Assessment Task 1
Assessment name: The Deteriorating Patient: Case Studies
Learning outcomes measured: 1. Consolidate knowledge of key NMBA Registered Nurse Standards for
Practice, National Safety and Quality Health Service Standards, and National Health Priorities to enable effective decision making, planning and action in a range of complex clinical situations across the lifespan.
2. Apply knowledge of anatomy, physiology and pathophysiology to support evidence-based decisions for planning and action.
3. Demonstrate structured decision making and clinical reasoning to review a range of health situations, synthesise evidence and data, determine priorities, and formulate plans and interventions in line with timeframes and agreed goals.
Length: 1500 words +/- 10%
Estimated time to complete task: Approximately 30 hours
Weighting: 50%
Individual/Group: Individual
Authentic Assessment: Yes No
Formative/Summative: Summative
How will I be assessed: As a percentage using a rubric
Due date: 22nd September submitted via Turnitin in your NSB236 Blackboard site by 8:45 pm. More information about Turnitin is available on the FAQs about Turnitin page.
Presentation requirements: This assessment task must:
? Be a written academic essay containing an introduction, body and conclusion, addressing the task.
? Use QUT APA referencing for citing academic literature
? Assignment cover sheet must be included as the first page of your document
? Be submitted in electronic format via Turnitin.
? A minimum 15 references be cited from valid, contemporary journal articles or books no older than 10 years.
? The use of websites as references is NOT permitted
Task description: For this essay you are asked to pick ONE case scenario related to a type of shock:
Option 1: Anaphylaxis
Option 2: Hypovolaemia
Option 3: Cardiogenic
What you need to do: The 1500 word essay should cover the following points:
1. Review your chosen case scenario with the lecture and tutorial material associated with the deteriorating patient.
2. Review your knowledge and understanding related to:
a. The physiology and pathophysiology of the different types of shock for your selected scenario;
b. The physical assessment of those body systems involved;
c. The ISBAR framework for effective communication to the medical and/or nursing team
Part 1:
? You are required to consider the associated signs and symptoms of your chosen condition and discuss the findings as they relate to each part of the ABCDE pneumonic. You need to be able to critically explain the link with the associated signs and symptoms, the pathophysiology/physiology and what the physical assessment identifies. (Approximately 1000 words)
Part 2:
? Having completed your physical examination of your chosen condition you are required to construct a structured written handover to the doctor using ISBAR. (Approximately 500 words)
Resources needed to complete task: • Case study outlines and clinical documents available on your Blackboard site.
• Access to Understanding Pathophysiology 2nd edition by Craft et al., (2016)
• Access to Health Assessment & Physical Examination 5th edition by Estes et al., (2016) • QUT Cite|Write APA guide.
• Turnitin Tip Sheets.
Assignment Case Studies
Anaphylaxis Jim Palmer is a 53 year old farmer who was admitted this morning with severe cellulitis to his left lower leg; he has already received one dose of Flucloxacillin 1gram IV as a slow bolus in the Emergency Department. You give him is second dose of Flucloxacillin. Ten minutes later Jim’s call bell rings and upon arrival you find him breathless and complaining of a tight feeling in the throat and feeling lightheaded and dizzy. As you begin to assess Jim, you also notice his level of consciousness is reducing.
Hypovolaemia Maureen Hardy is a 77 year old women who has been sent in by her GP for review who has had two episodes of haematemesis at home. Four hours after arriving on your ward she vomits blood and has blood around
her mouth, you also note that she appears pale, sweaty and drowsy. Maureen is responding only to verbal stimuli.
Cardiogenic Frank James a 72 year old man has been admitted to your ward with an acute exacerbation of his chronic heart failure. He is sat in a semi-high fowler’s position, mildly diaphoretic, slightly short of breath and complaining of nausea. The next morning Mr. James continues to complain of shortness of breath and restless with a chest pain score of 2. The MO orders an urgent chest x-ray and it is noted in his medical notes that his heart failure is worsening and he has developed pulmonary oedema. On examination he is confused, sweating and pale.
Assignment Hints
The assignment is asking what you findings would be if you were to undertake a physical examination of your chosen case study and report back using ABCD. Remember the patient profile might not cover all aspects of ABCD. For example if your patient was short of breath you would explain how, what and why they were short of breath.
? The What: what did your physical examination find?
? The How: how did it manifest itself?
? The Why: why did this occur?
To put this into perspective. The patient presents with pneumonia. Your physical examination for breathing reveals asymmetrical chest movements when the patient is asked to take a deep breath and they are using accessory muscle breathing, you note tachypnea, some central cyanosis and when you percuss you hear a dull sound over the affected lung. Auscultation reveals course crackles on expiration that clear with coughing and reduced air entry on the effected side. The sputum that is produced is green and purulent. Now critically explain how and why this is occurring. For this you will need to review your physiology and pathophysiology of breathing and pneumonia. So the books you will need to review to get you started are:
Reflecting on what you found write an ISBAR of the relevant and pertinent information you would convey to the doctor.
Anaphylaxis Case Study
Jim Palmer is a 53 year old farmer who was admitted this morning with severe cellulitis to his left lower leg; he has already received one dose of Flucloxacillin 1gram IV as a slow bolus in the Emergency Department. You give him his second dose of Flucloxacillin. Ten minutes later Jim’s call bell rings and upon arrival you find him flushed, breathless and complaining of a tight feeling in the throat and feeling lightheaded and dizzy. Jim has bilateral chest movements and the depth of his breathing is shallow, you can hear an audible wheeze and has some central cyanosis. As you begin to assess Jim, you also notice his level of consciousness is reducing, he is becoming drowsy and responding to voice only.
His observations are:
- Resps 26bpm
- BP 99mmHg systolic on palpation
- HR 130bpm regular
- Temp 37.4°C
- SaO2 91% on RA
Jim’s peripheries are cool and clammy. His capillary refill time is 4secs. There is wide spread urticarial rash (picture below) and swelling of his lips, fingers and toes. His blood glucose is 5.3mmols/ltr
Hypovolaemia Case Study
Maureen Hardy is a 77 year old women who has been sent in by her GP for review who has had two episodes of haematemesis at home. Four hours after arriving on your ward she vomits blood and has blood around her mouth, you also note that she appears pale, sweaty and drowsy. Maureen is responding only to verbal stimuli on the AVPU scale. She has been taking the following medication:
? Diclofenac Acid 50mgs PO (with food) BD for arthritic knees
? Warfarin 2mgs PO mane for atrial fibrillation (INR 2.7)
Her observations are:
- BP 80mmHg systolic
- HR120bpm and irregular
- Resps 28bpm
- SaO2 unreadable
- Capillary refill time 4secs
- Temp 36.5°C (core)
You also note that her pupils are dilated 3-4mms but are equal and reactive to light. She has equal bilateral chest movement and the depth of breathing is normal. She has a slightly distended abdomen.
The lab results have also arrived which show:
- Haemoglobin 9g/dL (12-15g/dL)
- Platelets 150000 (100,000-450,000K/uL)
- Haematocrit 27% (36-44%)
Her Chest X-ray is normal
And her ECG reveal sinus tachycardia:
Cardiogenic Case Study
Frank James a 72 year old man has been admitted to your ward with an acute exacerbation of his chronic heart failure. He is positioned in a semi-high fowler’s position, is mildly diaphoretic, slightly short of breath and complaining of nausea. Mr. James has a history of stable angina for an undetermined period. However, he has revealed that for the past 3 weeks, he has been experiencing pain radiating to his back every hour, which is relieved with sublingual nitroglycerin (GTN). There is a family history of cardiovascular disease with an older brother dying from a myocardial infarction (MI) and a sister who has had 3 MI’s. Mr. James has a 30 year history of cigarette smoking and continues to smoke 1 pack/day. He has been taking the following medication:
? Aspirin 7mgs PO mane
? Atenolol 50mgs PO mane
? Isosorbide mononitrate 30mgs PO nocte
? Lisinopril 10mgs PO mane
The next morning Frank continues to complain of shortness of breath and restlessness with a chest pain score of 8/10 that is radiating to his left arm. The MO orders an urgent chest x-ray and it is noted in his medical notes that his heart failure is worsening and he has developed pulmonary oedema. On examination he is confused, sweating, pale and centrally cyanosed.
His observations on admission and currently are as follows:
On Admission Currently
Am Pm
? BP 156/98mmHg
? HR 124
? Resps 30bpm
? Temp 37°C ?
?
?
? 140/100mmHg
HR 130bpm
Resps 28bpm
SaO2 92% on
FiO2 10ltrs ? BP 96/50mmHg
? HR 128bpm
? Resps 36bpm
? U/O 20mls/hr for the past 2 hours
His 12 lead electrocardiogram (ECG) reveals Q waves, ST depression and T wave inversion which may signify ischemia.
His chest x-ray reveals diffuse infiltrates that resemble “bat wings” consistent with pulmonary oedema.
“Bat wings”
NSB236 Assessment Task 1 Rubric
Name:
Learning outcomes assessed: 1, 2 and 3 Weighting: 50 %
Criteria 7 6 5 4 3 2 - 1
Critical Thinking &
Knowledge
Weighting 50%
Consolidate knowledge of key NMBA Registered Nurse Standards for Practice, National Safety and Quality Health
Service Standards, and
National Health Priorities to enable effective decision making, planning and action in a range of complex clinical situations across the lifespan.
Assignment content: critical explanation reflects a
comprehensive interpretation and critical explanation of the assessment data; Assignment content: critical explanation reflects good
interpretation and critical explanation of the assessment data; Assignment content:
critical explanation reflects sound interpretation and some critical explanation of the assessment data; Assignment content: critical explanation reflects basic
interpretation and some or no critical explanation of the assessment data – content not overly discerning; Assignment content:
limited critical explanation reflects poor interpretation and no critical explanation of the assessment data – content not discerning; Assignment content: no critical explanation reflects poor interpretation and no critical explanation of the assessment data – content not discerning;
Comprehensive understanding of the central issues of the question – all key physical assessment
issues addressed; Good understanding of the central issues of the question – almost all key physical assessment
issues addressed; Sound understanding of the central issues of the question – most key physical assessment issues addressed; Fair understanding of the central issues of the question – some key physical assessment
issues addressed; Poor understanding of the central issues of the question – not all key physical assessment
issues addressed; No understanding of the central issues of the question – no key physical assessment
issues addressed;
Demonstrated a comprehensive depth of reasoning and logical and analytical thinking
Mostly demonstrated a depth of reasoning and logical and analytical thinking Soundly demonstrated a depth of reasoning and logical and analytical thinking
Adequately demonstrated depth of reasoning and logical and analytical thinking You have not adequately demonstrated depth of reasoning and logical and analytical thinking You have not demonstrated depth of reasoning and logical and analytical thinking
Apply knowledge of anatomy, physiology and pathophysiology to support evidencebased decisions for planning and action.
Weighting 15%
Comprehensive application of pathophysiological and physiological concepts which demonstrated an understanding of links between the patient condition and assessments performed Good application of pathophysiological and physiological concepts which demonstrated an understanding of links between the patient condition and assessments performed Sound application of pathophysiological and physiological concepts which demonstrated an understanding of links between the patient condition and assessments performed Fair application of pathophysiological and physiological concepts which demonstrated a fair understanding of links between the patient condition and assessments performed Poor application of pathophysiological and physiological concepts which demonstrated little understanding of links between the patient condition and assessments performed No application of pathophysiological and physiological concepts which demonstrated no understanding of links between the patient condition and assessments performed
Apply knowledge and skills to
communicate and collaborate effectively.
Weighting: 25 % You succinctly and accurately described essential information in each element of the ISBAR framework. You clearly and accurately described mostly essential information in each element of the ISBAR framework. You soundly an described
information element of framework. d accurately essential in each the ISBAR You adequately and sometimes accurately described essential information in each element of the ISBAR framework. You have not adequately and accurately described essential information in each element of the ISBAR framework. ISBAR framework not used.
Your handover flowed logically and contained only essential information that related to the health problems identified from the comprehensive physical assessment of the case study. Your handover was logical in most parts and contained mostly essential information that related to the health problems identified from the comprehensive physical assessment of the case study. Your handover was sound and somewhat logical with some essential information that related to the health problems identified from the comprehensive physical assessment of the case study. Your handover was adequate and somewhat logical that related to the health problems identified from the comprehensive physical assessment of the case study. Your handover was inadequate and not logical. You have missed crucial sections of essential information that related to the health problems identified from the comprehensive physical assessment of the case study. Your handover was wholly inappropriate inadequate and not logical. You have missed large sections of essential information that related to the health problems identified from the comprehensive physical assessment of the case study.
Used correct terminology and professional language consistently with the case study. Used correct terminology and professional language for most of the handover the case study. Used correct terminology and professional language for some of the handover the case study. Used correct terminology and professional language for part of the handover the case study. You have not used correct terminology and professional language for the majority of the handover the case study. Correct terminology and professional language used infrequently the case study.
Correctly cited all sources both within the text and reference list with no errors; Correctly cited all sources both within the text and reference list with few errors; Correctly cited most sources both within the text and reference list with s0me errors; Correctly cited some sources both within the text and reference list with a number of errors; Poor citation of sources both within the text and reference list; Poor citation of sources both within the text and reference list;
Consistently and correctly used QUT APA referencing style; Correctly used QUT
APA referencing style; Used QUT APA
referencing style with minimal errors; Used QUT APA
referencing style with occasional errors; Referencing style inconsistently applied and inaccurate; Referencing style inconsistently applied and inaccurate;
Expressed ideas clearly, concisely and fluently with correct spelling and grammar; Expressed ideas reasonably clearly, concisely and fluently with minimal spelling and grammatical
errors; Expressed most ideas clearly with minimal spelling and grammatical errors; Expressed most ideas clearly with occasional spelling and grammatical
error; Poor communication of ideas with frequent spelling and grammatical error; Poor communication of ideas with frequent spelling and grammatical error;
Did not use direct quotes; Rarely used direct quotes; Sometimes used direct quotes; Sometimes used direct quotes; Overuse of direct quotes; Overuse of direct quotes;
Kept to word limit. Kept to word limit. Word limit under/over the 10% allowance. Struggled with word limit. Not within required word limit. Not within required word limit.