Assessment

Abdominal Hernia (Pre-Op)

Overview of recent history

Patient Information
Name: Jackie Hernandez
DOB: 02/04/1949 AGE: 72
Hospital number: 000001
Allergies: Penicillin (anaphylaxis)

Presenting complaint:
• Jackie has been admitted onto the Surgical Assessment Unit (SAU) for planned surgery
on her abdominal hernia today (Todays Date). Jackie has been Nil by Mouth (NMB) since
midnight. – check for consent, check for dentures, nail varnish, and metal works, anti-
embolic stockings and NMB
• Walked into hospital unaided but is finding it difficult to mobilise now due to abdominal
pain, pain 7/10. – assess pain score, check for meds after assessment.
• She is anxious/crying about her upcoming surgery– provide emotional support, show
compassion, re-assure and be emphatic

Past Medical History: Underactive thyroid since 2008

Social History:
• Normally- fully mobile and self-caring,
• Lives with her husband,
• House with stairs.
• Smoker.
• Doesn’t drink alcohol.
• Has a normal diet, overweight BMI 34
• Works as a dinner lady in a local school.

Concern:
Work concern – Refer to social service to inform the employer / sick note will be given upon
discharge

Traps:
Cigarette & lighter, Food & water (NMB), Hearing aid, Eyeglasses

NEW OSCE Version 1.0 Page | 1

NEW OSCE Version 1.0 Page | 2
Assessment
Candidate notes
This document is for your use and is not marked by the examiners.
Patient’s details:
Name: Jackie Hernandez
Hospital number: 00001
Address: 1 Sweet Street, Northampton, NN2 7AL
Date of birth: 02/04/1949
Airway
• clear

Breathing
• Respiration, rhythm, depth
• O2 saturation

Circulation
• BP
• Pulse
• Capillary refill

Disability
• abdominal pain 7/10
• Nil by mouth
• smoker
• alert

Exposure – full clinical history

• Temperature
• Underactive thyroid (2008)

NEW OSCE Version 1.0 Page | 3

Assessment
Candidate notes
This document is for your use and is not marked by the examiners.
Physical
• Overweight, BMI 34
• Difficulty in mobilising due to abdominal pain
• NBM status since midnight
• 7/10 abdominal pain

Psychosocial
• Lives with husband
• Works as a dinner lady (work concern)
• Anxious about upcoming surgery

Spiritual
• No spiritual concerns

Sexual
• Lives with husband

NEW OSCE Version 1.0 Page | 4

Planning

Patient details:
Name: Jackie Hernandez
Hospital number: 00001
Address: 1 Sweet Street, Northampton, NN2 7AL
Date of birth: 02/04/1949
1) Nursing problem/need
___ is experiencing abdominal pain due to abdominal hernia with a pain score of
#/10
Aim(s) of care:
____ will verbalize relief of abdominal pain with a pain score between 2-3 out of 10
or less
Re-evaluation date:
Today, 11/03/22, hourly, or if any clinical condition changes.
Nursing Interventions
1. Explain plan of care to ___ and gain consent for all nursing interventions.
2. Monitor and record ___’s observations every ___ as per NEWS score of __
and escalate according to policy.
3. Assess ___’s pain location, radiation and intensity using 0-10 pain scale utilizing
pain assessment tool.
4. Teach ___ alternative pain management such as: diversional activities, deep
breathing exercises, and relaxation techniques
5. Administer to ___ her prescribed medications and monitor for their
effectiveness after 30 minutes.
6. Refer ___ to pain management team upon consent as needed.
7. Instruct ___ the use of call bell and place within reach.
8. Document all aspects of care given to ___.

Name (Print): Tarra Mae Ravena

Nurse signature: Date: 11/03/22

NEW OSCE Version 1.0 Page | 5

Planning

2) Nursing problem/need
___ is feeling anxious about upcoming surgery.
Aim(s) of care:
___ will verbalize anxiety relief and demonstrate improved focus
Re-evaluation date:
Today, 11/03/22, every 4-hourly, or if any clinical condition changes.
Nursing Interventions
1. Explain plan of care to ___ and gain consent for all nursing interventions.
2. Monitor and record ___’s observations every ___ as per NEWS score of __
and escalate according to policy.
3. Orient ___ to the immediate environment and offer self to show support,
compassion and empathy.
4. Encourage verbalisation of ___’s feelings and concerns regarding the upcoming
surgery.
5. Teach on proper Anxiety Reduction Techniques such as deep breathing
exercises, positioning techniques and positive imagery.
6. Administer to ___ her prescribed medications and monitor for their
effectiveness after 30 minutes.
7. Refer ___ to surgical team upon consent as needed.
8. Instruct ___ the use of call bell and place within reach.
9. Document all aspects of care given to ___.

Name (Print): Tarra Mae Ravena

Nurse signature: Date: 11/03/22
NEW OSCE Version 1.0 Page | 6
Planning

3) Nursing problem/need
___ has upcoming abdominal hernia repair that requires safe preparation for
theatre.
Aim(s) of care:
___ will verbalize that she feels safely prepared for upcoming surgery
Re-evaluation date:
Today, 11/03/22, every 4-hourly, or if any clinical condition changes.
Nursing Interventions
1. Explain plan of care to ___ and gain consent for all nursing interventions.
2. Monitor and record ___’s observations every ___ as per NEWS score of __
and escalate according to policy.
3. Assess ___ for any worn accessories/jewelleries and remove for safekeeping
prior to theatre.
4. Measure and prepare the proper size of anti-embolic stockings for ___ to use
after surgery.
5. Ensure that surgeon has properly explained the procedure and ___ has given
informed consent prior to theatre.
6. Explain to ___ and enforce Nil by mouth at least 6-8 hours before planned
procedure.
7. Perform and secure all laboratory and diagnostic tests required for theatre.
8. Administer to ___ her prescribed medications and monitor for their
effectiveness after 30 minutes.
9. Refer ___ to surgical team upon consent as needed.
10. Instruct ___ the use of call bell and place within reach.
11. Document all aspects of care given to ___.

Name (Print): Tarra Mae Ravena

Nurse signature: Date: 11/03/22
NEW OSCE Version 1.0 Page | 7
IMPLEMENTING CARE: SAFE ADMINISTRATION OF MEDICATIONS

OSCE Nursing Field: Adult

Candidate Paperwork and Briefing

Scenario:
Jackie Hernandez has been admitted for elective surgery for an abdominal hernia. She has been
admitted on to short stay surgical ward.
Please administer and document her 12.00 medications, safely and in accordance with the
NMC standards.
It is today and it is 12: 00

• Talk to your patient

• Please verbalise what you are doing and why.
• Read out the chart and explain what you are checking/giving/not giving and why.
• Complete all the required drug administration checks.
• Complete the documentation and use the correct codes.
• The correct codes are on the chart and on the drug trolley.
• Check and complete the last page of the chart.
• You have 15 minutes to complete this station, including the required documentation.
• Please proceed to administer and document her 12:00 medications, safely in accordance with
the NMC standards.

NEW OSCE Version 1.0 Page | 8

 Hernandez 1.8 meters

Jackie 13.5 stone (86.4kg)

02/04/1949 34

000001
Surgical Assessment Unit (MAU) MR Darzi
07:30

Dr. Z Khan 12312321 Dr Z Khan 587

Penicillin Anaphylaxis

Dr Z Khan 587

NEW OSCE Version 1.0 Page | 9

 Hernandez 1.8 meters

Jackie 13.5 stone (86.4kg)

02/04/1949 34

000001
Surgical Assessment Unit (MAU) MR Darzi
07:30

NEW OSCE Version 1.0 Page | 10

 Hernandez 1.8 meters

Jackie 13.5 stone (86.4kg)

02/04/1949 34

000001
Surgical Assessment Unit (MAU) MR Darzi
07:30

NEW OSCE Version 1.0 Page | 11

 Hernandez 1.8 meters

Jackie 13.5 stone (86.4kg)

02/04/1949 34

000001
Surgical Assessment Unit (MAU) MR Darzi
07:30

NEW OSCE Version 1.0 Page | 12

 Hernandez 1.8 meters

Jackie 13.5 stone (86.4kg)

02/04/1949 34

000001
Surgical Assessment Unit (MAU) MR Darzi
07:30

Levothyroxine

100 mcg OD PO 5 days 12:00 Sija Tomas

Today Treat thyroid

hormone

+4 days deficiency
x

Dr Z Khan 587 Dr. Z Khan

Enalapril

20 mg BD PO 5 days 12:00 Sija Tomas

Today Treat high
blood pressure
+4 days 18:00 Sija Tomas x

Dr Z Khan 587 Dr. Z Khan

NEW OSCE Version 1.0 Page | 13

 Hernandez 1.8 meters

Jackie 13.5 stone (86.4kg)

02/04/1949 34

000001
Surgical Assessment Unit (MAU) MR Darzi
07:30

NEW OSCE Version 1.0 Page | 14

 Hernandez 1.8 meters

Jackie 13.5 stone (86.4kg)

02/04/1949 34

000001
Surgical Assessment Unit (MAU) MR Darzi
07:30

NEW OSCE Version 1.0 Page | 15

Evaluation
Candidate notes
This document is for your use and is not marked by the examiners.
Patient details:
Name: Jackie Hernandez
Hospital number: 00001
Address: 1 Sweet Street, Northampton, NN2 7AL
Date of birth: 02/04/1949
Situation
• Abdominal hernia
• Complaints of abdominal pain and is anxious for upcoming surgery
• NEWS score of __

Background
• Admitted today due to planned surgery, diagnosed with abdominal hernia
• ___ is allergic to penicillin and have anaphylaxis as reaction
• ___ is alert but feels anxious, lives with her husband
• Walked into hospital unaided but is finding it difficult to mobilise now due to
abdominal pain
• Normally mobile and self-caring, ___ on NBM since midnight
• ___ will undergo abdominal hernia repair

Assessment
• Recite VS
• ___ is experiencing abdominal pain due to abdominal hernia with a pain score
of #/10
• ___ is feeling anxious about upcoming surgery.
• ___ has upcoming abdominal hernia repair and requires safe preparation for
theatre.
• Interventions done and medications given

Recommendation
• NEWS: Escalation type
• Refer to social services to inform employer (work concern)
• Monitor every 15 minutes for the first hour, 30 minutes for 2-hours, every hour
for 4-hours then 2hours thereafter.

NEW OSCE Version 1.0 Page | 16