Drowsy man with COPD on a medical ward
RCSI OSCE practice station
Acute management · 1 min to read · 10 min to perform
Review the charts and equipment at the bedside.
Mr Declan WalshI've an awful sore head... I'm very tired.
Free · no sign-up · uses your one free station
Open the full station (charts, voice, result letter) →The task
You are the nurse on a medical ward. Mr Declan Walsh, aged 68, has chronic obstructive pulmonary disease and was admitted with a chest infection. He is having a nebuliser. His daughter asked you to look at him because he seems sleepy, and she has stepped out to make a phone call. A staff nurse is available. Introduce yourself, confirm his identity and assess him. Review the charts and equipment at the bedside. Take and record observations, decide what is wrong and what to do now, and contact the doctor by phone using ISBAR.
What this station tests
- Patients with COPD at risk of carbon dioxide retention need a prescribed oxygen target of 88 to 92 per cent.
- In patients at risk of carbon dioxide retention, run nebulisers on air and give controlled oxygen alongside if needed.
- Drowsiness with a high saturation is an emergency sign; reduce, do not remove, the oxygen.
- Always escalate drowsiness urgently with ISBAR.
- Teach patients to carry an oxygen alert card.
Sources for the clinical content
- British Thoracic Society: guideline for oxygen use in healthcare and emergency settings
- HSE: living with COPD
- 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.