OSCE Prep - Assessments Flashcards
Glucometry Purpose
To check blood glucose levels
Normal levels vary between 4-8 mmol/L
Glucometry Procedure
- Infection control measures
- Prepare sample site - distal lateral fingertip - clean with alcohol swab
- Open test strip and insert into meter, check LOT numbers match
- Remove cap from lancet and select depth according to location and skin softness
- Depress lancet on sample site and then dispose of immediately
- Press blood sample to white area on test strip until 3 short lines appear. Meter will display BGL reading automatically
Glasgow Coma Scale Purpose
Assesses a patient’s level of consciousness in three categories: Eye opening, verbal response, and motor response
Not used for newborns (APGAR instead)
Minimum score is 3, maximus score is 15
Glasgow Coma Scale Procedure
Eye opening: 4 - eyes open spontaneously 3 - eyes open in reaction to speech 2 - eyes open in reaction to pain 1 - no response Verbal response 5 - oriented 4 - confused 3 - inappropriate words 2 - incomprehensible sounds 1 - no response Motor response 6 - obeys commands 5 - localises to pain 4 - withdraws from pain 3 - flexion response 2 - extension response 1 - no response
Add the best responses from each category to find the patient’s GCS scope
Neurological Status Assessment Purpose
To check the patient for altered awareness or for sensory or motor changes
Neurological Status Assessment Procedure
Remember - Ghastly, Vastly, PMS
GCS (score from 3-15)
Vital Signs Survey (HR, RR, BGL, BP, SpO2, temp)
Pupillary response (check with penlight for equality and reactivity)
Motor function (ask patient to squeeze with a hand or move toes etc)
Sensory function (ask if patient can feel touch stimuli on limbs and extremities)
Non-invasive Blood Pressure Purpose
To determine the patient’s blood pressure
Hypotension (low BP) can cause cardiovascular compromise, hypertension can cause heart attack or stroke, either can be a diagnostically useful symptom
Normal ranges: Systolic 100-120, diastolic 80-100
Contraindications
Do not apply BP cuff to limb with AV fistula, significant injury, limb with lymph node removed post mastectomy
Non-invasive Blood Pressure Procedure
- Place an appropriately sized cuff approx. 1 inch above the crease of the elbow
- Palpate the radial pulse and inflate the cuff until it is no longer felt
- Place stethoscope bell over brachial artery and inflate cuff a further 30 mmHg - no sound should be heard
- Slowly deflate cuff and watch gauge to note where sounds are heard
- First heard Korotkoff sound indicated the systolic pressure, when sound disappears it indicates diastolic
Pulse Oximetry Purpose
To determine a patient’s oxygen saturation
May be ineffective if patient is wearing nail polish or if hands are dirty
Sensor cannot distinguish between oxygen and carbon dioxide - High CO2 levels will read as high oxygen levels
Pulse Oximetry Procedure
Place sensor on patient’s finger and note reading
Pain Assessment (OPQRST) Purpose
To determine location and severity of the patient’s pain
Pain Assessment (OPQRST) Procedure
Onset - when did the pain start?
Provocation/palliation - is there anything that makes the pain better or worse?
Quality - what does the pain feel like?
Region/radiation/referral - where is the pain located? Any other areas/radiating pain?
Severity - how bad is the pain? (1-10 scale, Wong-Baker)
Timing - Is it coming and going?
Perfusion Status Assessment Purpose
To determine is sufficient blood is being circulated to all areas of the body
Perfusion Status Assessment Procedure
Skin - Warm, pink, and dry?
Pulse - should be 60-100 bpm. Weak/bounding, thready?
BP - Within normal range?
Consciousness - AVPU
Primary Survey Purpose
To immediately identify and treat life-threatening conditions
Primary Survey Procedure
DRSABCD Danger - to self, others, the patient Response - AVPU Send for help - CCP, police etc Airway - Do they have a patent airway, any obstruction? Breathing - Adequate ventilation? Circulation - Adequate pulse?
Address any issues as they emerge
Repeat if there is a change in patient condition
Secondary Survey Purpose
To gain a clinical picture of the patient’s condition
Secondary Survey Procedure
SAMPLE
Signs and symptoms - what the patient is experiencing, include OPQRST
Allergies
Medications
Last ins and outs - food, water, bladder and bowel voiding, vomiting
Events - why they called the ambulance
VITAL SIGNS SURVEY
Heart rate, respiratory rate
blood pressure, temperature, oxygen saturation, glucose level
PHYSICAL EXAMINATION
Check head to toe for DCAPBTLS - Deformities, contusions, abrasions, penetrations, burns, tenderness, lacerations, and swelling
Respiratory Status Assessment Purpose
To assess if a patient is breathing adequately
Respiratory Status Assessment Procedure
CAPERRSSS Consciousness - Alert/altered Appearance - Calm/distressed Pulse - 60-80 bpm Effort - Chest or abdomen movement, use of accessory muscles Rate - 12-18 breaths per minute Rhythm - Regular even cycles Skin - Pink, warm, and dry Speech - Any difficulty Sounds - Stridor, wheezing, crackles
Tympanic Thermometer Purpose
To determine the patient’s temperature
Normal is 37.5 degrees Celsius
Tympanic Thermometer Procedure
- Place a disposable cover on the probe
- Place the probe in the ear, angled toward the opposite ear
- Push and release the Start button
- Note temperature and dispose of probe cover
