T-Levels Health (Adult Nursing and Healthcare Support) Syllabus

Describe the path of blood through the heart starting from the vena cava.

Vena cava $\to$ right atrium $\to$ tricuspid valve $\to$ right ventricle $\to$ pulmonary artery $\to$ lungs $\to$ pulmonary vein $\to$ left atrium $\to$ bicuspid (mitral) valve $\to$ left ventricle $\to$ aorta $\to$ body.

What is the main function of the respiratory system and where does gas exchange occur?

To take in oxygen and remove carbon dioxide. Gas exchange occurs in the alveoli of the lungs by diffusion across the thin, moist alveolar walls.

Name the main organs of the digestive system in order.

Mouth $\to$ oesophagus $\to$ stomach $\to$ small intestine (duodenum, jejunum, ileum) $\to$ large intestine $\to$ rectum $\to$ anus. Accessory organs: liver, pancreas, gallbladder.

What is homeostasis?

The maintenance of a stable internal environment within narrow limits despite changes in external conditions, e.g. regulation of temperature, blood glucose, water and pH.

Explain negative feedback in homeostasis.

A control mechanism where a change from the set point is detected by receptors, and the body responds via effectors to reverse the change and return the variable toward the set point (e.g. body temperature regulation).

State the normal reference ranges for adult resting heart rate, respiratory rate and body temperature.

Heart rate: $60\text{–}100\ \text{bpm}$; respiratory rate: $12\text{–}20$ breaths per minute; body temperature: approximately $36.1\text{–}37.2\,^{\circ}\mathrm{C}$ (around $37\,^{\circ}\mathrm{C}$).

What is a normal adult blood pressure value and what do the two numbers represent?

Around $120/80\ \text{mmHg}$. The top number is systolic pressure (heart contracting/ejecting blood) and the bottom is diastolic pressure (heart relaxing/filling).

How is Body Mass Index (BMI) calculated and what range is classed as healthy?

$$\mathrm{BMI} = \frac{\text{mass (kg)}}{\left[\text{height (m)}\right]^{2}}$$ A healthy range is $18.5\text{–}24.9\ \text{kg/m}^{2}$; $25\text{–}29.9$ is overweight and $\geq 30$ is obese.

What is the difference between a communicable and a non-communicable disease, with examples?

Communicable diseases are infectious and can spread between people (e.g. influenza, tuberculosis, COVID-19). Non-communicable diseases are not infectious (e.g. type 2 diabetes, coronary heart disease, cancer).

List four modifiable lifestyle risk factors for non-communicable disease.

Smoking, poor diet (high fat/sugar/salt), physical inactivity and excessive alcohol consumption. (Others: obesity, stress.)

What is the difference between Type 1 and Type 2 diabetes?

Type 1 is an autoimmune condition where the pancreas produces little or no insulin (usually early onset, insulin-dependent). Type 2 is where the body becomes resistant to insulin or produces insufficient amounts, strongly linked to lifestyle and often managed with diet, medication or insulin.

What are the core values of person-centred care (the '6Cs')?

Care, Compassion, Competence, Communication, Courage and Commitment.

Define person-centred care.

An approach that places the individual at the centre of their care, treating them with dignity and respect, recognising their preferences, needs and values, and involving them as an equal partner in decisions about their care.

What is meant by 'dignity' and 'privacy' in care?

Dignity means treating someone with respect, valuing their individuality and not causing embarrassment. Privacy means giving the person freedom from intrusion and keeping personal/bodily matters and information confidential.

Distinguish between verbal and non-verbal communication, giving examples of non-verbal.

Verbal is communication using words (spoken or written). Non-verbal communication is without words, e.g. body language, facial expressions, eye contact, gestures, posture, touch and tone of voice.

What is active listening and name two techniques used in it?

Fully concentrating on, understanding and responding to the speaker. Techniques include maintaining eye contact, nodding, paraphrasing/summarising, asking clarifying questions and not interrupting.

Name three communication aids that support people with sensory or communication needs.

British Sign Language (BSL) / interpreters, Makaton, hearing loops/aids, braille, picture/symbol boards (e.g. PECS), and translation services.

What is safeguarding and what are the main categories of abuse defined under the Care Act 2014?

Safeguarding means protecting an adult's right to live in safety, free from abuse and neglect. Categories include physical, sexual, psychological/emotional, financial/material, neglect, discriminatory, organisational, domestic abuse, modern slavery and self-neglect.

State the five statutory principles of the Mental Capacity Act 2005.

1) Assume capacity unless proved otherwise; 2) support the person to make their own decision; 3) an unwise decision does not mean lack of capacity; 4) any decision made for someone lacking capacity must be in their best interests; 5) choose the least restrictive option.

What is the two-stage test of mental capacity?

Stage 1: Is there an impairment of, or disturbance in, the functioning of the mind or brain? Stage 2: If so, does it mean the person is unable to make the specific decision (understand, retain, weigh up the information, and communicate the decision)?

What are DoLS (Deprivation of Liberty Safeguards)?

Legal safeguards under the Mental Capacity Act ensuring that any restriction amounting to deprivation of a person's liberty (who lacks capacity) in a care home or hospital is lawful, in their best interests and the least restrictive option, with proper authorisation.

What is health promotion and name a model used to plan it?

The process of enabling people to increase control over and improve their health through education, prevention and supportive environments. A key framework is Tannahill's model (health education, prevention, health protection); the Ottawa Charter is also widely used.

Describe the stages of the Transtheoretical (Stages of Change) model of behaviour change.

Pre-contemplation $\to$ contemplation $\to$ preparation $\to$ action $\to$ maintenance (with possible relapse). Developed by Prochaska and DiClemente.

What are the three levels of disease prevention with an example of each?

Primary prevention stops disease occurring (e.g. vaccination, health education); secondary prevention detects/treats early (e.g. screening); tertiary prevention reduces impact/complications of existing disease (e.g. rehabilitation).

What is the purpose of a care plan and what does it typically contain?

A care plan documents an individual's assessed needs and how they will be met. It contains personal details, assessed needs, goals/outcomes, the support/interventions required, who provides them, and review dates.

Name the stages of the care planning cycle.

Assessment $\to$ planning $\to$ implementation $\to$ evaluation/review (then re-assess). Sometimes summarised as ASPIRE: Assess, Plan, Implement, Review/Evaluate.

What are 'activities of daily living' (ADLs)? Give examples.

Routine self-care tasks people perform daily for independence, e.g. washing/personal hygiene, dressing, eating and drinking, mobility/transfers, toileting/continence and grooming.

What does the acronym NEWS2 stand for and what is it used for?

National Early Warning Score 2 — a standardised tool that scores six physiological observations (respiratory rate, oxygen saturation, systolic blood pressure, pulse, level of consciousness/AVPU, temperature) to detect and respond to clinical deterioration in adults.

What are the '5 moments for hand hygiene' identified by the WHO?

1) Before touching a patient; 2) before a clean/aseptic procedure; 3) after body fluid exposure risk; 4) after touching a patient; 5) after touching patient surroundings.

What is the 'chain of infection' and how is it broken?

The sequence: infectious agent $\to$ reservoir $\to$ portal of exit $\to$ mode of transmission $\to$ portal of entry $\to$ susceptible host. Breaking any link (e.g. hand hygiene, PPE, isolation, sterilisation) prevents the spread of infection.

What are 'standard precautions' in infection prevention and control?

Basic measures applied to all patients regardless of infection status, including hand hygiene, use of PPE (gloves, aprons, masks), safe handling/disposal of sharps and waste, environmental cleaning and respiratory/cough etiquette.

What is a long-term condition and what is meant by self-management?

A long-term (chronic) condition is one that currently cannot be cured but can be managed with treatment, e.g. asthma, diabetes, COPD, arthritis. Self-management is supporting people to take an active role in monitoring and managing their own condition day to day.

What are the five priorities for care of the dying person (end of life care)?

1) Recognise the person may be dying and communicate this; 2) communicate sensitively; 3) involve the dying person and those important to them in decisions; 4) support the family/those important to them; 5) create an individual plan of care delivered with compassion.

What is the difference between palliative care and end-of-life care?

Palliative care is holistic care to relieve symptoms and improve quality of life for people with a serious/terminal illness, which can be given at any stage. End-of-life care is the support given in the last phase of life (often the last year/days) including dying with dignity.

What is an advance care plan / advance decision?

A voluntary process where a person, while they have capacity, records their wishes and preferences for future care. An Advance Decision to Refuse Treatment (ADRT) is legally binding and lets a person refuse specified treatment in advance should they lose capacity.

What is rehabilitation and what is the goal of promoting independence?

Rehabilitation is a process of supporting a person to recover, regain or maintain skills and function after illness, injury or disability. Promoting independence aims to enable people to do as much as possible for themselves (a 'reablement' approach) to maintain autonomy and dignity.

Give examples of services and roles found in community and primary care.

GP surgeries, district/community nurses, health visitors, community pharmacists, social workers, occupational therapists, physiotherapists, and care provided in people's homes or community clinics rather than in hospital.