Debriefing Package for NSB231 Integrated Nursing Practice 2- “Mr Harry Bright”

This debriefing package is designed to assist you with assessment 1 for NSB231 Integrated Nursing Practice 2- “Mr Harry Bright”. It includes identification of assessments performed and not performed by student nurses in the SIM that linked to the potential problem of impaired tissue perfusion related to haematoma formation or bleeding, and a structured verbal handover to the doctor advising of the patient’s chest pain using the ISBAR format.

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
1. Pain assessment Chest pain is a critical
symptoms in post-
operative patient of
coronary angioplasty.
After coronary stent
placement the pain
observed because of the
over-dilation and
stretching of the artery.
The chest pain also
observed because of
squeezing feeling where
occlusion observed due
to the catheterization in
the chest. Therefore,
pain assessment would
provide the idea about
the patient’s pain and
the reason behind pain
which assists in
development of the
interventions for
prevention of the stroke.
de Araujo, L. B. D. S., de
Magalhães Andrade, M. T.,
de Lima Quinteiro, T.,
Júnior, R. A., & Fernandes,
A. M. S. (2019). Intra-aortic
Balloon Pump in Acute
Myocardial Infarction and
Ischemic Mitral
Insufficiency.
In Cardiovascular
Surgery (pp. 143-151).
Springer, Cham.
2. Vital sign
assessment Vital signs are most basic
Function in the basic’s
function. The four main
vital signs routinely
monitored such as blood
pressure, pulse rate,
respiratory rate along
with body temperature.
In the coronary
angioplasty procedure,
the potential problem is
ischemic stroke where
McGillion, M., Yost, J.,
Turner, A., Bender, D.,
Scott, T., Carroll, S., ... &
Krull, K. (2016).
Technology-enabled
remote monitoring and
self-management—Vision
for patient empowerment
following cardiac and
vascular surgery: User
testing and randomized
controlled trial
protocol. JMIR research
protocols, 5(3).

2
School of Nursing
NSB231 Integrated Nursing Practice 2- “Mr Harry Bright”
Student De-Briefing Package
arteries of the brain
become narrowed
caused reduced blood
flow. Due to the
narrowed wall, the blood
pressure become high
which can be monitored
through the vital signs
and helped to manage
the ischemic stroke or
prevention of it. Other
signs were also helped to
provide an idea of the
development of ischemic
stroke.
3.Wound
assessment
One of the side effect of
cardiac catheterization is
wound or bruises and
occlusion. Since patient
had minimum wound
oozing and no bruising
was observed in patient.
Without assessment and
management of wound
can give rise to the
CLABSI infection. The
wound assessment was
important to detect
weather to infection was
caused or not to prevent
the infection.
White, L. A., Brent, K.,
Eherenman, H., & Vance,
C. (2016). Infection
Prevention and Quality
Coordinators Collaborating
to Decrease Central Line
Associated Blood Stream
Infections (CLABSI) by
Monitoring Central Line
Catheter
Maintenance. American
Journal of Infection
Control, 44(6), S94-S95.
Neurological
assessment Neurological assessment
involving CNS is crucial
for assessing sensory
neuron and motor
responses, especially
reflexes for determining
whether the nervous
system is impaired.
During the onset
ischemic stroke, due to
the hindrance of blood
flows, the neurological
impairment was
observed such as
dysfunctional reflexes.
Therefore, neurological
assessment is crucial.
Sung, P. H., Chen, K. H.,
Lin, H. S., Chu, C. H.,
Chiang, J. Y., & Yip, H. K.
(2019). The Correlation
between Severity of
Neurological Impairment
and Left Ventricular
Function in Patients after
Acute Ischemic
Stroke. Journal of Clinical
Medicine, 8(2), 190.

3
School of Nursing
NSB231 Integrated Nursing Practice 2- “Mr Harry Bright”
Student De-Briefing Package
Chest airway entry
Chest airway entry
assessment is crucial
assessment because
after angioplasty, the
blockage of the artery
was cleared which was
presented before.
Therefore, chest air entry
would provide a concise
idea of how well the
heart is able to pump the
blood. Therefore, this
assessment is crucial.
Hernández, E. G., &
González, Z. H. D. (2016).
Postoperative Continuous
Positive Airway Pressure
(CPAP). In Noninvasive
Mechanical Ventilation and
Difficult Weaning in Critical
Care(pp. 179-182).
Springer, Cham.
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

4
School of Nursing
NSB231 Integrated Nursing Practice 2- “Mr Harry Bright”
Student De-Briefing Package
Question 2
Reflect on the simulation at the point in time when Mr Bright complained of chest
pain. Using the ISBAR format, Use the table below to write your structured verbal
handover to the doctor advising of the patient’s chest pain. You will need to reflect
back on your SIM as well as the patient’s clinical documentation available on BB to
complete thoroughly all areas of ISBAR.
If you have not attended your SIM this week use this time to research chest pain
post PCI to assist you in your SIM and for this assessment 1 task. Research ISBAR
and what you are required to communicate in each step.
Handover
Tool
Written Script
I
 Mr. Harry Bright , 67 yers old man
 admission on 10/01/16 at 6:00 in the morning
 under doctor black
 Address: 2, park st. Ashgroove
 Admitted in the ward with the chest pain
S Recently undergone angioplasty: potential problem
related with the ischemic stroke.

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School of Nursing
NSB231 Integrated Nursing Practice 2- “Mr Harry Bright”
Student De-Briefing Package
 I have reviewed Mr. harry bright personally when he was
arrived at PACU.
 He was placed at femoral artery catheter during
assessment
 He was engaged into coronary artery injections where
40% of the occlusion observed for the patient
 His sheath was removed during recovery and he was
suffering from mild chest pain.
 When he was presented in the ward in his right coronary
artery he had an angioplasty and drug eluting stent was
located and it was quite problematic procedure.
 Cardiac monitoring during the stent replacement
indicated some myocardiac ischemia.
 The case was handed over from cath lab staff since the
physician had some struggle regarding doing the
produce and also during monitoring.
 Medical observer immediately contacted when patient
was complaining about his chest pain.
B Issue : ischemic stroke
Medications:
 Metropolo 50mg bd
 Aspirin 300mg daily
 Metformin 500 mg bd
 Simvastatin 20mg daily
 He was a person with hypertensions for 10 years
 Frequently unstable angina
 He had well controlled diabetes type II , he was
administrated with oral hypoglycemic

 20 cigarette daily
 Allergies : not known
A  His height was 170 centimeter and weight was 100kg

 His vital signs were monitored where his blood
pressure was 150/90 which suggested high blood
pressure
 During other assessments pulse his pulse rate was 90
and respiratory rate was 18.
 The oxygen saturation of the patient was normal
highlighting spO2 98%.
 No wound oozing was observed
 During assessment no hematoma was observed.
 No radiation was detected in the further assessments

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School of Nursing
NSB231 Integrated Nursing Practice 2- “Mr Harry Bright”
Student De-Briefing Package
 Central chest pain was observed where pain score was 6
out of 10.
 For resolving the chest pain , nitroglycerin spray
sublingually was given to him which resolved his chest
pain
 His CNS assessment was performed to see neurological
function of patient
 His chest air entry was assessed to see the
functionality of arteries
 His ECG was taken and no further chest pain was
observed for the patient.
R  The admission of patient in the ward to evaluate the
ischemic stroke
 Assessment of ECG report for patient
 The Care for the patient as per the PTC pathway to
reduce the symptoms and development of Ischemic
stroke

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School of Nursing
NSB231 Integrated Nursing Practice 2- “Mr Harry Bright”
Student De-Briefing Package
References:
de Araujo, L. B. D. S., de Magalhães Andrade, M. T., de Lima Quinteiro, T., Júnior, R.
A., & Fernandes, A. M. S. (2019). Intra-aortic Balloon Pump in Acute
Myocardial Infarction and Ischemic Mitral Insufficiency. In Cardiovascular
Surgery (pp. 143-151). Springer, Cham.
Hernández, E. G., & González, Z. H. D. (2016). Postoperative Continuous Positive
Airway Pressure (CPAP). In Noninvasive Mechanical Ventilation and Difficult
Weaning in Critical Care(pp. 179-182). Springer, Cham.
McGillion, M., Yost, J., Turner, A., Bender, D., Scott, T., Carroll, S., ... & Krull, K.
(2016). Technology-enabled remote monitoring and self-management—
Vision for patient empowerment following cardiac and vascular surgery: User
testing and randomized controlled trial protocol. JMIR research
protocols, 5(3).
Sung, P. H., Chen, K. H., Lin, H. S., Chu, C. H., Chiang, J. Y., & Yip, H. K. (2019). The
Correlation between Severity of Neurological Impairment and Left Ventricular
Function in Patients after Acute Ischemic Stroke. Journal of Clinical
Medicine, 8(2), 190.
White, L. A., Brent, K., Eherenman, H., & Vance, C. (2016). Infection Prevention and
Quality Coordinators Collaborating to Decrease Central Line Associated Blood
Stream Infections (CLABSI) by Monitoring Central Line Catheter
Maintenance. American Journal of Infection Control, 44(6), S94-S95.