NSB231 Integrated Nursing Practice 2- “Mr Harry Bright” - De-Briefing Package

1
School of Nursing
NSB231 Integrated Nursing Practice 2- “Mr Harry Bright”
Student De-Briefing Package
Clinical Simulation Learning Experience
This template has been designed to assist you with assessment 1. The number of
rows does not indicate the amount of assessment data to be identified. It is only
a guide. Use this template as part of the debriefing session after the simulation.
Question 1
Use the table below to identify the assessment that was performed by the
student nurses in the SIM that linked to the potential problem of impaired tissue
perfusion related to haematoma formation or bleeding.
Assessment
performed
Critical
thinking/discussion
Research link
Blood pressure was
monitored by the
nurse in regular
interval, which
resulted in
increase in high
blood pressure
from 130/85 to
170/110 .
Patient who has
undergone angioplasty
may have tissue
perfusion or anastomoses
due to which the flow of
blood might get increase.
High blood pressure
increase the contraction
of heart which result in
ineffective pumping of
blood in the heart and
the situation of high
pulmonary pressure can
result in haematoma.
Pulmonary pressure is
associated with the
effective cardiac output,
and when the pressure
increase, it results in
ischemia stroke (Reeves,
Walters & Mahmud,
2018).
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.
Nurses assessed
the patient’s heart
rate which was
ranging to 110
beats per min
Patient who undergo
angioplasty have the
problem of high
contraction of heart walls,
due to which the heart
rate increase, thus can
lead to excessive
pumping of blood to and
from the heart, causing
tissue perfusion and may
result in hematoma
(Compostella et al.,
Compostella, L., Lakusic, N.,
Russo, N., Setzu, T.,
Compostella, C., Vettore,
E., ... & Bellotto, F. (2016).
Functional parameters but
not heart rate variability
correlate with long-term
outcomes in St-elevation
myocardial infarction patients
treated by primary
angioplasty. International
journal of cardiology, 224,
473-481.

2
School of Nursing
NSB231 Integrated Nursing Practice 2- “Mr Harry Bright”
Student De-Briefing Package
2016).
Nurse has make
assessment of pain
in the patient and
noticed the change
in pain score from
8/10 to 10/10. As
nursing
intervention he
was administered
with morphine to
control the pain.
Morphine is known to
decrease heart rate,
pressure in blood and
venous return. It is also
knowing to stimulate
histamine mediated
process which prevent
any kind of infection. It
helps to lower the
myocardial oxygen
demand in patient post
angioplasty. This can help
to eliminate the chance
of any tissue perfusion.
Bellandi, B., Zocchi, C.,
Xanthopoulou, I., Scudiero, F.,
Valenti, R., Migliorini, A., ... &
Parodi, G. (2016). Morphine
use and myocardial
reperfusion in patients with
acute myocardial infarction
treated with primary
PCI. International journal of
cardiology, 221, 567-571.
Use the table below to identify the assessment that was not performed by the
student nurses in the SIM that linked to the potential problem of impaired tissue
perfusion related to haematoma formation or bleeding.
Assessment
NOT
performed
Critical
thinking/discussion
Research link
Nurse has not
made an
assessment for
arrhythmias
and monitored
the changes in
ST segment by
employed an
ECG test soon
after coronary
angioplasty.
Research says that
patient who has
undergone angioplasty
have irregular rhythm
of sinus in heart and
result in low cardiac
output in the patient.
Thus, increase the
chance of hematoma
leading to myocardial
ischemia. In order to
know that current
situation of the patient
it is important to
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.
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.

3
School of Nursing
NSB231 Integrated Nursing Practice 2- “Mr Harry Bright”
Student De-Briefing Package
monitor the ST
segment of ECG
reading as this will
imply the correct
rhythm of heart and
hemodynamic
instability.
Nurse has not
made any
assessment
related to
neurological
changes in the
patient.
Research analysis says
that, people with
surgery in coronary
artery often shows
complication of
hypoperfusion during
the surgery, which
result in neurological
changes in the patient.
By making neurological
assessment nurse, if
nurse observe any
changes in response
sense organ, they can
predict its reason to be
hypoperfusion of blood
which can cause
internal bleeding in
patient.
Foreman, P. M., & Harrigan, M. R.
(2016). Carotid Artery Angioplasty
and Stenting Without Distal Embolic
Protection
Devices. Neurosurgery, 80(1), 66-
66.
Nurse has not
done the
assessment to
check the renal
output of the
patient.
It is often seen that
people who have went
angioplasty face the
issue of renal
dysfunction leading to
high chance of
ischemia. Renal output
will indicate the correct
cardiac output which is
the indirect indicator
for heamatoma in
patient.
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.
Nurse has not
made any
assessment for
Heamatoma after
angioplasty cause
inflammation and
Makino, K., Hirano, K., Kobayashi,
N., Yamawaki, M., Araki, M.,
Sakamoto, Y., ... & Ito, Y. (2019).
Impact of infection severity on