Week 2 Practice OSCE Vital Signs doc sept 19 PDF

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OSCE practice...

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OSCE SCENARIO:

You are working as a nursing student with the local office nurse. Your job is to do preliminary assessments of all patients before they see the Nurse Practitioner. A 40-yearold male named Pat Pressure presents into your care after checking their blood pressure at a local pharmacy. Pat is worried about “high blood pressure”. You, the student, will meet the patient for the first time and perform a problem focused assessment involving a short subjective data collection and physical exam of the stated problem.

63-166 Vital sign practice OSCE – JBornais & SMorrell, D Laing, Fall 2016

Information Provided to the “Patient” You are Pat Pressure a 40 year-old who has come to the office because when you were in the pharmacy your blood pressure was high. Try to act out the part and send body language expressing concern. You will give the following details to the student only if you are asked: ● You came to the clinic because the blood pressure reading at the pharmacy was high ● It read 146/92 ● This is the first time you have ever noticed your BP being high although you don’t normally test it ● You are a factory worker. You work full time at a plant but are currently laid off ● You are married with 2 children ● Your Dad died of cancer when he was in his 70’s and your Mom has high blood pressure ● You are not aware of any medical conditions however it has been a few years since you have had a complete physical examination ● You do not have any headaches or blurred vision. ● You smoke 1 pack of cigarettes per day ● You do not take any medications just vitamins ● You do not have any allergies to medication, food, or environment ● You drink about 1-2 beers a day maybe a few more on weekends ● You love fatty foods ● You usually season your food with salt and pepper but you don’t think you do this in excess ● You don’t currently exercise

*STAY IN CHARACTER EVEN IF YOUR STUDENT DOES NOT*

Criteria Description There are NO partial marks. The student completes the described criteria correctly for a mark, as per the Jensen Textbook, OR does not receive the 63-166 Vital sign practice OSCE – JBornais & SMorrell, D Laing, Fall 2016

Marks

mark. 1.

The student ➢ sets the environment up to promote client safety and confidentiality. Draws curtain or closes door to ensure client comfort AND ➢ introduces him/herself formally (first and last name) and states his/her role AND ➢ is dressed in professional attire and wearing proper ID (i.e. trimmed nails, hair pulled back and off the face and collar, facial piercing removed or covered, and jewelry limited to two studs in the ears and a plain wedding band only (as per Collaborative Nursing Policy).

2.

The student ➢ uses appropriate biological safety procedures – and washes hands for minimum of 15 seconds or sanitizers their hands until the gel is dry AND ➢ gathers appropriate equipment, ensuring instruments are sterile/clean (i.e. stethoscope, thermometer).

3. The student ➢ Gathers demographic data – e.g. name, address, phone number, age, occupation, marital status, number of children 4. The student ➢ Asks patient his/her reason for seeking care (chief concern). Student proceeds with brief focused subjective data collection 5. The student ➢ asks the patient about any relevant history regarding blood pressure (at least THREE of the following): diabetes, heart disease, stroke, MI, hyperlipidemia, angina, or any other illness the examiner feels are relevant. 6. The student ➢ questions the patient about any associated symptoms of altered blood pressure (at least TWO of the following): headaches, blurred vision, light-headedness, dizziness, ringing in the ears, palpitations, chest pain, shortness of breath, or any other illness the examiner feels are relevant. 7. The student ➢ asks the patient about his/her general past health (at least THREE of the following): cancer, blood disorders, arthritis, or any other 63-166 Vital sign practice OSCE – JBornais & SMorrell, D Laing, Fall 2016

illness the examiner feels is relevant. 8. The student ➢ questions patient about any relevant family history of diseases/illnesses (at least THREE of the following): HTN, hyperlipidemia, stroke, diabetes, MI, angina, stroke, or any other illness the examiner feels is relevant. Additional subjective data collection questions

9. Student asks if patient is taking any medication including ALL of the following: herbal medications, vitamins, OTC, and prescription medications 10. Student asks patient about ALL of the following allergies: to medications, food, and environmental allergens 11. Student asks about THREE of the following self-care behaviours – last physical exam, smoking history (or exposure to secondary smoke), alcohol, salt intake, diet, exercise, immunizations, or any other items the examiner feels in relevant 12. Student asks an Abuse Assessment Screen (AAS) question with appropriate preamble. 13. Student reports on general survey, including data on ALL of the following: physical appearance (e.g. dressed for weather/age/gender, clean/groomed, no odour), body structure (e.g. physical development consistent with age, no joint abnormalities, body parts symmetrical, small/med/large build), mobility (e.g. posture upright while sitting, rises unaided, moves freely in environment, no assistive devices, steady gait), AND behaviour (e.g. cooperative, affect is animated, maintains eye contact, A+Ox4, responds appropriately to questions). 14. Student explains to patient what he/she is doing as he/she proceeds with the physical exam. Student proceeds with taking vital signs:

15. The student ➢ asks patient if he/she has had anything to drink, eat, or smoke, and if he/she has exercised in the last hour. 16. the student ➢ instructs patient to remain silent during vital sign measurement 63-166 Vital sign practice OSCE – JBornais & SMorrell, D Laing, Fall 2016

17. The student takes patient’s temperature ➢ Places thermometer correctly in mouth or ear (taking temperature in the mouth will require the mouth to be closed for the entire reading. If the patient speaks during temperature measurement the student should retake the temperature.) ➢ Correctly reports the temperature in Celsius AND identifies whether the temperature is within a normal oral temperature range for the stated age (36.5 – 37.5 oC). If using a tympanic thermometer states the appropriate range for tympanic readings (36.00C to 37.50C) 18. The student takes the patient’s pulse: ➢ Begins counting with “zero” for the first pulse felt ➢ Takes pulse at radial site for 60 seconds ➢ Reports pulse rate ➢ Reports pulse rate (within +/- 4 of the instructor’s reading) ➢ Identifies whether the pulse is within the normal range (60-100 BPM). ➢ Reports patient’s rhythm, amplitude, and elasticity and identifies if they are normal: e.g. rhythm(regular), amplitude (2+), and elasticity (smooth, straight, & resilient) 19. The student takes the patient’s respirations: ➢ Takes respirations for 30 seconds (and multiplies by 2) or if irregular, takes for a full minute AND ➢ takes the respirations unobtrusively. ➢ Reports respiratory rate ➢ Reports respiratory rate (within +/- 2 of the instructor’s reading) ➢ Reports the following about the respirations: symmetrical, relaxed breathing, regular breaths, automatic breaths, silent breaths OR states the respirations are eupneic ➢ Identifies whether respirations are within the normal range for the stated age (12 - 24 respirations per minute for patient 65 or older; 1220 for adult patient under 65). 20. The student determines the patient’s oxygen saturation with the pulse oximetry ➢ assesses capillary refill in the extremity to be used (reports that the colour returns in less than 3 seconds) ➢ assesses pulse strength in the extremity to be used and verbalizes findings (2+) ➢ places probe appropriately on finger and obtains oxygen saturation 63-166 Vital sign practice OSCE – JBornais & SMorrell, D Laing, Fall 2016

reading ➢ Identifies whether the reading is within the normal range for oxygen saturation (92% -100% - consider the patient) 21. The student takes the patient’s blood pressure: ➢ asks the patient to sit or lie down, if sitting ensures patient’s feet are flat on the floor, and legs are uncrossed ➢ asks the patient not to speak during the BP measurement ➢ ensures patient’s arm is supported and at heart level. ➢ Uses palpation technique to locate brachial artery and determine where to place cuff AND ➢ Places appropriate size blood pressure cuff correctly on the patient ➢ Student performs an estimated systolic blood pressure ➢ Palpate the radial artery and inflating the cuff until the pulsation disappears- note the mmHg when it disappears. ➢ Pump the cuff to 30 mm hg above where the pulse stopped. ➢ Slowly open the valve noting the mmHg when the pulsation is palpable again- this is the estimated SBP. ➢ Student performs standardized blood pressure (after waiting 1530 seconds after estimating the systolic pressure) ➢ Reinflate the cuff 30 above the estimated systolic blood pressure ➢ Open the control valve so that the rate of deflation of the cuff is approximately 2 mmHg per second. ➢ A cuff deflation rate of 2 mmHg per second is necessary for accurate systolic and diastolic estimation. ➢ Read the systolic level (the first appearance of a clear tapping sound [phase I Korotkoff]) ➢ Read the diastolic level (the point at which the sounds disappear [phase V Korotkoff]). ➢ States diastolic blood pressure (within +/- 6mmHg of the instructor) ➢ States systolic blood pressure (within +/- 6mmHg of the instructor) ➢ Identifies whether the blood pressure reported is within the normal range for the stated age (100-139 systolic over 60-89 diastolic). 22. Student performs basic relevant health teaching with patient i.e. smoking cessation, exercise, diet, or any other area the examiner feels relevant. 23. Student uses appropriate therapeutic communication techniques, communicating with patient with dignity and respect during interview

63-166 Vital sign practice OSCE – JBornais & SMorrell, D Laing, Fall 2016

➢ Invited the patient’s story –used at least one open-ended communication question and one focused question with regards to generating the patient’s story 24. Student concludes the assessment with a summary comment that reflects the patient’s findings AND explains the next steps i.e: I have now completed my assessment, your vital signs were ______, I will share these findings with the NP or MD. Do you have any questions? Mark

TOTAL

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Teaching and Learning Section When blood pressure is low it can be accompanied by dizziness, diaphoresis (sweating), shortness of breath, and blurred vision. When blood pressure is high patients are usually asymptomatic. However, when a patient present with high blood pressure, a nurse should inquire about headaches, dizziness, blurred vision, palpitations, chest pain, and shortness of breath. By asking patients about changes in their recent health, the prudent nurse hopes to gather data in the health history to help with his/her hypothesis or nursing diagnosis. Risk factors that contribute to high blood pressure include a past medical history of hyperlipidemia (high cholesterol) or diabetes mellitus and the use of medications such as estrogen in oral contraceptives. A patient must be asked about family history of cardiac disease or hyperlipidemia. A nurse should inquire about tobacco and cocaine use. A patient’s lifestyle can affect blood pressure and the nurse should inquire about diet, alcohol, exercise, living arrangements, and stressful employment. These are important lifestyle modifications and essential health teaching factors for patients with high blood pressure.

63-166 Vital sign practice OSCE – JBornais & SMorrell, D Laing, Fall 2016...