OSCE › Station
Post-operative care: bleed, DVT and a new stoma
RCSI heading: Nursing process in the acute situation. You get 2 minutes with the descriptor outside the door and 10 inside, marked competent or not competent on every line. RCSI publishes no sample for this station; the descriptor below follows the layout of the two samples it does publish. Check rcsi.com before your date.
Rehearse it
Stand up, say it aloud, use whatever is on your desk as the equipment. The debrief is the competency sheet and the assessor’s questions.
To assess recognition of a post-operative haemorrhage and a deep vein thrombosis, the first actions for each, VTE prevention, and care and teaching for a new colostomy.
Mr Tom Fitzgerald, 58, day one after an anterior resection with a new colostomy. At 11:00 he is pale and clammy, his abdominal drain has filled with 400 mL of fresh blood since 09:00 and the wound dressing is soaked. His left calf is tender and swollen compared with the right. He has not looked at his stoma yet.
You are required to act on the bleeding, assess for DVT and state the prevention measures he should have, assess and describe the stoma, and begin his teaching.
- Recognise the bleed: pallor, clammy skin, drain output, soaked dressing; ABCDE, full observations and INEWS, escalate immediately
- Actions: lie him flat with legs raised if hypotensive, oxygen as prescribed, do not remove the dressing but reinforce and mark it, measure and record the drain, keep him nil by mouth, IV access patent, call the surgical team and the nurse in charge
- State the signs of hypovolaemia in order: tachycardia, narrowing pulse pressure, rising respiratory rate, falling urine output, then hypotension and confusion
- Assess the calf: unilateral swelling, warmth, tenderness, redness, pain on walking; compare both legs, measure circumference; do not massage
- Report the suspected DVT for medical review and imaging; say why anticoagulation may be complicated by active bleeding
- State VTE prevention after surgery: risk assessment on admission, early mobilisation, hydration, anti-embolism stockings if fitted correctly, prophylactic low molecular weight heparin as prescribed, intermittent pneumatic compression if used
- Assess the stoma: colour (pink and moist is healthy; dusky, black or pale needs the team), size and shape, oedema, output and its consistency, the surrounding skin, the appliance seal
- Start teaching: what the stoma is, why it does not hurt, when to empty and change the bag, what output to expect, what to report
- Acknowledge how he feels about the stoma; involve the stoma care nurse and, if he wishes, his family
- Document the drain volumes, observations, the escalation and who came, the DVT findings and the stoma assessment
Throughout: communicate in an accurate, clear and effective manner; demonstrate a level of competence essential for safe practice.
The pass: theory and OSCE
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Competencies assessed
Every RCSI descriptor lists the same five domains from the NMBI standards.
- Professional values and conduct of the nurse
- Nursing practice and clinical decision-making
- Knowledge and cognitive competences
- Communication and interpersonal competences
- Management and team competences
Mistakes candidates report
- Waiting for the blood pressure to fall before calling anyone.
- Peeling off the soaked dressing to "have a look".
- Massaging the sore calf.
- Describing the stoma as "fine" without colour, output and skin.
- Forgetting the person: a first look at a stoma is a shock. Ask how he is.
Practise the parts
Sources
- HSE: Deep vein thrombosis checked 2026-09-16
- HSE: Preventing blood clots in hospital (VTE) checked 2026-09-16
- Irish Stoma Care and Colorectal Nurses Association: stoma care checked 2026-09-16
- NHS: Having an operation, recovery checked 2026-09-16
This descriptor is a practice piece written to the shape of the RCSI samples. It is not an exam task, and the exam may ask anything from the reading list.