NSG3RDP\/NSG3RDM Semester One 2020
\nSCHOOL OF NURSING & MIDWIFERY
\nNSG3RDP\/ NSG3RDM \u2013 Recognising and Responding to the Deteriorating Patient
\nAssessment activity 1 – 2000 words (35% of overall subject mark)
\nDue date: 11.5.2020 (09.00)
\nSubject Intended Learning Outcomes (SILOS)
\n1. Explain common pathophysiology, as it relates to assessment data and pharmacology, that can result in deterioration of an individual’s condition in order to develop appropriate interventions.
\n2. Apply the clinical reasoning cycle to provide person-centred care for individuals experiencing a deterioration in health in order to provide safe nursing care.
\n3. Develop an awareness of and contribute to the risk management strategies of a healthcare agency, in order to implement incident reporting procedures and apply risk management procedures.
\nContext
\nSerious adverse events, such as unexpected death, intensive care admission and cardiac arrest, are often preceded by observable physiological, clinical abnormalities and deterioration. Other serious events, such as suicide and aggression, are also often preceded by observed or reported changes in a person\u2019s behaviour or mood that can indicate deterioration in their mental state.
\nEarly identification of deterioration may improve outcomes and decrease interventions required to stabilise patients whose condition deteriorates in a health service organisation.
\nThe warning signs of clinical deterioration are not always identified or responded to appropriately. The organisational and workforce factors that contribute to a failure to recognise and respond to a deteriorating patient are complex and overlapping (Australian Commission on Quality and Safety in Health Care, 2017)
\nNSG3RDP\/NSG3RDM Semester One 2020
\nTask
\nIn this assessment you are required to further explore the trauma case study introduced in topic (sample nursing essay examples by the best nursing assignment writing service) two and three of your LMS and workshop materials for NSG3RDP\/RDM.
\nYou will be provided with an ISBAR handover and a National Observation Chart (NOC) for Joanna Cleese. (These documents will be attached at the end of this instruction sheet)
\nUsing the provided information and current academic literature please provide a response to the following three questions
\nInstructions
\nPlease answer the following questions as instructed
\n\u2022 Question 1 (750 words)
\nThe condition of your patient Joanna Cleese described in the ISBAR handover, appears to be changing. (Please refer to the attached documentation)
\nUsing the information that you have identified from the NOC and the ISBAR case study handover:
\n1. Discuss the possible causes of Joanna\u2019s changing condition, supporting your response with contemporary literature and the associated significant cues, signs and symptoms listed in the case study.
\n2. Explain what possible further deterioration could occur for this patient, with a detailed evidenced -based response.
\n(Please support your justification and rationales with quality peer-reviewed literature).
\n\u2022 Question 2 (750 words)
\nThere are many tools that can be utilised when assessing a patient. When assessing a deteriorating patient accurate assessment is essential. Compare and contrast the following methods of patient assessment and their appropriate applications for the deteriorating patient.
\n1. Primary (ABCDE)
\n2. Head to toe assessment
\n(Please support your discussion with evidenced based literature).
\n\u2022 Question 3 (500 words)
\nA change in a patient\u2019s heart rate, blood pressure, temperature and respiratory rate can all be an indication of clinical deterioration. It has been suggested that a changing respiratory rate is the earliest indication of clinical deterioration and yet it is often not measured correctly, or not measured at all. Using evidence-based literature to support your arguments:
\n1. Discuss why a changing respiratory rate is an important indicator of clinical deterioration.
\n2. Explain how the respiratory rate can be measured reliably and accurately.
\nNSG3RDP\/NSG3RDM Semester One 2020
\n**Discussions are to be supported with relevant and contemporary literature.
\n**References: Reference list and appendices are excluded from the word count.
\n**References to be no older than ten years
\n**10% word limit allowed.
\nResources
\nAustralian Conmission on Quality and Safety in Health Care. (2017). National Quality and Safety Health Care Standards Edition Two,. Retrieved from https:\/\/www.safetyandquality.gov.au\/wp-content\/uploads\/2017\/11\/National-Safety-and-Quality-Health-Service-Standards-second-edition.pdf
\nHow to find scholarly literature: http:\/\/latrobe.libguides.com\/finding-information
\nHow to reference using APA6: http:\/\/latrobe.libguides.com\/referencing\/referencing_tool
\nSubmission process
\nPlease use the submission template provided to document information. The document, which includes the completed submission template should be submitted as ONE Word document.
\nYour assignment should be submitted via the Turnitin assignment submission link located in the LMS site for this subject by the due date and time. The submission process is an automatic acknowledgement that you have complied with the guidelines for student responsibility for academic integrity: http:\/\/www.latrobe.edu.au\/students\/academic-integrity\/explanation
\nIf you have any questions about the assignment please contact the subject coordinator Jen Austerberry either by emailing j.austerberry@latrobe.edu.au or calling: 94964457 or 0417562176.
\nExtensions and special consideration
\nStudents must seek a formal extension to submit after the due date where there are extenuating circumstances. Please read the instructions on the following web page http:\/\/www.latrobe.edu.au\/?a=668155
\nYou submit your request for an extension of the due date from this webpage.
\nIf you have a personal issue or illness that is affecting your study, you may need to apply for special consideration. It is recommended that you discuss your situation with the course coordinator (Liz Pascoe) as soon as possible.
\nEligibility to apply for Special Consideration does not automatically imply eligibility to receive it. Certain criteria must be satisfied in order to receive Special Consideration. Please refer to the policy information and on-line form located at: http:\/\/www.latrobe.edu.au\/special-consideration
\nNSG3RDP\/NSG3RDM Semester One 2020
\nLate submission
\nThere are policies and procedures to guarantee fair, consistent and transparent treatment of late submission of assessment tasks provide equity around extensions to submission dates and penalties associated with not submitting assessment by the due date and time.
\n5% of the total possible marks will be deducted each day (or partial day) delayed submission, for a maximum of up to five (5) working days after the due date. Assessment tasks will not be accepted after the following occurrences:
\n\u2022 the fifth (5th) working day after the due date; or
\n\u2022 feedback on the assessment task has been returned to any student by the Teaching Team member.
\nThe policy relating to late submissions can be located at: https:\/\/policies.latrobe.edu.au\/document\/view.php?id=148
\nNSG3RDP\/NSG3RDM Semester One 2020
\nSchool of Nursing & Midwifery: NSG3RDP\/NSG3RDM Assessment One
\nCRITERIA
\nExcellent (> 80 %)
\nVery good (70% – 79%)
\nGood (60% – 69%)
\nFair (50% – 59%)
\nPoor (<50%)
\nMARK
\nQuestion One
\nDiscusses the possible causes of Joanna\u2019s changing condition
\nExplains what possible further deterioration could occur
\nUSE OF LITERATURE TO SUPPORT DISCUSSION
\n(35% of total mark)
\n28 + marks
\nClearly and consistently discuss possible causes of the Joanna\u2019s changing condition
\nClearly and consistently explains what possible further deterioration could occur
\nDemonstrated an excellent understanding of links between the necessary concepts.
\nDemonstrated clear and consistent evidence of critical appraisal of reference material
\nEvidence of synthesis of information and logical development of arguments
\n24 – 27 marks
\nClearly and mostly consistently discuss possible causes of the Joanna\u2019s changing condition
\nClearly and mostly consistently explains what possible further deterioration could occur
\nDemonstrated a very good understanding of links between the necessary concepts.
\nDemonstrated some evidence of critical appraisal of reference material
\nSome evidence of synthesis of information and logical development of arguments
\nLiterature predominantly used effectively to support key ideas
\n21 – 23 marks
\nGood but inconsistent attempt to consistently discuss possible causes of the Joanna\u2019s changing condition
\nGood but inconsistent attempt to consistently explain what possible further deterioration could occur
\nDemonstrated good understanding of links between the necessary concepts.
\nDemonstrated inconsistent evidence of critical appraisal of reference material
\nInconsistent evidence of synthesis of information and logical development of arguments
\nLiterature inconsistently used to support key ideas
\n18 – 22 marks
\nFragmented and inconsistent attempt to discuss possible causes of the Joanna\u2019s changing condition
\nFragmented and inconsistent attempt to explain what possible further deterioration could occur
\nDemonstrated limited understanding of links between the necessary concepts.
\nDemonstrated limited evidence of critical appraisal of reference material
\nLimited evidence of synthesis of information and logical development of arguments
\nLiterature poorly used to support key ideas
\n<17 marks
\nDemonstrated lack of understanding of possible causes of the Joanna\u2019s changing condition
\nDemonstrated lack of understanding of what possible further deterioration could occur
\nDemonstrated lack of understanding of links between the necessary concepts.
\nNo evidence of critical appraisal of reference material
\nNo evidence of synthesis of information and logical development of arguments
\nOverreliance on direct quotes Key ideas not supported by the literature
\n\/35
\nNSG3RDP\/NSG3RDM Semester One 2020
\nQuestion Two
\nCompares and contrasts
\n1. Primary (ABCDE)
\n2. Head to toe assessment
\nUSE OF LITERATURE TO SUPPORT DISCUSSION
\n(35% of total mark)
\n28 + marks
\nClearly and consistently compared the two methods of assessment
\nDemonstrated an excellent understanding of links between the necessary concepts.
\nDemonstrated clear and consistent evidence of critical appraisal of reference material
\nEvidence of synthesis of information and logical development of arguments
\n24 – 27 marks
\nClearly and mostly consistently compared the two methods of assessment
\nDemonstrated a very good understanding of links between the necessary concepts.
\nDemonstrated some evidence of critical appraisal of reference material
\nSome evidence of synthesis of information and logical development of arguments
\nLiterature predominantly used effectively to support key ideas
\n21 – 23 marks
\nGood but inconsistent attempt to compare the two methods of assessment
\nDemonstrated good understanding of links between the necessary concepts.
\nDemonstrated inconsistent evidence of critical appraisal of reference material
\nInconsistent evidence of synthesis of information and logical development of arguments
\nLiterature inconsistently used to support key ideas
\n18 – 22 marks
\nFragmented and inconsistent attempt to compare the two methods of assessment
\nDemonstrated limited understanding of links between the necessary concepts.
\nDemonstrated limited evidence of critical appraisal of reference material
\nLimited evidence of synthesis of information and logical development of arguments
\nLiterature poorly used to support key ideas
\n<17 marks
\nDemonstrated lack of understanding of the two methods of assessment
\nDemonstrated lack of understanding of links between the necessary concepts.
\nNo evidence of critical appraisal of reference material
\nNo evidence of synthesis of information and logical development of arguments
\nOverreliance on direct quotes Key ideas not supported by the literature
\n\/35
\nQuestion Three
\nDiscusses why a changing respiratory rate is an important indicator of clinical deterioration.
\nExplains how the respiratory rate can be measured reliably and accurately
\nUSE OF LITERATURE TO SUPPORT DISCUSSION
\n28 + marks
\nClearly and consistently discusses the changing respiratory rate significance and explains the means of achieving assessment accuracy
\nDemonstrated an excellent understanding of links between the necessary concepts.
\nDemonstrated clear and consistent evidence of critical appraisal of reference material
\n24 – 27 marks
\nClearly and mostly consistently discusses the changing respiratory rate significance and explains the means of achieving assessment accuracy Demonstrated a very good understanding of links between the necessary concepts.
\nDemonstrated some evidence of critical appraisal of reference material
\nSome evidence of synthesis of information and logical
\n21 – 23 marks
\nGood but inconsistent attempt to consistently discuss the changing respiratory rate significance and explain the means of achieving assessment accuracy
\nDemonstrated good understanding of links between the necessary concepts.
\nDemonstrated inconsistent evidence of critical appraisal of reference material
\n18 – 22 marks
\nFragmented and inconsistent attempt to discuss the changing respiratory rate significance and explain the means of achieving assessment accuracy
\nDemonstrated limited understanding of links between the necessary concepts.
\nDemonstrated limited evidence of critical appraisal of reference
\n<17 marks
\nDemonstrated lack of understanding of the significance of the respiratory rate or the means of achieving accuracy.
\nDemonstrated lack of understanding of links between the necessary concepts.
\nNo evidence of critical appraisal of reference material
\nNSG3RDP\/NSG3RDM Semester One 2020
\n(25% of total mark)
\nEvidence of synthesis of information and logical development of arguments
\ndevelopment of arguments
\nLiterature predominantly used effectively to support key ideas
\nInconsistent evidence of synthesis of information and logical development of arguments
\nLiterature inconsistently used to support key ideas
\nmaterial
\nLimited evidence of synthesis of information and logical development of arguments
\nLiterature poorly used to support key ideas
\nNo evidence of synthesis of information and logical development of arguments
\nOverreliance on direct quotes Key ideas not supported by the literature
\nACADEMIC INTEGRITY & FORMATTING
\n(5% of total mark))
\n4+ marks
\nCorrect use of APA V6 in-text and end-text format.
\nUse of submission template and specified formatting. No spelling typing or grammatical errors
\nWithin 10%-word limit.
\n4 marks
\nCorrect use of APA V6 in-text and end-text format, minor errors.
\nUse of submission template and specified formatting. Minor spelling, typing & grammatical errors.
\nWithin 10%-word limit.
\n3 marks
\nOccasional errors in APA V6 format.
\nUse of submission template and specified formatting. Minor spelling, typing & grammatical errors.
\nWithin 10%-word limit
\n2 marks
\nReferences provided but incorrect use of APA V6 format.
\nUse of submission template. Inconsistent use of specified formatting. Consistent spelling, typing and grammatical errors.
\nWithin 10%-word limit
\n\u22641 mark
\nReferencing does not adhere to APA V6 format.
\nSpecified presentation & formatting not used. Spelling, typing and grammatical errors throughout the paper which impact on fluency and coherency.
\nExceeds 10%-word limit.
\n\/30
\n\/100
\nNSG3RDP\/NSG3RDM Semester One 2020
\nAttached documentation
\nHandover ISBAR
\nSetting Emergency Department
\nTime frame: Three hours post arrival by ambulance. (1730hrs)
\nPatient identification
\nJoanna Cleese
\n55-year-old female
\nSocial history
\nLives alone Widowed Three adult children
\nWorks in IT as a computer programmer
\nSituation\/Setting the scene
\nInitial Investigations\/treatment
\nJoanna was up on a ladder cleaning the gutters when she fell approximately two metres onto a concrete path.
\nJoanna was found by her neighbour immediately following the fall, lying face down on her left side on the concrete path.
\nInitially Joanna was unresponsive for 2-3 minutes before responding to voice in a confused manner.
\nAn ambulance was called by the neighbour and Joanna was transported to La Trobe Emergency Department.
\nInjuries include
\nHaemopneumothorax
\nFractured ribs 3-6
\nFractured left neck of femur (NOF)
\nFractured left radius and ulna
\nHead laceration
\nGeneralised bruising to left chest and shoulder temporal area, left abdomen, thigh and left arm
\nChest\/abdomen\/pelvic\/ left arm and leg x-rays
\nHead CT scan
\nIntercostal catheter (ICC) inserted 5th intercostal space mid axillary line
\nTwo wide bore intravenous cannulas\u2019
\nIntravenous (IV) fluid administration
\nIntravenous pain management
\nLeft wrist splinted
\nLeft leg external traction
\nBackground\/Past medical and
\nsurgical history
\nMedications
\nHypertension
\nRecently diagnosed Type 2 Diabetes
\nObesity BMI 40
\nNSG3RDP\/NSG3RDM Semester One 2020
\nAllergies
\nRamipril 5mgs BD orally
\nMetformin 500mgs BD orally
\nPenicillin
\nAssessment information
\nAirway patent
\nPatient verbalising
\nRR 26
\nICC insitue 20cm suction, absence of swing or bubbling
\n200mls frank blood drained initially, nil further drainage
\nO2 Sat 94% nasal prongs 2lpm O2
\nTemp 36.5
\nGCS 14 confused to time and place
\nP\/S 8\/10 chest, leg and abdomen
\nHR 120
\nBP 90\/55
\nRecommendations\/ Important considerations
\nPatient awaiting transfer to general surgical ward.
\nRemains nil by mouth (NBM)
\nSurgical repair of #NOF planned for next day
\nContinues IV fluids, analgesia
\nHourly observations.
\nIncluded documentation
\nNational patient observation chart
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