Confused patient after a fall with a head injury
NMC OSCE practice station

The task

You are the nurse in an emergency department. Gordon Whitfield, aged 79, was brought in by his daughter after a fall at home this morning in which he hit his head. He seems muddled. A healthcare assistant is available. Introduce yourself, confirm his identity and carry out a systematic assessment using an A to E approach, including a focused neurological assessment. Record his 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 single red score of 3 in any NEWS2 parameter, such as new confusion, needs an urgent response even when the total is low.
• Head injury plus anticoagulants is high risk: escalate immediately and mention the anticoagulant and the last dose.
• Use the Glasgow Coma Scale with all three components, and check pupils and limb power.
• Until the Glasgow Coma Scale is 15, record neurological observations at least every 30 minutes; any fall, more vomiting or unequal pupils means call for help at once.
• Use family to confirm identity and baseline when the patient is confused.

Sources for the clinical content

• NICE NG232: Head injury: assessment and early management
• Royal College of Physicians: National Early Warning Score (NEWS2)
• NICE NG41: Spinal injury: assessment and initial management
• NMC: The Code

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

Practise next

• Breathless older patient with a chest infection
• Worsening abdominal pain after bowel surgery
• 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