OSCE Prep - Assessments

Question 1

Glucometry Purpose

Answer 1

To check blood glucose levels

Normal levels vary between 4-8 mmol/L

Question 2

Glucometry Procedure

Answer 2

1. Infection control measures
2. Prepare sample site - distal lateral fingertip - clean with alcohol swab
3. Open test strip and insert into meter, check LOT numbers match
4. Remove cap from lancet and select depth according to location and skin softness
5. Depress lancet on sample site and then dispose of immediately
6. Press blood sample to white area on test strip until 3 short lines appear. Meter will display BGL reading automatically

Question 3

Glasgow Coma Scale Purpose

Answer 3

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

Question 4

Glasgow Coma Scale Procedure

Answer 4

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

Question 5

Neurological Status Assessment Purpose

Answer 5

To check the patient for altered awareness or for sensory or motor changes

Question 6

Neurological Status Assessment Procedure

Answer 6

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)

Question 7

Non-invasive Blood Pressure Purpose

Answer 7

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

Question 8

Non-invasive Blood Pressure Procedure

Answer 8

1. Place an appropriately sized cuff approx. 1 inch above the crease of the elbow
2. Palpate the radial pulse and inflate the cuff until it is no longer felt
3. Place stethoscope bell over brachial artery and inflate cuff a further 30 mmHg - no sound should be heard
4. Slowly deflate cuff and watch gauge to note where sounds are heard
5. First heard Korotkoff sound indicated the systolic pressure, when sound disappears it indicates diastolic

Question 9

Pulse Oximetry Purpose

Answer 9

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

Question 10

Pulse Oximetry Procedure

Answer 10

Place sensor on patient’s finger and note reading

Question 11

Pain Assessment (OPQRST) Purpose

Answer 11

To determine location and severity of the patient’s pain

Question 12

Pain Assessment (OPQRST) Procedure

Answer 12

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?

Question 13

Perfusion Status Assessment Purpose

Answer 13

To determine is sufficient blood is being circulated to all areas of the body

Question 14

Perfusion Status Assessment Procedure

Answer 14

Skin - Warm, pink, and dry?
Pulse - should be 60-100 bpm. Weak/bounding, thready?
BP - Within normal range?
Consciousness - AVPU

Question 15

Primary Survey Purpose

Answer 15

To immediately identify and treat life-threatening conditions

Question 16

Primary Survey Procedure

Answer 16

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

Question 17

Secondary Survey Purpose

Answer 17

To gain a clinical picture of the patient’s condition

Question 18

Secondary Survey Procedure

Answer 18

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

Question 19

Respiratory Status Assessment Purpose

Answer 19

To assess if a patient is breathing adequately

Question 20

Respiratory Status Assessment Procedure

Answer 20

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

Question 21

Tympanic Thermometer Purpose

Answer 21

To determine the patient’s temperature

Normal is 37.5 degrees Celsius

Question 22

Tympanic Thermometer Procedure

Answer 22

1. Place a disposable cover on the probe
2. Place the probe in the ear, angled toward the opposite ear
3. Push and release the Start button
4. Note temperature and dispose of probe cover