NUR2800 Simulated Practice
 Reasons for end-to-end anastomosis /5 marks
 Subjective and Objective assessment data. /10 marks
 Specific pre-operative nursing cares. /10 marks
 Observations and nursing cares. /10 marks
 Observations between 1300hrs to 1500hrs. /5 marks
 Priorities of care according to 5 Rights of Clinical Reasoning. /15 marks
 Complete SBAR. /5 marks
 Medication orders. /10 marks
 Post-operative care over next 24hrs. /10 marks
 Post-operative complications. /15 marks
 Planning discharge /5 marks
Total Marks /100
NUR2800 SIMULATED PRACTICE
Discuss what would be expected of the RN (you) in looking after Mrs Catherine
Windsor from the day of her admission for an abdominal surgical procedure. Utilise
the principles of clinical reasoning to assist in determining what the nurse should
assess, monitor, and plan including why/what/how and when to intervene and the
rationales associated with these during the evolving situation.
You are advised to read Levett-Jones’ et al. article on ‘The five rights of clinical
reasoning’ and Banning’s article on ‘Clinical reasoning and its application to nursing’
(on DiReCt). There are other articles on DiReCt and in various journals and text
books that would assist you in completing this assignment.
As the nurse is the first point of patient contact in patient care, there is an
expectation that the nurse will be in a prime position to identify when a patient is at
risk of experiencing a critical event through the presentation of warning signs. As
these warning signs may be “missed or not always identified or managed
appropriately” (Levett-Jones et.al. 2010), it is likely that the patient may deteriorate to
a stage where/when suitable rescue (management) may not be possible.
The nurse who “collects cues, processes the information, come to an understanding
of a patient problem or situation, plan and implement interventions, evaluate
outcomes, and reflect on and learn from the process” (Levett-Jones et.al. 2010) is
said to undertake the process of clinical reasoning. Clinical reasoning “focuses on
the assimilation and analysis of health care evidence” …. which is viewed “as the
hallmark of the expert nurse” (Banning 2008).
Mrs Catherine Windsor, 61yrs old, has Type 2 diabetes treated with medication,
exercise and dietary control. She lives alone and her children live out of state. Over
the past six months Mrs Windsor has noticed that she was losing weight, has had
repeated urinary tract infections, having a poor appetite, is lethargic and doesn’t
have as much strength as she used to have. Her weight is 54kgs and her height is
174cms. She used to be a keen gardener. She is quite anxious about the surgery.
She also admits to taking Dandelion and St John’s Wort for the last year.
With various tests performed over the last fortnight, Mrs Windsor was diagnosed as
having prolonged intestinal obstruction. She was admitted for surgery to remove a
cancerous growth in her transverse colon. She went to theatre at 1000hrs. She had
an end-to-end anastomosis performed over a stent. The operation progressed as
expected with no unexpected events.
Question 1 5 marks
Discuss the various health conditions and the reasons why an end-to-end
anastomosis may need to be performed on a patient diagnosed with prolonged
Question 2 10 marks
Describe, with appropriate rationale, the subjective and objective assessment data
that would need to be collected during the pre-operative phase?
Question 3 10 marks
Discuss the specific pre-operative nursing cares that would be provided to Mrs
Upon returning from theatre at 1300hrs, Mrs Windsor has an NG tube insitu and she
has an IDC on hourly drainage. Prior to returning to the ward, Mrs Windsor was
administered 25mgs Metoclopramide. She has also returned to the ward with a PCA
insitu for pain control. A unit of whole blood (350mL) is running over 4hrs.
Medications have been prescribed as per chart.
Question 4 10 marks
Identify what observations and nursing cares would the nurse commence for Mrs
Windsor following her return to the ward at 1300hrs? How often should these
observations be monitored? Include your rationale.
It is now two hours since Mrs Windsor returned from theatre. The frequency of
observations is continued at half hourly intervals. As the RN looking after her, you
are going over the observations and updating the charts.
Question 5 5 marks
Between 1300hrs to 1500hrs, the following observations have been recorded for Mrs
Windsor (see charts). Include in your discussion on the observations the following
a) Would any of the observations cause the RN to be concerned? WHY?
b) What actions should the RN undertake in relation to their concerns?
The following observations were then recorded over the next hour (see ADDS chart
for 1600hrs and 1630hrs). As the RN looking after the patient, there seems to be
some concern in relation to the Mrs Windsor’s present condition.
At 1640hrs, the nurse-call bell is activated within the four bed area where Mrs
Windsor is situated. When the RN answers this, another patient informs you that Mrs
Windsor has slumped her head to one side.
As the RN looking after Mrs Windsor, you assess the overall and immediate
situation. Upon pulling down the sheets, it is noted that there is a pool of blood
around the waist of Mrs Windsor. The emergency call bell is activated. The following
observations are noted (at 1645hrs) (see chart).
Question 6 15 marks
Using the 5 Rights of Clinical Reasoning, discuss the priorities of care, and its
rationale that would be appropriate at this time considering Mrs Windsor’s history
and the procedure that was performed.
Question 7 5 marks
Complete, and attach, an SBAR that the RN would utilise when calling the doctor to
explain the essence of the emergency.
Over the next 15 minutes, the surgical team have assessed the presenting situation
and it is concluded that Mrs Windsor will be taken to theatre for an exploration of the
anastomosis and the effects of the bleed into the abdominal cavity. Mrs Windsor is
intubated and wheeled to theatre. Her children are informed of the presenting crisis.
Question 8 10 marks
Discuss the clinical indications and provide a rationale (WHY) for each of the
medication orders which has been written up for Mrs Windsor. Include the nursing
responsibilities that would be associated with the medication orders.
Mrs Windsor is returned to the ward after having an oversewing of a leak at the site
of the anastomosis. A blood transfusion is in progress for 2 units of whole blood.
Question 9 10 marks
List the post-operative care that Mrs Windsor would require during the next 24 hours
Question 10 15 marks
List possible postoperative complications of (the procedure that Mrs Windsor
underwent.) OR (following general surgery).
Over the next few hours, Mrs Windsor’s condition improves. By the next morning she
is sitting up in the bed at 350. Her observations are now being taken 2hrly. Following