Sleepier than usual: a patient with COPD on the ward
NZ nursing OSCE practice station

The task

You are the nurse on a medical ward. Doreen Whitcombe, aged 68, has COPD and was admitted two days ago with a chest infection. A health care assistant tells you she seems sleepier than before. Carry out a respiratory and general assessment, state what you find and what it means, and act on your findings. Record her observations and your assessment on the chart provided, decide who you need to inform and how urgently, and keep Mrs Whitcombe informed as you work. A doctor can be reached by phone.

What this station tests

• Know the prescribed oxygen target before changing or giving oxygen, especially in COPD.
• Drowsiness in a patient on oxygen is an urgent sign, not just tiredness.
• Reduce oxygen to the target range rather than stopping it, and recheck saturation soon after.
• Escalate urgently with ISBAR and ask for a blood gas when carbon dioxide retention is suspected.
• Ask what worries the patient and answer honestly.

Sources for the clinical content

• Thoracic Society of Australia and New Zealand oxygen guidelines for acute oxygen use in adults (PubMed record)
• Asthma and Respiratory Foundation NZ: New Zealand COPD guidelines quick reference guide
• Health Quality & Safety Commission: New Zealand early warning score and vital signs chart user guide

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

Practise next

• Chest pain in a middle-aged man at the emergency department