HOW DOES YOUR HEART WORK?
The blood enters the right atrium, one of the upper receiving chambers of the heart.
Blood is pumped through the tricuspid valve into the right ventricle. The right and left ventricles are larger than the right&left atria because they are responsible for pumping action of the heart. The right ventricle pumps de-oxygenated blood away from the heart through the T-shaped pulmonary artery.
By the time blood arrives in the lungs the body has taken out most of the oxygen and made use of it for tissue function. In a healthy heart blood flows efficiently through the heart to the lungs, which re-oxygenate the blood and return it to the heart through the pulmonary vein. Oxygenated blood enters the heart through the left atrium and is pumped to the left ventricle. The left ventricle is encased in thicker cardiac muscle than the right side because it has to pump oxygenated blood around the entire body via the aorta, the largest artery of the body.
The cardiac cycle relies on the efficiency of the 4 valves between the atria, the ventricles and the pulmonary blood vessels. These valves open to let in sufficient blood flow to fill each heart chamber and then shut to prevent the backflow of blood. Irregularities in blood flow because of blockages in the blood vessels can lead to heart disease.
KAKO DELUJE VAŠE SRCE?
Kri vstopi v desni atrij, eden izmed zgornjih prejemajočih komor srca. Kri je prečrpana skozi trikuspidalno zaklopko v desni ventrikel/prekat. Leva in desna prekata sta večja kot levi in desni preddvor zato, ker sta odgovorna za črpalno ukrepanje srca. Desni prekat črpa s kisikom napolnjeno kri stran od srca skozi pljučno arterijo v obliki črke T. Sčasoma ko kri prispe v pljuča, je telo porabilo večino kisika, ki ga je porabilo za delovanje tkiv. V zdravem srcu kri teče uspešno skozi srce v pljuča, kjer se kri ponovno napolni s kisikom in se vrne v srce skozi pljučno veno. S kisikom napolnjena kri vstopi v srce skozi skozi levi atrij in je prečrpana v levi prekat. Levi prekat je je ovit v debelejši srčni mišici kot desni zato, ker mora črpati s kisikom napolnjeno kri po vsem telesu preko aorte. Največje arterije v telesu. Srčni cikel je odvisen od učinkovitosti štirih zaklopk med atrijem, prekatom in pljučnih krvnih žil. Te zaklopke se odprejo in spustijo zadosten pretok krvi, da napolni vsako srčno votlino, nato se zaprejo da se prepreči povratni pretok krvi. Nepravilnosti v srčnem pretoku zaradi blokad v krvnih žilah lahko vodijo v bolezni srca.
A NURSING HANDOVER
Healthcare preofessionals write entries about patients in their care in the Patient Record. The Patient Record documents patient care and, as such, forms a permanent legal record of treatment. At the end of each nursing shift, the outgoing nurses give a verbal handover to nurses on the oncoming shift. The nurses on the incoming shift are briefed on changes in patient progress and patient care. The handover is usually performed face-to-face but some institutions use recorded handovers. The information which is reported during the handover is gathered from the Patient Record, the Care Plan and any other charts which document specific patient care.
(ZDRAVSTVENA) SESTRSKA PREDAJA
Zdravstveni delavci pišejo vnose o pacietnih in njihovi oskrbi v pacientovo dokumentacijo. V pacientovi dokumentaciji je dokumetirana pacientova oskrba, in tako ima obliko stalni pravni zapis o zdravljenju. Ob koncu vsake negovalne izmene, odhajujoče sestre dajejo ustno predajo za sestre ki prihajajo na izmeno. Medicinske sestre, ki pridejo na negovalno izmeno so obveščene o spremembah o bolnikovem napredku in pacientovi negi. Predaja se običajno izvaja iz oči v oči, toda nekatere institucije uporabljajo zabeležene predaje. Informacije, ki je bila poročana med predajo se zbirajo iz paceintove dokumentacije, negovalnega načrta in drugih zapisov kjer je dokumentirana posebna pacientova oskrba.
AUDISCRIPT
1.5
Nick: Mrs Smits complaind of chest pain at 10 pm. The SHO was performed. Oxygen was administered via a mask. Her blood pressure was two hundred and twenty over one hundred and her pulse was one hundred and twenty at five past ten. The SHO ordered an ECG, which was done by nursing staff. GTN sublingual was given with good effect. The chest pain was relieved within a couple of minutes.
1.6
Jenny: all right, now I’ll just let you know about Mrs Small BP. As you know, she was admitted just before 2am yesterday with poorly managed hypertension. She’s quite elderly and trying to cope at home but the previous medication wasn’t working well for her at all. Doctor Fielding wants to put her on something else and wants to monitor her BP in hospital over 3 days. If you look at her Obs. Chart from yesterday, you’ll see that she was quite hypertensive on admission. BP was one hundred and seventy three over one hundred and one, pulse eighty-six. At 6am her BP was about the same, one seventy-five over ninety and pulse seventy six. During the morning shift at 10am she shot up to 2 hundred and ten over thirty, with a pulse of a hundred an twelve. She had some chest pain, too. Doctor Fielding came up to see her about the chest pain and high BP. He did all the usual things for her ECG, GTN sublingually,and she settled a bit by 2pm. By two, her BP was one ninety-five over ninety and her pulse was ninety-seven. I took her obs.again at 3pm, just before handover. She’s gone down to one eighty over eighty-five with a pulse of eighty six. Doctor Fielding’s happy with that but just keep an eye on her, will you?
1.5
Nick: gospa Smits se je ob 22h pritoževala zaradi bolečin v prsih. Višji uradnik je bil obveščen. Kisik je bil dan s pomočjo maske. Njen krvni pritisk je bil 220 ob 10:05 uri. Višji uradnik je naročil EKG, ki je bil izveden s strani zdravstvenega osebja. Gliceril trinitrat je bil dan podjezično, z dobrim učinkom. Bolečina v prsnem košu je bila razbremenjena v nekaj minutah.
1.6
Jenny: vredu, vas bom obvestil o krvnem tlaku gospe Small. Kot veste je bila sprejta tik pred drugo uro zjutraj s slabo vodeno hipertenzijo. Je precej v letih in se skuša doma soočiti stem, toda prejšnja zdravila ji niso pomagala kaj prav dosti. Zdravnik Fielding bi jo dal na kaj drugega in želi spremljati njen krvni tlak v bolnišnici več kot 3 dni. Če pogledate njene zapise o opazovanju od včeraj, bosta videla da je bila precej hipertenzivna na sprejemu. Krvni tlak je bil 173/101, pulz pa 86. ob 6h je bil njen krvni tlak približno isti, 175/90 in pulu 76. V času dopoldanske izmene ob 10h se je povzpel tlak na 210/30, s pulzom 112. Tudi bolečine v prsnem košu je imela. Zdravnik Fielding je prišel k njej zaradi bolečin v prsih in visokega pritiska. Naredil je vse običajne stvari za njo, EKG, GTN podjezično in tako se je poravnalo malo do druge ure. Do druge ure je bil njen krvni tlak 195/90 in njen pulz je bil 97. ponovno sem jo opazoval ob 15h, tik pred predajo. Šla je navzdol na 180/85 s pulzom 86. zdravnik Fielding je zadovoljen stem, toda pazite nanjo, ali boste?
WOUND ASSESSMENT CHART
3.5
K: hello, Gary, isn’t it? I’m Krisztina and this is Judy. How are you doing?
G: not too bad now. I’ve had something for the pain , so it’s bearable now.
K: that’s good. You’ve had a tetanus shot, too. I see. We’ll clean up the wound for you now. I’ll leave you with Judy and she’ll do the dressing for you.
G: ok thanks, it looks pretty awful, doesn’t it?
J: mm, it was a nasty bite, especially with those puncture wounds. Krizstina what do you suggest I clean the wound with?
K: it’s best to flush it with lots of Normal Saline before you do the dressing. We do that first Gary because it reduces the risk of infection. Even though only fifteen to twenty percent of dog bites get infected, puncture wounds like yours have a greater chance of infection. You’ll be prescribed some antibiotics to take at home too.
G: um speaking of going home, can you give me some advice on looking after this at home?
K: sure the wound will be left open, it won’t be sutured gary, because it heals better if it is left open not stiched closed. I’d like you to keep the dressing clean and dry and come to Outpatients to have the dressing changed daily. I’ll get you an appointment card while Judy’s doing the dressing for you.
G: all right, what should i do about the antibiotics?
K: you’ll be prescribed some antibiotics by the doctor a bit later. You’ll get a script which you can take to the hospital pharmacy to be filled. Make sure you take the whole course of the antibiotics. That’s very important. Is there anything else you were concerned about?
G: oh just one thing. Should I get a medical certificate? It looks like I might me off work for a couple of days.
K: yes, that’d be a good idea. I’ll ask the doctor on duty to write one for you.
3.6
Jennifer: OK, moving on to Gary Stephens bed 17. does everyone knows gary stephens? He was attacked in the street by a dog 2 weeks ago. Initially he went A&E and was treated there. He had some deep puncture wounds in his left calf and was in a lot of pain.
Brian: the dog bit him twice didn’t i?
J: yeah and it bit him quite deeply. As I said he went to A&E, the wound wasn’t sutured but kept open as per the protocol for dog bites with puncture wounds. Gary was given a tetanus shot and sent home with instructions to come to the dresising clinic every day to have the dressing changed. Unfortunatelly, he tried to do it himself and now he has an infection in the wound and has been admitted to hospital for treatment. Actually, it’s quite a bad infection. The wound smells quite a bit.
B: so what are we going with the wound now?
J: right, um he had a wound review yesterday as the wound had to be reassessed. The adges weren’t healing because of the infection. The wound is quite sloughy too, but it isn’t necrotic. The surrounding skin is a little inflamed so he was started on IV antibiotics yesterday. It was decided to debride the wound in line with wound bed preperation guidelines. You all went to the CPD session on that last week, didn’t you?
Felicity: yeah, everyone went and I’ve put the guidelines up in the Treatment Room.
J: oh thats goog. He went this morning for a surgical debridement of the wound and came back around 2pm. He’s feeeling ok after the debridement, it’s not too sore. There’s a small amount of purulent ooze. There’s just a little pus in the centre of the wound. the wound has an antimicrobal dressing over it, which is it to remain intact untill tomorrow. After that, it’ll need a daily dressing.
B: ok thats good and he’ll have an assessment by the Vascular team on Monday. K: pozdravljen Gary kajne? Sem Krisztina in to je Juday. Kako si?
G: ne preveč slabo sedaj, ker sem dobil nekaj za bolečino tako da je znosna.
K. to je dobra. Dobil si injekcijo tetanusa vidim. Počistili bomo rano za vas, pustila vas bom z Judy in bo previla rano.
G: hvala, zgleda precej grozno kajne?
J: je bil grd ugriz, še posebaj zaradi vbodnih ran. Kristina kaj predlagaš, sčim bi očistila rano?
K: najbolje da jo izpereš z normalno soljo preden you previješ. To naredimo najprej Gary, ker zmanjša tveganje za infekcijo. Kljub temu da samo 15 do 20% pasjih ugrizov privede do infekcije, vbodni ugrizi kot je tvoj imajo večjo možnost infekcije. Predpisali vam bodo antibiotike da jih boste vzeli domov.
G: ali mi lahko date kakšen nasvet kako bom doma skrbel za rano?
K: seveda, rano bo ostala odprta, ne bo bila šivana, ker se bolje celi če je odprta in ne zašita. Želim da ohranjate vaše obloge čiste in suhe in da hodite dnevno do ambulante da vam bomo zamenjali obloge. Prinesla vam bom naročilnico ko vam bo Judy obložila rano.
G: seveda, kaj pa naj naredim glede antibiotikov?
K: zdravnik vam bo predpisal nekaj antibiotikov malce pozneje. Dobili boste recept, katerega boste odnesli v bolnišnično lekarno da vam izpolnejo. Poskrbite, da boste jemala antibbiotike redno. To je zelo pomembn. Ali je še kaj, kar bi vas skrbelo?
G: samo še nekaj. Ali bi lahko dobil zdravniško potrdilo? Zgleda da ne bom šel v službo nekaj dni.
K: ja to bi bila dobra ideja. Bom vprašala dežurnega zdravnika , da vam ga napiše.
3.6
J: ok pojdimo do Garyja Stephansa postelja 17. ali vsi poznate garyja? Napadel ga je pes na ulici 2 tedna nazaj. Najprej je šel na urgentni oddelek in je bil zdravljen tam. Imel je globoke vbodne rane in njegov levi golen ga je zelo bolel.
Pes ga je napadel dvakrat kajne?
Ja in ga ja ugriznil precej globoko. Kot sem rekla je šel na urgentni oddelek, rana ni bila zašita bila je odprta zaradi protokola od pasjih ugrizih z vbodnimi ranami. Gary je prejel injekcijo tetanusa in je bil poslan domov z navodilom, da pride previti rano na kliniko vsak dan. Na žalost je poskušal sam to storiti in sedaj ima infekcijo rane in je bil sprejet v bolnišnico na zdravljenje. V bistvu je precej grda infekcija. Rana precej smrdi.
B: in kaj bomo naredili sedaj glede rane?
J: seveda, imela je pregleda rane včeraj , ker je morala biti ponovno ocenjena. Robovi se niso celili zaradi infekcije. Rana je precej krastasta tudi, tudi ni nekrotična. Koća okoli rane je malce vneta zato je prejel intravenezno antibiotike včeraj. Odoločeno je bilo da se očisti rano v skladu s smernicami za pripravo obloge. Saj ste šli vsi na CPD sestanek prješnji teden kajne?
Felicity: seveda, vsi smo šli in postavila sem smernice v sobi za zdravljenje.
J. to je dobro. To jutro je šel na kirurško čiščenje in je prišel nazaj okoli 14h. Počuti se dobro , in ni preveč vneto.. majhna količina gnojnega izcedka je pristona. Malo gnoja je v sredini rane. Čez rano je dobil antibakterijsko oblogo, in mora ostati intaktna do jutri. Po temu se bo izvajala dnevno previjanje.
B: to je dobro, in v ponedeljek bo imel pregled pri žilni ekipi.
HOW DO YOUR KIDNEYS WORK?
Unfiltered blood enters the kidney for filtration through the renal artery from the heart. Blood passes to the kidneys in large quantitirs so that it can be filtered well and have most of the waste products removed. Renal veins carry the cleand blood away from each kidney. Renal veins are wider than renal arteries because they transport blood towards the inferior vena cava of the heart. The blood returned from the heart through the renal artery contains a toxic product called urea, and also high levels of salt and large amounts of water. The kidney’s function is to filter out these unwanted materials. In addition, the kidney also reasorbs any products the body needs and secretes waste materials as urine.
Blood enters the kidney through the hard outer layer, or cortex. The filtration units of the kidney, called nephrons, are found in the renal cortex. The nephrons help filter out waste from the blood, leaving a filtrate of important salts and glucose. The next section of the kidney is called the renal medulla. This is where the level of salt and water in urine is controlled. Sodium ions are concentrated in the medulla so that very concentrated urine is produced. Any excess water and waste products are then secreted as urine. The urine collects in the renal pelvis, which is the fan-shaped section at the narrowest part of the kidney that joins onto each ureter. The ureters are two tubes which transport the urine from the kidney to the bladder, or storage section. From the bladder there is another tube called the urethra which is where the urine passes to the outside.
KAKO DELUJEJO VAŠE LEDVICE?
Nefiltrirana kri vstopi v ledvico za filtracijo preko ledvične arterije srca. Kri prehaja v ledvica v velikih količinah da se lahko dobro filtrira in je večina odpadnih snovi odstranjenih. Ledvične vene prenesjo očičene kri stran od vsake ledvice. Ledvične vene so širše kot ledvične arterije, ker prenašajo kri v smeri vene kave inf. Srca. Kri ki se vrne od srca skozi ledvično arterijo vsebuje strupene produkte, snovi ki se imenuje sečnina, in tudi visoko koncentracijo soli in veliko kolečino vode. Funkcija ledvice je da izloči te nezaželene snovi stran. Poleg tega, ledvica tudi reabsorbirajo snovi ki jih telo potrebuje in izloča odpadne snovi kot je urin.
Kri vstopi v ledvico skozi trdo zunanjo plast, ali skorjo. Enote ki filtrirajo v ledvicah, imenovane nefroni, so najdeni v ledvični skorji. Nefroni pomagajo filtrirati odpadne snovi iz krvi, tako da pustijo filtrat pomembnih soli in glukoze. Naslednji odsek v ledvicah se imenuje ledvična sredica. Tu se nadzoruje raven soli in vode v urinu. Natrijevi ioni so skoncentrirani v sredici, tako, da se lahko proizvaja zelo koncentriran urin. Odvečna voda in odpadne snovi se izločijo v urinu. Urin se zbira v ledvični medenici , ki je v odseku podeben ventilatorju na najožjem delu ledvice, kjer se združi na vsak sečevod. Sečevoda sta dve cevi, kateri prevažata urin iz ledvic v sečni mehur ali oddalek za skladiščenje. Iz mehurja je še ena cev, ki se imenuje sečnica, kjer se urin izloči na prosto.
THE PANCREAS
The pancreas is a small L-shaped organ which sits against the doudenum behind the stomach. It is quite small, at around 15cm long. The pancreatic duct runs along the middle of the pancreas and empties into the duodenum. It supplies pancreatic enzymes, also called pancreatic juices, which aid in the digestion process. This is described as the exocrine function of the pancreas, exo meaning ‘out of”. Pancreatic juices flow out of the pancreas through the pancreatic duct. The pancreatic duct is joined by the common bile duct before emptying into the duodenum. The pancreas also has an endocrine function, endo meaning ‘within’. This is the release of hormone within the bloodstream. There are 4 main types of hormone produced in the hormone-producing cells of the pancreas-the islets of Langerhans (islet cells). One of the 4 cell types-beta cells-produce insulin. The function of insulin is to lower blood sugar level. Beta cells make up almost 80% of all islet cells. Alpha cells make up almost 20 percent, and these release glucagon, which raises the level of glucose in the blood. This is the opposite function of insulin. The level of glucose in the blood is called either blood sugar level (BSL) or blood glucose level (BGL). Insulin stimulates cells in the body to use or store the glucose produced from the metabolism of carbohydrates in food. Glucose is used in the body as energy source.
TREBUŠNA SLINAVKA
Trebušna slinavka je majhen, v obliki črke L organ, ki leži poleg dvanajstnika, za želodcem. Je precej majhen organ okoli 15cm dolg. Cev trebušne slinavke poteka po sredine slinavke in se izprazni v dvanajstnik. Zagotavlja encime trebušne slinavke, ki se imenujejo pankreatični sokovi, ki pomagajo v procesu prebave. To je opisano kot eksokrina funkcija slinavke, ekso pomeni ‘zunaj’. Pankreatični sokovi se prenašajo skozi slinavko v pankreatično cev. Cev trebušne slinavke je združena z cevnjo žolčevoda preden se sprazni v dvanajstnik. Slinavka ima tudi endokrino funcijo, endo pomeni znotraj. To je sproščanje hormona v krvni obtok. Obstajajo 4 glavni tipi hormonov proizvedenih v hormonih, ki proizvajajo celice trebušne slinavke- Langerhansovi otročki (otoček celic). Ena od 4 tipov celic. Beta celice-proizvajajo inzulin. Funkcija inzulina je da znižuje raven sladkorja v krvi. Beta celice predstavljajo skoraj 80% vseh otočkov celic. Alfa celice predstavljajo skoraj 20% , in le te sproščajo glukagon, ki zvišuje raven glukoze v krvi. To je ravno nasprotno delovanje inzulina. Raven glukoza v krvi se imenuje ali raven krvnega sladkorja, ali ravn glukoze v krvi, inzulin stimulira celice v telesu da porabijo ali shranijo glukozo proizvedeno iz presnove ogljikovih hidratov v hrani. Glukoza se uporablja v telesu kot vir energije.
THE RESPIRATORY SYTEM
Tim, a Charge Nurse on the Paediatric Respiratory Ward is desribing the normal flow of air into the lungs to Susie an 8-year old patient. She has been admitted after having her first serious asthma attack and needs education about managing her condition.
2.4
Susie and Tim are having a chat about breathing , what happens to her airwys when she has an asthma attack, so that she can cope when she has another attach. He got her a booklet so she can take a look of the diagram of the respiratory system. She’s telling her what happens to the air when it comes into our bodies and travels to our lungs. The air is breathed into nasal cavity-the nose, where it’s warmed and filtred. It moves past the oral cavity-the mouth, and it goes trhrough the pharynx or throat, and then it comes to the epiglottis-the little plap which stops food going into your lungs when swallowing. The air is moving past your larynx or voice box, and it moves down your trachea or windpipe, and into the bronchus. Thats’ the part which swells when you have an attack. The bronchus divides into 2 lungs, that are covered by the pleural membrane. The special covering protects your lungs. Pleural is a medical words for lungs. Inside the lungs are the alveoli, which are masses of tiny sacs which help your lungs to exchange carbon dioxide for oxygen. Then you can breath out the carbon dioxide. Things around your lungs are the ribs. In between the ribs we have intercostal space, which means in between the ribs.
The healthy airways have a lining of healthy tissue. The tissue layer ins’t very thick. But the tissue in the asthma airways is thicker, because it becomes inflamed. The muscle layer around the tissue contracts or squeezes. In the healthy airways, the air flows through the airways and is conducted into and out of the alveoli or tiny sacs. In the alveoli carobon dioxide is exchanged with oxygen. This is called respiration or breathing. In the asthmatic airways the tissue becomes swollen during an asthma attack, this means the airways is narrowed. Chest muscles tighten and it becomes difficult to breathe. You start wheezing when you breathe in.. it also takes longer for you to breathe again.
Tim, zadolženi zdravstveni tehnik na pedaitričnem respiratornem oddelku opisuje normalni pretok zraka v pluča Susie 8 letni pacientki. Bila je sprejeta po tem ko je imela prvi resni astmatični napad in rabi izobraževanje o tem kako se soočati z njenim stanjem.
2.4
Susie in Tim imata pogovor o dihanju, kaj se zgodi z dihalnimi poti ko ima astmatični napad, da se bo lahko spoprijela ko bo dobila naslednji napad astme. Prinesel ji je knižico da si lahko ogleda diagram respiratornega sistema. Pove ji kaj se zgodi z zrakom ko gre v naše telo in potuje do pljuč. Zrak je vdihan v nosno votlino, nos, kjer se zrak segreje in očisti. Pomika se preko ustne votline, usta, in gre skozi pharynxa oz grla ……….epiglottis=poklopec…….