OSCE Assessment

Beginning of the assessment

1. Walk into the room and perform my 5 moments of hand hygiene. This is to avoid cross
contamination with my patient
2. I am now checking my environment, making sure there are no hazards around.
3. Checking whether the bed brakes are on
4. Hello, I am Raj and I am going to be your nurse today.
5. Can I please check your name and date of birth against your ID band please
6. That perfect. It matches your ID band so that is all correct
7. How are you feeling today
8. Did you sleep ok last night
9. I have conducted my normal A-D assessment.
10. With airway, it is patent as my patient is talking to me.
11. With breathing, the patient is breathing cause he is talking to me. I can also see the chest
rising and falling
12. With circulation, I felt the pulse of the patient while I was talking to him. Skin colour is nice
and pink. So sign of cyanosis. Skin is nice and warm on touch. Therefore circulation is normal
13. With disability, the patient has responded to me coherently which shows cognitive ability.
Patient is alert and oriented. GCS can range from 14-15
14. A-D is normal
15. I am now going to do a set of obs for my patient. Is that okay with you? I will be doing your
blood pressure, checking your heart rate and temp and your oxygen saturation
16. Put the oxygen saturation probe on the patient first.
17. Clean stethoscope and while waiting to dry check pulse
18. Check pulse for a full minute
19. Check resp for a full minute
20. At this point verbally say what the resp, heart rate and O2 sat is and write it down as well
21. I am now going to check the tympanic temperature. Can I please get a temp. Joint it down
22. I am now going to check your blood pressure. Is that okay?
23. Say what the blood pressure is and write it down
24. I am now going to clean my equipment. Clean the stethoscope
25. Check on the patient. How are you feeling
Airway

1. Okay, she seems to have really noisy breathing.

2. I am going to need some help to manage this
3. I AM GOING TO PRESS THE EMERGENCY BELL
4. I am going to pop on a pair of gloves
5. Can you hear me? Can you hear me talk?
6. She has gone unresponsive
7. I am going to lower the bed
8. Move the pillow out of the way
9. Call the patient name while you look listen and feel. I am feeling for breath on my face. I am
looking in to see if there is anything obstructing. I cannot see anything but I can hear this
really noisy breathing.
10. If there was anything in there I could suction it out. Anything that could be in is saliva,
secretions, vomit, blood or foreign objects such as food or teeth
11. I will need to suction this. There are two methods in doing this
12. Method 1: I can use a yankeur sucker. I will connect this to the suction. I go on both sides
and suction it on the way out. I keep doing this till there is no secretions visible
13. Method 2: If for some reason I cannot get the yankeur sucker in, I use a suction catheter.
The same principle is applied. I connect it to the suction. Put it in and suction it on the way
out. Again I keep doing this till no secretions are visible
14. I now reassess my patient
15. I am looking in the airway. I cannot see anything. There is still a noisy breathing.
16. I am now going to do some airway maneuverers
17. Head tilt and jaw thrust. The patient has improved. Patient is breathing. The noise has
stopped
18. I need to secure the airway. I can use an orophongeal airway or nasopharyngeal airway.
19. I measure my oropharyngeal airway from the angle of the jaw to the incisors
20. I put it in and once it hits the palate I turn it around and insert it. That sits in the airway and
helps protect it.
21. If I could not get that in. A reason for this is clenched teeth. I could use a nasopharyngeal. Its
measured 6 for female and 7 for male. It is measure by the diameter of the end of this with
the diameter of the nostril. That fits perfectly.
22. I wouldn’t use both. It is usually one or the other. I wouldn’t use a nasopharyngeal if the
patient had a head injury or some sort of nose injury.
23. Assess patient breathing again
24. You hear a cough. Take out the oropharyngeal airway by asking patient to spit it out.
25. How are you feeling.
26. You had a bit of a turn there. Your airway was making funny noises.
27. Sit them up
28. We will need to pop some oxygen on you ok? I am going to put oxygen for her through a non
rebreather mask. I am going to put 15L/min and put it on my patient
Breathing

1. Okay, she seems to have really noisy breathing.

2. I am going to need some help to manage this
3. I AM GOING TO PRESS THE EMERGENCY BELL
4. I am going to pop on a pair of gloves
5. Can you hear me? Can you hear me talk?
6. She has gone unresponsive
7. I am going to lower the bed
8. Move the pillow out of the way
9. Call the patient name while you look listen and feel. I am feeling for breath on my face. I am
looking in to see if there is anything obstructing. I cannot see anything but I can hear this
really noisy breathing.
10. If there was anything in there I could suction it out. Anything that could be in is saliva,
secretions, vomit, blood or foreign objects such as food or teeth
11. I will need to suction this. There are two methods in doing this
12. Method 1: I can use a yankeur sucker. I will connect this to the suction. I go on both sides
and suction it on the way out. I keep doing this till there is no secretions visible
13. Method 2: If for some reason I cannot get the yankeur sucker in, I use a suction catheter.
The same principle is applied. I connect it to the suction. Put it in and suction it on the way
out. Again I keep doing this till no secretions are visible
14. I now reassess my patient
15. I am looking in the airway. I cannot see anything. There is still a noisy breathing.
16. I am now going to do some airway maneuverers
17. Head tilt and jaw thrust. The patient has improved. Patient is breathing. The noise has
stopped
18. I need to secure the airway. I can use an orophongeal airway or nasopharyngeal airway.
19. I measure my oropharyngeal airway from the angle of the jaw to the incisors
20. I put it in and once it hits the palate I turn it around and insert it. That sits in the airway and
helps protect it.
21. If I could not get that in. A reason for this is clenched teeth. I could use a nasopharyngeal. Its
measured 6 for female and 7 for male. It is measure by the diameter of the end of this with
the diameter of the nostril. That fits perfectly.
22. I wouldn’t use both. It is usually one or the other. I wouldn’t use a nasopharyngeal if the
patient had a head injury or some sort of nose injury.
23. Assess patient breathing again
24. She is not breathing. I need to breathe for them with a bag valve mask
25. Connect it to the oxygen supply and put it up to 15L
26. I am going to wait for the bag in inflate. I am going to use the C and J grip. The J grip goes to
the jaw
27. I can see the rise and fall of the chest so I know there is a good seal on the mask. I would
average 1 every 5 seconds. This can average to 12-16 resp per minute.
28. I keep doing this till my patient regains consciousness and starts breathing or till the met
team comes
29. You hear a cough. Are you okay? Take out the oropharyngeal airway. Can you hear me? Are
you okay?
30. You stopped breathing for a moment. Let me put some oxygen on for you and I will reassess
you
31. Make her seat upright
32. We will need to pop some oxygen on you ok? I am going to put oxygen for her through a non
rebreather mask. I am going to put 15L/min and put it on my patient
33. Airway is patient cause she is talking to me and she is breathing
Circulation

1. How are you feeling. Patient is deteriorating