Questions 1

Mrs Jones is 63 years old and has been admitted to the medical
admissions ward from the A&E with a 3 day history of
breathlessness at rest and increased sputum production and cough.
She has had COPD for the last 7 years, has suffered progressive
disabling breathlessness on minimal exertion over the last 2 years
and has had frequent exacerbation requiring hospital admission. She
has home nebulisers.

Observations
A Airway Patent
Trying to talk but is unable to complete a sentence without taking a breathe, coherent.
Productive Cough, Green purulent sputum
B Using her accessory muscles
Barrel Chest
Central Cyanosis
 RR 32 bpm,
 Pulse oximetry – 82%
o ABG’s

 Auscultation –
wide spread expiratory wheeze, coarse Crackles lower bases of her lungs

C HR 128 / minute sinus tachycardia – bounding pulse,

BP 170/ 90 mmhg
Temperature 39°C
D Drowsy, but roused by voice, agitated and confused
Level of consciousness is 15 when assessed using the Glasgow coma scale.
Blood sugar 5.6 mmols/ l
E She is very shaky and has a flapping hand tremor.
Flushed appearance with very warm oedematous peripheries.
Presence of finger clubbing.
 BMI of 18
 Question 2
Mr Edward Black is an 80kg 52 year old Business man who has
been admitted for investigations of palpitations. He has woken at
2am with central crushing chest pain radiating to his lower jaw. It is
the worst pain he has ever experienced. He feels cold, dizzy and is
sweating profusely. Edward is complaining of dizziness and
palpitations and says he feels nauseous. He says it has been getting
worse over the last 20 minutes, but had not called the nurses as he
did not want to bother them. He is escorted into hospital by his wife,
16 year old daughter who is sitting her GCSE’s. Mr Black also has
an 8 year old son who at home, unaware of his father’s illness he is
asleep in bed and being looked after by a neighbour.

Observations
A Clear – speaking in full sentences – chest hurts
B RR 26, Chest clear, short of breath –
C HR 128 / min
BP 80/45 mmHg,
T 37.2 °C.
 Record resting 12 lead ECG
(Shows marked ST elevation in anterior leads V 1 - V 4)
D Alert
 Glucose 8.5mmols/l
E Central crushing chest pain radiating down his left arm and up into his neck
 Question 3

Mrs Hicks is a 68 year old woman admitted to your ward yesterday

with a fever, abdominal discomfort and diarrhoea. Over the last4
hours her abdominal pain has become worse and you notice that her
abdomen is distended. She has no significant prior medical history.
She weighs 75Kgs.

Assessment

A- Airway patent, talking in complete sentences.

B- Respiratory rate 26 breaths per minute, Chest sounds clear.
 Pulse oximetry – 82%
Arterial blood gas

C HR 118 sinus tachycardia,

BP 80/ 40 mmhg (has fallen progressively from 110/ 80 over last 4
hours),
Temperature 39° C
C-Reactive Protein (CRP) 10mg/dl
White Cell Count raised 209 /L
Urine output last 3 hours – 30mls , 25 mls, 0mls .
D Roused by voice, Confused / delirious cannot remember date,
disorientated.
E Dry mouth and skin
 Question 4
You are on a la te shift on A5 and are doing your 18.00 obs on
Brian a normally fit and well 60 year old man who has had a
coiling of an aneurysm that morning. You carry out a full set of
observations and complete a NEWS score.

His Resp Rate is 22bpm

His 02 SpO2 are 94% on 35% Oxygen
His heart Rate is 95bpm
BP 98/50
His Temp 36.9C
He is 100 kg, he is catheterised
His urine output is 30mls an hour.
He is responding to pain only.
GCS 9 (was 15 earlier that day)
 Question 5
You are on an early shift on D8 and are doing your
10.00 obs on Sandra an 80 year old lady who
was admitted overnight having been found
collapsed at home query cause. You carry out a
full set of observations and complete a NEWS
score.

Resp Rate 26bpm

Her SpO2 is 90% on
room air
Heart rate 90 bpm
BP 105/92
Her urine output is 25mls an hour for the last 4 hours
(catheterised).
Temp 36.0 C
AVPU is pain and she is increasingly confused