OSCE Toolbox | Clinical Skill 1 - Scenario

By Amina Adnan • March 21, 2024 • Last reviewed: 24/09/24 •

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Summary Expert

In this scenario, the student is expected to demonstrate how to take an accurate manual blood pressure.

Please ensure that this scenario and mark scheme aligns with the most up-to-date guidelines from the UK NICE and the BNF when using it for your OSCE assessment.

You will need a student pharmacist and an actor for this OSCE station.

Revision Topics

Be aware, this may reveal any answers!

Student Instructions

Actor Instructions

This may reveal scenario objectives!

Mark Scheme

Introduction

0 / 2

Introduce yourself with an appropriate greeting

Confirm patient details: Name and age

Equipment

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Correctly picks up a:

Stethoscope

Sphygmomanometer

Explanation

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I am going to measure your blood pressure today. This will involve me placing this cuff around your arm and inflating it with this pump. I will also listen to your pulse with my stethoscope.

You can experience some discomfort during this process when I inflate the pump or pins and needles in your hand.

If at any point during this procedure, you feel too uncomfortable or are in pain, please let me know and I will stop.

Contraindications

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Relative contraindications:

Lymphoedema - swelling in your arms

Paresis or paralysis - muscle problems

Arterial or venous lines e.g. venous catheter - any lines

Absolute contraindications:

Dialysis shunt

Recent surgical wound/operations

Mastectomy

Consent

0 / 1

Are you happy with me going ahead with the procedure? - Or similar

Patient preparation

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Make sure the patient is sitting on a chair (without crossing their legs)

Position their arm in a comfortable position ideally at heart level and resting on the table

Ask the patient if they have an arm preference

Ask the patient to roll up their sleeve/ expose their arm up to their shoulder

Ensure they are relaxed and do not talk during the process.

Correct positioning of the blood pressure cuff

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Make sure the blood pressure cuff is fully deflated before placing it on the patient's arm

Check the location of the patient's brachial artery. This is normally medial (closer to the centre of the body) to the biceps brachii tendon, which can be felt in the middle of the elbow crease. It is normally lateral (further to the outside of the body) than the medial epicondyle of the humerus (the inner bony part of the elbow)

Place the blood pressure cuff around the patient's arm

Line up the cuff marker with the brachial artery

Measuring the approximate systolic blood pressure

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Measure the patient’s approximate systolic blood pressure. You do this to make sure that you do not make the cuff too tight when trying to get a blood pressure reading.

Make sure the valve on the blood pressure cuff is closed

Palpate the patient's radial pulse with your index finger and ring finger. Do not use your thumb!

Inflate the blood pressure cuff until you can no longer hear their radial pulse. Make a note of the reading- this value is the patient's approximate systolic blood pressure

Open the valve to deflate the blood pressure cuff so that it is ready for you to use to measure the blood pressure. Ensure the arrow is pointing at 0 on the sphygmomanometer when you do this!

Measuring the accurate blood pressure

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Close the valve on the blood pressure cuff

Place the diaphragm of your stethoscope over the patient’s brachial artery

Inflate the blood pressure cuff ensuring you inflate 20-30 mmHg over the approximate systolic blood pressure

Slowly deflate your cuff, it is advised to go 2-3 mmHg a second initially as you get used to performing this procedure.

Carefully listen to your stethoscope to identify the first Korotkoff sound. You may need to listen to some audio on the internet to know what you are listening for. This first sound represents the patient's systolic blood pressure. Make a mental note of this value.

Carry on deflating the cuff until the sound you are hearing completely disappears. The final pulsing sound that you hear is called the fifth Korotkoff sound. This represents the patient's diastolic blood pressure. Make a mental note of this value.

If you have time, repeat these 2 more times, and take an average of the 3 values.

Discusses that some practitioners recommend doing it 4 times and discounting the first reading completely as the patient’s blood pressure may be high in the first reading because of the ‘white collar effect’.

After the procedure

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Tell the patient their blood pressure reading and briefly explain what this means (e.g. high, medium, low)

If abnormal, you could say you will pass this on to a colleague who will discuss management with them.

Thank the patient for their time.

The student did not say anything that could harm the patient

This includes but is not limited to, providing incorrect information or medication, misdiagnosing conditions, neglecting to inquire about allergies, making incorrect referrals, or failing to act on red-flag symptoms.

Time Management

0 / 1

Completed the scenario in time and achieved 70% of marks

Any criteria marked in red must be met to pass this station.

Referral Criteria

References

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Referral Criteria for the Manual Blood Pressure Practical

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Referral Criteria for the Manual Blood Pressure Practical

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