Hamish OSCE

Question 1

To which class of drug does Salbutamol belong?

Answer 1

Bronchodilators

Question 2

Please outline how salbutamol works ?

Answer 2

Usually given as an inhaler, salbutamol is a short acting B2 - agonist that stimulates B2- receptors leading to smooth muscle relaxation, thereby improving airflow ( bronchodilator ) through constricted airways

Question 3

What are the indicators for using salbutamol with hamish?

Answer 3

Salbutamol is used with hamish for his shortness of breath, to help open his airways and improve blood oxygen concentrations. This will be given as a nebuliser to enable delivery of a significantly higher dose of 2.5mg than an inhaler

Question 4

What side effects of salbutamol may hamish expierence?

Answer 4

Some children can feel their heart beating differently or feel a little jittery. This is usually temporary and will settle down. Some children may have a rash, headache nausea or have muscle spasms but again these tend to be temporary. If any of these happen regularly please speak to your doctor. Or if your worried call your asthma specialist nurse or dial 111 all this information will be on the leaflet with your take home medicines

Question 5

How does the salbutamol work to help hamishs breathing?

Answer 5

Salbutamol works by helping to open airways to allow more air into the lungs

Question 6

How often will I need to give hamish the salbutamol when we go home?

Answer 6

This inhaler you will give him when he is finding it more difficult to breathe, for example when he’s stressed or during excercise

Question 7

Is there anything else I could do to help hamishs breathing?

Answer 7

• Ensure hamish receives his preventer inhalers regularly
• Encourage regular excercise to maintain a healthy respiratory system
• if hamish has an asthma attack, follow the advice in your asthma action plan
• distract hamish to help keep him calm
• administer reliever inhaler as prescribed
• if no improvement dial 999

Question 8

Concern 1: From the history and assessment outline three physiological concerns you have for hamish, and relate them to the Pathophysiology of asthma

Answer 8

Hamish has dyspnoea, Tachypnoea and use of accessory muscles

This is caused by an allergen or irritant which leads to airway hypersensitivity that causes smooth muscle contraction and oedema which narrows the airways and leads to poor gas exchange so there’s a lack of circulatory oxygen and the body then compensates this it causes a increased breathing rate to increase the amount of circulatory oxygen there is a use of the accessory muscles to force more air through the narrower airways and into the lungs.

Question 9

Concern 2: From the history and assessment outline three physiological concerns you have for hamish, and relate them to the Pathophysiology of asthma

Answer 9

Cyanosis and low SpO2

This causes the airways to narrow which leads to insufficient gas exchange and a lack of circulatory oxygen due to the heart having to pump smaller oxygen concentration around the body faster so the cells then receive oxygen.

Question 10

Concern 3: From the history and assessment outline three physiological concerns you have for hamish, and relate them to the Pathophysiology of asthma

Answer 10

Tachycardia

Tachycardia causes the airways to narrow which leads to poor gas exchange and lack of circulatory oxygen which causes the heart to work harder as it pumps smaller oxygen concentration around the body faster so that cells receive oxygen

Question 11

Name one concern relating to hamishs mental well-being

Answer 11

Hamish is very anxious and stressed and needs support

Question 12

Explain the process you would follow in preparation for prioritising care and writing a care plan.

Answer 12

Review hamishs history

Review assessment and clinical observations and decide which are out with acceptable limits

Decide the ADLs with which hamish needs support

Consider priority of importance of Hamishs needs

Write the care plan, ensuring each element is SMART

Ensure evaluation date is set

Question 13

For each of the four priorities of care identified what actions will you take to alleviate them?
Concern 1: Hamish has dyspnoea, Tachypnoea and use of accessory muscles

Answer 13

Administer bronchodilators, steroids, and oxygen as prescribed

Question 14

For each of the four priorities of care identified what actions will you take to alleviate them?
Concern 2: Cyanosis and low SpO2

Answer 14

Administer bronchodilators, steroids and oxygen as prescribed and continuous SpO2 monitoring

Question 15

For each of the four priorities of care identified what actions will you take to alleviate them?
Concern 3: Tachycardia

Answer 15

Monitor HR regularly and report to senior staff if deterioration

Question 16

For each of the four priorities of care identified what actions will you take to alleviate them?
Concern 4: Hamish is very anxious and stressed and needs support

Answer 16

Provide advice and reassurance

Question 17

Of those 4 priorities of care, which three are the most urgent?

Answer 17

Hamish has dyspnoea, Tachypnoea and use of accessory muscles

Cyanosis and low sp02

Tachycardia

Question 18

What is salbutamol ?

Answer 18

Salbutamol is an inhaled medicine that helps open tight airways.

Question 19

Why does hamish need salbutamol?

Answer 19

Hamish is thought to have something called asthma, which causes his airways to become tight and swollen

Question 20

So if hamishs breathing becomes normal should I stop giving him the salbutamol?

Answer 20

Yes , it’s a short acting medicine so should act quickly to relieve hamishs symptoms. Follow the advice given on the asthma action plan about when to give it and when to stop