New confusion in an older woman, with her son present
RCSI OSCE practice station

The task

You are the nurse on a medical ward. Mrs Maura Kavanagh, aged 84, has mild memory problems at baseline but her son Liam says she has become more confused and sleepy over the last two days. He is at her bedside. Introduce yourself, confirm her identity and speak with both of them. Assess her using a recognised screening tool for sudden confusion, look for possible causes, and take and record observations. Decide what is most likely and telephone the doctor using ISBAR. Explain to her son what you think is happening and what you will do, and complete the record.

What this station tests

• Use a recognised screening tool and show the scoring.
• Always ask family about baseline and onset; sudden change is delirium until proven otherwise.
• Look for treatable causes: infection, constipation, dehydration, medicines, pain.
• Non-drug measures come first: glasses, hearing aids, orientation, sleep, family.
• Escalate promptly with ISBAR and explain delirium to the family.

Sources for the clinical content

• 4AT: rapid assessment test for delirium
• 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

• Wheeze and breathlessness in a young woman