Clinical Simulation and Clinical Handover

This essay focuses on the case study of Mr. Bright who underwent angioplasty for unstable angina. It discusses the correct nursing assessment performed and the ones that were missed. The essay also covers the clinical handover of the patient using the ISBAR format.

Running head: CLINICAL SIMULATION AND CLINICAL HANDOVER
CLINICAL SIMULATION AND CLINICAL HANDOVER
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1CLINICAL SIMULATION AND CLINICAL HANDOVER
The essay is going to focus on case study of Mr Bright who has just undergone
angioplasty as he was suffering from unstable angina. He is 67-year-old man, a potent smoker,
having prior issue of hypertension and diabetes mellitus. The essay will reflect on the simulation
performed by nurse in taking effective assessment of the patient.
Correct nursing assessment performed by the nurse in simulation:
On the basis of critical evaluation of nursing care post angioplasty, it can be said that, the nursing
assessment given to Mr Bright are correct while some major assessment was not conducted by
them.
1. Pain assessment was conducted by the nurse by giving proper medication. As seen from
the case study, the patient was left with 10% stenosis at the site of surgery which needs to
be removed. On amputation, it resulted in bleeding and chest pain. Nurse gave
nitroglycerin spray to manage his pain. Nitroglycerin is effective in controlling chest pain
as it increases the blood flow in heart and reduce vascular resistance. It is also known to
lower the blood pressure thus; the medication can help to reduce the stroke (Pragani et
al., 2017).
2. The nurse took assessment to monitor the current status of heart after angioplasty. Nurse
took ECG reading to know the functioning of heart. Research say that ECG shows the
status of systole and diastole of heart which reflect the amount of oxygen being travelled
to heart. If ECG reading comes abnormal, prediction can be made that adequate amount
of oxygenated blood is not pumping by heart. It is important to conduct the test in order
to know the function of heart as this will also reflect the side effect or chance of ischemia
after angioplasty (Sinha, et al., 2017).

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3. Nurses gave assessment for any bleeding from the site of stent replacement, which is
important as because during surgery the aorta and atrium are cannulated and bleeding can
also occur from chest tube site. Hence its assessment will give insight to the nurse about
the chance of occurrence of hematoma (Wang et al., 2019).
The nursing assessment not performed by the nurse.
1. Nurses has not monitored the patient for initial 15 min post operation. Sebaaly (2016)
says that continuous observation of patient will help to determine hemodynamics status,
hematoma, and pedal pulse. Ignorance of such can lead to chance of ischemia.
2. Nurse have not monitored for sign of arrhythmias and changes in ST segment just
following with coronary angioplasty. Sharif and Always (2016) says that after
undergoing angioplasty patient may have irregular sinus rhythm and myocardial ischemia
is the major reason of low cardiac output in postoperative period. Hence, nurse need to
examine the patient for cardiac and hemodynamic instability (Rhim et al., 2016).
3. Nurses has not monitored the pressure of pulmonary artery; Research analysis says that it
should be checked in fixed interval in every 60 min. It is essential for maintaining the
pressure to check tissue perfusion and to avoid any surgical anastomoses. Low pressure
can decrease the contraction of heart and ineffective pumping of blood which can lead to
uncontrollable situation of heart stroke (Reeves, Walters & Mahmud, 2018).
4. Nurse has not performed any neurological assessment of the patient. Patient who has
undergone angioplasty, increases the chance for neurological complications and stroke
which can be caused by hypoperfusion during surgery. Thus, neurological assessment
should be done in continuous manner as risk of ischemia stroke still persist after
operation (Foreman & Harrigan, 2016).

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5. Nurse has not monitored the renal output of the patient. Pavlidis et al. (2015) suggests
that, one of the indicator of operative cardiac output is adequate and accurate renal
perfusion. Renal dysfunction is usually seen in people who have high chance of ischemia.
Thus, its continuous monitoring will help the nurse to check for any stroke in patient.
6. Nurse has not assessed the patient for any local or systemic symptoms of infection in the
patient. Makino et al., (2019) in his study recognized that chance of infection is seen in
sternal or incision in leg after cardiac surgery which is due to hematoma in patient.
7. Additionally, patient was not assessed for any sign of suppression of the immune system.
Aldemir et al., (2015) said that surgeon may give some corticosteroid after angioplasty to
reduce the risk of inflammation which might occur after heart surgery. Hence, nurse
should check effectiveness of immune system that can be able to respond to the medicine.
Clinical handover of patient using ISBAR format
Clinical handover is the effective mean of communication of information of patient to
other nursing staff. ISBAR format involve to represent the condition of patient by the mean of
identification, situation, background, assessment and recommendation in relation to the disease
of the patient (Beament, et al., 2018).
IDENTIFICATION- Firstly, Nurse need to introduce herself and give her identification.
Secondly, the nurse need to know about the patient. Hence, upon conversation, it came to know
that patient name is Mr Harry Bright, who has undergone angioplasty and is shifted to ward.
SITUATION- On observation of the current situation of the patient indicated the symptoms of
myocardial ischemia. His blood pressure has gone to 170/100 and blood glucose level has risen
to 10mmol/l. He was not able to give response and had slurry speech. He was complaining of

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pain in chest which is sign for ischemia stoke. At the site of surgery, there was plaque deposit
which is quite fragile and on monitoring indicated ischemia.
BACKGROUND- Mr Bright is 67-year-old man with medical history of hypertension and
diabetes mellitus which is controllable with proper medication. He is a smoker and can smoke 20
cigarettes per day. He had undergone angioplasty in his right coronary artery where a drug
eluting stent was placed.
ASSESSMENT- On assessing the patient first he showed high blood pressure and high blood
glucose level which is sign of heart dysfunction. The patient was left with 10% stenosis at the
site of surgery, on monitoring he complained for chest pain, immediately Nitro-glycerine spray
was administered sublingually to resolved the issue of pain and high blood pressure (Boden et
al., 2015. Nurse checked his wound, ECG was taken which came normal. He was not having
pain at the site and condition of patient become normal.
RECOMMENDATION- The patient was recommended to quit smoking as this can make his
situation worse. He was given counselling to maintain healthy diet rich in protein and
recommended to avoid any high sugar and carbohydrate food. Further, he was also
recommended to take his medication of blood pressure and diabetes in time and in regular basis
to avoid situation of stroke.

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Reference
Aldemir, M., Adalı, F., Çarşanba, G., Tecer, E., Bakı, E. D., & Taş, H. U. (2015). Comparison of
neutrophil: lymphocyte ratios following coronary artery bypass surgery with or without
cardiopulmonary bypass. Cardiovascular journal of Africa, 26(4), 159.
Beament, T., Ewens, B., Wilcox, S., & Reid, G. (2018). A collaborative approach to the
implementation of a structured clinical handover tool (iSoBAR), within a hospital setting
in metropolitan Western Australian: A mixed methods study. Nurse education in
practice, 33, 107-113.
Boden, W. E., Padala, S. K., Cabral, K. P., Buschmann, I. R., & Sidhu, M. S. (2015). Role of
short-acting nitroglycerin in the management of ischemic heart disease. Drug design,
development and therapy, 9, 4793.
Foreman, P. M., & Harrigan, M. R. (2016). Carotid Artery Angioplasty and Stenting Without
Distal Embolic Protection Devices. Neurosurgery, 80(1), 66-66.
Makino, K., Hirano, K., Kobayashi, N., Yamawaki, M., Araki, M., Sakamoto, Y., ... & Ito, Y.
(2019). Impact of infection severity on clinical outcomes in critical limb ischemia with
tissue loss after endovascular treatment. Heart and vessels, 34(1), 84-94.
Pavlidis, A. N., Jones, D. A., Sirker, A., Mathur, A., & Smith, E. J. (2015). Prevention of
contrast-induced acute kidney injury after percutaneous coronary intervention for chronic
total coronary occlusions. The American journal of cardiology, 115(6), 844-851.

6CLINICAL SIMULATION AND CLINICAL HANDOVER
Pragani, M. A., Desai, K. P., Morrone, D., Sidhu, M. S., & Boden, W. E. (2017). The Role of
Nitrates in the Management of Stable Ischemic Heart Disease: A Review of the Current
Evidence and Guidelines. Reviews in cardiovascular medicine, 18(1).
Reeves, R. R., Walters, D., & Mahmud, E. (2018). Renal artery stenosis and ambulatory blood
pressure monitoring: A case report and review of the literature. Catheterization and
Cardiovascular Interventions, 91(4), 760-764.
Rhim, J. K., Jeon, J. P., Park, J. J., Choi, H. J., Cho, Y. D., Sheen, S. H., & Jang, K. S. (2016).
Prediction of prolonged hemodynamic instability during carotid angioplasty and
stenting. Neurointervention, 11(2), 120.
Sebaaly, M. G. (2016). Renal Artery Angioplasty and Stent Placement. In Procedural Dictations
in Image-Guided Intervention (pp. 451-454). Springer, Cham.
Sharif, S. E., & Alway, S. (2016). The diagnostic value of exercise stress testing for
cardiovascular disease is more than just st segment changes: a review. J. Integr.
Cardiol, 2(4), 41-55.
Sinha, S. K., Mishra, V., Jha, M. J., Razi, M., Abdali, N., Mahrotra, A., ... & Krishna, V. (2017).
Successful restoration of complete heart block to normal sinus rhythm by primary
angioplasty of dual left anterior descending artery. Cardiology research, 8(2), 73.
Wang, L., Pei, D., Ouyang, Y. Q., & Nie, X. (2019). Meta‐analysis of risk and protective factors
for gastrointestinal bleeding after percutaneous coronary intervention. International
journal of nursing practice, 25(1), e12707.