Written OSCA: Clinical Reasoning and Care Plan for Lisa, a Patient

This document presents a written OSCA (Observed Structured Clinical Assessment) focusing on the application of the clinical reasoning cycle to a patient scenario involving Lisa, a 38-year-old mother recovering from emergency bowel surgery. The assessment identifies a key patient problem, supported by synthesized facts and inferences such as oxygen saturation levels, respiration rate, and medication usage. It establishes goals for patient improvement, including normotensive blood pressure, improved vital signs, increased urine output, and decreased anxiety. The assessment outlines specific nursing actions, such as monitoring electrolytes, using ISBAR for communication, and adjusting IV rates. Evaluation methods include monitoring oxygen saturation, urine output, and blood pressure levels. The document includes references to support the clinical reasoning and proposed interventions, demonstrating a comprehensive understanding of patient care within the context of the clinical reasoning cycle. Desklib provides access to similar solved assignments and study resources for students.

Running head: WRITTEN OSCA ASSESSMENT 1
Written OSCA Assessment
Student’s name
Institutional Affiliation

WRITTEN OSCA ASSESSMENT 2
Written OSCA Assessment
Issue Identity
The clinical reasoning cycle allows nurses to collect cues about the patient problem,
process the information, and arrive at an understanding of the patient problem or the specific
situation in which the patient is found (Schoenwaldab et al. 2018). The process is meant to help
the nurse to develop a patient plan of intervention, evaluation, and reflection.
Synthesis of facts and Inferences
The saturation of Oxygen is 95% and 50 % when using the nasal prongs in-situ (Battié,
2013). The rate of respiration for the patient is shallow and measures 16-20 meaning the nurse
can help the patient develop solutions for proper posture and breathing (Merrifield, 2016). Her
cough is weak and non-productive implying she is in need of a constant flow of oxygen to her
lungs (Boyle, 2017). The inclusion of Fentanyl in her medication means she is under immense
pain such as the pain presented during cancer (Mukasa, 2015). The medicine belongs to a class
of drugs referred to as narcotic analgesics.
Verbalization
The patient is placed on bed rest. The head of the bed must be elevated, and her position
must frequently change to lower the diaphragm and improve the chances of chest expansion
(Coster, Watkins, & Norman, 2018). It enhances expectoration of secretions, mobilization, and
stabilization of the chest cavity, which is essential for proper body metabolism (Grant, 2016).
Decreased flow of air happens in areas that have a high concentration of the fluid. Sounds of
bronchial breath can occur in areas that high fluid capacity (Battié, 2013).

WRITTEN OSCA ASSESSMENT 3
Establish goals
The nurse must listen out for whizzing sounds, which occur because of accumulation of
fluids. After determining the correct diagnosis of the disease, the nurse needs to establish the
right medical procedures for the patient (Grant, 2016). Pneumonia arises from the inflammation
of the lung cavity because of attacks by microorganisms like Bacteria, viruses, fungi and micro
bacteria (Boyle, 2017). The condition is the sixth leading cause of death in the United States
primarily among young children, and therefore the nurse needs to exercise caution when dealing
with it (Coster et al. 2018).
Verbalization
1. Normotensive in a period of 1 hour
2. Improved signs that are vital in 2 hours
3. Increased output of urine in an hour
4. Decreased rates of anxiety in less than an hour
5. Improved Blood Pressure levels
Take action
The drug works by altering the brain’s affinity to pain to change the manner in which the
body of the patient reacts to pain (Boyle, 2017). The nurse must desist from using the patch form
of the drug for purposes of relieving pain that is mild, and that can quickly go away (Merrifield,
2016). Presence of the Ondansetron ODT in the prescription means the patient nauseates. The
drug is used alone or along with other medications to prevent the patient from vomiting (Lakea,
et al., 2017).

WRITTEN OSCA ASSESSMENT 4
Initiates:
1. Monitoring of the salts in the body of the patient
2. Collection of MO data with the use of ISBAR
3. Acquiring a fluid challenge order
4. Reduction of the IV rate
5. Looking out for the vital signs
6. Urine output monitoring
7. Raising the patient foot to the bet
Evaluate
The nurse will ask the patient whether she or he feels any better
Reviews:
1. The state of Oxygen Saturation
2. The rate of urine output
3. The level of blood pressure
The drug creates the best results for patients under radiation therapy and cancer treatment
procedures (Boyle, 2017). It is essential for preventing vomiting and nausea after surgery (Grant,
2016). The drug works by blocking one of the natural substances of the body that leads the
patient to vomit. The drug is dissolved on top of the tongue and should not be swallowed or
dissolved like other drugs (Grant, 2016). The patient’s metabolic test shows stability in the
electrolytes of the patient, and therefore it is not a cause for alarm. The nurse assesses the depth
and rate of chest movements for shallow respirations and discomfort of the moving chest due to
the walls or the fluids on the chest cavity (Mukasa, 2015).

WRITTEN OSCA ASSESSMENT 5
Reference
Battié, R. (2013). Perioperative Nursing and Education: What the IOM Future of Nursing Report
Tells Us. AORN Journal, 98(3), 249-259.
Boyle, D. (2017). Nursing Specialty Certification and Patient Outcomes: What We Know in
Acute Care Hospitals and Future Directions. Journal of the Association for Vascular
Access, 22(3), 137-142.
Coster, S., Watkins, M., & Norman, I. (2018, April 11). What is the impact of professional
nursing on patients’ outcomes globally? An overview of research evidence. AORN
Journal, 98(3), 249-259.
Grant, R. (2016, February 3). The US is Running Out of Nurses . Retrieved January 11, 2017,
from The Atlantic : http://www.theatlantic.com/health/archive/2016/02/nursing-
shortage/459741/
Lakea, D., K.Engelke, M., A.Koskoa, D., Roberson, D. W., Fany, J., Feliciana, J., et al. (2017).
Nicaraguan and US nursing collaborative evaluation study: Identifying similarities and
differences between US and Nicaraguan Curricula and Teaching Modalities Using the
Community Engagement Model. Nurse Education Today, 51(1), 34-40.
Merrifield, N. (2016, December 19). Universities warn of 20% drop in applicants for nursing
courses after end of bursary . Retrieved January 11, 2017, from Nursing Times Journal :
https://www.nursingtimes.net/news/education/universities-warn-of-drop-in-applicants-
for-nursing-courses/7014339.article

WRITTEN OSCA ASSESSMENT 6
Mukasa, B. (2015). A Public Health Leadership Theory to Address the Shortage of Public Heatlh
Leaders. Walden, 1(1), 1-28.
Schoenwaldab, A., Windsorb, C., Gosden, E., & Douglasb, C. (2018). Nurse practitioner led pain
management the day after caesarean section: A randomised controlled trial and follow-up
study. International Journal of Nursing Studies, 78(1), 1-9.