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Using your knowledge of the A-E assessment read the scenario and go through an A-E assessment.
Situation: You are a student nurse walking to work. You see a homeless woman that you are concerned about. You call the emergency services
Background: You see this woman on your regular walk to work and know that she is a homeless person. When you saw her last night on the walk from work to home, she passed the normal pleasantries.
Assessment: You don't know what is wrong but you are worried. She looks pale and mottled hands/fingers responsive to pain only. Breathing is shallow respiration 10.
Recommendation: Explain what you need to do.

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Be ready to present what you have discussed to the wider group. Each group has 10 minutes.

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Do not log off just switch off camera and mute yourself. Enjoy!

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Enjoy your lunch. Please do not log off, mute your mikes and switch off your cameras.

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Be ready to present what you have discussed to the wider group.

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Lesson Aim
To gain knowledge and understanding of Patient assessment by discussing the principles and techniques for patient assessment.

Outcomes

1. Students will develop a working knowledge and
understanding of what constitutes effective
communication.

2. Understand the importance of patient assessment.

3. Students will know how to perform a patient assessment
in a systematic way.
4.  Document findings from the case scenario.

5.  Students will hand over the care they have delivered
using an SBAR tool.

6. Participate in peer discussions and self-reflection.

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What does the A-E approach stand for?

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From the scenario list, how would you consider prioritising the care of these patients?

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Situation: Frankie is a 45-year-old homeless woman who has been admitted with abdominal pain.
Background: Frankie has been homeless for the past 9 months since she and her partner separated and she lost her job.
Assessment: Frankie looks unkempt, she is in a lot of discomfort.
Recommendation: You are working in the A&E department with your practice supervisor who has asked you to take Frankie's vital signs and assist Frankie with a bed bath.
Decision: Document and hand over to your practice supervisor the care you have given Frankie.

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List ways of making communication effective.

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Blood Pressure: Korotkoff Sounds | Ausmed Explains...

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What observations are part of vital signs?

List the normal ranges for each of the vital signs.

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What is prioritisation of care?
Why is prioritisation of care important?
What skills are needed to prioritise care?
Can you name any assessment tools used to aid prioritisation?

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Work Through this Scenario

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OSCE 17: Non-accidental injury (NAI). OSCEs done by recent fellows at a high level to provide an example of a good pass and additional advice on providing a framework to answer the scenarios.

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What is the main role of communication?
What are the four main methods of communication?

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A

Ensure the surrounding are safe to complete any observations of the patient

Checking the patients airway management for any obstruction, can the patient speck or is she wheezing and airway movment.

B

Acknoledgment of rr being 10 breathe per minute

Checking the pattern of if it is fast or slow.

C

Mottled skin

The pulse and documenting this.

Patient is pale

Recovery position if required

D

Fingers responsive to pain

Check temperature to touch

E

If safe to do so and maintaining dignity and privacy complete a skin check

Head to toe examination

Other observations

As a priority making the patient comfortable with pain management.

Communicating all outcomes with the emergency services using the SBAR method for effective care and intervention.

Checking pupil dilation for possible traumatic injuries.

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Situation: You are a student nurse working within a GP setting. You and your practice supervisor are running a drop-in clinic. Katia is a new mother who comes in and explains that she thinks her baby does not love her.
Background: Katia had been trying to have a baby for 5 years and went through 3 rounds of IVF. She is 9 weeks postbirth. Her birth was long with a failed induction and ended with an emergency caesarean.
Assessment: Katia is low in mood, and gets agitated at times and although she holds her baby her body language displays detachment from her child. She looks tired. You believe that Katia is suffering from postnatal depression.
Recommendation: Explain what you need to do and specify the timeline.

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Understanding the audio-visual skill of blood pressure reading

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Understanding the audio-visual skill of blood pressure reading

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LearningTools: Blood Pressure Basics - Audio-Visual Coordination Skills

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A to E Assessment - ABDCE Clinical Approach

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A to E Assessment for Deteriorating and Acutely Unwell Patients | ABDCE Clinical Approach

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Is making decision based on the urgency of who needs care

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Is making decision based on the urgency of who needs care

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What tools do we have to help us prioritise the care we give?

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Find information of what good documentation should look like.

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Katia needs to be referred to Cognitive behavioural Therapy within 5 weeks.

Ensure good sleeping pattern

Social activities

Family and friends support

GP Prescription for anti depressant

Counselling

Behavioural chart to monitor.

Social worker ( multi-disciplinary team to be involved )

Detailed information of her personal life such as if she is single or have a partner.

Baby

Enough feeding for the baby

Health visitor for frequent visits.

if Katia is attending baby's appointments. such her immunisations,

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Situation: You are working as a nurse on the medical ward and have been assigned to care for a 65-year-old patient named Mrs. Johnson who was admitted yesterday after suffering a fall at home. She has a history of dementia and has been diagnosed with mild cognitive impairment. This morning, Mrs. Johnson is restless and agitated, refusing to cooperate with the nursing staff.

Background: Mrs. Johnson's medical chart notes indicate that she is taking medication for her dementia, including donepezil and memantine. She has a history of falls in the past, and her primary care physician has been monitoring her condition closely. Yesterday, Mrs. Johnson fell at home and hit her head, which may have exacerbated her symptoms.

Assessment: As you enter Mrs. Johnson's room, you notice that she is sitting in bed, looking agitated and restless. She appears disoriented and confused, not knowing where she is or why she is there. When you ask her about her pain level, she responds with rambling statements and doesn't seem to understand your questions. Her vital signs are within normal limits, but she is hypertensive and tachycardic.

Recognition: Based on your assessment, you recognise that Mrs. Johnson's agitation may be related to her dementia symptoms, which may be exacerbated by her recent fall and head injury. You also recognise that her ability to provide informed consent for medical treatment may be impaired due to her cognitive impairment.

As a year 1 student, you are tasked with assessing Mrs. Johnson's mental capacity to make decisions about her medical treatment. What criteria would you use to determine if Mrs. Johnson has the capacity to make decisions:

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Situation:

Michaela, a 19-year-old university student, was participating in a university netball sports activity when she suddenly became breathless and dizzy. She was unable to continue running and had to stop and sit down. The first aider was called, and following assessment the first aider decided to call an ambulance to transport Michaela to accident and emergency.

Background:

Michaela has a history of mild asthma, which is well-controlled with her inhaler. She uses her inhaler as prescribed and has not had any recent episodes of breathlessness. She is otherwise fit and healthy, with no other significant medical conditions.

Assessment:

On arrival at A&E, Michaela is sitting on a trolley, looking anxious and short of breath. Her respiratory rate is 28 breaths per minute, and her oxygen saturation is 92% on room air. Her blood pressure is 110/70 mmHg, and her heart rate is 100 beats per minute. Her temperature is 37.2°C.

Response:

Based on the NEWS2 score what would your decision be give a rationale for your plan of care.

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Video: how to undertake a manual blood pressure

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Video: how to undertake a manual blood pressure

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Improve Article 👀

Blood pressure (BP) measurement often appears in OSCEs and you'll be expected to confidently carry out the procedure. This blood pressure measurement OSCE guide provides a clear step-by-step approach to measuring blood pressure, with an included video demonstration.

Gather equipment

Gather the relevant equipment for measuring blood pressure:

Stethoscope

Sphygmomanometer: ensure you have an appropriately sized cuff. A cuff that's too small may overestimate BP, and a cuff that is too large will underestimate BP.

Introduction

Wash your hands and don PPE if appropriate.

Introduce yourself to the patient including your name and role.

Confirm the patient's name and date of birth.

Briefly explain what the procedure will involve using patient-friendly language: "Today I would like to measure your blood pressure, this will involve inflating a cuff around your arm whilst listening to your pulse with my stethoscope. The procedure shouldn't be painful, but it may feel a little uncomfortable when the cuff is fully inflated and you might experience some pins and needles in your hand. If at any point you want me to stop, just let me know."

Gain consent to proceed with blood pressure measurement.

Position the patient sitting on a chair, with their arm comfortably placed at approximately heart level.

Check if the patient has a preference as to which arm to use. Avoid using an arm that has local pathology such as post-mastectomy lymphoedema.

Ask the patient to adequately expose their upper arm on the relevant side by rolling up their sleeve.

Check if the patient has any pain before proceeding with blood pressure measurement.

You might also be interested in our collection of 900+ OSCE Stations, including a range of practical procedure stations.

Attaching the blood pressure cuff

1. Check that the blood pressure cuff size is appropriate for the patient's arm and that it is fully deflated.

2. Confirm the location of the brachial artery by palpating medial to the biceps brachii tendon and lateral to the medial epicondyle of the humerus.

3. Wrap the blood pressure cuff around the patient's upper arm, lining up the cuff marker with the brachial artery.

Measuring blood pressure

Estimate an approximate systolic blood pressure

To begin with, you need to determine an approximate systolic blood pressure. This is helpful in preventing over-tightening of the cuff during the accurate measurement of blood pressure.

1. Ensure the valve on the blood pressure cuff is closed.

2. Palpate the patient's radial pulse, located at the radial side of the wrist, with the tips of your index and middle fingers aligned longitudinally over the course of the artery.

3. Inflate the blood pressure cuff until you can no longer feel the patient's radial pulse. Note the reading on the sphygmomanometer at the point at which the radial pulse becomes impalpable. This reading is an approximate estimate of the patient's systolic blood pressure.

4. Open the valve and deflate the blood pressure cuff.

Measure the blood pressure accurately

Now that you have an approximate systolic pressure, you can perform an accurate assessment of systolic and diastolic blood pressure.

1. Close the valve on the blood pressure cuff.

2. Position the diaphragm of your stethoscope over the brachial artery.

3. Re-inflate the cuff 20-30 mmHg above the systolic blood pressure you previously estimated.

4. Then slowly deflate the cuff at around 2-3 mmHg per second.

5. Using your stethoscope, listen carefully for the onset of a pulsatile noise. The first of these pulsatile noises is known as the first Korotkoff sound. The pressure at which the first Korotkoff sound becomes audible represents the patient's systolic blood pressure.

6. Continue to deflate the cuff, whilst listening through your stethoscope until the pulsatile sound completely disappears. The final pulsatile noise you hear is known as the fifth Korotkoff sound and represents the patient's diastolic blood pressure.

7. If the patient's blood pressure is outside of the normal range you should repeat the assessment on the same arm after a few minutes and also consider assessing blood pressure using the patient's other arm.

Blood pressure abnormalities

Blood pressure abnormalities may include:

Hypertension: blood pressure of greater than or equal to 140/90 mmHg if under 80 years old or greater than or equal to 150/90 mmHg if you're over 80 years old.

Hypotension: blood pressure of less than 90/60 mmHg.

Narrow pulse pressure: less than 25 mmHg of difference between the systolic and diastolic blood pressure. Causes include aortic stenosis, congestive heart failure and cardiac tamponade.

Wide pulse pressure: more than 100 mmHg of difference between systolic and diastolic blood pressure. Causes include aortic regurgitation and aortic dissection.

Difference between arms: more than 20 mmHg difference in blood pressure between each arm is abnormal and may suggest aortic dissection.

To complete the procedure

Once a blood pressure recording has been obtained, remove the blood pressure cuff.

Explain to the patient that the procedure is now complete.

Discuss the blood pressure results with the patient, including any further steps that may need to occur (e.g. follow-up, further investigations, initiation of treatment).

Thank the patient for their time.

Dispose of PPE appropriately and wash your hands.

Document the lowest blood pressure recording in the patient's notes.

Reviewer

Michelle Spence
Senior Nurse Practitioner

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Blood Pressure Measurement - OSCE Guide | BP Reading | Geeky Medics

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A step-by-step guide to blood pressure (BP) measurement in an OSCE setting, with an included video demonstration.

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Group 1 Add your thoughts and feelings about each of the scenarios

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1) Patient neglected, unwell, no motivation (spilt from partner and lost job), mental health, malnurished due to homelesness could be contributed to abdominal pain. Poor hygeine as bed bath is required (skin inspection can take place). Monitoring of vital signs and organs are fully functioning. Ensure patient is not dehydrated.

2) Safeguarding, child wellbeing, No parental guidance, infection risk, Parental classes, poor timing for the child to be checked (12 hours after incident), poor child supervision

3) Confusion, impacts on wellbeing, can understand irregular symptoms, positive nursing experience to aid healing, possibly past trauma, determination through crisis,

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Introduction: Introduce yourself to Frankie, to establish rapport and seeking consent before starting the procedure.

Physical assessment : Vital signs to be done to query any health conditions such as any prone infections, since she has been homeless for 9 months. To check her Blood Pressure, Respiration, Pulse, Temperature and her saturation level. To check her urine dip sample.

Mobility assessment : Assess Frankie's level of mobility. If she would need support or is independent.

Pain assessment : Since she is experiencing discomfort pain scale needs to be done to know the level of the pain.

Check her sacral areas, body map to completed for Frankie.

stool assessment : to ask Frankie her history of bowel movement.

Food and Fluid: Ask Frankie her output of food and fluid.

Family connection which can include children, relatives any family of sort.

Substance of abuse of asking if she uses any hard drugs or is she on any medication.

Health history: any IBS , any previous health condition.

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Vital Signs: Temperature, Pulse, Respirations & Blood Pressure - Clinical Skills | @LevelUpRN

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Group 2 Add your thoughts and feelings about each of the scenarios

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Group 3 Add your thoughts and feelings about each of the scenarios

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NMC OSCE NEWS CHARTS / NEWS 2 / National Early Warning Scoring System Explained / How to Chart OSCE

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Keep records of all evidence and decisions. NMC

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Keep records of all evidence and decisions. NMC

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1) Effective communication-

Active listening

Clear and respectable

Concise

Appropriate body language

Appropriate language

Enagaging communication

Open ended questions

Emotional intelligence

Non Judgemental

Observant with patients behaviour and communication

Cultural Awareness

Trust

2) Main role of communication

To understand one another

Build relationships and ensure positive experiences

Educating patients

Provide safe and person centred care

Expressing needs and wants (both from patient and nurse)

3)Four main methods of communication

Verbal

Non-verbal

Visual

Written

4)What good documentation should look like

Should be clear and accurate

Behaviour of a patient should be noted how they have slept, communicated,

Detailed and concise information should be present

Kept up to date in real time with the patient

Patient medication rights and awareness of other mobidities.

Cultural awareness detailling what the patient can and cannot eat (e.g a muslim patient will be halal or possibly vegetarian)

Knowing the resuscitation status of the patient.

Completing in line with the NMC code of conduct

Safety and equipment checks (height of the bed, call bell in reach. patient using a wheelchair, if moving and handling required)

Patient wishes and thoughts to be shared for person centred approach (answering a call bell was too long, patient could not close the window, extra blankets were required).

Activites of daily living such as toileting, independence or dependence of care (opening bowels or passing urine).

Noting any interactions with the MDT's and and outstandings tasks needing to take place.

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Towards a unified vision of Nursing and Midwifery

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Towards a unified vision of Nursing and Midwifery

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Communication is the act of conveying a message from one person to another through body language, eye contact, facial gestures, speaking and written, pictures, signs language, flash cards, music, touch, braille.

Ways of making communication effective :

Speak clearly and audible.

Right tonation.

Documentation

Eye contact

Active listening

Conducive environment.

Child friendly language

Giving people time to process their understanding and retain information.

Auditory aids in-situ.

Clarify doubt.

Interpreter

Interacting with other people.

Four Main Methods of communication:

Verbal Communication

Non- verbal Communication ( Sign language,Braille)

Visual communiaction ( pictures, flash cards, posters)

Written

Best documentation practice

Keep it clear and concise

Be accurate

Be consistent

Relevance

Legible

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1) Malnurished due to homelessness, poor diet and could be due to abdominal pain, Mental health impact, poor hygeine (unkempt), possible low mood due to partner seperation and job loss. Vital signs to be monitored and organ function. Possibly would require vaginal examination. Pain management to be implemented. Skin inspection during bed bath. Urine and blood samples. Medication history.

2) Safeguarding, poor timing of seeking help for child after 12 hours, poor supervision, parental classes possibly.

3) Determination through crisis, vivid memory but unable to remember past 2 weeks, positive nursing experience, possible past trauma

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Considering if a condition is acute or chronic, this can be due to sudden illness or injury to the patient. The nurse is to apply an effective response to adapt to the patients needs and making clinical decisions.

1) Prioritisation 1, 2 and 3

2) Stop and deterioration of patients and care is managed effectively. Pain mangement and severity of pain to be managed (pain scale measurement), how to help the patient.

3) Problem-solving, communication (MDT, families, relatives also), organisation, time management, Ability to delegate, medication management, decision making for the patients best interests (dependent on capacity to make their own deceisions), advocation, interpersonal skills (working with patients for person centred care).

4)Vital signs (NEWS chart), Capacitiy to make informed decisions, A-E assessment, Waterlow assesment (Skin inspection). Fluid input and output, falls assessment.

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Introduction: introduce yourself, establish rapport and seek consent before starting the procedure. Ask about her feeling at the moment to assess her mental health.

Physical assessment: Check her NEWSCORE. Body map checks such as bruises, moisture lesion, skin tear. Ask her if her periods are regular. Urine dip stick to identify any infection and pregnancy test as well.

Mobility: Assess her mobility for support or she is independent.

Medical history: Assess her previous medical history if she knows and any medication she is on. Ask about her allergies.

Family Connection: Ask about her family, if she is in contact with any of them.Ask her cultural background.

Urine and stool assessment: History of her bowel movement, when was her last bowel movement.

Food and Fluid, her intake and output to know her MUST score.

Substance abuse; since she is homeless, if she is taking any hard drugs and any alcohol.

Sleep pattern: How well she sleeps and her duration. If she is been abused sexually or physically.

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Communication is the act of conveying a message from one person to another through body language, eye contact, facial gestures, speaking and written, pictures, signs language, flash cards, music, touch, braille.

Ways of making communication effective :

Speak clearly and audible.

Right tonation.

Documentation

Eye contact

Active listening

Conducive environment.

Child friendly language

Giving people time to process their understanding and retain information.

Auditory aids in-situ.

Clarify doubt.

Interpreter

Interacting with other people.

Four Main Methods of communication:

Verbal Communication

Non- verbal Communication ( Sign language,Braille)

Visual communiaction ( pictures, flash cards, posters)

Written

Best documentation practice

Keep it clear and concise

Be accurate

Be consistent

Relevance

Legible

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1) What is the A-E approach

Airway

Checking or observing any airway obstructions

Breathing

Patient is breathing comfortably with room air or oxygen and respiratory rate is within range

Circulation

Measuring the capillary refill time and patients colour of the patients skin is not pale or has cyanosis

Disability

AVPU, Glasgow coma scale and blood glocise montitoring

Exposure

Full body examination if required exposing the body

2) Observation for vital signs:

Blood pressure (hypo 90/60, normal 120/80, hyper 140/90)

Respiratory rate (12rr to 20rr)

Pulse (60-100 bpm)

SpO2 (equal to or more than 96)

Temparature (36.1 - 38.0)

Blood glucose if required ( 4.0 - 9.0

Ketones if required (Below 0.1)

Pain observation

Opened bowels or passed urine

Skin integrity

Alertness or consciousness

Fluid input and output

Catherisation management

Comfort levels

Scenario response

Patient is scoring 7 which will need to be reported to the nurse in charge.

The patient is required to be continously monitored.

Oxygen to be administered through mask and levels monitored. Although patient is sitting try repositioning getting the patient to sit upright.

Try to relax and clam the patient through reassurance.

Give the patient fluid for hydration

Find out when the inhaler was last admistered and how many puffs. How often have they been using their inhaler in the last few days.

Evaluate external factors that can be effecting her

Managing any pain if the patient has acknowledged this as a priority.

Using relatives or significant person to communicate how they are feeling or medical history.

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A- Airway ; ensure there is no obstruction on the airway carnal. Tilt the head. Saturation

Observations which are part of vital signs are; from NICE guidelines

Temperature - (36.5 -37.5 degree celcuis)

Blood pressure- (120/80mm/Hg)

Respiration rate-( 12-18)

Heart rate (Pulse) - (60 -100 beats per minute)

Oxygen Saturation -(95-100)

Situations;

She is dizzy, breathless becuase she has asthma,

Micheala should be placed on observation, review her medications and inhaler.

Give her inhaler to bring her breathing up.

Educate her on some activities which should not be done and lifestyle.

Educate her on her choice of diet and fluid hydration.

B- Breathing; patient in an upright position. Respiratory

C- Circulation; blood pressure reading.

D- Disability; anxious, pain, discomfort, movement , dizziness.

E- Exposure; temperature