Nursing and Complex Care OSCA study PDF

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OCSA Assessment - Deteriorating Patient ...

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HNB3 1 4 1NURSI NGANDCOMPL EXCAREOSCA BACHEL OROFNURSI NG 2 0 2 0 SCENARI O1–Pr e p a r a t i o nI n f o r ma t i o n : St u d e n tGui d e

"Get In My Belly" by greyglass is licensed under CC BY-NC-SA 2.0

Mi k eDu k ei sa5 2 y e a r o l dma nwh oh a sb e e na d mi t t e dt oy o u rwa r du n d e rCa r d i o l o g ywi t hc o mp l a i n t s o fi n c r e a s i n gd y s p n o e ao ne x e r t i o nwi t h“ n i g g l i n gc h e s td i s c o mf o r t ” .Heh a sap a s tme d i c a l h i s t o r yo f h y p e r t e n s i o n ,h y p e r c h o l e s t e r e mi a ,e n j o y sa g l a s so fwi n e wi t hd i n n e r ,h a sa f a mi l yh i s t o r yo f c a r d i o v a s c u l a rd i s e a s ea n di sac u r r e n t s mo k e r .Mi k es a y st h a t h eh a sr e c e n t l yh a dar e s p i r a t o r yt r a c t i n f e c t i o n . Cu r r e n t me d i c a t i o n st h a t Mi k eh a sb r o u g h t i nwi t hh i mi n c l u d e : 1 .Wo r ko u t wh yt h ep a t i e n t i so nt h e s ep a r t i c u l a r d r u g s : 

Ca p t o p r i l 1 2 . 5 mgPODa i l y–ACE( a n g i o t e n s i nc o n v e r t i n ge n z y me ) I n h i b i t o r * An g i o t e n s i ni sah o r mo n et h a t e n c o u r a g e sv a s o c o n s t r i c t i o na n di n c r e a s e dBP* T h i swi l l b eu s e df o r Mi k e ’ sHT N. Ch e s tp a i ni sas i d ee ff e c to ft h i sme d i c a t i o n :s e eh o wl o n gp a t i e n th a su s e dt h i sme d i c a t i o n , c a nc a u s ed y s p n o e a .



At o r v a s t a t i n1 0 mgPODa i l y–St a t i n s : l o we r sBa dc h o l e s t e r o l . Bl o c k st h ee n z y mei nt h el i v e r t h a t i sr e s p o n s i b l ef o r c h o l e s t e r o l s y n t h e s i s . Pa t i e n t s h o u l dn o t b ed r i n k i n ga l c o h o l a st h i sc a u s e sar i s ei nt r i g l y c e r i d e( at y p eo f f a t )( g r e a t e r t h a n2 0 0mg / d l )t h a tc a nc a u s ea t h e r o s c l e r o s i sa n dt h e r e f o r ec o r o n a r ya r t e r yd i s e a s ea n d s t r o k e .

Ph y s i c a l Ex a mi n a t i o no na d mi s s i o n    

RR–2 2b p m HR–8 4 BP1 4 0 / 9 0 T e mp–3 6C

VI CT ORI AUNI VERSI TYABN8 3 7 7 6 9 5 4 7 3 1CRI COSPr o v i d e rNo . 0 0 1 2 4 K



Sa O2–9 6 %RA

Pos s i b l eVi t a l Cha n ge s :   

RR–2 8b p m HR–1 2 0b p m Sa O2–8 9 %RAwi t hi n c r e a s e dWOB

2 .I f MrDu k ewe r et od e t e r i o r a t ei np r i o r i t yo r d e r&a sp e rt h eOSCAr u b r i cc o n s i d e ry o u rn u r s i n g a c t i o n s / i n t e r v e n t i o n sf o r MrDu k e . 5 2 3 4 Pe r f o r ma n c eCr i t e r i a( i n 1 p r i o r i t yor d e ro f Su p e r v i s e d ) ( I n d e p e n d e n t ) ( De p e n d a n t ) ( Ma r g i n a l ) ( As s i s t e d ) ( a s s e s s me nt ) [ Nu mb e r si n d i c a t eNMBARe g i s t e r e d Nu r s eSt a n d a r d sf o rPr a c t i c e ]

I d e n t i f yPa t i e nt ( 1 . 4 , 2 . 2 , 6 . 5 )

Ch e c kp a t i e n t wr i s t b a n da n dc h e c kO2 , s u c t i o na n dc a l l b e l l .

I n t r o d u c e ss e l f , I d e n t i fi e s t h ep a t i e n t &c o mp l e t e sa b e d s i d es a f e t yc h e c k

Pe r f o r msa Pr i ma r y As s e s s me n t ( 1 . 1 , 2 . 2 , 3 . 1 , 4 . 1 , 4 . 2 , 5 . 1 , 7 . 2 ) I sc o mp e t e n t a t p e r f o r mi n g wi t hv e r b a l i s a t i o naq u i c k p r i ma r ya s s e s s me n t t o d e t e r mi n et h es a f e t yo f t h e p a t i e n t . Ra t i o n a l i z e sh o w t h i si sd e t e r mi n e d

ABCDE:* Y o uMUSTt r e a tt h efi n d i n gp r ob l e m&d o c u me n t v i t a l b e f o r emo v i n gt on e x t s t e p * Ai r wa y :Ch e c kf o r p a t e n c y : Ca nt a l ka n dr e s p o n dv e r b a l l y , a b i l i t yt os p e a k–o n ewo r d e da n s we r . Br e a t h i n g : WOB: u s i n ga c c e s s o r ymu s c l e s , d y s p n o e a , RR, Sa O2 , a u s c u l t a t el u n g s , c h e s t d i s c o mf o r t wh e n b r e a t h i n g , c h e s t s y mme t r y , d e p t ho f b r e a t h i n g . Ci r c u l a t i o n :s k i nc o l o u r , s k i nt e mp , c a pr e fi l l , a s s e s sa n ya b n o r ma l v e i n s , p a l p a t ep e r i p h e r a l p u l s e s , b p , u r i n e o u t p u t s i g n s , Pa i nAx( PQRST ) , ECGp l a c e me n t , me d i c a t i o nf o rp a i n , r e a s s e s sO2r a t ei f n e e d e d . Di s a b i l i t y :e x a mi n ep u p i l s , BSL , GCS, r e a s s e s sABC. Ex p o s u r e :f u l l b o d yc h e c k , a s kp a t i e n t q u e s t i o n s . He a dt ot o eAx F o c us e dAx

VI CT ORI AUNI VERSI TYABN8 3 7 7 6 9 5 4 7 3 1CRI COSPr o v i d e rNo . 0 0 1 2 4 K

Pe r f o r msa1 2 L e a dECG( 1 . 1 , 6 . 1 ) Cor r e c t a n a t omi c a l l a ndma r k i ngof e l e c t r o d e s ( v e r ba l i s ea sy ou p l a c et he e l e c t r o d e s ) & c o r r e s pond i ngl e a d p l a c e me nt . Comp l e t e sa nECG& d o c u me n t sa l l r e l e v a n t i n f o r ma t i o no nt h eECG

ECGs i g n a l sa r er e c o r d e dt oe x a mi n eh e a r t r a t e , h e a r t r a t ev a r i a b i l i t y , a r r h y t h mi aa n do t h e rs i mi l a r f u n c t i o n s . V1( C1 )F o u r t hi n t e r c o s t a l s p a c ea t t h er i g h t s t e r n a l b o r d e r V2( C2 )F o u r t hi n t e r c o s t a l s p a c ea t t h el e f t s t e r n a l b o r d e r V3( C3 )Ha l f wa yb e t we e nl e a d sV2a n dV4 V4( C4 )F i f t hi n t e r c o s t a l s p a c ei nt h emi d c l a v i c u l a rl i n e V5( C5 )L e f t a n t e r i o r a x i l l a r yl i n eo nt h es a meh o r i z o n t a l p l a n ea sV4 V6( C6 )L e f t mi d a x i l l a r yl i n eo nt h es a meh o r i z o n t a l p l a n ea sV4a n dV5 RA( R)Ri g h t a r m( i n n e rwr i s t ) L A( L )L e f t a r m( i n n e r wr i s t ) RL( N) Ri g h t l e g( i n n e ra n k l e ) L L( F )L e f t l e g( i n n e ra n k l e )

I de n t i f y : I n t r o d u c ep a t i e n t : Mi k eDu k e5 2Y O, Ma l e Re q u e s t s a s s i s t a n c ef r om Si t u a t i o n : Pr e s e n t e d1d a ya g owi t hs h o r t n e s so f b r e a t ha n dc h e s t d i s c o mf o r t . Cu r r e n t l yo nCa p t o p r i l f o r s e n i o rs t a ffu s i n g h y p e r t e n s i o na n dAt o r v a s t a t i nf o rh y p e r c h o l e s t e r o l e mi a . I SOBARh a n do v e r r v a t i on : T a c h y c a r d i ca t 1 2 0 , T a c h y p n o e a2 8 , i n c r e a s i n gwo b , Sa O28 9 %-h y p o x i cp u t o n5 Lr e b r e a t h e r ( 1 . 1 , 1 . 4 , 2 . 7 , 3 . 3 , Obse m a s k m a y n e e d t o b e i n c r e a s e d . P a i n i n t h e c h e s t h a s i n c r e a s e d . 3 . 4 , 3 . 5 , 6 . 1 , 6 . 2 , 6 . 5 ) Ba c k g r o u n d :Ca r d i o v a s c u l a rd i s e a s ei nf a mi l yHx , c u r r e n t s mo k e ra n dag l a s so f wi n ee a c hn i g h t . Su ff e r e da r e c e n t r e s p i r a t o r yi n f e c t i o n . Pr o v i d e sr e l e v a n t i n f o r ma t i o nt os e n i o r s t a ff . I sa bl et oi de nt i f yt h e n e e df o ra s s i s t a nc e f r oms e n i ors t a ff

Effe c t i v e Co mmu n i c a t i on ( 1 . 4 , 1 . 5 , 2 . 1 , 2 . 2 , 3 . 2 )

As s e s s me n t : ABCDEr e s u l t s : Po s s i b l eCOPDHy p o x i a , A CSa t r i s ko f AMI , r i s ko f p n e u mo t h o r a x , a t h e r o s c l e r o s i s , s t r o k e . Re c o mme nd a t i on : u r g e n t r e v i e wb yd o c t o r , mo n i t o r EGC, mo n i t o r v i t a l s , r e q u e s t o r d e r f o rF BC, ABGs ,x r a y , u r i n a l y s i sa n dfl u i db a l a n c ec h a r t .

KNOWWHY! I n t e r v e n t i o n&Ra t i o n a l :

Cl e a r l ye x p l a i n sa l l p r o c e d u r e st ot h ep a t i e n t a n dp r o v i d e sr a t i o n a l e s . Pr o v i d e st h ep a t i e n t

VI CT ORI AUNI VERSI TYABN8 3 7 7 6 9 5 4 7 3 1CRI COSPr o v i d e rNo . 0 0 1 2 4 K

r e a s s u r a n c e . Co mmu n i c a t e sc l e a r l ywi t h s e n i o r s t a ff . Do c u me n t a t i o ni s c o mp l e t e .

Po s s i b l ed i a g n o s i s&Ra t i o n a l :

Ai r wa y : I na c u t er e s p i r a t o r yf a i l u r e ,a i mt oma i n t a i na no x y g e ns a t u r a t i o no f9 4 – 9 8 %.I np a t i e n t sa tr i s ko f h y p e r c a p n i cr e s p i r a t o r yf a i l u r e( s e eb e l o w) a i mf o r a no x y g e ns a t u r a t i o no f 8 8 – 9 2 %. Br e a t h i n g : RR:I n c r e a s i n gr e s p i r a t o r yr a t ei sama r k e ro fi l l n e s sa n dawa r n i n gt h a tt h ep a t i e n tma yd e t e r i o r a t e s u d d e n l y . Ch e s t I n s p e c t i o n : Assess the depth of each breath, the pattern (rhythm) of respiration and whether chest expansion is equal on both sides. Note any chest deformity (this may increase the risk of deterioration in the ability to breathe normally).

Di ffe r e n t i a l Di a g n o s i s : Si g n s&Sy mp t o ms Re c e n t r e s p i r a t o r yi n f e c t i o n , s mo k e r , SOB, WOB, f a mi l yHxo f c a r d i o v a s c u l a r d i s e a s e : COPD:Emp h y s e ma( a i rs a c sa r ed a ma g e da n de n l a r g e d ,u n a b l et oe x c h a n g eg a s e se ff e c t i v e l y ) , Ch r o n i cBr o n c h i t i s( I n fl a mma t i o na n ds we l l i n go ft h el i n i n go ft h ea i r wa y s ,l e a d i n gt on a r r o wi n ga n d o b s t r u c t i o ng e n e r a l l yr e s u l t i n gi nd a i l yc o u g h ) . SOBo ne x e r t i o n / s mo k e r Hy p o x i a :L a c ko fo x y g e nc i r c u l a t i n gt h eb o d yd u et op o s s i b l ec a r d i a cc o r o n a r yCAS,COPD.T h i s c a u s e sl a c ko f o x y g e nt ot i s s u e sa n do r g a n s .

VI CT ORI AUNI VERSI TYABN8 3 7 7 6 9 5 4 7 3 1CRI COSPr o v i d e rNo . 0 0 1 2 4 K

F u r t h e r e l a b o r a t i o no f t h i sp a t i e n t wi l l b eh a n d e do v e r d u r i n gy o u r OSCA. Re f e r t ot h er u b r i cf o r e x p e c t a t i o n sd u r i n gt h i sOSCA Y o uwi l l h a v e1 0mi n u t e sONL Yt od e mo n s t r a t ey o u r a b i l i t yt oma n a g eMi k eDu k e

VI CT ORI AUNI VERSI TYABN8 3 7 7 6 9 5 4 7 3 1CRI COSPr o v i d e rNo . 0 0 1 2 4 K...