Clinical Reasoning and the Deteriorating Patient

Clinical Reasoning and the Deteriorating Patient

Value: 50%

Length: 1800 words

Submission method options: EASTS (online)

Task

This assessment will require the student to apply the clinical reasoning cycle to a complex scenario and discuss the nursing role.

Using the Case Study provided on the NRS312 Subject Interact 2 site (under ‘Assessment Resources’), you will apply the Clinical Reasoning Cycle to the Case Scenario.

Your critical analysis should address the following:

1. Analyse the case study and develop a discussion of the application of each element of the Clinical Reasoning Cycle as outlined by Levett-Jones, T. (Ed.). (2017). Clinical Reasoning: Learning to think like a nurse (2nd ed.). Frenchs Forest, NSW: Pearson Australia.
2. Use the clinical data provided to identify moments of deterioration and four (4) evidence-based nursing interventions that are appropriate at the moments of deterioration. Include your reasoning, justification and rationale utilising ‘the slippery slope’.
3. Use the ISBAR communication tool provided in the I2 site under Assessment Item 2 to develop a handover script to the Medical Officer you are calling  (No more than 250 words).

While sub-headings can be used to structure this assessment, tables and dot points are not permitted.

Your responses must be supported by peer-reviewed evidence, commensurate with the level of evidence-based practice expected of a beginning practitioner. 

You must support your discussion with a MINIMUM of 10 recent (less than 7 years old) and credible sources.   Credible sources include the following:

• peer reviewed journal articles (these are the highest quality sources)
• contemporary text books
• best practice guidelines
• government documents
• health facility clinical guidelines, pathways and policies/procedures
• websites containing content aimed at health professionals (usually ending in .org, edu or .gov)

This paper is a piece of formal academic writing and should therefore adhere to academic writing conventions. Sub-headings are acceptable but point form and tables should not be used.

Rationale

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Subject learning outcomes

This assessment task will assess the following learning outcome/s:

• be able to collect, interpret and document subjective and objective data in the seriously ill or deteriorating person (aligns with Nursing and Midwifery Board of Australia National Competency Standards for the Registered Nurse: 1.1, 1.2, 2.5, 4.1, 5.1, 5.2, 5.3, 7.4, 8.1, 8.2).
• be able to demonstrate a broad knowledge which links the underlying pathophysiology of serious cardiac, respiratory and neurological presentations to their clinical manifestations (NMBA 2.6, 3.1, 3.4, 4.1, 7.4).
• be able to apply theoretical knowledge, critical thinking and the use of best evidence to contribute to the planning and implementation of appropriate nursing interventions for the person experiencing a serious or life-threatening illness (NMBA 1.2, 2.5, 2.6, 3.1, 3.2, 3.3, 3.4, 4.1, 6.1, 6.2, 6.4, 7.1, 7.2, 7.4, 7.7, 7.8, 8.1, 8.2, 10.3).
• be able to apply theoretical knowledge to safely perform selected procedural skills including venepuncture, intravenous cannulation, administration of blood products and management of central venous access devices, required for the care of patients experiencing serious or life-threatening illness (NMBA 1.2, 2.5, 7.1, 7.2, 7.4).
• be able to analyse the legal and ethical considerations associated with the management of the deteriorating patient (NMBA 1.1, 2.1, 2.2, 2.3, 2.4, 2.5, 7.4, 7.5, 7.6, 9.3, 9.5).
• be able to communicate effectively with individuals, groups and members of the interdisciplinary team in the acute care environment (NMBA 1.2, 2.3, 2.4, 2.5, 5.1, 5.2, 5.3, 6.1, 6.2, 6.3, 7.4, 7.5, 7.6, 7.7, 9.1, 9.2, 9.3, 9.4, 10.2, 10.4)

Graduate learning outcomes

This task also contributes to the assessment of the following CSU Graduate Learning Outcome/s:

• Academic Literacy and Numeracy (Skill) – CSU Graduates demonstrate the literacy and numeracy skills necessary to understand and interpret information and communicate effectively according to the context.
• Information and Research Literacies (Skill) – CSU Graduates demonstrate the skills required to locate, access and critically evaluate existing information and data.
• Professional Practice (Skill) – CSU Graduates demonstrate discipline-specific technical capabilities and self-appraisal required for a beginning practitioner or professional.

This paper is a piece of formal academic writing and should therefore adhere to academic writing conventions. Sub-headings are acceptable but point form and tables should not be used.  The paper must be word processed and not handwritten. Leave 2 cm margins and double line space your work, so that there is ample space for markers to comment. In addition,

• Font must be 12pt, unless otherwise indicated.
• All pages must be numbered.
• Student name and number must be included in the header or footer of every page of every assignment.
• A title page must accompany your written assessment task and include the subject name and code, title of the assessment task, due date, submission date, lecturer’s name, student name and student number.

NRS312 2018-30 Clinical Case Study for Assessment 2

Situation: You are a first-year graduate RN in a general surgical department. Mary Smith, 82 years old, is one of your 8 patients and underwent a left total knee replacement under general anaesthesia 6 hours ago.

Past medical history: osteoarthritis of both knees, with limited range of movement and pain on weight bearing in the left knee. She has Type 2 Diabetes Mellitus, diagnosed 3 years ago, essential hypertension, fatty liver disease with moderate enlargement, and diabetic neuropathy in both feet with intermittent mild neuropathic pain and no neurological deficit. Mary weighs 100kgs.

Medications: Metformin 1000mg twice daily, Empagliflozin 10mg once daily, Metoprolol 25mg twice daily, Atorvastatin 10mg once daily, Karvezide 300/12.5 once daily, fish oil 5000mg daily, Hypericum 1 tablet daily.

You approach her bedside and note she is fully alert, GCS 15/15, her surgical wound dressing is dry with no ooze and her PCA has not been accessed in the past hour. Mary states her pain is 7/10 in her Left knee and she feels lightheaded. She has not wanted to eat and has tried sips of water and she feels nauseated.

There is a 18G IV catheter in her right hand and 200mL of isotonic saline remaining in the IV bag, running at 80mL per hour via a pump. The PCA circuit is attached to this line.

Vital signs 60 minutes ago: BP 123/70, radial pulse 55, RR 18, SpO2 96%, FiO2 0.21, T 36.2, peripheral capillary refill 2 seconds, warm digits.

Vital signs now: BP105/56, radial pulse 66 regular, RR20, SpO2 93%, FiO2 0.21, T36.4 tympanic. BGL11.5mmol/L, Peripheral capillary refill is 3 seconds plus pale cool digits.

Extra info

Hello All,

NRS 312 is currently undergoing some changes, and I ask for your patience as these are worked through.

I have reviewed the forum in relation to Assessment Two: Clinical Reasoning and the Deteriorating Patient and would like to offer the below answers to common questions.

·       
A date or time is not required in relation to when the patient went to theatre, just consider it is 6 hours ago when you assess her now.

·       
The capillary refill being tested is that of the toes, due to the fact that the patient has recent knee surgery.  However, the fingers could/should also be assessed as part of a complete assessment.

·       
Do not make up any information if it is not provided in the case study, Do not assume she is catheterised, what would need to be reviewed if she was or wasn’t as part of your assessment?

·       
In text references are not included in the word count, nor is your reference list

·       
Appendices are NOT permitted in this assessment

·       
Sub headings are suitable to use, however dot points are not

Finally, it appears the first question is causing the most confusion and after much discussion there will be minor changes posted to the assessment in a revised subject outline, by Monday 4^th March.

The changes will be evidenced in the marking rubric.

These changes will be:

You will be required to review the case study, develop a discussion of each stage clinical reasoning cycle AND apply these stages to the patient Mary Smith,

For example: Mr James Green is a 55 year old man who is a  new admission to the ward following a motorbike accident resulting in a fractured left tibia and fibula. This offers health care workers a first impression of the patient (Grey, 2015p.2).

The word limit for this assessment is now a maximum of 2000 words.

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