OSCE A-E COPY Flashcards
What is Step 1?
Greet the Patient, introduce yourself, Explain the interaction, and gain consent.
Close the curtain or acknowledge the closed door for patient privacy and dignity.
Introduction
Wash your hands - say you have.
Are you comfortable with eye contact?
Do you need anything before we start? (toilet, to make a phone call etc.)
If you need me to repeat myself or say something in a different way, please tell me.
What is Step 2?
Confirm the Patient’s identity. (Name, DOB, Hospital Number,) Check wristband!
check date admitted
Preferred Name?
What is Step 3?
Insert the correct date and time into the observation chart.
What is Step 4?
AIRWAY
AIRWAY
Check the airway is clear (Speaking clearly).
What to do if the patient wasn’t speaking clear?
If a patient weren’t speaking clearly, I would check for obstruction.
Airway obstruction causes paradoxical chest and abdominal movements (‘see-saw’ respirations) and the use of the accessory muscles of respiration.
Checking for sounds, like rattles, snoring, a stridor, or a wheeze.
If present, I would do a head tilt and a chin lift (if unconscious).
What to if conscious, treat as if chocking (Stridor or quiet).
What is Step 5?
Breathing
Take Respiratory rate (By chest movement) for 1 minute.
What is Step 6?
Breathing
Observe rhythm, rate and depth of breathing.
Breathing effort should be easy (nonlabored) and in a regular rhythm.
Observe the depth of respiration and note if the respiration is shallow or deep.
What is Step 7?
Breathing
Take saturation (SpO2) with an oxygen sat probe.
Note:
- If the patient had nail polish/paint on, cold fingers (use acetone to clear).
- Carbon Monoxide (CO) poisoning. This will give falsely high readings because the sensing probe cannot distinguish between oxyhemoglobin and carboxyhemoglobin.
- Cold fingers/ Hypothermia will lower blood circulation to the peripherals by maintaining the core with oxygen.
- Skin colour
What are normal respiratory rates?
12-20
What are normal O2 saturations?
96%<
What is Step 8?
Circulation
Take the radial (wrist) pulse.
What is Step 9?
Circulation
Observe regularity, strength and rate of pulse.
What is Step 10?
Circulation
Use a blood pressuring machine or manual.
- Preferred Arm?
- Fold it in half, and check that the patient’s arm fills it.
- Identify brachial pulse.
- Any Brachial Fistulas?
What is Step 11?
Circulation
Assess peripheral capillary refill time.
Place hand next to heart, and pinch finger for 5 seconds, blood should return after 2 seconds.
What is Step 12?
Circulation
When did the patient last passed urine
PU/
Ask for urine colour.
What are normal blood pressure measurements?
120/80
What is a normal pulse (HR)?
60-100 (If tachycardia, then are they stressed/in pain/exercised).
What is a normal temperature?
37C (>0.5<)
What can influence temperature?
Infection - signs of different temperature = Shiver (Cold) or Rigour (Heat shivers)
Being exposed to different temperatures, such as being in the cold etc.
What are normal glucose levels?
4-7
What to do if the patient has a lower glucose level?
Hypoglycemia
Give sugary food, and then a carb (for longer energy).
If NBM (Nil by mouth) or pre-op, IV infusion is 10%.
What to do if the patient has a higher glucose level?
Hyperglycemia
Speak to the Senior nurse-
Ask if they’ve taken their shots if diabetic possibly about insulin dosage.
What is a normal urine output?
0.5ml/hr per kg
0.25ml/hr per kg post op.
What is Step 14?
Disability
AVCPU
A = Alert
V = Voice
C = (New) Confused
P = Pain (responds to pain)
U = Unresponsive.
What is Step 15?
Assess the patient’s pain (0/3)
I would also note the patient’s behaviour in non-verbal signs of pain. Older patients may be less likely to disclose they’re in pain.
If pain is present, take a SOCRATES Assessment. If higher than 4, give pain medication.
What is Step 16?
Assess blood Glucose level.
What is Step 17?
Assess pupils - PERLA
P = Pupils
E = Equal
R = Round, Reactive to
L = Light
A = Actively
add an extra R = Round (added as best practice).
Same on both sides.
If wrong = Possible Neurological damage, if the left eye is non responsive, right side of brain is damaged.
What is Step 13?
Circulation
Obtain a temperature measurement.
How to obtain temps:
Tympanic (Ear): dispose of the probe afterwards.
Oral (under the tongue), Dispose of thermostat after
Axillary (Armpit), Dispose of thermostat after
Check peripherals vs central (touch and sight of colourful skin).
If areas such as ears have an infection or lots of wax it could show incorrect temp.
What is Step 19?
Exposure
Check for skin integrity.
Rashes, oedema, wounds.
Explain why it’s important to check on skin integrity.
What is Step 20?
Exposure
SAMPLE - secondary assessment
S = Signs
A = Allergies
M = Medication (Meds, recreational drugs, over-the-counter drugs, how much alcohol a week, smoking, herbal remedies)
P = Past History (Medical, surgical and social).
L = Last Oral Intake and last menstrual cycle.
E = Everything else about what brings them in.
What is Step 21?
Calculate the NEWS Score.
What is Step 22?
Close interaction, let patient know I’ll review with the nurse, and ask about pain medication if needed.
Ask if they need anything.
Say to the examiner, I’ll go speak to my nurse supervisor.
If a patient had a rash what should you do?
Roll a glass over rash, if rash doesn’t blanch then it could be a sign of sepsis or meningitis.
What are the 6 symptoms of shock?
- Low blood pressure.
- Altered mental state, including reduced alertness and awareness, confusion, and sleepiness.
- Cold, moist skin. Hands and feet may be blue or pale.
- Weak or rapid pulse.
- Rapid breathing and hyperventilation.
- Decreased urine output.
How to sit?
Talk about SURETY to the examiner, eye contact, and sitting at the eye level.
SURETY (Sit at an angle, Uncross legs and arms, Relax, Eye contact, Touch, Your intuition).
What is Raynaud’s phenomenon? (Affecting the oxygen sat probe)
Raynaud’s phenomenon causes blood to stop flowing properly to the outer parts of the body. This happens mainly when you get cold, and it can also happen because of stressful situations.
When listening for sounds when the patient is breathing, what should you ask?
Breathing
Ask patient is they have a chronic airway condition. Could be a reason for them to have a cough or wheeze.
What to ask if the patient is bringing up when coughing etc.?
Breathing
Is the patient bringing up any sputum (mucus, phlegm).
What is the colour, amount etc.
How do you treat shock?
Raise the patient’s legs (unless they have fractures or a snake bite) above the level of the heart, with head flat on the floor.
Portsmouth sign
Situation in which the systolic blood pressure (SBP) reading (measured in mmHg) falls below that of the heart rate (HR) (measured in beats per minute).
If the patient seems stable, say you’re gonna do SAMPLE first.
If the patient seems stable, say you’re gonna do SAMPLE first.
