Breathless older patient with a chest infection
NMC OSCE practice station

The task

You are the nurse on a medical ward. Dorothy Hargreaves, aged 77, was admitted yesterday with a chest infection and is now more breathless. A healthcare assistant is available. Introduce yourself, confirm her identity, and carry out a systematic assessment using an A to E approach. Record her observations and early warning score on the chart provided, then decide who you need to tell and how urgently. Say aloud what you are checking and why, and describe any examination you would do.

What this station tests

• A NEWS2 of 5 or more is an urgent escalation. Do not repeat observations first and wait.
• Work A to E in order and say what you find; look at the patient as well as the chart.
• Use oxygen saturation scale 1 unless a clinician has prescribed scale 2.
• A chest infection with fever, fast pulse and low urine output should prompt sepsis thinking.
• Check allergy status before antibiotics are discussed or given.

Sources for the clinical content

• Royal College of Physicians: National Early Warning Score (NEWS2)
• NICE NG253: Suspected sepsis in people aged 16 or over
• British Thoracic Society: Guideline for oxygen use in healthcare and emergency settings
• NMC: The Code

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

Practise next

• Worsening abdominal pain after bowel surgery
• Confused patient after a fall with a head injury
• Children's nursing assessment of a child with a high fever
• Midwifery postnatal home visit with a feeding problem
• Midwifery assessment of reduced baby movements