Wheeze and breathlessness in a young woman
RCSI OSCE practice station

The task

You are the nurse on an acute medical assessment unit. Aoife Brennan, aged 24, has asthma and has come in with increasing wheeze and breathlessness since last night. A staff nurse is available. Introduce yourself, confirm her identity and carry out a focused respiratory assessment while keeping her safe. Take and record observations on the chart. Decide how severe this is and who you need to tell. Contact the doctor by phone using ISBAR when you have decided. Find out how she uses her inhaler and give clear advice about what she should do if this happens again.

What this station tests

• Look at the patient first: speech, effort and the chest tell you about severity.
• Compare peak flow with her best, not only with a chart average.
• Target oxygen saturation 94 to 98 per cent in asthma.
• Do not delay escalation to finish the history.
• Teach spacer use and a written action plan.

Sources for the clinical content

• HSE: asthma attacks
• British Thoracic Society: guideline for oxygen use in healthcare and emergency settings
• National Clinical Guideline No. 1: INEWS V2 summary, including the scoring key
• HSE: ISBAR communication tool
• NMBI: Code of Professional Conduct and Ethics
• RCSI: overseas aptitude test preparation (public topic list)

An original practice scenario with invented patients. Not an exam question.

Practise next

• New confusion in an older woman, with her son present