OSCE › Station
Acute situation: hypoglycaemia, ketones and a neurovascular check
RCSI heading: Nursing process in the acute situation. You get 2 minutes with the descriptor outside the door and 10 inside, marked competent or not competent on every line. RCSI publishes no sample for this station; the descriptor below follows the layout of the two samples it does publish. Check rcsi.com before your date.
Rehearse it
Stand up, say it aloud, use whatever is on your desk as the equipment. The debrief is the competency sheet and the assessor’s questions.
To assess recognition and first management of hypoglycaemia and raised ketones in type 1 diabetes, the sick day rules, and a neurovascular assessment of a limb in a cast.
Ms Aoife Ryan, 24, type 1 diabetes on basal-bolus insulin, admitted last night with a fractured right wrist in a below-elbow cast after a fall. At 07:30 she is sweaty, shaky and irritable; capillary glucose 3.1 mmol/L. She vomited once overnight. Her fingers on the right feel "tingly".
You are required to treat the hypo and recheck, check ketones and say what they mean, state the sick day rules, and do and document a neurovascular assessment of the right hand.
- Recognise the hypo: glucose under 4 mmol/L with sweating, shaking, irritability, and confirm she can swallow safely
- Give 15 g of fast-acting carbohydrate (glucose tablets, 150 mL non-diet fizzy drink or juice) and recheck in 10 to 15 minutes; repeat if still under 4
- Once above 4, give a longer-acting carbohydrate snack or the meal, and say when insulin is given relative to the meal
- State what changes if she cannot swallow: nothing by mouth, recovery position, glucagon IM as prescribed or IV glucose by the doctor, call for help
- Check blood ketones after vomiting: under 0.6 normal, 0.6 to 1.5 advice on insulin, above 1.5 urgent review, above 3 emergency
- State the sick day rules: never stop insulin, check glucose every 2 to 4 hours, check ketones, sugar-free fluids, carbohydrate as sugary drinks if not eating, seek help if vomiting or ketones rising
- Neurovascular assessment of the right hand: colour, warmth, capillary refill, swelling, movement, sensation, pulse, pain out of proportion, compared with the left
- Say the red flags and the action: pain not relieved by analgesia, tightness, paraesthesia, pallor, pulselessness: elevate, loosen or split the cast per protocol, call the doctor urgently
- Document glucose values, treatment and times, ketones, and the neurovascular findings on the chart with a repeat time
- Inform the team and the diabetes nurse specialist; say what needs a doctor now
Throughout: communicate in an accurate, clear and effective manner; demonstrate a level of competence essential for safe practice.
The pass: theory and OSCE
Run every station on the clock.
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Competencies assessed
Every RCSI descriptor lists the same five domains from the NMBI standards.
- Professional values and conduct of the nurse
- Nursing practice and clinical decision-making
- Knowledge and cognitive competences
- Communication and interpersonal competences
- Management and team competences
Mistakes candidates report
- Treating the hypo with a biscuit and tea. Fast-acting carbohydrate first, the slow one after the recheck.
- Not rechecking. The clock is part of the treatment.
- Giving fluids by mouth to a drowsy patient.
- Checking colour and pulse and stopping: movement, sensation and pain are the earlier signs.
- Recording "NV intact" without the six items and the time.
Practise the parts
Sources
- HSE: Type 1 diabetes, hypoglycaemia checked 2026-09-16
- HSE: Type 1 diabetes, ketones and DKA checked 2026-09-16
- Diabetes Ireland: sick day rules, type 1 checked 2026-09-16
- RCSI neurovascular assessment form (reading list) checked 2026-09-16
This descriptor is a practice piece written to the shape of the RCSI samples. It is not an exam task, and the exam may ask anything from the reading list.