Assessment Task 3: Case Study Extended Clinical Reasoning

Purpose

This assessment enables students to apply knowledge from unit learnings to an issue requiring extended clinical reasoning. The assessment will:

• Engage students in applying theory to practice.

• Facilitate understanding of the impact of illness on the patient.

• Provide an opportunity to demonstrate the use of a clinical reasoning framework to plan care for an acutely unwell patient.

Task

Students are required to apply knowledge from unit learnings to an issue requiring extended clinical reasoning.

Assignment Overview Task

1. Case Study

• Using the provided case study, apply a clinical reasoning approach to demonstrate high-quality, evidence-informed nursing care for an acutely unwell patient.

2. Using Evidence-Based Research

• Provide evidence-based responses to all questions.

• Use at least 15 evidence-based references, such as peer-reviewed journal articles, systematic reviews, or research studies published within the last seven years.

• Guidelines or policies (e.g., national standards) may be included, but should not be the primary source.

• Follow APA 7th edition formatting for in-text citations and reference list.

3. Reference Formatting

• Refer to ACU Library APA Citation Guide and APA Citation Guidelines.

Assignment Questions

Question 1: Presenting Medical Concern, Pathophysiology, and Further Nursing Assessments (600 words)

Part 1A

• Identify one significant presenting concern or potential issue Lily may be experiencing.

• Discuss observed evidence (signs and symptoms) that support your impression.

• Identify gaps or uncertainties where further assessments are required to clarify her condition and guide care planning.

Part 1B

• Using your initial impression, discuss potential underlying pathophysiological processes that could explain the observed signs and symptoms.

• Explain how these processes contribute to Lily’s clinical presentation.

Part 1C

• Identify and explain additional assessments required to provide further clarity regarding Lily’s condition.

• Present in a list format, with a brief rationale for each item.

• If recommending repeated assessments, justify why ongoing monitoring is required.

Question 2: Disease Pathophysiology and Complications 

• Lily is at risk of acute deterioration based on her medical and surgical history and presenting condition.

• Potential complications:

  • Septic shock

  • Respiratory failure / Acute Respiratory Distress Syndrome (ARDS)

  • Right-sided heart failure

  • Fluid overload

• Task: Select two (2) complications and address the following for each:

  1. Explain why Lily is at risk, referencing her clinical presentation and medical history.

  2. Discuss the underlying pathophysiological mechanisms, using evidence-based references and data from the case study.

Question 3: Identify Nursing Issues (400 words)

Part 3A

• Identify and prioritise three high-priority nursing problems/issues during Lily’s current admission.

• Focus on urgent clinical needs, not lower-priority issues (e.g., ADLs).

• Requirement: At least two actual problems and one potential at-risk problem, with justification.

Nursing Problem/Issue Format:

• Problem (P): State the issue (e.g., “Ineffective airway clearance”).

• Aetiology (A): Identify contributing factors (e.g., “related to excessive secretions”).

• Symptoms (S): Provide evidence/defining characteristics (e.g., “as evidenced by laboured breathing and oxygen saturation of 88%”).

Part 3B

• Justify why each nursing problem is a high priority.

• Explain its impact on Lily’s immediate safety, health, or recovery, using assessment findings, clinical reasoning, and evidence-based sources.

Question 4: Nursing Care Strategies (400 words)

• Identify, rationalize, and explain priority nursing care strategies for the first 24 hours of admission.

• Focus on strategies addressing most urgent needs identified in Question 3.

For each strategy:

1. Describe the nursing care strategy: Clearly state the intervention/action.

2. Rationalise the strategy: Explain why this action is a priority, referring to Lily’s clinical presentation, assessment findings, and nursing problems.

3. Explain how the strategy addresses patient needs: Connect the intervention to expected outcomes using evidence-based reasoning, supporting Lily’s immediate safety, health, or recovery.

Brief Summary of Assessment Requirements

This assessment requires students to apply theoretical knowledge from the unit to a real-world clinical scenario. The key objectives are:

• Apply a clinical reasoning framework to plan care for an acutely unwell patient.

• Demonstrate evidence-informed nursing practice using peer-reviewed references.

• Analyze the patient’s presenting concern, pathophysiology, and risk of complications.

• Identify high-priority nursing problems and formulate effective nursing care strategies.

• Reference all sources using APA 7th edition and ensure at least 15 evidence-based references are used.

Key pointers to be covered in the assessment:

1. Presenting medical concern and initial assessment.

2. Pathophysiological processes behind observed symptoms.

3. Further nursing assessments required.

4. Identification of potential complications (select two) and their mechanisms.

5. Prioritisation of nursing issues using the problem/etiology/symptoms format.

6. Justification for prioritising nursing problems.

7. Nursing care strategies for the first 24 hours of admission.

Academic Mentorship Approach

Step 1: Understanding the Case Study

• The mentor guided the student to read and analyze Lily’s case study thoroughly, highlighting presenting symptoms, medical history, and immediate concerns.

• Focused attention was given to identifying acute clinical priorities and potential gaps in information.

Step 2: Presenting Concern & Pathophysiology

• The student was instructed to identify one major presenting concern.

• Mentor helped to link signs and symptoms to potential pathophysiological processes.

• Example guidance included connecting respiratory distress to possible hypoxia or fluid overload.

• Further assessments were listed with rationales to clarify the patient’s condition, including vital signs monitoring, lab tests, and imaging.

Step 3: Identifying Complications

• Mentor advised selecting two potential complications (e.g., septic shock, ARDS).

• Each complication was analyzed by discussing risk factors, clinical indicators, and underlying mechanisms, supported with current evidence.

Step 4: Nursing Issues Identification

• Students were guided to prioritise nursing problems: two actual and one potential at-risk problem.

• Each problem was structured using the Problem (P) – Aetiology (A) – Symptoms (S) format.

• Mentor emphasized justification of priority based on patient safety and clinical urgency.

Step 5: Nursing Care Strategies

• The mentor worked with the student to plan interventions for the first 24 hours, focusing on the most urgent needs.

• Each strategy included:

  • Description of the intervention.

  • Rationale connecting the intervention to the patient’s presentation.

  • Expected outcomes, supported by evidence-based reasoning.

Final Outcome Achieved

• Student submitted a structured, evidence-based case study report.

• The report demonstrated:

  • Application of clinical reasoning framework.

  • Analysis of presenting concerns and pathophysiology.

  • Identification of priority nursing issues and interventions.

  • Use of APA 7th edition references with over 15 peer-reviewed sources.

• The submission successfully covered all learning objectives: clinical reasoning, patient safety, evidence-informed practice, and prioritization of care.

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