Critical Reflection on a Simulation

This document provides a critical reflection on a simulation scenario in nursing practice, specifically focusing on nursing assessment and clinical handover. It discusses the importance of assessment in nursing care, the elements of nursing assessment that were performed and those that were missed, and the recommended approach for communicating patient information during clinical handover. The document includes references to relevant guidelines and studies in the field.

Critical Reflection on a Simulation
Scenario
Student’s Name:
University:
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Table of contents
Table of contents 2
Question 1: (approx. 600-700 words) 3
Solution: 4
Question 2: (approx. 300-400 words) 6
Solution: 6
References 8
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Question 1: (approx. 600-700 words)
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Nursing assessment:
Assessment is considered as an important component in nursing practice which is essential to
plan care centered on the patient and his family. NMBA (i.e., Nursing and Midwifery Board of
Australia) states that the registered nurse has the role of assessment, planning, implementation,
and evaluation of nursing care by collaborating with people as well as the care team for
multidisciplinary health for achieving goals as well as health outcomes. In the present
simulation scenario of Mr. Bright who is a 67 years old man with a potential issue of ischaemic
stroke was observed post angioplasty (Hamm et al., 2011). Mr. Bright has undergone stenting
of the right coronary artery along with angioplasty in which large catheters are used and due to
dislodgement of the atheromatous material might have resulted in the embolization of the blood
circulation in the cerebral part which results in the issue of stroke. The following might be the
reason behind the stroke in Mr. Bright case.
Correct nursing assessment performed:
The assessment care element provided to him includes keeping a check on his obs after every
15 mins, providing normal saline at 100 ml per hour followed by ECG which depicted normal
results with no signs of pain, BGL was also carried out and found to be normal (i.e., 10
mmol/L). The element of care should also involve the routine use of thrombolytic agents as
well as anticoagulants which are linked with the embolization of cholesterol (Weintraub et al.,
2012). It has also been recognized in a study that ischaemic strokes followed by angioplasty are
also common among patients with a history of hypertension, smoking habits, as well as DMII
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as observed in Mr. Bright case, could also be one of the reasons behind the stroke. The
assessment was successful to follow up on the observations of hypertension, DMII, ECG.
However, it also missed the attribute of artery distributions as observed in our case when the
femoral sheath was removed at the time of surgery (Wright et al., 2011). The following
elements have been successfully carried out during assessment care such as recording serial
ECG on a regular basis.
The elements of nursing assessment that were not performed:
The placed stent was not properly evaluated while reducing catheter manipulation with the help
of decreased contrast. ECG levels were also found to be elevated at the time of stenting
procedure while the assessment care also lacks the use of thrombolytic agents along with
carrying out the discarding of atherosclerotic debris with the help of catheter (Mahajan, 2014).
The nursing assessment element practiced on Mr. Bright also lack the assessment of any
hemodynamic instability which might have resulted in cerebral perfusion and the formation of
any time of thrombus on the stent or the catheter should be assessed by the nurse (Rassaf,
Steiner & Kelm, 2013). During the assessment, the presence of 10% residual stenosis of the
artery was also not considerable assessed for any further issues (Stolker et al., 2010). However,
the assessment care was not able to include elements such as continuous ST monitoring of Mr.
Bright as certain elevations/depression were observed at the time of stent planting in any of the
2 contiguous leads. Measurement of the cardiac enzyme was also not included in the care
element which is dependent on time starting from the episode of pain, as during that time it is
essential to take a blood sample after 12 hours for troponin T as well as CK-MB(mass). Test of
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exercise stress is also not included in the element of assessment care with the help of a protocol
to interpret arrhythmia, and elevation of ST (Wright et al., 2011).
Question 2: (approx. 300-400 words)
Solution:
As per the recommendations made by the National Safety and Quality Health Service
Standards in terms of Clinical Handover, communicating Mr. Bright’s information should be
carried out as per a standard protocol and a format with the help of ISBAR structured process
for transferring Mr. Bright’s information to the doctor advising him about his chest pain post
angioplasty. ISBAR format for Mr. Bright’s condition is as follows (Moi, Söderhamn,
Marthinsen & Flateland, 2019):
● Identify: “Dr. Smith, this is the registered nurse on Surgery/Med at post operational care.
I have an order for a PE study for Mr. Bright. He has central chest pain ischaemic stroke
followed by angioplasty and I wanted to clarify the situation with you.”
● Situation: I’m caring for Mr. Bright in the postoperative care ward after he was returned
to the ward at 1650 hours. I’m calling with regards to his chest pain with no signs of
radiation. He is observed to have a reported pain of 1 out of 10 on the 1-10 scale mo
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contacted. He is given Nitroglycerin spray x 1 as ordered at 1601 hours which resolved
the pain and ECG was taken to confirm any issues”.
● Background: “Mr. Bright is a 67-year old man who had angioplasty and stenting of his
right coronary artery. But at the time of stent placement, ECG monitoring showed some
cardiac ischemia”
● Assessment: “Mr. Bright ranks his pain as a 6/10 on the point scale in the central part of
the chest. He has shown alert and oriented vitals, his obs are in normal range and a small
amount of ooze has been found at the site of the puncture with no vital signs of swelling,
pain or hematoma”.
● Recommendation: “I think that Mr. Bright has been at ease with no signs of chest pain
after he was given Nitroglycerin spray x 1. What would you prefer to do next? Are there
any tests or assessments you would like to order? What should I ask you for if the chest
pain reoccur ?”.
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References
Hamm, C., Bassand, J., Agewall, S., Bax, J., Boersma, E., & Bueno, H. et al. (2011). ESC
Guidelines for the management of acute coronary syndromes in patients presenting
without persistent ST-segment elevation: The Task Force for the management of acute
coronary syndromes (ACS) in patients presenting without persistent ST-segment
elevation of the European Society of Cardiology (ESC). European Heart Journal,
32(23), 2999-3054. doi: 10.1093/eurheartj/ehr236
Mahajan, S. (2014). Ischaemic Stroke Following Percutaneous Transluminal Coronary
Angioplasty (PTCA): A Rare Complication. JOURNAL OF CLINICAL AND
DIAGNOSTIC RESEARCH. doi: 10.7860/jcdr/2014/6238.4410
Moi, E., Söderhamn, U., Marthinsen, G., & Flateland, S. (2019). The ISBAR tool leads to
conscious, structured communication by healthcare personnel. Sykepleien Forskning,
(74699), e-74699. doi: 10.4220/sykepleienf.2019.74699
Rassaf, T., Steiner, S., & Kelm, M. (2013). Postoperative Care and Follow-Up After
Coronary Stenting. Deutsches Aerzteblatt Online. doi: 10.3238/arztebl.2013.0072
Stolker, J., Kennedy, K., Lindsey, J., Marso, S., Pencina, M., & Cutlip, D. et al. (2010).
Predicting Restenosis of Drug-Eluting Stents Placed in Real-World Clinical Practice.
Circulation: Cardiovascular Interventions, 3(4), 327-334. doi:
10.1161/circinterventions.110.946939
Weintraub, W., Grau-Sepulveda, M., Weiss, J., O'Brien, S., Peterson, E., & Kolm, P. et al.
(2012). Comparative Effectiveness of Revascularization Strategies. New England
Journal Of Medicine, 366(16), 1467-1476. doi: 10.1056/nejmoa1110717
Wright, R., Anderson, J., Adams, C., Bridges, C., Casey, D., & Ettinger, S. et al. (2011).
2011 ACCF/AHA Focused Update of the Guidelines for the Management of Patients
With Unstable Angina/Non–ST-Elevation Myocardial Infarction (Updating the 2007
Guideline). Journal Of The American College Of Cardiology, 57(19), 1920-1959. doi:
10.1016/j.jacc.2011.02.009
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