Station - Instructions for candidate
You are an intern on the surgical ward of a metropolitan public hospital.
Thanh Le, a 61-year-old long-haul truck driver, is on the surgical ward the evening before a laparotomy booked for tomorrow morning for a bowel obstruction that has not settled. The nursing staff have mentioned a patient-controlled analgesia (PCA) pump with morphine for after the operation, and the patient has asked for it to be explained tonight.
| Baseline observations (18:00) | Comfortable at rest; afebrile. HR 78 regular, BP 126/74 mmHg, RR 14 breaths/min, SpO2 98% on room air, temperature 36.8 C. Pain 2/10 at rest and 5/10 on coughing. |
|---|---|
| Nursing handover | Nil by mouth from midnight; consent signed; anti-embolic stockings applied; admission bloods sent and a group and save held. The PCA pump is prescribed for after surgery and will be set up in recovery. |
Your tasks are to:
- Explain to the patient how the patient-controlled analgesia pump works, how to use it and the safety limits built into it.
- Counsel the patient on the common and serious side effects and on what to report to the nursing staff immediately.
- Explore and respond to the patient's concerns about dependence, and answer the question about whether someone else can press the button.
- Discuss what happens next: how the pump will be reviewed, how pain relief will continue afterwards, and when driving and work can be reconsidered.
- You do NOT need to examine the patient.
- You do not need to take a full history.
- You do NOT need to prescribe, document or summarise to the examiner.
- The observation chart and admission bloods are in the notes; the examiner will provide them if you ask.
This is a 10-minute station, with 2 minutes of reading time.