Osce Master Copy PDF

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Holy grail of this course for the osce...

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OSCE * Sanitize your hands, Introduce yourself, Check their ID band, Explain the procedure, Check for risks, Clean Stethoscope.

General Survey; Measurement; and Vital Signs - raise/lower bed, put patient in the proper position, draw curtains for privacy if necessary.

General survey: P,BS,M,B 1. Physical Appearance 1) Age - appears his or her stated age. 2) Sex - sexual development appropriate for gender and age. 3) Level of consciousness (LOC) - alert and oriented, attending to your questions, and responding appropriately. (Person, place, time, situation) 4) Skin colour - even colour tone, pigmentation varying with genetic background, intact skin with no lesions. 5) Facial features - Symmetrical with movement, no signs of distress. 2. Body Structure 1) Stature - Height within normal range for age and genetic heritage. 2) Nutrition - Weight within normal range for height and body build, even distribution of body fat. 3) Symmetry - Body parts equal bilaterally and in relative proportion to each other. 4) Posture - Standing comfortable and erect as appropriate for age, normal “plumb line” (through anterior ear, shoulder, hip, patella, and ankle). 5) Position - Sitting comfortably in a chair, on the bed, or examination table, arms relaxed at sides, head turned to the examiner. 6) Body Build/Contour - Normal proportions (arm span = height (fingertip to fingertip), body length from crown to pubis approximately = to length from pubis to sole, obvious physical deformities: note any congenital or acquired defects). 3. Mobility 1) Gait - Normally, base width = to shoulder width, accurate foot placement, smooth, even, and well-balanced walk, presence of associated movements. 2) Range of motion (ROM) - Full mobility in each joint, deliberate, accurate, smooth, and coordinated movement.

4. Behaviour 1) Facial expression - Maintaining eye contact (unless a cultural consideration exists), expressions appropriate to the situation (eg. Thoughtful, serious, or smiling) 2) Mood and affect - Comfortable and cooperative with the examiner and interacting pleasantly (Face match emotion?) Ask: How are you feeling today? 3) Speech - Clear and understandable articulation (the ability to form words), fluent, even pace, convey ideas clearly, word choice appropriate (=education) 4) Dress - Clothes appropriate to climate and season, clean and fits the body, appropriate for culture and age (eg. Hutterite faith, women of Indian descent) 5) Personal hygiene - clean and groomed appropriately for patient’s age, occupation, and socioeconomic group, hair groomed and brushed.

Measurement: 1. Weight - Use a standardized balance or electronic scale (instruct patient to remove shoes, heavy clothing), record weight in kilograms and pounds 2. Height - Use a wall mounted device or the measuring pole on the balance scale (align head piece with top of head), Pt should be shoeless, standing straight and looking straight ahead. Feet, shoulders, and buttocks should be in contact with the wall or pole. 3. Body Mass Index - Is a practical marker of optimal weight for height BMI = Weight (kg) / Height (m2) 30 = Obese 4. Waist-to-hip ratio - Reflects body fat distribution = Waist circumference/Hip circumference * 1.0 or higher in men and 0.8 or higher in women is indicative of upper body obesity

Vital Signs: 1. Temperature: (36-38 degrees) - Wait 20 minutes before taking temperature if patient has just taken hot or iced liquids, 2 minutes if they have just smoked, 5 minutes if they have chewed gum. Rectal temperatures are usually 0.5° higher than oral temperatures, and axillary temperatures are usually 0.5° lower than oral temperatures. Oral: a) Slide disposable plastic probe cover over the thermometer until locks into place b) Place thermometer in posterior sublingual pocket (under the tongue) - this is because blood vessels are closest to the surface here and therefore can get a

c) d) e) f)

better reading due to the heat they produce, get patient to hold thermometer with their lips closed! Leave thermometer probe in place until audible signal occurs and patient’s temperature appears on digital display Take thermometer out of patient’s mouth and push ejection button on thermometer stem to discard plastic probe cover into garbage Return system back to appropriate unit Perform Hand Hygiene and ask how Pt is doing

2. Pulse: (60-100 bpm)  Measuring the rate and rhythm of the heartbeat. Influenced by exercise, emotions, medications, pain, etc. Wait 5-10 min if active  Tachycardia = abnormally fast heart rate (>100 bpm)  Bradycardia = slow heart rate (...