Assignment 3: Case Study Complex Care Assessment

The Task: Evaluate a Case Study

This assignment is designed to comprehensively assess your knowledge, understanding, and application of critical thinking and clinical reasoning in evaluating nursing care for people living with complex health conditions.

Instructions

In 1500 words (+/- 10%), select one of the case studies (as featured below) and address the following questions:

1. Identify the actual and potential nursing concerns for this person and explain the rationale behind your clinical decision making.

2. Identify four priority nursing interventions that will need to be undertaken to support this person and explain the rationale behind your clinical decision making.

Your responses should reflect the context of care delivery and consider what may be required to escalate care needs in these settings. You are expected to apply principles of age-appropriate, person- and family-centred care, involve the multidisciplinary team (MDT) where appropriate, and discuss relevant pathophysiology and pharmacology.

This assessment meets the following Topic Learning Outcomes

2. Demonstrate clinical reasoning and management of the nursing care needed to safely manage the fundamentals of care for clients in a variety of settings.

3. Consolidate the fundamental skills in medication safety including applying critical thinking and decision making to patient scenarios and evaluating the care provided.

Presentation Criteria

• Use the provided template to structure your assignment.

• Write this assignment in third-person narrative.

• Your assessment must be generated in Word format (i.e. .doc/.docx, not PDF).

• Basic font: Arial, Calibri, or similar, size 11 or 12, with 1.15 line spacing.

• Written in coherent Australian English that demonstrates progression towards the standard for written communication for professional nursing practice in Australia.

• Use appropriate professional terminology; do not use acronyms, abbreviations, or nursing jargon.

Referencing

• APA 7th edition format is required for both in-text citations and reference list.

• Markers must be able to access all resources used in your assignment.

• Aim for quality, reliable, and reputable nursing and Australian healthcare-related journals or professional websites (not consumer-based sites).

• Maintain academic responsibility and professional integrity when using the work of others.

Case Studies 

Case 1: Sam Preston

Samuel (Sam) Preston is an 8-year-old male residing in Brighton with his parents and two brothers.
Sam was diagnosed with Glioblastoma Multiforme (GBM) 12 months ago. Since diagnosis, he has undergone:

• Surgical resection of the tumour

• Multiple cycles of chemotherapy

• Targeted radiotherapy

A recent CT brain scan was performed following the onset of dysphagia (now managed with a PEG tube) and left arm paraesthesia. Imaging revealed a significant and inoperable enlargement of the GBM. After a collaborative discussion involving Sam, his family, and the MDT, a decision was made to transition to exclusive palliative care at home, supported by the Flinders University Community Palliative Care Team.

Past Medical History

• Glioblastoma Multiforme (GBM)

• Seizures secondary to brain tumour

• Dysphagia (PEG in situ)

• Left-arm paraesthesia

During a routine home visit, Sam’s brothers are playing quietly while parents converse in the kitchen. Sam is resting in bed, withdrawn, complaining of a ‘small’ headache. His mother reports the headaches are becoming more frequent and that Sam seems more anxious, especially at night, asking questions about death.

Medications (via PEG unless noted)

• Levetiracetam 230 mg BD

• Dexamethasone 4 mg QID

• Paracetamol 345 mg QID

• Morphine 4.6 mg PRN (every 4 hours)

• Midazolam 5 mg IN PRN (as per seizure plan)

Case 2: Akmal Muhammad

Akmal Muhammad is a 15-year-old male admitted to the paediatric ward for observation after an asthma exacerbation triggered during a panic attack. He received Salbutamol and Ipratropium via MDI and one dose of IV hydrocortisone.

Akmal is a refugee from Afghanistan living with his mother, Asal.

Past Medical History

• Asthma

• Post-Traumatic Stress Disorder (PTSD)

• Type 1 Diabetes Mellitus (T1DM)

He manages diabetes with a Humalog insulin pump and has started using a CGM. He states he manages the pump independently but has had difficulties recently.

During routine observations, he appears pale and lethargic. Two empty water bottles are beside him. He reports excessive thirst, frequent urination, and a persistent headache. You detect a fruity odour on his breath.

Medications

• 100mg IV Hydrocortisone 6 hourly

• 12 puffs Salbutamol via MDI 1 hourly PRN

• 8 puffs Ipratropium via MDI 4 hourly PRN

• Humalog Insulin continuous subcutaneous infusion (via pump)

Case 3

Charlotte is a 57-year-old female living at home with her older half-sister, Sophie, and Sophie’s husband, Heath. She is referred for ongoing care related to advanced Alzheimer’s dementia.

Past Medical History

• Down syndrome

• Osteoarthritis

• Ventricular septal defect

• Depression

• Dysphagia (PEG tube for long-term nutritional support)

Charlotte also has significant hearing impairment and limited verbal communication, relying on behavioural cues.

During a home visit, Sophie reports Charlotte has been coughing during and after PEG feeds for 24 hours. She is more fatigued and not wanting to get out of bed, becoming agitated during care.
She has:

• Temperature: 38.5°C

• Respiratory rate: 28

• Skin: diaphoretic

Medications (via PEG unless specified)

• Paracetamol 1g PRN

• Mirtazapine 30mg Daily

• Vitamin D 1,000 IU Daily

Use of Artificial Intelligence

Students are permitted to use AI to brainstorm ideas or structure documents, but cannot create assignment content using AI.

Students must provide:

• AI prompts used

• Drafts of their work

• Acknowledgement of how AI assisted

Brief summary of assessment requirements

This assessment requires a focused, evidence-based evaluation of one selected case study (Case 1, Case 2 or Case 3) in 1500 words (+/-10%) that demonstrates critical thinking and clinical reasoning in nursing care for people with complex health needs.

Core tasks:

• Select ONE case study from the three provided (Sam Preston; Akmal Muhammad; Charlotte Berman).

• Answer two questions:

  1. Identify the actual and potential nursing concerns for the chosen person and explain the clinical reasoning/rationale.

  2. Identify four priority nursing interventions required to support the person and explain the clinical reasoning/rationale.

• Demonstrate application of age-appropriate, person- and family-centred care, escalation pathways, and involvement of the multidisciplinary team (MDT) where appropriate.

• Include relevant pathophysiology and pharmacology linked to the clinical concerns and interventions.

• Use third-person narrative, professional Australian English, and hospital-appropriate terminology (no acronyms/jargon).

• Present in the provided template, Word format (.doc/.docx), Arial/Calibri 11–12, 1.15 spacing.

• Use APA 7th edition referencing (in-text + reference list) with reputable clinical/nursing sources (accessible to markers).

• Adhere to the university policy on AI use: AI may be used only for brainstorming/structure students must record AI prompts used and declare how AI assisted.

Key pointers to cover in the assessment

• State clearly which case was chosen.

• For actual nursing concerns: list immediate clinical issues (e.g., pain, seizures, PEG care, altered consciousness, DKA risk, aspiration, infection, respiratory compromise, dehydration) with brief pathophysiological explanations.

• For potential nursing concerns: identify foreseeable complications/escalations (e.g., increased intracranial pressure, aspiration pneumonia, status epilepticus, diabetic ketoacidosis, sepsis, dehydration, delirium).

• Provide clinical rationale for each concern referencing physiology, medication effects, monitoring parameters, and safety considerations.

• Select four priority nursing interventions (clearly ordered by priority) and for each: action steps, monitoring, expected outcomes, escalation triggers, and MDT referrals.

• Discuss pharmacology relevant to interventions (mechanism, dosing considerations, monitoring, adverse effects, interactions) and safe medication administration principles.

• Address family-centred care and communication strategies tailored to the patient’s age, culture, cognition, and family needs.

• Describe escalation criteria and how/when to seek medical review or emergency transfer.

• Demonstrate medication safety considerations (e.g., route issues with PEG, PRN decisions, pump management, titration, allergy/sensitivity checks).

• Provide evidence-based citations (peer-reviewed journals, clinical guidelines, local protocols).

• Ensure clear, concise academic writing in third-person and correct APA referencing.

How the Academic Mentor guided the student 

1. Clarify the brief and choose the case

   • Mentor reviewed the assignment rubric and learning outcomes with the student and helped select the most appropriate case based on the student’s clinical experience and learning goals (e.g., pediatric palliative care, paediatric DKA risk, or complex dementia care).

2. Define the scope and structure

   • Mentor provided a structured template aligned with the assessment requirements: Section A — Actual & potential concerns; Section B — Four priority interventions (each with rationale, monitoring, escalation); References.

   • Agreed on word allocation to ensure depth (approx. 700–800 words for part 1, 650–800 words for part 2).

3. Identify clinical concerns and link to pathophysiology

   • Mentor taught how to translate case data into clinical problems (e.g., fruity breath + polyuria = likely hyperglycaemia/DKA risk).

   • Coached the student on writing concise pathophysiological explanations that support nursing decisions (e.g., how GBM can increase intracranial pressure and precipitate headaches/seizures).

4. Select and prioritise interventions using clinical reasoning tools

   • Introduced prioritisation frameworks (Airway–Breathing–Circulation/ABC, clinical urgency matrices) to decide on the four most critical nursing actions.

   • Helped the student justify why chosen interventions are highest priority given immediate risks and setting (home vs ward).

5. Integrate pharmacology and medication safety

   • Guided the student to explain relevant medication actions, routes (PEG vs oral vs IN vs IV), dosing considerations, interactions (e.g., steroids effect on glucose, opioids and respiration), and monitoring requirements.

   • Emphasised safe documentation and PRN decision-making aligned with local policy.

6. Plan escalation and MDT involvement

   • Advised how to define clear escalation triggers (e.g., GCS drop, ABC compromise, RR >30, capillary ketones > threshold, seizure activity) and who to contact (intern, paediatrician, palliative care nurse practitioner, outreach team).

   • Mapped appropriate MDT referrals (dietitian for PEG, social worker for family support, physiotherapist/OT, endocrinology for diabetes issues, speech pathology for dysphagia).

7. Person- and family-centred communication

   • Coached on including family in care decisions, age-appropriate explanations, cultural sensitivity (e.g., refugee context for Akmal), and negotiating goals of care (especially relevant for palliative case).

   • Suggested practical wording and documentation approaches that demonstrate informed consent and shared decision-making.

8. Evidence and referencing

   • Assisted the student to locate high-quality Australian and international guidelines (e.g., Paediatric DKA guidance, Asthma Foundation or local asthma protocols, Palliative Care standards, infection and aspiration guidelines) and peer-reviewed articles to support claims.

   • Ensured in-text citations and reference list conformed to APA 7th.

9. Draft review and academic quality assurance

   • Reviewed drafts for clinical accuracy, coherence, third-person voice, and adherence to word count and formatting.

   • Checked for appropriate use of AI (if used): required prompts, how AI assisted (brainstorming/structure only), and included declaration per university instructions.

   • Performed a final check on spelling, grammar, and professional tone.

How the outcome was achieved

• Deliverable produced: A structured 1500-word assignment (in Word .docx) that: identifies actual and potential nursing concerns with pathophysiology and pharmacology links; lists four prioritized nursing interventions with clear rationales, monitoring, escalation criteria and MDT involvement; and includes APA 7th-referenced evidence from reputable clinical sources.

• Quality checks completed: alignment with rubric, third-person narrative, correct formatting, word count compliance, clinically accurate pharmacology notes, clear escalation plans, and inclusion of person-family centred strategies. AI use, if used, was documented and confined to brainstorming/structure only.

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