Assessment

Unstable Asthma

Overview of recent history

Patient Information
Name: Ann Jones
DOB: 01/01/1943 AGE 78
Hospital number: 00003
Address: 3 Sweet Street, Northampton, NN2 7AL
GP: Dr Baswaz, the Plaine Surgery, Northampton
Allergies: Penicillin (Anaphylaxis)

Presenting complaint:
• Ann has presented with shortness of breath and is currently receiving 10L of O2 via a
non-rebreather mask
• Ann has been diagnosed with unstable asthma and is being monitored on the Medical
Assessment Unit
• Ann Jones has not been mobilising due to her breathlessness. When mobilising she
quickly becomes breathless – refer to PT/OT to provide suitable ambulatory device
• Ann is struggling to sleep due to the breathlessness she is experiencing

• Past Medical History: Underactive thyroid (Hypothyroidism), Asthma

Social History:
• Ann is a smoker.
• Ann does not drink alcohol.
• She is married and lives with her husband
• She is a retired schoolteacher
• Normally mobile fit and well and keeps active.
• Normally eating a nutritional diet. Drinks plenty of fluids.
• Has 2 grown-up children, who don’t live in the area.

Concerns:
Ann worries about her husband being at home on his own as he has end stage COPD on home
oxygen.

Traps:
Cigarette & lighter, eyeglasses, inhaler, specimen pot, glass of water

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Assessment
Candidate notes
This document is for your use and is not marked by the examiners.
Patient’s details:
Name: Ann Jones
Hospital number: 00003
Address: 3 Sweet Street, Northampton, NN2 7AL
Date of birth: 01/01/1943
Airway
• clear

Breathing
• Extreme breathlessness
• Oxygen 10L/min via NRM
• Respiration, rhythm, depth
• O2 saturation

Circulation
• BP
• Pulse
• Capillary refill

Disability
• alert
• no pain
• ex-smoker

Exposure – full clinical history

• Temperature
• Underactive thyroid (hypothyroidism), asthma

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Assessment
Candidate notes
This document is for your use and is not marked by the examiners.
Physical
• Breathless when mobilising
• Struggle to sleep due to breathlessness
•

Psychosocial
• Concerned about husband being at home with end stage COPD + home oxygen
• Retired school teacher
• May need referral to social worker
• Married lives with husband

Spiritual
• No spiritual needs assessed

Sexual
• Partner is unwell

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Planning

Patient details:
Name: Ann Jones
Hospital number: 00003
Address: 3 Sweet Street, Northampton, NN2 7AL
Date of birth: 01/01/1943
1) Nursing problem/need
___ is experiencing breathlessness due to unstable asthma as evidenced by
respiratory rate of __ breaths per minute.
Aim(s) of care:
___ will verbalise relief from shortness of breath with respiratory rate of 12-20
breaths per minute and will have a normal breathing pattern and depth.
Re-evaluation date: Continuous
Today, 11/03/22, hourly, and if any clinical condition changes.
Nursing Interventions
1. Explain plan of care to ___ and gain consent for all nursing interventions.
2. Monitor and record ___’s observations every ___ as per NEWS score of __
and escalate according to NEWS2 policy.
3. Assess ___’s breathing pattern and depth. Monitor for signs of respiratory
distress such as cyanosis and laboured breathing.
4. Teach ___ about the use of deep breathing exercises and repositioning
techniques for optimal lung expansion.
5. Administer to ___ her prescribed oxygen and medications and monitor for
their effectiveness after 30 minutes.
6. Refer ___ to Respiratory Specialist Nurse upon consent as needed.
7. Instruct ___ the use of call bell and place within reach.
8. Document all aspects of care given to ___.
Monitor and record Ann’s observation
continuously due to elevated respiratory
rate of 22 breaths per minute and as per
NEWS policy.

Name (Print): Tarra Mae Ravena

Nurse signature: Date: 11/03/22

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Planning

2) Nursing problem/need
___ is experiencing reduced mobility due to unstable asthma
Aim(s) of care:
___ will be able to mobilize safely and effectively with or without minimal assistance
Re-evaluation date:
Today, 11/03/22, 4-hourly, and if any clinical condition changes.
Nursing Interventions
1. Explain plan of care to ___ and gain consent for all nursing interventions.
2. Monitor and record ___’s observations every ___ as per NEWS score of __
and escalate according to NEWS2 policy.
3. Assess ___’s manifestations of activity intolerance such as SOB, weakness and
fatigue.
4. Provide ___ a safe and clutter free environment and importance of adequate
footwear to mobilise safely.
5. Assist ____ with her activities of daily living while avoiding dependency
6. Administer to ___ her prescribed oxygen and medications and monitor for
their effectiveness after 30 minutes.
7. Refer ___ to Physiotherapist and Occupational therapist upon consent for
suitable ambulatory device.
8. Instruct ___ the use of call bell and place within reach.
9. Document all aspects of care given to ___.

Name (Print): Tarra Mae Ravena

Nurse signature: Date: 11/03/22

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IMPLEMENTING CARE: SAFE ADMINISTRATION OF MEDICATIONS

OSCE Nursing Field: Adult

Candidate Paperwork and Briefing

Scenario:
Ann Jones has been admitted with breathlessness, diagnosed with unstable asthma and is for
close observation on the medical assessment unit.
Please administer and document her 12:00 medications, safely and in accordance with the
NMC standards.
It is today and it is 12: 00

• Talk to the patient.

• Please verbalise what you are doing and why.
• Read out the chart and explain what you are checking/giving/not giving and why.
• Complete all the required drug administration checks.
• Complete the documentation and use the correct codes.
• The correct codes are on the chart and on the drug trolley.
• Check and complete the last page of the chart.
• You have 15 minutes to complete this station, including the required documentation.
• Please proceed to administer and document her 14:00 medications, safely in accordance with
the NMC standards.

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 Jones 1.6 meters

Ann 9 stone (63 kg)

01/01/1943 22.3

000003
Medical Assessment Unit (MAU) MR Darzi
07:30

Dr. Z Khan 12312321 Dr Z Khan 587

Penicillin Anaphylaxis

Dr A. Kumar 587

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 Jones 1.6 meters

Ann 9 stone (63 kg)

01/01/1943 22.3

000003
Medical Assessment Unit (MAU) MR Darzi
07:30

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 Jones 1.6 meters

Ann 9 stone (63 kg)

01/01/1943 22.3

000003
Medical Assessment Unit (MAU) MR Darzi
07:30

x
x

>92-94%

To continue until target reached

07:00
Non-rebreather mask @ 10L Today NRM/10L
H. Jones RN
Dr Z. Khan

Dr. Z Khan

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 Green 1.6 meters

Daisy 16 stone (101.6kg)

03/09/1940 41.2

000008
Medical Assessment Unit (MAU) MR Darzi
06:30

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 Jones 1.6 meters

Ann 9 stone (63 kg)

01/01/1943 22.3

000003
Medical Assessment Unit (MAU) MR Darzi
07:30

Levothyroxine

100 mcg OD PO 5 days 12:00 Sija Tomas

Treat thyroid
Today
hormone
deficiency
+4 days
x

Dr Z Khan 587 Dr. Z Khan

Prednisolone

40 mg OD PO 5 days 12:00 Sija Tomas

For asthma to
Today
reduce
inflammation of
+4 days
airway x

Dr Z Khan 587 Dr. Z Khan

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 Jones 1.6 meters

Ann 9 stone (63 kg)

01/01/1943 22.3

000003
Medical Assessment Unit (MAU) MR Darzi
07:30

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 Jones 1.6 meters

Ann 9 stone (63 kg)

01/01/1943 22.3

000003
Medical Assessment Unit (MAU) MR Darzi
07:30

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Evaluation
Candidate notes
This document is for your use and is not marked by the examiners.
Patient’s details:
Name: Ann Jones
Hospital number: 00003
Address: 3 Sweet Street, Northampton, NN2 7AL
Date of birth: 01/01/1943
Situation
• Complaints of shortness of breath and restless with chest pain when coughing
• NEWS score of __

Background
• Diagnosed with unstable asthma with history of hypothyroidism and asthma
• Admitted today due to SOB placed on 10L/min via NBM
• Alert, with allergy to penicillin and peanuts which gives anaphylactic reaction
• Patient is exhausted and is struggling to mobilise due to severe breathlessness
• Worried about husband who is unwell w/ end-stage COPD on home oxygen
• Lives with husband, normally mobile and self-caring

Assessment
• Recite VS
• ___ is experiencing breathlessness due to unstable asthma as evidenced by
respiratory rate of __ breaths per minute.
• ___ is experiencing reduced mobility due to unstable asthma
• Interventions done and oxygen, medications given
• The patient’s condition is getting worse and needs urgent attention

Recommendation
• NEWS: Escalation type
• Refer to social services for husband’s living condition

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