NSB016 Clinical Practice 6: Reflective Report on Post-Op Simulation

This report reflects on a clinical simulation involving a post-angioplasty patient, Mr. Harry Bright, focusing on the learning objective of post-operative assessment and management of chest pain. The simulation involved a 65-year-old male with a history of hypertension, type 2 diabetes, and hypercholesterolemia who developed myocardial ischemia post-surgery. The reflection covers the student's actions, including monitoring vital signs, administering nitroglycerin, and considering the patient's medication regimen. Reasoning behind clinical decisions, such as using nitroglycerin to relax cardiac muscles, is explained. The report concludes with lessons learned about the importance of close post-operative monitoring and patient education on diet and medication adherence to prevent complications. References to relevant medical literature are included to support the analysis and recommendations.

Running head: REFLECTION SIMULATION
Case Study Reflection
Name of Student
Name of University
Author Note

1REFLECTION SIMULATION
Reporting
During my practical, I was a part of the simulation for a patient Mr. Harry Bright, who
was admitted to my ward after angioplasty surgery. He had a history of unstable angina and
reported chest pain. The patient is a 65-year-old male who has a medical history of hypertension
for over ten years, type two diabetes, which is properly controlled using diet and
hypercholesterolemia, for which he takes drugs. After the surgery monitoring showed that, the
patient had developed myocardial ischemia. The sheath was removed and nitroglycerine was
given to him to relax his cardiac muscles and calm the chest ache. The patient smokes twenty
cigarette sticks per day (Boerma et al., 2010).
Responding
I found that the blood pressure is 150/90mmHg, which is quite high. The temperature of the
patient is normal and the dissolved oxygen level is 98%, for that I had nothing to worry. The
blood glucose level was 10.7mmol/L. the patient’s height was 175cm, the weight was 100 kg,
which I thought reflected that the person is obese according to his BMI report, which is 37. The
chest x-ray report showed that the patient is having obstructive air entry. I did not observer any
crepes or crackles in the lungs.
Relating
I checked the vitals, which showed he needed pain management and we provided him with
nitroglycerine to reduce the pain score (Boerma et al., 2010). The patient showed hypertensive
conditions for which I provided metropol for reducing chest pain and increase blood circulation.
I advised to patient to take metformin for dieting and controlling his weight. I advised the patient

2REFLECTION SIMULATION
to continue his warfarin dose for controlling his hypercholesterolemia (Patel et al., 2011).
Simvastati was also suggested to the patient to control his weight; I think should be admitted in
the hospital and commence a full blood count, electrolyte and urinalysis, blood coagulation
checkup and ECG (Peyronnet et al., 2014). I took care for the patient to monitor his PTCI
pathway to prevent and further complication.
Reasoning
Hypercholesterolemia causes the elevation of heart rate by blocking the cardiac passageway by
fat deposition. This is way I provided beta-blockers and hyperglycemias. Nitroglycerine
smoothens the cardiac muscle by activating the nitrogen oxide which relaxes the smooth muscle,
this is why my superior administered the NG to reduce angina and heart blockage.
Reconstructing
From this I learned that it is important to monitor the patient very closely after PACU, as further
complication can arise from a surgery like in this case when the ;patient developed myocardial
ischemia (Illuminati et al., 2010). I would advise the patient to control his diet and take his
medicines properly everyday to reduce repercussion of the congenital diseases.

3REFLECTION SIMULATION
References:
Boerma, E. C., Koopmans, M., Konijn, A., Kaiferova, K., Bakker, A. J., van Roon, E. N., ... &
Koetsier, P. M. (2010). Effects of nitroglycerin on sublingual microcirculatory blood
flow in patients with severe sepsis/septic shock after a strict resuscitation protocol: a
double-blind randomized placebo controlled trial. Critical care medicine, 38(1), 93-100.
Illuminati, G., et al. "Systematic preoperative coronary angiography and stenting improves
postoperative results of carotid endarterectomy in patients with asymptomatic coronary
artery disease: a randomised controlled trial." European Journal of Vascular and
Endovascular Surgery 39.2 (2010): 139-145.
Patel, M. R., Mahaffey, K. W., Garg, J., Pan, G., Singer, D. E., Hacke, W., ... & Becker, R. C.
(2011). Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. New England
Journal of Medicine, 365(10), 883-891.
Peyronnet, B., Baumert, H., Mathieu, R., Masson‐Lecomte, A., Grassano, Y., Roumiguié, M., ...
& Taille, A. (2014). Early unclamping technique during robot‐assisted laparoscopic
partial nephrectomy can minimise warm ischaemia without increasing morbidity. BJU
international, 114(5), 741-747.