Hello folks!
Hope you are all doing well.
It is unbelievable that this was my last second year placement!
I was placed at the Medical ward at the Royal Aberdeen Children’s Hospital. This was my first experience of the Children’s Hospital and I guess also my first experience in children’s nursing as a whole, and it had distinct differences to my neonatal placement.
The Medical Ward is situated on the second floor in RACH. It consists of 20 beds, 13 single rooms and 7 isolation cubicles. The is an oncology/ haematology corridor on the same floor and there is 7 single rooms. The ward also has an infectious and non infectious side. This ward nurses a wide range of children from birth to 16 yrs old.
My experience on Medical Ward was an interesting one…
I had a lot of experience in practicing observations and completing the PEWS chart and escalation stickers. The escalation stickers were used to escalate when a child PEWS scored, for example if their respiration rate was high. There was also different pews charts depending on the age of the child. I also had the opportunity to carry out a neurological examination.
Normal limits for children’s observations
| Age (years) | Respiratory rate (breaths per minute) | Heart rate (Beats per minute) | Systolic blood pressure |
| <1 | 30-40 | 110-160 | 70-90 |
| 1-2 | 25-35 | 100-150 | 80-95 |
| 2-5 | 25-30 | 95-140 | 80-100 |
| 5-12 | 20-25 | 80-120 | 90-110 |
| >12 | 15-20 | 60-100 | 100-120 |
I had the opportunity to deliver person centred and family centred care (which was my favioute part of the placement) and I received lots of lovely heartwarming feedback from all of the children and their families. I also took the opportunity to play some board games with one of the family’s. I found this really lifted the child and the family mood, and it gave them some head space away from the thoughts and worries of being in hospital (which made me feel really happy for them).
I had the opportunity to spend some time on the infectious side, non infectious side and oncology side of the medical ward. Please see the list of conditions I came across while on each of these areas.
Oncology:
*Acute lymphoblastic leukaemia (ALL)
- This is the most common type of cancer affecting children (ages 0-4)- it is less common in adults.
- It is a type of Blood cancer which starts from young white blood cells called lymphocytes in the bone marrow.
- It tends to develops quickly over days/weeks
- The case is unknown however it is said that those with genetic conditions are at a higher risk of this condition.
*Neuroblastoma
Neuroblastoma is a rare cancer that affects children, mostly under the age of 5 years. It develops in early nerve cells called neuroblasts and often starts in the tummy. This link provides lots of information about this condition.
Infectious and non infectious side:
*Asthma– Asthma is a chronic disease that comprises of intermittent outbreaks of severe but reversible bronchial obstruction in individuals that have hypersensitive or hyper-responsive airways. Asthma works very differently for each individual.
*Anaemia- Anaemia is a very common condition where the number of red blood cells or the amount of haemoglobin in red blood cells is less than normal. Iron deficiency anaemia is a specific type of anaemia caused by a lack of the mineral iron in the body. Iron is important in the formation of haemoglobin, so a reduced iron level causes a reduced haemoglobin level in the blood.
Iron deficiency anaemia is the most common form of anaemia. Iron is present in many foods such as red meat, fish and leafy green vegetables. If someone’s diet does not contain enough of these foods, they can develop iron deficiency anaemia.
It can also be caused if the body does not absorb iron from the food that we eat. This can occur if someone drinks a lot of cow’s milk as this blocks iron absorption. It can also develop due to long-term blood loss (for example when girls have periods).
*Belly dancing syndrome this was a very interesting one!
- Its is a rare condition
- Consists of involuntary repetitive rhythmic contractions of the diaphragm
- Causes vibration of the abdomen and it resonates with the movements of a bel dancer
- Also referred to as diaphragmatic flutter
- Can be intermittent (last minutes or hours)
- It is not associated with cardiac rhythms or normal respiratory rate.
- It is a form of myoclonus (sudden brief involuntary twitching of jerky of a muscle or group of muscles) cannot be stopped or controlled.
- Can occur when the patent is asleep and returns again when awake
- Pain can be present during contractions and the patterns of pain can mimic a myocardial infarction.
Bronchiolitis- This is a common chest infection that affects babies and children under 2. It is usually mild and can treated at home but can be serious. Early symptoms of bronchiolitis are similar to a cold; sneezing, runny nose blocked nose, cough and slightly high temp of 38 degrees. Other symptoms may include higher breathing rate, poor appetite, wheezing and becoming irritable. Symptoms usually worse between day 3 and 5/.
*Cystic fibrosis (CF) This is an inherited condition that causes sticky mucus to build up in the lungs and digestive system. This causes lung infections and problems with digesting food. It means that nutrients from food are not absorbed as they should which can lead to malnutrition. There is no cure for CF but there’s a range of treatments to help control the symptoms and prevent complications.
*Dystonia-This is a movement disorder. It involves the muscles contracting involuntarily, causing repetitive or twisting movements and abnormal postures. The movements and postures may be chronic or occur in episodes. This condition can affect one part of your body (focal dystonia) or two or more adjacent parts segmented dystonia. It can be painful and interfere with day to day tasks.
*Hypoxic ischemic encephalopathy– This is a brain dysfunction that occurs when the brain doesn’t receive enough oxygen or blood flow for a period of time.Hypoxic means not enough oxygen ischemic means not enough blood flow. Some children will experience no health issues or just mild moderate effects of HIE. While some others may have more severe and permanent disability such as developmental delay, cerebral palsy (motor impairment), epilepsy or cognitive impairment.
*Dilated Cardiomyopathy– This is rare in children. This is a type of heart muscle disease that causes the heart chambers (ventricles) to thin and stretch growing larger. It tends to start in the hearts main pumping chamber (left ventricle). Dilated cardiomyopathy makes it harder for the heart to pump blood to the rest of the body.
*Tuberculosis (TB) is a contagious airborne disease which commonly attacks the lungs but can affect any part of the body, from the bloodstream to the brain. Despite being preventable, detectable and curable, 10 million people were newly infected with the disease in 2020 alone and 1.5 million people died from it.
*Tetralogy of Fallots– Is a rare condition caused by a combination of four heart defects that are present at birth (congenital). These defects, which affect the structure of the heart, cause oxygen-poor blood to flow out of the heart and to the rest of the body. Infants and children with tetralogy of fallot can have blue-tinged skin because their blood doesn’t carry enough oxygen.
*Type 1 diabetes– Diabetes Mellitus is a group of metabolic diseases that are identified by increased blood glucose levels due also known as hyperglycaemia and the trouble in metabolising carbohydrates fat and protein in which results in the deficiency in the secretion of insulin, the action of insulin or indeed both. It is an autoimmune disorder of multiple aetiology (causes).
*West syndrome– It is a specific type of seizure. It involves Infantile/epileptic spasms associated by abnormal brain wave patterns called hypsarrhythmia and intellectual disability. It is a rare condition. A characteristic pattern called hypsarrhythmia can be seen on an electroencephalogram (machine that detects seizure activity).It happens in clusters. It can be as many as 150 seizures in a cluster and children can have up to 60 clusters a day which equals thousands of seizures.
*Rhino enterovirus- which is a respiratory condition a bit like the common cold.
Thats just a few of the conditions that I saw during my time on this ward. It was really heart warming when it came to the time the children and family’s could go home 🙂
Practiced Skills:
*Suctioning
*Blood glucose measurements
*Insulin Injection & the paper work involved
*Provided nutrition and understand the importance of nutrition. (Meals and providing different kinds of milks).
*Fluid charts
*Paediatric Drug administration and Calculations
What you want
______________ x Volume =
What you’ve got
Drugs that I came across during this placement:
| Amoxicillin (Antibiotic Penicillin) Aciclovir |
| Baclofen |
| Benzylpenicillin (sodium) There was also a benzathine |
| Carbamazepine |
| Caspofungin |
| Cefotaxime |
| Clindamycin |
| Clonazepam |
| Co-Amoxiclav |
| Cyclizine |
| Dalteparin |
| Desmopressin |
| Dexamethasone |
| Diazapam |
| Digoxin |
| Erythromycin |
| Esomeprazole |
| Furosemide |
| Gentamicin |
| Hydrocortisone |
| Ibroprofen |
| Insulin |
| Ipratropium bromide |
| Lactulose |
| Levetiracetam |
| Lorazapam |
| Melatonin |
| Metronidazole |
| Methylprednisolone |
| Midazolam |
| Morphine |
| Naloxone |
| Nifedipine |
| Nystatin |
| Oxybutynin hydrochloride |
| Paracetamol |
| Phenytoin |
| Ranitidine |
| Salbutamol |
| Tranexamic acid |
| Urokinase |
Well thats all from me now, heres to third year!
Wishing my cohort the very best as we take our our next steps as future nurses!
Chlo Jack On Her Mac 