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Michalea's A-E Assessment
Airway: Patent - Michaela is able to maintain her own airway. No added sounds.
Breathing: When you look, listen, and feel Michaela does not seem to be struggling to breathe when you count for 1 minute you find that her respiration is 22 bpm.
O2 Saturation - 96%
Circulation: Pulse rate 110 bpm regular and thready. B/P 130/85
Disability: Blood glucose 3 mmol, pupils are equal and reactive. Relatives of Michaela are concerned that her speech is not coherent and she does not recognise she is in hospital.
Exposure: Temp 36.2. No abnormality on exposure.

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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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Find information of what good documentation should look like.

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Blood Pressure: Korotkoff Sounds | Ausmed Explains...

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What does the A-E assessment stand for? Discuss in your groups all the components of a complete A to E assessment. What would you assess in each section?

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In Frankie's case, how would you consider prioritising the care of these patients?

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In Frankie's case, 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. She has disclosed she has a 8 year old daughter, who is staying with her friend.
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.

Answer the following questions:

What further assessments would you like to do to Frankie?

What are you worried about?

What would be your next steps?

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List ways of making communication effective.

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Gemma's A-E Assessment
Airway: Gemma is talking to her mother unable to complete full sentences.
Breathing: When you look, listen, and feel Gemma's respiratory rate seems fast, you can hear a wheeze and when you expose her chest of Gemma you see accessory muscles working hard. Respiratory rate 35.
O2 Saturation - 89%
Circulation: Pulse rate 120 bpm regular and strong. B/P 110/65
Disability: Gemma remains alert, pupils are equal and reactive to light. Blood sugar - 6 mmols
Exposure: On exposure, we notice accessory muscles are working very hard. Temp 36.2

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What is this? What do you use it for in hospitals? What do the colours mean?

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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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What does a physical assessment entail? What would you consider with regards to Frankie?

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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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Non-accidental injury (NAI).

Scenario Stem:

It’s 09:00 and you are the nurse in charge of the paediatric area of a suburban hospital. One of the nurses has attended a 16 month old called Kylie who has been brought in by her Dad approximately 12 hours after bilateral burns to her feet. Jason reports a story of running a bath and one of his older kids putting her in the bath when it was too hot and he was out of the room. The registrar has given analgesia but wanted you to review the patient prior to any ongoing management.

Your task is to undertake a focused history from Jason (the father) and formulate a management plan.

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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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Play this video and count the newborn pulse. What number did you get?

Is this a normal rate for a newborn?

What would this mean if you measured this rate for an adult patient?

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Newborn heart beat sound | How to calculate NB Heart rate | Normal NB Heart sound | Christina NP

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

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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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What observations are part of vital signs?

List the normal ranges for each of the vital signs.

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Stop the video when you get to discussion points.

What further assessments would you like to do?

What do is worrying you?

What do you think is happening?

How would you manage this situation? Would escalate? How and to who?

After the discussion, hear the rest of the audio clip. Write a reflection on what has been the patients journey.

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What is age-appropriate communication?
How would you describe an X-ray to a 5 year old and a 12 year old?

Discuss other communication barriers you have seen in practice and write the main points below?

How can you support the patient to understand the information and overcome communication barriers?

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

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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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What is the recommended post-operative observation timings according to this document?

According to this document when do children need to have their weight recorded?

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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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Using your knowledge of the A-E assessment read the scenario and go through an A-E assessment.
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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Using your knowledge of the A-E assessment read the scenario and go through an A-E assessment.
Situation: You are a student nurse working on the ward. You and your practice supervisor are caring for 6 patients. Marcus is a 14-year-old who was admitted last night with a temperature of 38, dry cough, and runny nose.
Background: Marcus has been out of sorts according to his mother. She says for the past 2 days he has had a dry cough Marcus started with a runny nose two days ago. Although she has been self-medicating with paracetamol and simple linctus. Last night Marcus became lethargic.
Assessment: Marcus looks very unwell. He has a dry cough, and runny nose and his eyes look watery. He has a high temperature.
Recommendation: This is Marcus' third day of symptoms. Explain what you need to do.

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Name the sepsis 6?
One of the 6 interventions needs to happen before giving antibiotics... Which one could this be? And why?

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What are the differences between the PEWS charts? Why is this necessary? What is the risk of using the wrong age group PEWS chart?