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List ways of making communication effective.

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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.  Develop a clearer understanding of documentation.

5.  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?

What does a physical assessment entail?

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

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

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

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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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Discuss your thoughts and feelings

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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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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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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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Reconfirm what she said. Demonstrating interpersonal skill example is empathy.

Signposting to useful and evidence based resources and providing interventional education and offer refferals to a specialised professional eg psychiatrist

Thoughts were she was undergoing in and out body experience consequently.

She is entering into reality

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Group 4

Protect the patient from other patients

History from the age of 22 when condition was triggered by relationship breakdown and cannabis use

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First priority is to find out if she is still experiencing the Bipolar Episode.

Reassessment, review, evaluate care.

Assess risk of relapse.

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The social aspects of her life will need to be looked into and assessed. Past life experiences such as smoking cannabis and recent experience of a broken relation. might be worth looking into how these event are affecting her thoughts and feelings. She clearly had family support, however her hearing voices of God talking to clearly affecting her mental state. This could also be possible symptoms of her being delusional . Her lack of sleep and appetite loss could also be an underlining factor

Fearing family may die and may be relating to her stress factors and could contribute to her mind racing resulting in possible heart palpitations

Sleeping patterns would also need to be assessed, as well as monitoring fluid and dietary intake as this could be a reason for memory loss

risk assessment could be carried out due to the fact that she works with children in a school. Safeguarding referral may be a possible option considering she has had 5 episodes of psychosis

auditory hallucinations of being spoken to by God and her father praying for her

mixed thoughts

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Group 4

In case the patient relapses

To safeguard the patient

Important to provide person centered care

To aid the patient in decision making

It helps for interventions

Time management to help allocate appropriate care

Good communication skills

Observation skills inc none verbal cues

Working in a MDT

Assessment tools-

MSE

ABC

News chart

Camberwell assessment of needs

DASS

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Prioritisation is important in other to avoid any danger to self and others.

To establish what is time sensitive.

Ensure the patient safety.

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Group 4

Speak clearly and maintain eye contact, give the patient time to respond.

Active listening

Do not stand over the patient

Ask open questions to encourage the patient to give more than one word answers

Control our emotions

Pay attention to none verbal cues

When we find a good pathway to the patient, create a hospital passport to aid other members of staff

Effective communication strategies-

To pass and gain information

Interact with the patient

To gain better understanding of the patient

For continuation of care

We communicate to express our feelings and concerns

Paramount for good teamwork

It helps to meet the needs of the patient

For update purposes

4 types of communication are Verbal, none verbal, visual and written

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Effective communication, active listening, informed decision making, Non judgemental, critical thinking, improve quality of care, ensure safety and improve patient outcome. clinical decision making

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BDS.

BAV-Q

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Active listening.

Using open questions.

Tone of voice.

Repeat a summary of what you've understood from the conversation, avoiding noisy environment

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Group 4

A-E stands for

A- airway

B- breathing

C- circulation

D- disability

E- exposure

A physical assessment involves

Inspection

Vital signs

Skin assessment

Height and weight

many others

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Airways.

Breathing.

Circulation.

Disability.

Danger.

Exposure.

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Vital signs-

Blood pressure range 120/80 is the normal rate

Respiratory range 12-18

Pulse range 60-100 per minute

Temperature range 36.1 to 37.2 degrees c

Saturation 95-100

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checking vital signs for the following;

1. Airway

referring to nose, mouth

2. breathing

possibly monitoring chest movement for regular breathing and the rate

3. circulation

heart rate, blood pressure, ECG monitoring and capillary refill time

4. disability

level of consciousness, limb movement, blood glucose

5. Exposure and environment

temperature,

Physical assessments entail checking skin for bruising, vital signs, patient weight, vision, checking ear, nose and throat, blood sugar levels

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Good record of News chart, clear documentation, accuracy

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checking vital signs for the following;

1. Airway

referring to nose, mouth

2. breathing

possibly monitoring chest movement for regular breathing and the rate

3. circulation

heart rate, blood pressure, ECG monitoring and capillary refill time

4. disability

level of consciousness, limb movement, blood glucose

5. Exposure and environment

temperature,

Physical assessments entail checking skin for bruising, vital signs, patient weight, vision, checking ear, nose and throat, blood sugar levels

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Effective communication

active listening

maintaining good eye contact

good non verbal communication and body language

Asking questions and reaffirming to establish understanding

a gentle touch depending on the situation and the patient

Giving patient time to respond

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Regarding the scenario of the homeless woman you the A-E assessment to use ---- Call the emergency services, reassuring her.

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Airways- I Looked inside patients mouth for obvious blockages

Breathing- Breathing is shallow with a respiration of 10

Circulation- Hands and fingers responsive to pain only.

Disability- None verbally responsive but she is responsive to pain in her hands and fingers.

Exposure- We have inspected the woman's body for any injuries or visual clues

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Regarding Katia's scenario:

She could suffering post-natal depression, further assessment needs to be done, therapy needed, social services to be informed, if there is a partner in her life, explore her social life, confirm if she uses alcohol, does she feel like harming herself or the baby.

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Start with the news scale, followed by the mental state examination (MSE) with Katia.

Refer Katia to her health visitor as this will aid in safeguarding the baby if risk are present.

The health visitor can also refer to social services to provide help to Katia and her baby