Students Orientation Document
Ward 25
Ophthalmology
Ninewells Hospital
Student Nurse: ______
Mentor 1: ______
Mentor 2: ______
Half way assessment date ___/___/___
Final assessment date ___/___/___
Photocopy when completed and file in SCN office
2015
Review Jun 2017
Welcome to ward 25.
The following information is a guide and any information or education can be added during your placement.
You should be allocated a mentor, if not see either the SCN or CN during your first week. If your mentor is absent see SCN or CN immediately.
You should discuss with your mentor particular skills and learning activities you wish to achieve. Set dates and times of achievement.
Also, write down comments and any problems, which arise affecting your objective setting.
If you have any particular problems or concerns with your placement please see me personally, your personal tutor or our ward PEF (contact details on ward poster or in CPPSU mentor folder), thank you.
SCN S.McGilvray
Ward Information
· Student information is on student notice board and information folder, along with general NHS policies, NHS Tayside policies and guidelines. Books and other learning materials are available but please do not remove from the ward.
· Your orientation of the ward and objectives should be discussed by the end of your first week.
· You are responsible for arranging with your mentor a date for your halfway assessment and final assessment. It is your responsibility to keep your competency books safe and up to date.
General responsibilities to discuss with mentor (date and sign when achieved)
0 Dress code
0 Responsibilities if you are sick or absent from duty
0 CPR and resuscitation trolley
0 Manual handling equipment and competencies
0 Fire safety procedure and equipment
0 Infection control policies, Standard Infection Control Practices, Food Hygiene and hand washing practice
Student’s experience and previous learning.
Discussion notes
Statement of Values Relating to the Education of Students
Ward 25
Ninewells Hospital
Dundee
We encourage students to ask questions and will always try to answer them. However, we will expect students to assist with their own learning by developing a questioning approach. We look forward to hearing your views and suggestions about how we can improve the learning experience for our students; this opportunity is available through the university questionnaire, our PEF (Practice Education facilitator), or ward team members.
We Will:-
· Treat students as individuals acknowledging their needs and encouraging their participation in formulating care management.
· Encourage students to feel part of the care team by involving them in assisting and directing healthcare professionals in providing patient care.
· Recognise and value the contribution of all students in the process of planning and carrying out patient care and assist them to achieve/maintain knowledge and skills in order to provide safe and effective care.
Mentors are responsible and accountable for:-
· Organising and co-ordinating student learning activities in practice.
· Supervising students in learning situations and providing them with constructive feedback on their achievements.
· Setting and monitoring achievement of realistic objectives.
· Assessing total performance – including skills, attitudes and behaviours.
· Providing evidence as required by programme providers of student achievement or lack of achievement.
· Liaising with others (e.g. mentors, sign-off mentors, practice facilitators, practice teachers, personal tutors, programme leaders) to provide feedback, identify any concerns about the student’s performance and agree action as appropriate.
· Providing evidence for or acting as a sign–off mentor with regard to making decisions about achievement of proficiency at the end of a programme.
Developed with the support of PEF (Practice education Facilitator) and NMC (Nursing & Midwifery Council) Standards to support learning and assessment in practice July 2008.
Review Jun 2017
Clinical experience (date and sign when achieved)
0 Guiding the visually impaired
0 Safety of the visually impaired in hospital setting
0 Admission and discharge process for routine in-patient and emergency admission
0 Admission and discharge process for day case surgery
0 Bathing the eye
0 Instillation of pre-operative dilating drops (in accordance with NHS Tayside drug administration policy)
0 Instillation of other topical treatments
0 Application of eye shield/dressing
0 Diabetic management and care, diet, drug regimes, protocols
Observation opportunities within ophthalmology (record details of learning for each opportunity achieved)
To be arranged with your mentor
Eye theatre
Learning outcomes
Area 6A/ orthoptist / IV fluoresceine angiography / treatment room/ nurse led glaucoma clinic
Learning outcomes
Pre-assessment clinic
Learning outcomes
LASER clinic
Learning outcomes
Macular degeneration- Intravitreal treatment clinic
Learning objectives
Ophthalmic education sessions with mentor (date and sign when achieved)
0 Basic anatomy and physiology of the eye
0 Measuring visual acuity
0 Cataracts
0 Glaucoma
0 Retinal disorders
0 Squint
0 Red eye
Learning outcomes
· As a student you will be able to achieve competent, safe, planned care for patients with a visual impairment under the supervision of Registered Nurses in ward 25.
· You will achieve any planned outcomes relevant to the stage of your training and education.
· The student will gain awareness of special needs of the visually impaired person.
· Communicate effectively with colleagues, patients and relatives
· Demonstrate safe effective practice using initiative, judgement and showing awareness of areas of learning development asking advice when necessary to maintain patient safety
· Demonstrate understanding of common ophthalmic conditions, nursing interventions and treatments
Student’s learning objectives should be documented in their personal books
Mentor’s comments
Glossary of terms commonly usedAmblyopia / Reduced visual acuity, vision in one eye does not develop fully during early childhood. In most cases, however, glasses do not help
Angiography / Diagnostic test in which vascular system is examined
Fluoresceine angiography is an eye test that uses a special dye and camera to look at blood flow in the retinaandchoroid, the two layers in the back of the eye.
Anisometropia / two eyes have unequal refractive power
Anterior chamber / The anterior chamber is filled with a watery fluid known as the aqueous humour, or aqueous. Produced by a structure alongside the lens called the ciliary body, the aqueous passes first into the posterior chamber (between the lens and iris) and then flows forward through the pupil into the anterior chamber of the eye
Aphakia / Absence of crystalline lens
Aqueous / Clear, watery fluid that fills anterior and posterior chambers
Astigmatism / Astigmatism is usually the result of an irregular-shaped cornea or lens. The cornea is the transparent layer of tissue at the front of the eye.
The cornea should be regularly curved like the surface of a football, but in cases of astigmatism it has an irregular curve, more like the shape of a rugby ball. This means that light rays entering the eye aren't focused properly, creating a blurred image
Axis / Line through the centre
Band keratopathy
EDTA / Calcium deposits on cornea – debridement used to remove calcium deposits
Apply 0.05 mol, 1.5% neutral disodium ethylenediaminetetra-acetic acid (EDTA) to the corneal surface, then scrape off calcium deposits
Blepharitis / Inflammation of the eyelids
Cataract / Opacity of crystalline lens
Canal of Schlemm / Drains aqueous humour
Canthus / Angle formed by junction of upper and lower eyelids
Cataract extraction / Removal of cataract either by intracapsular - the entire natural lens of the eye, including the capsule that holds it in place, is removed. or by extracapsular- involves removing the eye's natural lens while leaving in place the back of the capsule that holds the lens in place
Chalazion / Small swollen sebaceous gland in eyelid
Conjunctiva / Mucous membrane covering front of eyeball and lining of eyelids
Convergence / Process of directing visual axis of eyes to a near point
Cornea / Transparent portion of anterior surface of eyeball
Cyclodiode laser / For painful blind glaucoma – use a G-probe contact surface to indent the conjunctiva and sclera, thus improving energy delivery to the ciliary body
Cycloplegic / Drug to paralyze ciliary muscle
Dacryocystorhinostomy / Procedure to create opening between lacrimal sac and nasal cavity
DASEK – decemet’s automated stripping endothelial keratoplasty / Only the back layer of the cornea is removed, consisting of the endothelial cells and the Descemet's membrane that holds the cells. A partial thickness of the donor cornea, containing new endothelial cells, then is implanted to replace the dysfunctional cells.
Dioptre / Unit used in measuring lenses for spectacles
Diplopia / Seeing one object as two
“E” test / A way of testing visual acuity for someone who cannot understand the alphabet
Ectropion / Turning out of eyelid
Entropion / Turning inward of eyelid
Epiphora / Overflow of tears
Fields of vision / Entire area which can be seen without shifting gaze
Floaters / Opacities in vitreous humour that move about and appear as spots before eyes
Glaucoma / Raised intra-ocular pressure
Hypermetropia / Long-sightedness
Hyphaema / Blood in anterior chamber
Keratoconus / Cone shaped deformity of cornea
Keratometer / Instrument for measuring curvature of cornea
Lacrimal sac / Dilated area at junction of nasolacrimal duct and cannaliculi
Log MAR chart / visual acuity is scored with reference to the Logarithm of the Minimum Angle of Resolution, as the chart's name suggests
designed to enable a more accurate estimate of acuity
Miotic / A drug to constrict pupil
MOH’s (developed by Dr Frederick Mohs / Technique for removing Basal Cell Carcinomaand Squamous Cell Carcinoma (BCCs and SCCs), the two most common skin cancers
The procedure entails removing one thin layer of tissue at a time; as each layer is removed, its margins are studied under a microscope for the presence of cancer cells. If the margins are cancer-free, the surgery is ended. If not, more tissue is removed from the margin where the cancer cells were found, and the procedure is repeated until all the margins of the final tissue sample examined are clear of cancer
Mydriatic / A drug to dilate pupil
Myopia / shortsightedness
OCT / Optical coherence tomography - non-invasive imaging test that uses light waves to take cross-section pictures of your retina, the light-sensitive tissue lining the back of the eye.
Ophthalmoscope / Instrument for viewing inner eye particularly retina and associated structures
Orthoptist / Diagnose and manage disorders of binocular vision and mainly work in the NHS.
Phacoemulsification of lens / The phaco probe is an ultrasonic handpiece with a titanium or steel needle. The tip of the needle vibrates at ultrasonic frequency to sculpt and emulsify the cataract while the pump aspirates particles through the tip. In some techniques, a second fine steel instrument called a "chopper" is used from a side port to help with chopping the nucleus into smaller pieces. The cataract is usually broken into two or four pieces and each piece is emulsified and aspirated out with suction. The nucleus emulsification makes it easier to aspirate the particles. After removing all hard central lens nucleus with phacoemulsification, the softer outer lens cortex is removed with suction only. An irrigation-aspiration probe or a bimanual system is used to aspirate out the remaining peripheral cortical matter, while leaving the posterior capsule intact. The foldable IOL, made of silicone or acrylic of appropriate power is folded either using a holder/folder, or a proprietary insertion device provided along with the IOL. It is then inserted and placed in the posterior chamber in the capsular bag.
Photophobia / Sensitive to light
Pinguecula / Yellowish patch or bump on the conjunctiva near the cornea. The conjunctiva is the thin, moist membrane on the surface of the eye.
Posterior chamber / Part of aqueous chamber that lies behind the iris, but in front of lens
Presbyopia / Impairment of vision occurring in old age
Pseudphakia / Presence of artificial intraocular lens implant
Pterygium / A growth that develops across the clear cornea of the eye that can affect people who spend a lot of time outside in the sun.
Ptosis / Drooping of eyelid
Punctum / Opening of lacrimal ducts at inner canthus of eye
Pupil / Small hole in centre of iris through which light passes into eye
Refraction / Bending or deviation of rays of light, the test to ascertain amount of refractive error
Refractive error / Optical defect which prevent light rays from focusing on retina
Retina / Light-sensitive layer at the back of the eye that covers about 65 percent of its interior surface. Photosensitive cells called rods and cones in the retina convert incident light energy into signals that are carried to the brain by the optic nerve. In the middle of the retina is a small dimple called the fovea or fovea centralis. It is the centre of the eye's sharpest vision and the location of most colour perception.
Retinal detachment / occurs when the thin lining at the back of your eye called the retina begins to pull away from the blood vessels that supply it with oxygen and nutrients
Retinopexy
Pneumatic Retinopexy / Laser retinopexy uses a powerful light beam around the hole to seal or “spot weld” the retina to the underlying tissues, stopping the retina from detaching
Pneumatic retinopexy, inject a gas bubble into the middle of the eyeball then use a freezing probe (cryopexy) or laser beam (photocoagulation) to seal the tear in the retina.
Sclera / It forms the supporting wall of the eyeball, and is continuous with the clear cornea, the episclera, loose connective tissue, immediately beneath the conjunctiva; sclera proper, the dense white tissue that give the area its color; and the lumina fusca, the innermost zone made up of elastic fibers
Sheridan Gardner test / Consists of set of cards, each marked with a single letter of specific size, cards shown one at a time, at 6 meters (usually for children)
Slit lamp / Combination of light and microscope for examining eye
Snellen chart / For testing visual acuity, lines of letters in graded sizes
Strabismus / Squint, It is a condition where the eyes do not look in the same direction
Tarsorraphy / Surgical joining of upper and lower eyelids
Tonometer / Instrument for measuring intra-ocular pressure
Trabeculectomy / Surgical procedure to create a drainage channel in treatment of glaucoma
Uveitis / Inflammation of one or part of uveal tract (iris, ciliary body, choroid)
Visual acuity / Measurement of acuteness of vision
Vitreous / Transparent, jelly-like substance filing posterior space of the eye
COMMONLY USED EYE TREATMENT
ACETAZOLAMIDE CAPSULES / Reduce intra-ocular pressure
BENOXINATE / Corneal anaesthesia, to allow tonometry, fitting contact lens, removal of corneal foreign body
CHLORAMPHENICOL / Broad spectrum antibiotic
CYCLOPENTOLATE 1% / Dilate pupil and paralyses ciliary muscle lasts 24 hours
FLUBRIPROFEN SODIUM (OCUFEN) / Non steroidal anti-inflammatory and inhibits intra-operative miosis (does not have mydriatic properties)
HYPROMELLOSE / Tear deficiency
LACRI-LUBE / Ocular lubricant
LIGNOCAINE&FLUORESCEINE / Corneal anesthesia and stain
NEPAFEN
PHENYLEPHRINE 10% / Dilate pupil lasts 5-7 hours
PILOCARPINE / Miotic, constricts pupil, treat POAG and angle closure glaucoma
PREDNISOLONE ACETATE
TIMOPTOL / Beta blocker, reduces intraocular pressure by reducing production of aqueous humour
TROPICAMIDE / Short acting midriatic lasts 4-6 hours
VISCOTEARS / Ocular lubricant
Instillation of Eye Drops