Parotid Lymph Nodes?!

RE: Parotid Lymph Nodes?!

Anthony Todd — Thu, 26 Jan 2017 19:29:02 GMT

[quote user="Gillian Mostyn"]Erm....I thought you was involved in nurse training until recently[/quote]

Yes I was but I am sure I couldn't, and even you, would have some difficulty in answering the example in the apparent syllabus, which I assume it is, in the extract I posted.

I'd be interested to hear other practising vets' opinion as to the need for of some of the "syllabus" in the reference you kindly posted.

It is comprehensive, that's for sure, but I have my doubts about a lot of it's relevance, to veterinary nursing, and even veterinary science.

Structure and function of the lymphatic system, location of its main components - lymph nodes, right lymphatic duct, composition and colour of lymph, thymus, spleen, lacteals, thoracic duct, structure of a lymph node, flow of lymph through nodes and vessels, palpation of superficial lymph nodes; immunity

I wonder if practising vets would think this is essential knowledge for their veterinary nurse to know, and pass in examination?

RE: Parotid Lymph Nodes?!

Gillian Mostyn — Thu, 26 Jan 2017 19:08:13 GMT

[quote user="Anthony Todd"]I doubt if there's a vet in the country who could pass this, or would ever need to pass this, let alone a nurse.[/quote]

Really? I beg to differ.

However, if you are referring specifically to nursing models and theory of approaches to nursing well..erm...That's perhaps because vets aren't just 'big' nurses....

RE: Parotid Lymph Nodes?!

Gillian Mostyn — Thu, 26 Jan 2017 19:05:31 GMT

Are you actually serious Anthony? What did you expect it to say?

- know how to hold an animal

-Know how to clean a kennel

- know how to give an anaesthetic.

FFS... this is a 2 1/2 year vocational diploma or 3 or 4 year degree course. Of course it is comprehensive. As it should be.

[quote user="Anthony Todd"]Who does, and where is, the actual teaching done??[/quote]

Erm....I thought you was involved in nurse training until recently

Incidentally, seeing as you haven't referred to it (yet I assume you checked) the information about lymph nodes is covered by:

As you will have noticed, it doesn't go into any specific depth and therefore the avctualinformation is subject to the quality of the teaching. (Same as any teaching establishment, some teachers are better than others.) Hardly the fault of the nurse training system.

RE: Parotid Lymph Nodes?!

Anthony Todd — Thu, 26 Jan 2017 17:50:11 GMT

Well I have [all 209 pages]

I doubt if there's a vet in the country who could pass this, or would ever need to pass this, let alone a nurse.

Here's a flavour, and there's loads more on any and every facet anyone could ever think of, but try this for starters; you'll need more than a postcard! Sorry, can't reproduce the formatting but you'll get the idea

1 Understand the principles of a systematic approach to the provision of nursing care

1.1 Differentiate between the “medical” model of nursing and the nursing-focussed model

1.2 Explain the “Nursing Process”, mentioning a logical cycle of planning, implementation and evaluation

1.3Compare models of nursing, to include Roper, Logan and Tierney and Orem

1.4 Use a reflective approach to support nursing problem solving.

Ah, reflective" rings a bell. I think I've heard that before.

and on my "cuff inflation"

3.3 Summarise types of endotracheal tube and describe their use and maintenance

Cuffed and uncuffed, disposable and re-sterilisable

Correct placement (breath sounds, chest movement)

Cuff inflation

and that's all on "cuff inflation".....

Who does, and where is, the actual teaching done??

RE: Parotid Lymph Nodes?!

Anthony Todd — Thu, 26 Jan 2017 17:00:01 GMT

Thanks Gillian, I'll have a look.

RE: Parotid Lymph Nodes?!

Gillian Mostyn — Thu, 26 Jan 2017 13:05:19 GMT

https://awardingbody.rcvs.org.uk/document-library/qualification-handbook-2010

RE: Parotid Lymph Nodes?!

Anthony Todd — Thu, 26 Jan 2017 11:59:05 GMT

[quote user="Gillian Mostyn"]All there already.[/quote]

Didn't know that; where can I look?

Can you give me a link please.

RE: Parotid Lymph Nodes?!

Gillian Mostyn — Wed, 25 Jan 2017 19:32:22 GMT

[quote user="Anthony Todd"]

Chemistry of soda lime.

Air flow through sodalime canisters

Cuff pressure of endotubes

Mechanics and pressure of respiration

Central venous pressure ins and outs etc.

[/quote]

All there already.

RE: Parotid Lymph Nodes?!

Anthony Todd — Wed, 25 Jan 2017 10:26:29 GMT

[quote user="Clive Ansell"]Going back to LN's; there could be a single sentence at the end of a syllabus, for vets or nurses[/quote]

As an aside, I wonder if any vet in practice now has any comments of any nature on the training of RVNs 'cos it may help to reshape the syllabus.

Things, just of the top of my head, which may or may not be taught and would be [more?] relevant:

Chemistry of soda lime.

Air flow through sodalime canisters

Cuff pressure of endotubes

Mechanics and pressure of respiration

Central venous pressure ins and outs etc.

etc. etc.

Maybe already in the syllabus but we may be surprised, judging by my experience with a few RVNs

One star me or tell me to shut up; only trying to make it better for you guys....

RE: Parotid Lymph Nodes?!

Clive Ansell — Wed, 25 Jan 2017 10:01:17 GMT

[quote user="Anthony Todd"]It seems that the parotid LN is an exception then and, as we all have a finite capacity to absorb knowledge, let alone apply it, it would be better to add to the knowledge of things that will be needed rather than "knowledge" that won't be needed in a million years.[/quote]

I think we have an infinite capacity to absorb knowledge and learn; I'm still learning something most days and still have a thirst for knowledge. I used to hate being told at university "you don't need to know that", it seemed to be at odds with an institution that paraded slogans like "centre of excellence" and "centre of learning" etc.

Going back to LN's; there could be a single sentence at the end of a syllabus, for vets or nurses, and not necessarily examinable, along the lines of "there are many other small lymph nodes, and lymphoid tissue, that are usually clinically insignificant, but can in rare cases can become clinically relevant. e.g Parotid LN's"

RE: Parotid Lymph Nodes?!

Anthony Todd — Wed, 25 Jan 2017 07:21:29 GMT

[quote user="Gillian Mostyn"]I guess you are out of date with the veterinary nursing qualification. There are two separate learning pathways:[/quote]

Well not really. We were a teaching centre until 2013, so I was vaguely familiar, and involved.

[Remember the ridiculous random sampling of anaesthetic vapour levels in theatre....]

It sounds as if things have got even more distorted since then.

[quote user="Gillian Mostyn"](I agree with David - all knowledge is valuable and often becomes relevant later.)[/quote]

It seems that the parotid LN is an exception then and, as we all have a finite capacity to absorb knowledge, let alone apply it, it would be better to add to the knowledge of things that will be needed rather than "knowledge" that won't be needed in a million years.

Ironically the nurses who had difficulty passing the exams were the best nurses we had; the ones that passed were, in general, the ones that couldn't see the wood for the trees.

I agree the practical skills, which are mainly hands on, are well taught by experienced practical RVNs but the "valuable knowledge" could be better applied to the background to drip pumps [just as a simple example!!] rather than something esoteric, of which, even most vets, have never heard.

RE: Parotid Lymph Nodes?!

Gillian Mostyn — Tue, 24 Jan 2017 20:59:37 GMT

[quote user="Anthony Todd"]

I'd rather they knew how a drip pump worked and that it is rechargeable.

Being able to unblock a drip would be much more useful;

[/quote]

I guess you are out of date with the veterinary nursing qualification. There are two separate learning pathways:

The theory, learned at college, including anatomy etc, for which they have many exams. (I agree with David - all knowledge is valuable and often becomes relevant later.)

Then there is the practical side, learned in practice, where they learn such as how to use infusion pumps - taught by their clinical coach, who is either an RVN or a VS. They are examined in practical tests called OSCEs.

I don't know about you, but I think it is pretty close to how I learned. I certainly learned the majority of my practical skills while seeing practice.

RE: Parotid Lymph Nodes?!

David Mills — Tue, 24 Jan 2017 12:24:06 GMT

[quote user="Anthony Todd"]

[quote user="Clive Ansell"]and learning about them cannot be a bad thing even for nurses?[/quote]

As I have said before, there's "learning" to be examined and graded on, and there's "learning" that you need to know for your job, which is to assist vets in their dealing's with animals.

And learning about the virtually unknown parotid lymph node won't do that in a thousand years..

Pretty obviously the syllabus wasn't designed by anyone who had ever been in practice.

[/quote]

You can say that about probably 80-90% of the veterinary medicine course (most of the preclin years) - who can, or needs, to remember about DNA replication, enzymatic reactions, the apoptosis pathway, in everyday veterinary life?

Sometimes apparently irrelevant knowledge leads to greater knowledge.

RE: Parotid Lymph Nodes?!

Anthony Todd — Tue, 24 Jan 2017 10:32:31 GMT

[quote user="Clive Ansell"]and learning about them cannot be a bad thing even for nurses?[/quote]

As I have said before, there's "learning" to be examined and graded on, and there's "learning" that you need to know for your job, which is to assist vets in their dealing's with animals.

And learning about the virtually unknown parotid lymph node won't do that in a thousand years..

Pretty obviously the syllabus wasn't designed by anyone who had ever been in practice.

RE: Parotid Lymph Nodes?!

Clive Ansell — Tue, 24 Jan 2017 09:50:57 GMT

[quote user="Evelyn Barbour-Hill"]These are nurses not veterinary surgeons under discussion![/quote]

True, according to the OP.

I was just making the point that there could be clinical cases where knowledge of parotid LN's may be relevant, and learning about them cannot be a bad thing even for nurses?

RE: Parotid Lymph Nodes?!

Evelyn Barbour-Hill — Mon, 23 Jan 2017 14:44:59 GMT

[quote user="Clive Ansell"]I wouldn't say that knowledge of the parotid lymph nodes is irrelevant, there may be cases where they are enlarged either on clinical exam or by means of more advanced imaging such as CT or MRI, so may be relevant occasionally or rarely even. [/quote]

These are nurses not veterinary surgeons under discussion!

RE: Parotid Lymph Nodes?!

Anthony Todd — Mon, 23 Jan 2017 14:08:47 GMT

[quote user="Clive Ansell"]No knowledge is wasted, and may even help solve that unusual or difficult case one day[/quote]

I thought that was what the vet did?

RE: Parotid Lymph Nodes?!

Clive Ansell — Mon, 23 Jan 2017 13:56:06 GMT

[quote user="Anthony Todd"]on their ability to retain irrelevant information [/quote]

I wouldn't say that knowledge of the parotid lymph nodes is irrelevant, there may be cases where they are enlarged either on clinical exam or by means of more advanced imaging such as CT or MRI, so may be relevant occasionally or rarely even. No knowledge is wasted, and may even help solve that unusual or difficult case one day

RE: Parotid Lymph Nodes?!

Anthony Todd — Mon, 23 Jan 2017 13:07:03 GMT

to learn the parotid lymph node.....

I'd rather they knew how a drip pump worked and that it is rechargeable.

Being able to unblock a drip would be much more useful; can't expect modvets to be able to do that.....

They are being examined on their ability to retain irrelevant information and the more obscure it is the easier it is to pass a few and fail the rest.

Colour of the corpus luteum anybody??

Although, IMHO, the ones that fail are probably the ones I would have rather employed....

[undoubtedly will be a one star post, so I dunnit already.]

RE: Parotid Lymph Nodes?!

Elisabeth Knappett — Mon, 23 Jan 2017 11:42:12 GMT

Couple of stupid questions as we have a couple of trainees and neither of them (nor the clinical coach) remembers having to learn the parotid lymph node......is it specifically for equine (but just noted on the dogs head) and is it correctly labelled i.e. not the retropharyngeal mislabelled?

RE: Parotid Lymph Nodes?!

Beats — Fri, 20 Jan 2017 19:08:35 GMT

Miller's anatomy of dog 4th ed pp.541-545 "Lymph Nodes and Vessels of Head and Neck" names:

Parotid lymph center (parotid lymph nodes)

Mandibular lymph center (mandibular lymph nodes, buccal lymph nodes)

Retropharyngeal lymph center (medial retropharyngeal lymph node, lateral retropharyngeal lymph node)

Superficial Cervical lymph center (superficial cervical lymph nodes)

Deep cervical lymph center (cranial, middle and caudal deep cervical lymph nodes)

Aspinall nursing anatomy 3rd edition has diagram of "major" lymph ducts and nodes (p.90):

Parotid lymph node

Submandibular lymph node

Retropharyngeal lymph node

Prescapular lymph node (superficial cervical nodes in text)

Axillary lymph node

Tracheal duct

Bronchial lymph nodes

Thoracic duct

Cisterna chyli

Mesenteric lymph nodes

Superficail inguinal lymph nodes

Popliteal lymph nodes.

I noted very large parotid lymph nodes once only, in a cow though.... I suspect they are palpable in some lymphoma cases in dogs if you feel for them; they were fairly obvious on the one occassion I dissected to excise a parotid salivary gland.

RE: Parotid Lymph Nodes?!

Laura Kidd — Fri, 20 Jan 2017 12:47:45 GMT

pleasure and sounds sensible!

RE: Parotid Lymph Nodes?!

Michael Woodhouse — Fri, 20 Jan 2017 12:37:42 GMT

Thanks Laura, that's very helpful. I will not say too much on the open forum, but intend to have a quiet word next time we get a visit from the college.

RE: Parotid Lymph Nodes?!

Laura Kidd — Fri, 20 Jan 2017 09:33:12 GMT

Hello,

I have taught A and P to SVNs for years alongside working in clinical practice. Would hope my teaching materials are all of a high quality- but would also want to know if they are not.

It would depend on what training pathway the SVN is following, the species covered, the awarding body and syllabus that is taught what might need to be learned in relation to the lymphatic system. The syllabus we follow states that clinically relevant LNs need to be taught. SVNs are taught the general structure and function of the lymphatic system and should be aware there are numerous lymph nodes-.

Re clinically significant- I consider this to be the superficial/ palpable ones (e.g. (sub)mandibular, prescap/ superficial cervical and popliteals); I also teach the clinical significance of LNs such as the axillary inguinal, mesenteric and retropharyngeal; they are also taught about the cisterna chyli/ thoracic duct and clinical significance re chylothorax etc.

In answer to the original question, I have never taught the parotid LN but definitely do teach about retropharyngeal LNs. To the best of my knowledge have never seen a patient with enlarged parotid LNs but have seen many with RP LN enlargement.

In relation to the SVN syllabus and exams, however, I think any LN could in theory be examined......

RE: Parotid Lymph Nodes?!

Martin Atkinson — Fri, 20 Jan 2017 09:32:37 GMT

[quote user="Evelyn Barbour-Hill"]Why does a nurse need to know more than that there are various lymph nodes draining the head which may be palpably enlarged?[/quote]Just because they are only! nurses doesn't mean they don't have a thirst for knowledge. Don't devalue/denigrate their quest, nurture them. There's lots of things I don't need to know but I still want to know them. I'm happy when my nurse(s) ask me questions I don't know the answer to and take great pleasure in finding out with them in some cases they know more than I do and jolly good show for them.

They may not be clinically relevant but if you fancy doing a parotid salivary gland excision its probably best to know what is a salivary gland and what is a lymph node.