & Land Wards – September 2013
Your First Week on the Ward
You will have been expected to telephone the ward before your first day in order to get
your shift pattern.
The telephone numbers are


Ocean
Land
029 2074 3359 / 5330
029 2074 3274 / 3276
The Shift Times are




07:00 – 19:30
19:00 – 07:30
07:00 – 14:30
12:00 – 19:30
-
Day Shift
Night Shift
Early Shift
Late Shift
During your placement you will be allocated a mentor and co-mentor to work alongside
you. You can expect to work with a mentor at least 50% of the time. Please check the offduty regularly to ensure that your mentors are working with you whenever possible.
Nursing staff have to swap shifts occasionally in order to ensure that both wards are
covered. If it is possible for you to swap your shift to accommodate this, it will be
appreciated. Students are expected to work nights & weekends, but this should be with
their mentor and not excessive. Checking the off duty regularly may help you avoid
working weekends and nights without your mentor.
Occasionally you may find that your mentor may be working on the opposite ward for
random shifts (again this is to ensure that both wards are staffed adequately). You have
the choice to stay and work with your mentor or stay on your base ward.
Please have an idea of learning objectives before your first day. These can be discussed
during your preliminary meeting and your mentor can suggest further objectives if required.
Your mentors will acquaint you with the ward layout, fire exits and location of arrest
trolleys. Trust policies and procedures are to be found on the UHW Intranet.
You will have an intermediate meeting (halfway through your placement) where you can
discuss your progress or any problems you have. Further objectives can be discussed if
appropriate. Please note that competencies can be signed at any time during your
placement. It is often easier to get them signed at the time of completion rather than
waiting until the last week of your placement. In your final week you will have a meeting
with your mentors to discuss progress and finalise paperwork.
Staff and nursing students have two breaks during the twelve hour shift the first a ten
minute break and the second being a thirty minute unpaid breaks. These are taken at a
time suitable for the ward and it is expected that you are pro-active and tell the Nurse-InCharge when your workload allows you to take a break.
Please telephone the ward if you are unable to attend as per off duty because of illness or
personal problems. You are also expected to contact the University to inform them of
sickness or absence (Tel. No. 029 20 743636).
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Student Induction Pack – Ocean & Land Wards – September 2013
Useful Things to know and find out….
Notes
Names of your mentors
Location of Fire Exits
The Different Types of Fire Alarms
Fire Procedures
Basic layout of the ward
Location of Arrest Trolley
Awareness of the uniform policy
Location of Trust Policies and
Procedures
Emergency Telephone Numbers
Ext 2222 - Cardiac and Respiratory Arrest
Ext 3333 – Emergency telephone Number
(Security, Fire & Fast Bleeping
How to use Hospital Bleeping
System
Disposal of rubbish and waste
Notes:-
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Student Induction Pack – Ocean & Land Wards – September 2013
Ward Managers/Sisters
Ocean - Janice Gracie
Land – Susan Dinsdale
Band 6 Senior Staff Nurses
Ocean - Sue Melhuish, Marilyn Powell
Land – Anne Young, Stella Young,
Jan Delamere
TCU – Sue Lewis
Band 5 Staff Nurses
Band 2 Health Care Support
Workers (HCSWs)
Ward
Receptionists
Ocean – Alison
Land – Lynda & Sarah
Housekeepers
Catering
Staff &
Porters
Specialist
Nurses
Liaison Health
Visitor
Maggie Jones
Play
Specialists
Ocean – Juliet & Jen
Land – Polly & Clair
Safeguarding
Nurse’s
Nikki Harvey, Bev Evans
Ocean
Ward &
Land Ward
Medical
Nurse
Practitioners
People on the Wards
Consultants
Registrars
Senior House Officers
Speech
Therapists
(See page 17)
Pharmacists
Ocean – Rowena
Land - Angela
Dieticians
Physiotherapists
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Student Induction Pack – Ocean & Land Wards – September 2013
Ward Rules
The wards have rules which are expected to be followed by
staff, parents and patients. Parents have a copy of them in
the Bedside Information Folder. The folder can be
introduced as part of the admission procedure. Please
ensure that the rules are adhered to – diplomatically!
 Hot drinks should be kept out of the main corridor and four bedded bays
especially during the day unless the cups have lids on. Please direct parents to
the parents’ sitting room if they have hot drinks and make them aware of this very
important safety rule at admission.
 Please ensure that all spillages are cleaned up immediately and a
wet floor sign put up.
 Ensure that special care is taken with drinks around electrical
equipment.
 Please ensure that seat belts are used when using prams, pushchairs, highchairs
and wheelchairs.
 Please make sure that children have slippers or shoes on if they are walking
around the ward.
 Please use appropriate bins for nappies and rubbish.
 Parents are told not to bring alcohol and illegal substances on site. If you suspect
that they have or are under the influence, please inform the nurse in charge.
 Bed areas need to be kept uncluttered as possible to allow us to reach the child
easily.
 Check that cot sides are raised when parents leave their children.
 Only one parent may stay overnight except in exceptional circumstances and at
the discretion of the nurse in charge of the night shift.
 The ward computers and phones are only for use by staff. If a
relative phones for a parent, please take a message and ask the
parents to use their mobile phones or patient line. The nurses’
station is a busy area and medical notes will be visible.
 In order to keep the ward secure and safe – only staff (and nursing
students) should let people onto the ward. When you are letting patients and
families in and out of the ward please ensure you know who they are, who they
are visiting and who they are leaving with. If you have any doubt whether
somebody should be allowed off the ward or admitted onto the ward please don’t
hesitate to ask a member of the nursing staff.
 The treatment rooms are for staff and students only. Children and parents should
only enter when invited to do so by a member of staff.
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Student Induction Pack – Ocean & Land Wards – September 2013
Standards for Personal Appearance
Hair must be tied
back if long and worn
only at the collar line.
Only a single or pair
of plain stud earrings
can be worn. Nose,
tongue or eyebrow
studs are not to be
worn.
Minimal make-up only may be
worn while on duty.
Fob watches may
be worn (please
ensure that they
cannot hurt babies
when feeding).
Cardigans or sweatshirts
may not be worn during
clinical procedures. If they
are worn whilst on duty
they must be black or navy
in colour. Sleeves must be
short or rolled up above
the elbow.
Wrist watches or
bracelets must not
be worn.
Only a plain ring may be
worn in the clinical area.
Uniforms must be clean
and well pressed.
Hands must be clean and
nails short and clean. Nail
varnish or nail extensions
must not be worn.
Students
have
a
responsibility to wear
badges while on Trust
premises and to ensure
their badge details are
up to date and that the
badge is in good/clean
condition.
Footwear must be black in
colour with low heels and quiet
sole/heels. No clogs or peeptoes to be worn.
Information obtained from “Guidance for Standards of Dress
for Nurses, Midwives and Health Visitors” (see intranet).
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Student Induction Pack – Ocean & Land Wards – September 2013
Infection Control
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Student Induction Pack – Ocean & Land Wards – September 2013
Some of the conditions you may see on the ward include:-
ALL, AML, Febrile
neutropenia, Chicken Pox
Contact
Dermatology
Problems
Eczema, Psoriasis,
Cellulitis
TCU Admissions
Planned
investigations
Overflow from SKY
Nippy Patient,
Neurological Rehabilitation,
Sleep Studies
MRI under GA, pH
probes
Respiratory Problems
Gastrointestinal
Problems
Crohn's Disease,
Colitis, Gastrooesophageal Reflux,
Gastroeschisis,
Short Gut
Asthma, Cystic Fibrosis,
Empyema, Apnoeic Episodes
Febrile
Convulsions
Neurological
Problems
Epilepsy, Head
Injuries
Syndromes
Haematology Problems
Metabolic Problems
Jaundice, Haemophilia &
other clotting disorders
MCAD, Mitochondrial
Disorders
Rheumatology
Problems
Complex Fluid
Management
Juvenile Arthritis
Social
Admissions
ENT (Ear, Nose &
Throat Problems)
Endocrinology
Problems
Special
Needs
Ophthalmology
Obstructive Airways,
Adenoiditis,
Orbital Cellulitis
Type 1 diabetes,
Hyperinsulinaemia
Acute Infections
Meningitis, Tonsillitis, Urinary
Tract Infection, Upper
Respiratory Tract Infection,
Gastroenteritis, Bronchiolitis,
Croup, Pneumonia
Investigations into
Non-Accidental
Injury
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Student Induction Pack – Ocean & Land Wards – September 2013
Paediatric Normal Values
Basic Vital Signs
Normal ranges for pulse, blood pressure and respiratory rate in children
Newborn and young
babies
Older babies and
toddlers
Pre-school children
School children
Adolescents
Pulse (P): 110 -160 beats
per minute
Tachycardia (T): over
180 beats per minute
P: 110-160 beats per
minute
T: over 180 beats per
minute
P: 110 to 160 beats per
minute
T: over 160 beats per
minute
P: 80 to 120 beats per
minute
T: over 120 beats per
minute
P: 60 to 100 beats per
minute
T: over 100 beats per
minute
Systolic blood pressure SBP: 80 to 95 mm Hg
(SBP): variable, but
range 50 to 85 mm Hg
SBP: 80 TO 100 mm Hg
SBP: 90 to 110 mm Hg
SBP: 100 to 120 mm Hg
Respiratory rate (RR):
30 to 50 breaths per
minute
Tachypnoea (T): over 60
breaths per minute
RR: 25 TO 30 breaths
per minute
T: over 30 breaths per
minute
RR: 20 to 25 breaths per
minute
T: over 25 breaths per
minute
RR: 15 to 20 breaths per
minute
T: over 25 breaths per
minute
RR: 25 to 35 breaths per
minute
T: over 40 breaths per
minute
http://www.patient.co.uk/doctor/Paediatric-Examination.htm
Normal tympanic temperature 36 – 37ºC.
Low grade temperature 37.1 – 37.5ºC
Pyrexia – above 38ºC
Normal Oxygen Saturation Range 94-100% (The normal range may differ for children with
cardiac problems or special needs)
Minimum Urine Output
Babies & Toddlers
School-age children
Adolescents
> 2-3 ml/kg/hr
> 1-2 ml/kg/hr
0.5-1 ml/kg/hr
Signs of Dehydration
Children will have a number of the signs below when dehydrated







Sunken fontanelle (in babies)
Sunken eyes
Decreased urine output
Dry mucous membranes (mouth & lips)
Dry skin, less elasticity
Poor capillary refill time (more than 3 seconds)
Pale and lethargic
Blood Glucose – normal range
Normal range 4-8mmol/l
Hypoglycaemia <3.0 mmol/l (<2.5 mmol/l requires investigation)
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Student Induction Pack – Ocean & Land Wards – September 2013
Administration of Medicines on the Ward
Children receive medication mainly via one of the following routes:O or PO
T
IM
- Oral
- Topical
- Intramuscular
PR
IV
SC
- Per Rectum
- Intravenous
- Subcutaneous
Medications are given at the intervals below:PRN
OD
BD
TDS
QDS
– as required
– once a day
– twice a day
– three times a day
– four times a day
Stat
1°
2°
3°
4°
- immediately
- one hourly
- two hourly
- three hourly
- four hourly
Most paediatric doses are calculated according to body weight and are usually much
smaller than adult doses. Other doses are calculated on age. All medicines are checked
by two qualified nurses. Whilst on placement student nurses should practice calculating,
drawing up and administering drugs to patients under the direct supervision of two
registered nurses.
All medicines are locked away. However drugs are divided into two categories, controlled
drugs (CDs) and non-controlled drugs.
The non-CDs are locked in a single locked cupboard and consist of drugs like antibiotics,
mild analgesia etc.
The CDs are locked in a double locked cupboard. They consist of stronger analgesics (e.g.
morphine), potassium or any drug whose use has to be monitored. The use of CDs is
monitored in the Control Drug Book which keeps an accurate record of the amount of the
drug in the cupboard, how much has been used, by which patient and which nurses
administered the drug. The prescription chart is also signed to indicate that the dose has
been given.
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Student Induction Pack – Ocean & Land Wards – September 2013
Commonly Used Drugs
You may complete this in as much or as little detail as you want.
Drug Name
Generic/
Brand
Dose
Route
Notes
Pain / Pyrexia
Paracetamol
(Calpol)
Ibuprofen
(Nurofen, often
known as
Brufen)
See BNF
Age related
See BNF
age related
6-8 hrly
Max TDS
Codeine
Phosphate
30 – 60mg
(12 – 18 years)
Diclofenac
(Voltarol)
4-6 hrly
1mg/kg
TDS
Oral /
See BNF
rectal / IV
Oral
** Can cause gastric irritation – ensure child /
baby is eating / feeding adequately **
** If child asthmatic use under hospital
supervision **
Pain
Morphine
(Oral known as
Oramorph)
Doses vary
according to
pain and
route
Salbutamol
(Ventolin)
Doses vary
according to
severity
Ipatropium
Bromide
(Atrovent)
As above
Beclamethasone
1-2 puffs
twice a day
Oral /
rectal
**Can cause constipation**
Not to be used in children under 12yrs of age
due to unpredictability of respiratory
depression.
Oral /
**Can cause gastric irritation leading to
rectal
gastric bleeding if in use for long periods.
May need to be prescribed ranitidine /
omeprazole to reduce the risk of this**
Oral /
**Side effects include itching, nausea,
Patches /
depression of the respiratory centre,
IV
constipation, dry mouth and hallucinations**
Antidote – Naloxone
Asthma
(Becotide)
Budesonide
(Pulmicort)
Prednisolone
Inhaler /
Acts as a reliever and is a bronchodilator
Nebuliser **Side effects include tachycardia, agitation**
/ IV
**If used for extended periods leads to low
potassium levels – will need to be checked**
Inhaler /
Acts as a reliever
Nebuliser
Inhaler
Inhaler
Usually a 3
day course
1mg/kg OD
Oral
Is an inhaled steroid that acts as a long term
preventer
Very important parents know that preventers
must be given as directed even when child is
well
Inhaled steroid – Preventer
Steroid – acts in the short term.
When course is long term must be weaned.
** Side effects include weight gain,
osteoporosis, stunted growth **
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Student Induction Pack – Ocean & Land Wards – September 2013
Commonly Used Drugs (continued)
Drug Name
Generic/
Brand
Dose
Route
Notes
Epilepsy, Seizures & Spasms
Sodium
Valproate
(Epilum)
Midazolam
Lamotrigene
Baclofen
Phenytoin
Carbamazepine
(Tegratol)
Paraldehyde
Bacterial Infections
Co-amoxiclav
(Augmentin)
Amoxicillin
Ceftriaxone
Flucloxacillin
Cefotaxime
Ceftazidime
Meropenem
Tobramycin
Constipation
Lactulose
Sodium
Picosulphate
Movicol
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Student Induction Pack – Ocean & Land Wards – September 2013
Commonly Used Drugs (continued)
Drug Name
Generic/
Brand
Dose
Route
Notes
Reflux & Gastric Irritation
Ranitidine
Gaviscon
Domperidone
Omeprazole
Other Medication (add any other drugs you come across)
This list is not exhaustive!! Look at drug charts. What are the different drugs for? Are there
any drugs that are incompatible with each other? Are there any side effects?
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Student Induction Pack – Ocean & Land Wards – September 2013
Admission & Discharge
1
3
6
2
4
A
1.
2.
3.
4.
5.
6.
7.
C
Light Switches
Call Button
Call Button Reset
Crash Buzzer
Suction Unit
Parent’s bed
Reclining chair
D
5
B
E
E
Bed areas need to be checked daily, on
admission and on discharge. Remember
checking bed areas is a NURSING
responsibility, not just Nursing Auxiliaries.
7
E
Cleaning equipment and ward areas are a
very important NURSING responsibility
(audited by several organisations).
A – Oxygen – Are both flow meters working? Is there a clean mask?
B – Suction – Is it working? Has it been used? Is tubing clean? Are there enough suction
catheters of each size? Is there a yankhaur sucker?
C – Parent’s Bed (if present) – On discharge check than bed has been stripped of all linen
and it has been put away securely.
D – If saturation monitors being used, check that the limits are set appropriately and
saturation probe has been repositioned at least once a shift. On admission/discharge
ensure that monitor is clean and has an “I’m clean” sticker on it and that a clean saturation
probe is present.
E – Lockers & Beds/Cots – Are they clean? Does linen need changing? On discharge
clean beds and cots with tufty wipes (or soap and water). Mattresses need to be regularly
checked for needle strike through and dismantled to allow thourough cleaning. Make up
with fresh linen. Are the cots/beds at their lowest level?
Has housekeeping been made aware of discharge by writing “Please Clean” on
whiteboard?
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Student Induction Pack – Ocean & Land Wards – September 2013
Admission and Discharge (continued)
Accurate and up to date record keeping are a legal requirement for all hospital admissions.
Records have to be legible and correct. All entries must be signed. Students must have
their entries counter-signed by a qualified nurse.
It is the Responsibility of the Nursing Student to ensure all counter-signing is
completed.
Admission Paperwork
Medical Notes
 Yellow Front Sheet – Personal details, Next of Kin Details, Social Details, GP & Health
Visitor, Birth History, Infectious Contact History, Immunisation History
 Admission Detail Forms – Baseline Observations, Weight, Height, Presenting
complaints (remainder of form makes up part of medical clerking – completed by
medical staff)
 History Sheets – detailing changes in condition and care given (completed by both
medical and nursing staff)
Bedside Folder
 Peach Assessment Booklet (if over 2yrs of age) or Pink Assessment Booklet (if under 2
years of age).
 Drug Chart – Weight, height & allergies (must be checked with qualified staff)
 TPR – Baseline vital signs and subsequent observations
 Feed or fluid balance charts
 Appropriate Care Plans (available in Nursing Care Plan File on computer as well as
drawers. If not available there are blank ones available for completion).
 Special observation charts (e.g. seizure or BM)
 Skin Bundle check list
 Oral assessment check list
Other
 Has the admission been added to the Clinical Workstation? Try and do as soon as
possible to ensure admission time is as correct as possible. (For more information about
the Clinical Workstation please ask the Ward Receptionist)
 Are child’s details in admission book and added to computerised Handover Sheet?
 If any confidential information regarding a patient i.e. social service input is highlighted
ensure this information is added to the safety briefing?
Discharge Paperwork
Medical Notes
 History Sheets – Has all care been evaluated?
 Discharge sheet to be completed in the Peach/Pink Assessment Booklet.
Other
 Health visitor / School Nurse form. Midwives have to be contacted if baby under 1
month.
 Do the parents need discharge information, open access forms or ward telephone
numbers? Has the discharge information been completed in the Assessment Booklet?
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Student Induction Pack – Ocean & Land Wards – September 2013
 Has discharge information been put in admission book?
 Do they need Outpatient follow-up or Ward Review?
 Discharge child from clinical work station.
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Student Induction Pack – Ocean & Land Wards – September 2013
“Fundamentals of Care” and the Admission Booklet
"Fundamentals of Care" is a Welsh Assembly initiative to improve the consistency and
quality of the delivery of health care of adults. This initiative has been extended to the care
of children. There are 12 practice indicators which relate to the basic aspects of care.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
Communication and information
Respecting People
Ensuring Safety
Promoting Independence
Relationships
Sleep, rest and activity
Ensuring comfort, alleviating pain
Personal Hygiene and appearance
Eating and Drinking
Oral Health and hygiene
Toilet Needs
Preventing pressure sores
These indicators are audited annual using the All Wales Audit Tool.
In order to make auditing easier and focus ward staff, the ward managers of the paediatric
medical, surgical and oncology wards developed an admission booklet to ensure that each
of these indicators were assessed on a regular basis during a hospital admission.
During the admission procedure the different indicators are assessed. If any needs are
identified they then form the basis of any care plans.
Components of the indicators must be assessed daily e.g. Indicator 12 (Preventing
pressure sores). This is assessed by the completion of the Glamorgan Paediatric Pressure
Ulcer Risk Assessment Scale. A child’s clinical condition can change rapidly therefore
regular assessments ensure that appropriate care is given.
www.wales.nhs.uk/documents/booklet-e.pdf
http://wales.gov.uk/docs/phhs/publications/empowering/090427empoweringen.pdf
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Student Induction Pack – Ocean & Land Wards – September 2013
Specialist Nurses
These are some of the specialist nurses involved with the ward. If you have an interest in
spending a few hours with them, tell your mentor. Your mentor may be able to arrange this
on your behalf.
Breast Feeding Advisor
Child protection
Community Midwives
Continence Nurse
Counsellor
Cystic Fibrosis
Judy Rogers
Nikki Harvey
Bev Evans
Brenda Cheer
Sue King
Sandra Hall
Kath Azzopardi
Discharge Liaison Nurse
ENT Specialist Nurse
Epilepsy Nurse Specialist
Haematology
Lesley Lowes
Corinna Brettland
Rachel Harris
Sally Wright
Simon Jones
Rhian Greenslade
Val Wilmot
Ros Atkinson
Alison Robinson
Health Visitor (Liaison)
Maggie Jones
Infectious Disease Nurse
Medical Nurse
Practitioners
Neonatal Outreach
Neurological
Nutrition
Emily Blake
Diabetic Nurse Specialists
Respiratory
Respiratory & Allergy
Nurse Team (REACH)
Office
Office
Claire Thirsk
Clare Sadlier
Claire Briggs
Janet James
Sarah Burn
Ruth Powell
Jessica Pitcher
Ext 2873
Ext 6407
Ext 5030
Ext 4627
Ext 3272
LRP 07623 905629
LRP 07623 905572
Ext 4892
Ext 5435
Ext 5185
Ext 5056
Ext 3460
Ext 3403
Ext 6685
Bleep 5271
Ext 8262
Ext 3294
Bleep 6200
Ext 3249
LRP 07659 588858
Ext 5331
LRP 07623 905600
Ext 2116
Ext 8271
Llandough 725621
LRP 077654 332278
Other items of interest:1. Planned MRIs – every Wednesday and Thursday. It may be possible to follow a
child through admission, general anaesthetic, MRI and recovery. To be arranged
through your mentor.
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Student Induction Pack – Ocean & Land Wards – September 2013
Parents and the Ward
Both wards encourage Family Centred Care. One parent is
encouraged to stay with their child. However there may be
occasions when both parents wish to stay. This is at the discretion
of the Nurse-in-Charge and may be granted in exceptional
circumstances.
In some cases parents may not be able to stay and wish for a
family member to stay in their place. This is allowed as long as the
family member is 18 years or older and is prepared to take
responsibility for the child they are staying with. It must also be borne in mind that parents
may not be able to stay due to family commitments and may not have family and friends to
help. Parents must be supported in this decision and reassured that they can telephone
the ward at any time to check on their child.
There is a pull-down bed for 1 parent in every cubicle in both Ocean and Land Wards. Pull
down beds are also present by every bed space in Ocean. Parents staying with their
children in four bedded bays in Land can use reclining chairs (if available) or armchair and
stool.
If required, parents’ accommodation can be applied for. The number of Warden is Ext
4765. The accommodation is allocated on need with the priority given to parents with
children in PICU/HDU and those further away from home. This should be explained to
parents to ensure they are not disappointed if accommodation is unavailable.
On the ward, parents have their own coffee room with kettle, fridge, freezer and
microwave. It is the responsibility of the parents to wash their own dishes and put them
away. All food brought in by parents have to be clearly marked with their name and the
date.
Children are not allowed in the coffee room and hot drinks are strictly forbidden
from outside this room.
Parents also have their own toilet and shower facilities. Towels can be given on request.
Parents are allowed to use their mobile phones. When showing parents around the ward it
must be emphasized that they must respect doctors, nursing staff and the children/parents
around them when using them. There is also a Patientline telephone.
The Patientline televisions are primarily for the use of the children (which is why it is free).
They operate between 07:00 and 21:00. They will not work after 21:00 even if a Patientline
card is used.
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Student Induction Pack – Ocean & Land Wards – September 2013
Abbreviations
1°
2°
A&E
BD
BP
CAU
CD
CPAP
D&V
EBM
ECG
EEG
ENT
FBC
FiO2
IM
IV
LP
M,C & S
MSU
Neb
NG/NGT
NPA
O or PO
O/E
OD
PR
QDS
SpO2
TDS
Top
TPN
TPR
U&E
URTI
UTI
1 hourly
2 hourly
Accident & Emergency
Twice a day
Blood Pressure
Children’s Assessment Unit
Controlled Drugs
Continuous Positive Airway Pressure
Diarrhoea and Vomiting
Expressed Breast Milk
Electrocardiogram
Electroencephalogram
Ear, Nose & Throat
Full Blood Count
Concentration of oxygen administered
Intramuscular
Intravenous
Lumbar Puncture
Microscopy, Culture & Sensitivity
Mid Stream Urine
Nebuliser
Naso-gastric Tube
Nasal Pharyngeal Aspiration
Oral or Per oral
On Examination
Once a day
Per Rectal
4 times a day
Concentration of oxygen in blood as measured by pulse oximetry
3 times a day
Topical
Total Parenteral Nutrition
Temperature, Pulse, Respiration Rate
Urea & Electrolytes
Upper Respiratory Tract Infection
Urinary Tract Infection
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Student Induction Pack – Ocean & Land Wards – September 2013
Nursing Calculations
Section 1 - Unit Conversions
Many calculations require different volumes or weights to be converted into the same unit
or volume. To convert larger units to smaller units the larger units is multiplied. To convert
smaller units to larger the smaller is divided. All weights, volumes in any equation must be
in the same unit.




Kilograms (kg) to grams (g) = kg x 1000
Grams (g) to milligrams (mg) = g x 1000
Milligrams (mg) to micrograms (mcg) = mg x 1000
Micrograms (mcg) to nanograms (ng) = mcg x1000

Convert 250mg to grams.

Convert 0.5g to mg

Convert 250mcg to mg

0.05g – how many milligrams?

0.25 micrograms – how many nanograms?

750 milligrams – how many grams?

1.575 micrograms - how many milligrams?
Converting units of volume works in exactly the same way.

Convert 0.75 litres to millilitres

Convert 57 ml to litres

Convert 1250 microlitres to millilitres
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Student Induction Pack – Ocean & Land Wards – September 2013
Section 2 - Drug Calculations
Dosages are dependant on the patient’s weight. This is usual
practice in paediatric nursing where the weight of each child
varies and determines the dose of the medication required. To
calculate the dose is: the dose per kg multiplied by the weight in
kg of the child.
Calculation of drug dosages is usually achieved through the
common formula: ‘what you got, over what you have, multiplied by
what it in is’ (Wright 2008).
Volume wanted = Weight of drug wanted
x
Weight of what you have
the volume the drug is in
Example:
A child requires paracetamol as pain relief. The dosage is prescribed as 180mg. The
paracetamol comes as oral suspension 120mg in 5ml.
180mg = what you want
120mg = what you got
5ml = volume it is in
180mg x 5ml = the volume wanted (6.25mls)
120mg

Ibuprofen 130mg is to be given orally for the pain relief. The stock mixture contains
100mg in 5ml. What is the volume to be given?

500mg tablets of paracetamol. 750mg is prescribed. How many tablets will you
give?

Paracetamol comes as 120mg in 5ml.How much should be given for a dose of
90mg?
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Student Induction Pack – Ocean & Land Wards – September 2013

440mg choral hydrate is prescribed. A bottle contains 200mg in 5ml. What volume
should be given?

A 4 month old is pyrexial. Paracetamol is 15mg/kg and the child weighs 7.9kg.
What is the dose required? Using a 120mg in 5mls solution of paracetamol, what
volume of the drug should be given?

A baby requires cefotaxime. The dosage is 50mg/kg and the baby weighs 2.4kg.
What dose is required?

A baby is to have 62.5mcg of atrovent (Ipatropium Bromide) nebuliser. The
ampoules come in 250mcg in 1ml. What volume would you give and how much
0.9% saline would you need to add to give an overall volume of 3ml?

A child weighing 12.1kg has been admitted to the ward with a diagnosis of
meningitis. The doctor has written up ceftriaxone. The dose is 80mg/kg. How much
dose would be needed?

A child has been prescribed IV Ambisome (an antifungal). The vial has been made
up with water as directed by the instructions to give a concentration of 4mg/ml. If
the dose is 30mg what volume has to be taken from the vial? The drug has to be
further diluted in 5% dextrose to give a concentration of between 0.2mg/ml and
2mg/ml. What are the maximum and minimum infusion volumes?
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Student Induction Pack – Ocean & Land Wards – September 2013
Section 3 – Estimating Weight (Children 1-10yrs)
Weight (Kg) = (Age in years + 4) x2
For example the estimated weight of a 5 year old is
(5 yrs + 4) x 2 = 18kg
However the actual weights of children vary widely and the
above calculation is only for use in emergency situations. All
children must be weighed on admission to the ward if not already weighed in CAU or A&E.
Also if a child is an in-patient for more than a week and there are concerns about weight
gain they need to be weighed twice a week (usually Monday and Thursday).
Section 4 – Fluid Requirements
Allow 100ml per kg for the first 10kg.
Allow 50ml per kg for second 10kg.
Allow 20ml per kg for remainder of weight in kg.
Example: 24hr fluid requirement for child weighing 25kg
10kg at 100ml/kg = 10kg x 100ml/kg = 1000ml
10kg at 50ml/kg = 10kg x 50ml/kg = 500ml
5kg at 20ml/kg = 5kg x 20ml/kg = 100ml
Total = 1000ml + 500ml +100 ml = 1600ml
Divide the total amount by 24 hours to obtain the rate in ml per hour.
Rate = 1600ml / 24hr = 66.6667ml/hr = 66.7ml/hr (corrected to 1 decimal space)

Calculate the maintenance fluid requirement for 24 hours for a child that weighs
4kg. Calculate the child’s maintenance fluid per hour.

A child weighing 28kg requires full maintenance fluids. What would their fluid
requirements be for 24hours? Calculate the child’s maintenance fluid per hour.
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Student Induction Pack – Ocean & Land Wards – September 2013

A child aged 8 months weighs 7.8kg. She requires 24 hours of full maintenance
fluid. How much is required? Calculate the child’s maintenance fluid per hour.
If a child is dehydrated, the deficit needs to be replaced. This is
calculated by:
Deficit in ml = weight (Kg) x % dehydration x 10

If a child is 5% dehydrated and weighs 14kg. How much is the
deficit?
The deficit is then added to the maintenance fluid requirements (NICE guidelines).
So for example if a child weighs 20kg and is 5% dehydrated - rehydration is carried out
over 24 hours (if blood results show that Sodium is high rehydration is given over 48
hours).
Maintenance requirement is calculated at 1500ml in 24 hours.
Deficit is calculated at 20kg x 5 x 10 = 1000ml
Therefore the rehydration volume over 24 hours would be 2500ml (104ml.hr).
If a child is in shock a fluid bolus of 20mls/kg is given.

If a child comes in needing a fluid bolus and weighs 25kg. How much fluid bolus
would you need to give?
(See Appendix 1 for protocol for fluid and electrolyte therapy in children)
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Student Induction Pack – Ocean & Land Wards – September 2013
Section 5 – Infusion rates – Enteral feeding and intravenous infusions
 A child is prescribed a 50mg pamidronate infusion which is diluted to 250ml in 0.9%
sodium chloride. The duration of the infusion is 4hrs. What rate do you set on the IV
pump?
 A child needs a blood transfusion. Needing 280mls of blood to be transfused over 4
hours. What rate do you set on the IV pump?
 A 50kg adolescent has taken a paracetamol overdose. A blood test confirms that they
are above treatment level and require acetylcysteine (Parvolex) administration. The
vials come in a concentration of 200mg/ml.
If the initial dose is 150mg/kg to be given over 15 minutes, what volume of
Parvolex needs to be added to a 200ml bag of 5% glucose? What is the infusion
rate?
The second dose is 50mg/kg added to 500ml 5% glucose infused over 4 hours.
What is the infusion rate?
The final dose is 100mg/kg in 1000ml 5% glucose over 16 hours. What is the
infusion rate?
 If a dietician wanted a 480ml feed to run over 10 hrs via a naso-gastric tube. What rate
would you set the pump?
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Student Induction Pack – Ocean & Land Wards – September 2013
Section 6 - Fluid Charts
A fluid balance chart is crucial to monitor all input and output (Huband and Trigg 2000).
Input includes oral, feeds given enterally i.e. NG tube and intravenous fluids.
Output includes urine, gastric aspirate/vomiting and stool (Huband and Trigg 2000).
Fluid
Balance
is
measured
over
24
hours from 7:00 to 7:00
the next day.
The fluid balance is
calculated
by
subtracting the output
over a period of time
from the input over the
same period of time.
Urine output is also a
very
important
calculation.
It is
calculated by dividing
the volume of urine by
the weight of the child
and then further divided
by the amount of time it
was measured.
Colloid fluids are fluids
that
contain
large
insoluble
molecules
such as proteins. An
example of a colloid is
blood
or
Human
Albumin Serum.
Crystalloid fluids contain
smaller
soluble
molecules
such
as
mineral
salts.
An
example of a crystalloid
is 0.9% saline or 0.45%
NaCl / 5% glucose.
Both fluids are used in fluid resuscitation with different pros and cons. An excellent article
was written in 2000 which discusses fluid balance in children (Willock, J. & Jewkes, F. (2000)
Making sense of fluid balance in children. Paediatric Nursing. 12(7), 37-42).
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Student Induction Pack – Ocean & Land Wards – September 2013
Section 7 - Moles
A mole is a word which represents an amount of atoms or
molecules. In one mole there are 6 x 1023 atoms/molecules. In 2
moles there are 2 x (6 x 1023). This is a convenient way of dealing
with different substances.

There is 20mmol of potassium in 1litre bags. There needs to be 40mmol in the bag.
How much amount of potassium would you need to add to a bag?

A doctor prescribes 1L of 0.45% NaCl (sodium chloride), 5% glucose with 20mmol
of KCl (potassium chloride). You need to use 500 ml bags. How much KCl is in
each 500 ml bag?
Section 8 – Baby feeding requirements
Age of baby
Newborn
1 week to 8 months
9-12 months
(Trigg et al 2006).
Average total fluid requirements in
24hrs in ml/kg
30
150
120
1oz = 30ml

On the basis of the figures in table, how much should a 3 month old baby receive
weighing 5.2kg in 24 hrs?

If a 1 week old weighs 3kg. How much in 24hours would the baby require in feeds?

A baby (9months old) comes onto the ward with faltering growth. Mum says the
baby is taking 4 oz feed every 6 times a day. Baby weighs 7.2kg. Is this an
appropriate feeding requirement in 24 hours? What feeding advice would you give?
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Student Induction Pack – Ocean & Land Wards – September 2013
Test Questions
1) Work out a child’s weight from his age
a) An 8 year old
b) A 3 year old
2) What is the normal range of respiratory and pulse rates for
a) A 6 month old baby
b) A 3 year old child
3) Define the word “bradycardia” and state why it is a significant feature.
4) What does capillary refill time represent and how do you measure this?
5) What does pulse oximetry measure?
6) List some signs of dehydration (all ages including babies).
7) Why would it be necessary to administer a fluid bolus to a patient?
8) How would you work out how much to give?
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Student Induction Pack – Ocean & Land Wards – September 2013
9) In resuscitation, what does A, B, C stand for?
10) What does A V P U stand for and when would you use them?
11) List 6 reasons for a child to have a fit.
12) List some of the drugs more commonly used in the treatment of
a) Meningococcal meningitis
b) Opiate poisoning
c) Exacerbation of asthma
13. Why would it be necessary to use an intra-osseus needle?
14. What would you be looking for when testing a urine sample of a diabetic?
15. What are the long term consequences of diabetes being poorly controlled?
16. What are the symptoms of shock?
30
Student Induction Pack – Ocean & Land Wards – September 2013
References
Cardiff and Vale NHS Trust., (2004) Clinical Guidelines Handbook, Cardiff, Cardiff and
Vale NHS Trust.
Huband, S., Trigg, E., (2000) Practices in children’s nursing: Guidelines for hospital and
community, Churchill Livingstone, London
Trigg, E., Mohammed, T. A., 2006 Practices in children’s nursing: Guidelines for hospital
and community, 2nd edition, Churchill Livingstone, Elsevier.
Wright, K., (2008) Drug calculations part one: a critique of the formula used by nurses,
Nursing standard, 22 (36) pp. 40-42.
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Student Induction Pack – Ocean & Land Wards – September 2013
Appendix 1
32
Student Induction Pack – Ocean & Land Wards – September 2013
Appendix B – Reading List
Ayliffe V (2009) Clinical features and management of atopic eczema in children.
Paediatric Nursing. 21, 9, 35-43.
Baulch, I. (2009) Assessment and management of pain in the paediatric patient. Nursing
Standard. 25(10), 35-40.
Bethal, J. (2010) Distinguishing features of preseptal and orbital cellulitis. Paediatric
Nursing. 22(2), 28-30.
Booker R (2008) Pulse oximetry. Nursing Standard. 22, 30, 39-41.
Broom, M. (2007) Physiology of fever. Paediatric Nursing. 19, 6, 40-45.
Browne, M.E, (2006) Communicating with the child who has autistic spectrum disorder: a
practical introduction. Paediatric Nursing. 18 (1), 14-17.
Crook, J. (2010) Fever management: evaluating the use of ibuprofen and paracetamol.
Paediatric Nursing. 22(3), 22-26.
Davie, A. & Amoore, J. (2010) Best practice in the measurement of body temperature.
Nursing Standard, 24 (42), 42-49.
Davies, J. & Huws-Thomas, M. (2007) Care and management of adolescents with mental
health problems and disorders. Nursing Standard. 21 (51), 49-56.
Dobson, P., Rogers, J. & Weaver, A. (2009) Assessing and treating faecal incontinence in
children. Nursing Standard 24(2), 49-56.
Donovan C, Blewitt J (2010) Signs, symptoms and management of bacterial meningitis.
Paediatric Nursing. 22, 9, 30-35.
Gould D, Drey N (2008) Hand hygiene technique. Nursing Standard. 22, 34, 42-46.
Fitzpatrick A, Dowling M (2007) Supporting parents caring for a child with a Learning
Disability. Nursing Standard. 22, 14-16, 35-39.
Harrop, M. (2008) Psychosocial impact of cystic fibrosis in adolescence. Paediatric
Nursing 19 (10), 41-45.
Honeyman, C. (2007) Recognising mental health problems in children and young people.
Paediatric Nursing. 19, 8, 38-44.
Howlin, F. & Brenner, M. (2009) Cardiovascular assessment in children: assessing pulse
and blood pressure. Paediatric Nursing. 22 (1), 25-35
Joanna Briggs Institute (2007) Management of asymptomatic hypoglycaemia in neonates.
Nursing Standard. 22, 8, 35-38.
Joanna Briggs Institute (2008) Effective dietary interventions for overweight and obese
children. Nursing Standard. 22, 18, 35-40.
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Student Induction Pack – Ocean & Land Wards – September 2013
Lowes L (2008) Managing type 1 diabetes in childhood and adolescence.
Nursing Standard. 22, 44, 50-56.
Lynch F. (2009) Arterial blood gas analysis: implications for nursing. Paediatric Nursing
21(1), 41-44.
Myers, J. (2009) Advanced practice in the management of children with eczema.
Paediatric Nursing. 21(2), 36-42.
Paediatric Nursing (2006) Anaphylaxis guideline update. Volume 20(6) p 19,
Narramore, N. (2008) Supporting breastfeeding mothers on children’s wards: an overview.
Paediatric Nursing. 19(1), 18-21.
National Institute for Health and Clinical Excellence (NICE) (2007) Triage, assessment,
investigation and early management of head injury in infants, children and adults.
http://guidance.nice.org.uk/CG56
National Institute for Health and Clinical Excellence (NICE) (2009) Diarrhoea and Vomiting
caused by Gastroenteritis: Diagnosis, assessment and management in children younger
than five years. www.nice.org.uk/Guidance/CG84
Purssell, E. (2009) Tympanic thermometry – normal temperature and reliability. Paediatric
Nursing. 21(6), 40-43.
Robertson K (2010) Understanding the needs of women with postnatal depression.
Nursing Standard. 24, 46, 47-55.
Sadlier, C. (2008) Long-term parenteral nutrition. Paediatric Nursing. 20, 10, 37-43.
Spence, C. (2005) Cystic fibrosis-related diabetes: practice challenges. Paediatric Nursing.
17 (2), 23-26.
Watkins, P. (2008) Atopic eczema in children: clinical guidelines for daily practice. Primary
Health Care, 18(8), 41-46.
Willock, J. & Jewkes, F. (2000) Making sense of fluid balance in children. Paediatric
Nursing. 12(7), 37-42.
Willock, J., Anthony D. & Richardson, J. (2008) Inter-rater reliability of the Glamorgan
Paediatric Pressure Ulcer Risk Assessment Scale
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Notes:-
35