Written OSCA Assessment

You are required to present a 500-word written academic piece that is supported using contemporary evidence.

Guided by the Clinical Reasoning Cycle and patient scenario, students are required to utilize clinical reasoning and demonstrate knowledge regarding the care of Lisa. In this written OSCA students will need to clearly identify one problem, presenting sound rationales that support their decision. Students are encouraged to draw on the patient’s story, cues and related information as they do this. Students are required to outline one goal, nursing care/action and how evaluation will take place; providing rationales supported by literature. Students must focus their nursing care to address the identified problem

SCENARIO:

You a third-year nursing student working on a surgical ward allocated to the high dependency area. It is 7:30am and you have just received the following handover from night staff. Your buddy nurse asks you to care for Lisa today.

Lisa a 38-year-old mother of two who competes in triathlons. Lisa presented to theemergency department 48 hours ago with an acute abdomen and was diagnosed with perforated bowel secondary to suspected diverticulitis. Lisa underwent emergency midline laparotomy with division of adhesions and resection of 10 centimetres of bowel. Since returning to the ward she has suffered intractable pain that is not well controlled with a PCA and intrawound catheters. Her pain is reduced to a 2/10 for about 2 hours after the local anaesthetic via the intra-wound catheters and then increases to 7-8/10. Lisa attempted to sit out of bed yesterday but was unable to sit due to the pain and discomfort while sitting. She had a CT scan which was NAD. Overnight Lisa had a 10 minute period of AF which altered blood pressure. She was given IV potassium and magnesium by MET Call Team.

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On Assessment the following is identified:

CNS: Alert and Orientated rating her pain at a 6/10 and increasing. Lisa has a Fentanyl PCA with 20 mcg background, and 20mcg boluses with a 5 minutes lock out which was increasedafter review by the pain team yesterday. In the last hour she has had 12 demands and 8 deliveries. Lisa has equal limb strength and is able to move herself in bed with assistance. Her GCS is 15 and PEARL. Lisa prefers to lay flat in left lateral position curled up, asking that you do not sit her up as it hurts too much.

CVS: IVC X 2 insitu, one in right forearm, the other in left forearm, both VIP score 0 IV therapy is running at a 6 hourly rate. She has warm peripheries and is slightly diaphoretic. Her vital signs are stable with a heart rate of 80-90 beats per minute in sinus rhythm, blood pressure ranges from 100-106/ 56-60, Temperature is 37.2 celcius. Overnight she has had short runs of AF, self-reverting on the monitor, lasting about 10 minutes. During the most recent episode of AF at 0500hrs today she felt short of breath and her Blood Pressure fell to 85/50. Currently she is in sinus rhythm.

RESP: Respiratory rate of 16-20 shallow breathing, oxygen saturation of 95% on using the AIRVO2 at 50% Flow 40L/min nasal prongs insitu. She has a very weak cough non-productive. On auscultation air entry to bases is quiet but heard in the midzones.

GIT: Abdomen is tender to touch, but soft. Bowel sounds are present throughout all quadrants. Bowels have not been open but she is passing flatus. She remains nil oral at this stage only having ice for comfort, awaiting surgical review. Currently no nausea and has not vomited overnight.

Renal: IDC remains insitu due to immobility. Over the past 4 hours the urine output has been 110ml. Urine test was NAD.

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Metabolic: BSL range between 6.0 and 8.0mmol/L, electrolytes have been stable and morning blood tests of U&E, Mg, K, PO4, LFT, FBE and Coags have been taken at time of MET Call. For repeat at 1000hrs.

Wound: Midline dressing intact, minimal ooze on dressing. No heat or redness noted. Intrawound cathethers insitu. No pressure areas but marking from sheets noted on back.

Social: family aware and husband and children will be visiting in the afternoon.

Regular Medications:

Drug Dose Frequency Route Times

Clexane 40mg BD SC 0800

Paracetamol 1000mg QID IV 0600, 1200, 1800, 2400

Metronidazole 500mg 8/24 IV 0800, 1600, 2400

Ceftrixone 2g Daily IV 0800

PRN Medications:

Drug Dose Frequency Route Times given since midnight

Tramadol 100mg 6/24 IV 0500

Metoclopramide 10-20mg 6/24 IV 0500

Ondansetron 4-8mg 6/24 IV 0200

Intrawound Block orders:

Drug Dose Frequency Times given since midnight

Ropivacaine 0.2% – 20ml per Catheter – 4/24 – 0100, – 0500

PCA Orders:

Drug Dose Concentration Route Bolus

dose

Lock out Background infusion rate

Fentanyl 500mcg in 50ml N/Saline 10mcg/ml IV 20mcg 5 minutes 2ml/hr

All written assessments must align to academic standards.

Academic standards require:

• the use of third person, unless specifically indicated otherwise;
• APA 6th edition for in-text citations and reference list;
• adherence to word count;
• a 12 size font in either Arial, Times New Roman or Calibri;
• 5 spacing; and
• submitted using a MS word document only

Note this assessment does not require an introduction or conclusion.

All assessments should have a title page that specifies:

• Unit Code & Unit Name
• Student Name
• Student Identification number
• Title of assignment
• An accurate word count including in-text citations, but not the end references

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Students should refer to VU Assessment for Learning policy regarding word count and late submission penalties