Assessment Task 2: Surgical Case Study

Case Study

Alan Morley (pseudonym) is a 62 year old semi-retired plumber. He weights 104 kg.

Since 2021 when he was diagnosed with congestive cardiac failure (CCF) he has worked 2 days per week. He enjoys gardening and still plays golf once a week.

• His further history includes:

AMI 2016 and 2020 (stents x 2 to LAD)

• Type 2 diabetes diagnosed 5 years ago
• Motor vehicle accident in 2004: fractured ribs, right humerus and severe concussion.
• Smoker: Ceased 2 years ago

Alan’s medications include the following:

• Aspirin 100mg daily
• Atorvastatin 20mg daily
• Amlodipine 5mg daily
• Bisoprolol 10mg daily
• Metformin 500mg daily

Today, Alan had a right hip replacement, and he is recovering on the surgical ward. Intraoperatively he lost around 350mls of blood. He received 1 litre of Hartmann’s fluid in theatre. Shortly after returning to the ward he was slightly hypotensive with a blood pressure of 95/48mmHg. The anaesthetist was contacted and he ordered fluid administration to continue with normal saline at a rate of 125 ml/hour.

Alan is now 5 hours post-operative.

He has called for you. He states that he feels ‘a bit breathless’, has an irritating cough and he feels a lightheaded. You notice him to be pale and his skin is clammy to touch. You check his vital signs. Alan’s respiratory rate is 26 breaths/minute and oxygen saturation level is 93% on room air. When you feel his pulse, it is thready and quick at a rate of 105 beats/minute. His blood pressure is 89/45mmHg.

Although the following instructions are repeated from Mylo, please take some time to read all the instructions and steps provided in the assessment and resources section Assessment Task 2

Part 1: Response to patient scenario

Commence your assessment with a short introduction to prepare the reader for what follows and to present what will be discussed in your assignment.

Provide a 550 word response to the above scenario. You may want to consider the following questions to guide you with your essay.

1. Consider Alan’s history, provide a brief overview of how his comorbidities and medical history could impact on his recovery.

• Are there any medications that may need to be withheld or reviewed on the day of the operation?

1. You have been provided with some vital signs and a brief clinical picture. Would you do any further assessment to gain a more thorough picture of what is occurring? Describe your assessment. Include the mean arterial pressure (MAP) in your answer providing your working out and state whether you would be concerned about the parameter.
2. Describe why you think Alan is exhibiting the above clinical signs and symptoms? What do you think is occurring on a physiological basis? Provide at least 1 main problem that needs to be addressed.
3. In addition to the assessment you have already described, how would you respond in this situation? For instance how would you address the above patient problem(s)?
4. If your response includes seeking for assistance and making a MET call, what might you be doing whilst waiting for the response team to arrive?

Provide at least 6 references for your discussion.

Part 2 Copilot Activity

Part 2A: Copilot response.

Provide the following prompt to the Generative AI tool Copilot

You are the nurse caring for Alan a 62 year old man who weighs 103kg and who has just had a hip replacement. Alan has a history of Ischemic heart disease, congestive cardiac failure, type 2 diabetes, a motor vehicle accident in 2004 (which resulted in fractured ribs, a fractured right humerus and severe concussion) and smoked up until 2 years ago. Alan has been reported to be short of breath, coughing intermittently and feeling lightheaded. His blood pressure is 89/45mmHg, Heart rate 105 bpm, Respiratory rate is 26 breaths/min., and oxygen saturation is 93% on room air. What would your response to the situation be?

Copy the Copilot response and paste it at the end of the essay under Appendix A: Copilot Response

If copilot has provided you with information without referencing. Provide it with the following prompt:

“Provide some references for the above”

Part 2B: Analysis of Copilot response.

Provide an analysis of the copilot response comparing it to your response in Part 1. Consider the following in your answer. Your response should be around 350 words. Please ensure you check the instructions in the assessment and resources section including the steps outlining the use of AI and referencing AI in your work Assessment Task 2

1. Which suggestions aligned with your own thoughts?
2. Were there additional suggestions that are relevant and useful that you had not thought of? Did you learn anything from the responses provided?
3. Were there any omissions in the response that you had included in your answer.
4. Did co-pilot calculate or mention the importance of mean arterial pressure?
5. Were there any suggestions presented that you consider but are not necessarily appropriate/relevant?
6. Did you agree with the priorities of care suggested by copilot or would you conduct recommendations in a different order?
7. Were there any assumptions made? Was the information appropriate to a senior nurse / advanced clinician like yourself who is completing postgraduate studies? Or was it more directed towards a nursing student or the public?
8. Are full references provided? (Can you locate them?)

• Were the references provided current, peer reviewed, primary sources (primary research publications)
• Were the references provided relevant to the topic with key points that you can effectively use as citations within your paper?

Your analysis should be around 350 words.

Provide references for your discussion

Provide a short conclusion to your essay to summarise your discussion and findings.

Assessment Requirements Summary

Assessment Task 2 required a comprehensive response to a clinical scenario involving Alan Morley, a 62-year-old post-operative hip replacement patient with a complex medical history including congestive cardiac failure, type 2 diabetes, ischemic heart disease, and prior traumatic injuries. The assessment was divided into two main parts:

1. Part 1: Response to Patient Scenario

   • Provide a 550-word essay discussing Alan’s condition.

   • Key points to address:

     • Impact of comorbidities and medical history on post-operative recovery.

     • Medications requiring review or withholding on the day of surgery.

     • Further assessment of vital signs and clinical status, including calculation of mean arterial pressure (MAP) and interpretation.

     • Physiological explanation of Alan’s symptoms and identification of primary clinical problems.

     • Nursing interventions and immediate response, including MET call procedures.

     • Use of at least six academic references.

2. Part 2: Copilot Activity

   • Part 2A: Use a generative AI tool (Copilot) to provide a care response to Alan’s scenario. Include this in Appendix A.

   • Part 2B: Analyze the AI response in comparison to the student’s own essay (~350 words), focusing on alignment, additional insights, omissions, MAP relevance, appropriateness for clinical level, and referencing quality.

The assessment concludes with a short summary of findings and discussion.

Approach by the Academic Mentor

The Academic mentor guided the student through the assessment using a structured, step-by-step methodology:

1. Understanding the Case Scenario

   • The mentor encouraged the student to thoroughly read Alan’s medical history, surgical details, and post-operative observations.

   • Key teaching point: recognize how comorbidities such as CCF, diabetes, and ischemic heart disease can influence recovery and complication risk.

2. Planning the Response (Part 1)

   • The student was guided to structure the essay with a clear introduction outlining the purpose and scope.

   • Each paragraph was planned around:

     • Clinical impact of comorbidities

     • Medication considerations (e.g., continuation or withholding)

     • Vital signs interpretation and further assessments, including MAP calculation:

       MAP=(SBP+2×DBP)3=(89+2×45)3=59.7 mmHgMAP = \frac{(SBP + 2 \times DBP)}{3} = \frac{(89 + 2 \times 45)}{3} = 59.7 \text{ mmHg} MAP=3(SBP+2×DBP)=3(89+2×45)=59.7 mmHg

       • Highlighted that MAP < 65>

     • Physiological reasoning for symptoms: hypoperfusion, fluid deficit, post-operative bleeding risk, and early signs of shock.

     • Immediate nursing actions: oxygen supplementation, fluid therapy continuation, patient monitoring, and preparing for MET call.

   • References: the mentor emphasized using current, peer-reviewed sources to support statements.

3. Engaging with AI Support (Part 2)

   • The mentor demonstrated how to input a detailed prompt into Copilot to generate a clinical response.

   • The student was guided to critically review the AI output, checking for:

     • Alignment with their own reasoning

     • Accuracy of vital sign interpretation, particularly MAP

     • Completeness and relevance of suggested interventions

     • Appropriateness for postgraduate clinical level

   • The mentor emphasized referencing any AI-sourced content and reflecting on discrepancies between AI suggestions and student reasoning.

4. Analysis and Reflection

   • Students were prompted to compare AI responses with their own, noting omissions, additional useful suggestions, and whether AI prioritized care correctly.

   • The mentor encouraged reflection on learning outcomes: critical thinking, clinical reasoning, evidence-based practice, and safe patient care decision-making.

Outcome Achieved

By following this structured approach:

• The student successfully produced a clear, evidence-based response addressing all required points.

• They demonstrated ability to interpret vital signs, calculate MAP, and recognize hypotensive shock in a post-operative patient.

• The AI analysis enhanced the discussion, allowing the student to critically evaluate external input.

• All learning objectives were met: clinical assessment, physiological reasoning, nursing intervention, use of AI responsibly, and academic referencing.

Learning Objectives Covered

• Application of theoretical knowledge to clinical scenarios

• Understanding of post-operative care for high-risk patients

• Critical evaluation of AI-generated clinical suggestions

• Evidence-based decision-making and prioritization of care

• Professional academic writing and referencing

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