Student Osce exam batch 2020
Advance Surgery
Blood transfusion:
1.Check the physician order for blood transfusion. And consent
2.Take sample for blood grouping and cross matching . Check the blood bottle for safety.
3.Obtain or review the patient blood trans fusion history
4.Insert large bore cannula. prepare emergency drugs beside the patients(epinephrine ,anti-
histamine}ensure its patency using normal saline
5.check vital signs as base line
6.Give Lasix and normal saline 50-100ml before blood administration according to physician order.
7.Monitor patient for complications for first 15minuties.dyspnea ,rashes, purities ,chills and wheezing
8.if complications appear stop blood and notify the doctor
9.after blood finish check vital signs
10.Documentation time date procedure and any complication if occur
Care of patient post cardiac surgery(open heart surgery)
Great patient and introduce your self
Teach patient about (disease , risk factor ,management}
Teach patient regarding drugs (anticoagulant medication) and drug side effect (bleeding(
Avoid vigorous exercise and falling
Teach patient to avoid injures ton prevent bleeding ,brushing with smooth teeth brush
Tech patient about life style changes to avoid recurrence of diseases ( smoking –diet-exercise –
control of diabetes and hypertension)
Teach patient about complication of stopping medication (clots formation )
Teach patient about important of regular follow up to check investigation special (INR) to
adjust the drug level
Documentation
Care of chest tube:
1.Greeting the patient and introduce yourself, explain
2.Wash hand & put on clean gloves
3.Assess respiratory status including:
-Chest movement
-Respiratory patter ( rate, depth and rhythm)
-Auscultated the chest for breath sound
4.Site of insertion:
Check occlusive dressing at exit site/ need for dressing
-Check for presence of signs of infection
Chest tube & tubing:
-Check the tube connection with skin
-Check the tube is secured with tubing
-Check the tubing is secured with bottle
-Check tube for kinks or loops
-Check for swinging of fluid within tubing
5.Drainage system :
-Keep the collecting apparatus below the level of the chest
Assess for fluctuation of the level with respiration
Derange :
- Color & consistency
- Measure amount of drainage
6.Documentation
Dry dressing :
1.Check the physician order
2. Explain the procedure to the pt
3. Wash your hands & wear clean gloves & check equipment’s
4. Remove dressing and observe wound.
5.Wash your hands (surgically), wear sterile gloves
6. Drape the patient
7. Clean skin around wound
8. Clean the wound properly
9. Following aseptic technique
10. Place dressing over, Secure with tape
11.Assist the pt to comfortable position
12. Care of equipment
13. Remove gloves & hand washing
14. Documentation
Immediate post-operative care:
1.Obtain a report from the PACU nurse and review the operating room and PACU data.
2.Perform hand hygiene and put on gloves.
3.Identify the patient and determine level of consciousness, Keep privacy and explain procedure.
4.Place patient in safe position semi- flower’s.
5.Ensure safety ( side rails, co-patient…).
6.Obtain and record vital signs frequently.
7.Evaluate the respiratory status, Oxygen saturation level, airway is patent, and correct the problems if
present.
8.Evaluate the circulatory status: skin color and capillary refill correct the problems if present.
9.Determine swallowing, gag reflexes.
10.Evaluate activity status : movement of extremities.
11.Check dressing for color, presence of drains, and amount of drainage.
12.Assess bleeding from the surgical site.
13.Verify that all tubes and drains are patent.
14.Verify and maintain IV infusion at correct rate, Monitor electrolytes, intake and output.
15.Assess for pain and relieve it by administering medications.
16.Review additional surgeon orders.
17.Encouraged to perform breathing, support coughing and leg exercises at frequent intervals.
18.Remove gloves, Perform hand hygiene. Documentation
Urinary catheter insertion:
1.verify order for catheter insertion
2.Review patient record for any later allergy
3.Assess for perinea erythema, drainage and odor
Plan
1.Gather equipment into the tray
2.Explain the procedure to patient and provide privacy
Implantations
1.Perform hand hygiene
2.Position the patient properly; female assists to dorsal recumbent position ( supine position with knees
flexed and separated; feet flat on the bed. Male; Supine position with legs extended
3.Drape the client
4.Dons clean procedure gloves and washes the perinea area with soap and water; dries perinea area
5.Removes and discards gloves
6.Perform hand hygiene ( surgical hand wash)
7.Open sterile catheter kit and place on bedside table without contaminating the inside of warp.
8.Apply sterile gloves
9.Drape the patient with sterile drapes
10.Organize supply on sterile field .Open inner sterile package containing catheter. Pour sterile
antiseptic solution. Sterile cotton. Open packet contain lubricant. Sterile specimen container
11. before inserting indwelling catheter test the balloon by injecting fluid from prefilled syringe into
balloon port
12.Open the packet of water – soluble lubricant and lubricate the catheter tip
13.Lubricate the catheter 2.5-5 cm for women and 12.5-17.5 for men
14. Place sterile tray and content on sterile drape between legs
15.Cleanse urethral meatus
16. Insert catheter
17 Allow bladder to empty fully or gradually to confirm the catheter in the bladder
18. Inflate balloon fully with amount of fluid recommended by manufacture ( sterile water)
19.Attach end of catheter to collecting tube to drainage system
20.Assist client to comfortable position
21.Remove gloves and dispose the equipment
22.Perform hand hygiene
23.Documents the procedure and patient tolerance to it: catheter size, amount, color of urine
Care of patient with nasal bleeding
1- Greet the patient& introduce your self
2- Explain the procedure to the patient
3- Wash hands and Wear gloves
4- Assess the vital signs especially BP
5- Asses the nose and bleeding site for amount and severity of bleeding
6- Position the patient in sitting position with head flexed for ward
7- Press the nose strill by thumb and index for 10 minutes
8- Instruct the patient to breath per mouth and stop taking
9- If not stop prepare for nasal back insertion or consult for management
10- Document the result
Care of patient post cataract surgery
-monitor vital signs
Asses pain and discomfort, administer analgesic if needed
Eye protection ensure the protective eye shield is in place
Instruct the patient not to rub or press in the eye
Positioning
Encourage the patient to rest in semi flower’s position (head elevated)
Observation of complication(watch for signs of bleeding ,increased pain, change
in vision, report any up normal change.
Educate patient about advice against heavy lifting or strenuous activity ,instruct
on avoiding water in the eyes( swimming)
Teach how to administer eye drops anti biotic ,anti inflammatory
Hand hygiene before Appling eye drops. explain how to clean around eye e with a
clean cloth
Follow up appointment with ophthalmologist
Wearing sun glass and emotional support
mangment of patient with head injury
Airway (assess and maintain patent airway)
Suction if needed and protect cervical spine(spine collar)
Breathing (O2 and intubation ) respiratory rate,effort
Look for chest injury ,check vital signs
Circulation (Check for bleeding),check BP .insert 2 large cannula and fluids if hypo
tensive
Neurological assessment check GCS , pupil size and movement limb movement
and seizure
monitor signs of increased ICP(vomiting,bradi cardia,unequal pupuil)
Give medications as ordered.pain mangment , manitol for raised ICP and tetanus
prophlaxis
nutritional support (initiate within 3 to 5 days),
Rehabilitation activities.
Skin care
Monitor intake and output.
document
trachestomy care
1- Pre procedure preparation:
-confirm physician, order for tracheostomy care
-check the type and size of the tracheostomy tube
2- Catheter supplies:
-sterile gloves ,sterile dressing supplies, normal saline solution and new
tracheostomy holder
3- Patient preparation :explain procedure to the patient ,patient
privacy ,position the patient in semi fowler position
4- Tracheostomy care procedure:
-hand hygiene
5- Access respiratory statues(respiratory rate, effort, oxygen saturation and
auscultate lung sound}
6- Suctioning if needed use sterile technique
7- Clean stoma site use sterile saline, avoid hydrogen peroxide
8- Change tracheostomy holder, ensure ties is not too tight
9- Inspect tracheostomy tube (check for patency, secure placement of the
tube, replace inner cannula if applicable)
10- Apply new dressing
11- Post operative care
-Reassess respiratory statues
-record date , time of care, condition of stoma and complication
-educate patient about sign of infection, how to mange secretion and when to
seek help
-ensure emergency equipment is available(keep spare trach tubes, suction
equipment, oxygen source )
-ensure patient is comfort, re assess pain level
12- Documentation
Sterilization
1. Wash hands.
2. Rinse soiled equipment in cold water.
3. Wash equipment with warm water and soap using a brush.
4. Rinse under running water.
5. Dry thoroughly with soft cloth.
6. Check the efficiency of equipment before packing.
7. Organize all equipment according to the order of use.
8. Used Sterile packaging, i.e., pouches, wrap, or rigid containers serve to
maintain the sterility of processed instruments and allow for aseptic opening at
point of use.
9. Place the package liner in the middle area of table.
10. Close the package as follows:
∗ Close the first flap (Proximal )
∗ Close the right lateral flap then the left lateral flap
∗ Then closed the distal flap.
11. Fix the package with adhesive tape.
12. Label the package with department number, date, and signature.
13. Used Steam sterilization or dry heat for sterilizing instruments, trays.
Suction(oropharngeal suction)
1. Assess the client for clinical signs indicating the need for suctioning
2. Introduce self and verify, the client’s identity and Provide for client privacy.
3. Explain to the client what you are going to do and how he/she can
participate. Prepare the equipment
4. Perform hand hygiene and Wear gloves and other PPE as indicated.
5. Position client in the lateral position and Place the towel or moisture-
resistant pad over the pillow or under the chin.
6. Turn the suction device on and set to appropriate negative pressure on the
suction gauge.
7. Test the pressure of the suction and the patency of the catheter
8. Moisten the tip of suction catheter with sterile water or saline.
9. Pull the tongue forward, if necessary, using gauze.
10. Without applying suction advance the catheter about 10 to 15 cm along
one side of the mouth into the oropharynx.
11. Perform suctioning by Apply your finger to the suction control port to start
suction, and gently rotate the catheter. A suction attempt 10 to 15 seconds
12. Rinse the catheter with sterile water or saline and repeat suctioning until
the air passage is clear.
13. Allow sufficient time between each suction for ventilation and oxygenation.
Limit suctioning to 5 minutes in total.
14. Encourage the client to breathe deeply and to cough between suctions.
15. Promote client comfort and assist him with oral or nasal hygiene.
16. Dispose of equipment and ensure availability for the next suction.
17. Empty and rinse the suction collection container as needed
18. Assess the effectiveness of suctioning.
19. Hand washing
20. Document the procedure (the amount, consistency, color, and odor of
sputum date - time – response)
Measuring blood pressure
1-Wash your hands.
2-Prepare all required equipments.
3-Check the client’s identification.
4-Explain the purpose and procedure to the client.
5-Support the selected arm and turn the palm upward.
6-Remove any constrictive clothing 7-Palpate brachial artery.
8-Center the cuff’s bladder approximately 2.5 cm (1 inch) above the site where palpated the brachial
pulse.
9-Wrap the cuff snugly around the client’s arm and secure the end approximately.
10-Inflate cuff to pressure 20-30 mmHg above point at which pulse disappears.
11-Position the stethoscope’s earpieces comfortably in ears.
12-Open the clamp and allow the aneroid dial to fall at rate of 2 to 3mmHg.
13-Deflating the cuff and note the point where the sound disappears.
14-Record blood pressure on the client’s chart.
15-Replace the instruments to proper place
Check glass comma scale
1.Greeted the patient and co-patient, introduce him/herself and explained what is going to do.
2.Maintained privacy.
3.Wash hands and done gloves
Check the patient’s eye response
4.Eyes open spontaneously.
5.Eyes open in response to voice. ½
6.Eyes open in response to pain. ½
7.No eye opening response. ½
Checked the patient’s verbal response
8.Oriented.
9.Confuse conversation but able to answer you.
10.In appropriate response (word).
11.Incomprehensive sound.
12.No verbal response.
Check the patient’s motor response
13.Obeys command to move.
14.Localize pain full stimuli.
15.Withdraws from painful stimulus.
16.Flexion, abnormal decorticate posturing.
17.Extension, abnormal decorticate posturing.
18.No movement response.
19.Remove gloves, Wash hands.
20.Document the procedure, the consciousness level.
Ear wash(irrigation}
1-verfy doctor order
2-explain procedure to the patient ,obtain consent
3-wash hand and apply gloves
4-check for contra indication(perforated ear drum ,infection, ear surgery history)
5-gather equipment:irrigation syringe,normal saline,kidney basin,cotton balls or
gauze and otoscope for inspection before and after
6-position patient in semi setting position,tilit head toward affected ear to allow
drainage
7-fill syringe with normal saline
8-direct the stream along the top wall of ear canal
9-irrigate genially using intermittent pressure, genially pull auricle up and back
11-allow fluid and debries to drain into basin
12-ispect the ear canal with otoscope again and dry external ear with cotton or
gauze
13-monitor for pain ,dizziness or sign of infection
14-documntation date and time ,type and amount of solution ,ear irrigate,
appearance of cerumen / debris and any complication
