Clinical Simulation and Clinical Handover

Running head: CLINICAL SIMULATION AND CLINICAL HANDOVER
CLINICAL SIMULATION AND CLINICAL HANDOVER
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Author’s Note:

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).

2CLINICAL SIMULATION AND CLINICAL HANDOVER
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).