Worsening abdominal pain after bowel surgery
NMC OSCE practice station

The task

You are the nurse on a surgical ward. Kwame Mensah, aged 58, had a bowel operation two days ago and now has worsening abdominal pain. A healthcare assistant is available. Introduce yourself, confirm his identity and carry out a systematic assessment using an A to E approach, including a focused assessment of his abdomen. Record his observations and early warning score on the chart provided, then decide who you need to tell and how urgently. Say aloud what you are checking and why, and describe any examination you would do.

What this station tests

• A NEWS2 of 5 to 6 is an urgent response. Do not give analgesia and wait before telling a senior.
• A tense, tender abdomen with no bowel sounds, fast pulse and low urine output after bowel surgery needs urgent surgical review.
• Score the pain, but also examine: inspect, listen, then palpate gently.
• Keep the patient nil by mouth until reviewed and ask the doctor about fluids and analgesia.
• Listen to the patient's fear and be honest about what is not yet known.

Sources for the clinical content

• Royal College of Physicians: National Early Warning Score (NEWS2)
• NICE NG180: Perioperative care in adults
• NICE NG253: Suspected sepsis in people aged 16 or over
• NMC: The Code

An original practice scenario with invented patients. Not an exam question.

Practise next

• Breathless older patient with a chest infection
• Confused patient after a fall with a head injury
• Children's nursing assessment of a child with a high fever
• Midwifery postnatal home visit with a feeding problem
• Midwifery assessment of reduced baby movements