NURBN3030 Assessment clinical reasoning cycle

Learning outcomes:

This assessment supports course learning outcomes K1, K3, S1, S3, A1.

Purpose: This task is designed to assess students’ abilities in applying clinical reasoning to patient deterioration. Including:

• Recognition of alteration to normal parameters and

• Signs of deterioration in patients,

• Appropriate escalation of care related to the situation and

• Implementation of relevant and evidence-based assessments and interventions that are reasonable to expect of a graduate nurse.

Format: PowerPoint slides with video and narration recorded using Kaltura. All students must be visualised and clearly audible for each of their parts in the presentation.

Presentation length: Should be no more than 20 minutes in length. Your PowerPoint slide show should be used to guide your presentation only (i.e., do not include all information on your slides and then read it).

Description:

In this assignment students are required to:

Working as a group, present and discuss the following case study using all elements of the clinical reasoning cycle to identify priorities of care, rationalise the necessary assessment/s, identify the relevant intervention/s for the patient presentation, and evaluate and reflect upon the intended outcomes. Students should use current, evidence-based best practice to rationalise and support their ideas. Each student should present for approximately 5 minutes. It is a requirement that you work together and liaise with one another to ensure cohesion across all elements presented. All students must be visualised on camera for the entirety of their individual presentations.

CRICOS Provider No. 00103D RTO Code 4909

Case study:

Peter Sampson is an 82-year-old man admitted to the medical ward for aspiration pneumonia.

Medical Hx: Embolic Stroke 2 years ago, dysphagia, IHD, AF.

Medications: Metoprolol, Apixaban, Perindopril, Vit D, Multivitamin.

Social Hx: Peter lives in low-level residential aged care and has done so for the past 8 years. He remains reasonably active after his stroke and is independent with ADL’s. Peter requires thickened fluids, although he does not like the taste and texture so regularly ignores this and drinks un-thickened fluids.

Peters’ wife passed away several years ago. He has two daughters and several grandchildren who visit him regularly. His eldest daughter is listed as NOK and has medical power of attorney.

HOPC: Several days ago, Peter was noted by the care assistant to have a productive cough. The visiting GP was notified and attended two days later at which point Peter had significant WOB, productive cough, and Tachycardia. The GP determined that Peter required admission to hospital and IV antibiotics. An ambulance was called, and Peter was transported to the local emergency department. On assessment in ED Peter was noted to have a RR of 28 with increased WOB, his 02 saturations were 90% on RA. On auscultation he had crackles in the left lower lobe. A chest XR showed a left lower lobe pneumonia. Pathology showed an elevated WCC and CRP and VBG showed mild compensated respiratory acidosis. Blood cultures and sputum specimens were sent. Based upon these findings Peter received 1g Ceftriaxone and Azithromycin 500mg. HFNP was initiated at a 20L with humidification to assist with WOB and secretions and removed 2 hours later as Peter stabilised. After 4 hours in ED Peter was transferred to the ward.

The next day, you are caring for Peter on your busy afternoon shift. At 1400hrs you assess Peter on handover and note that he has 2L O2 insitu via nasal prongs, is sitting up in bed and is alert and orientated. He cheerfully tells you that he is looking forward to his daughter visiting him later this evening. You note that his respiratory rate is increased at 22 breaths per minute, and he is flushed, but he has just been up to the bathroom, you make a note to check this again in an hour and instruct Peter to press his call bell if he needs anything.

Your shift continues to be busy, and you are unable to get back to Peter. At 1730hrs as you are exiting another patient’s room, Peters daughter is waiting outside his room. She states that she is concerned and thinks something is not quite right with Peter as he thinks that she is her sister and that he is in his nursing home.

You immediately go in to assess peter and carry out a primary survey and vital signs. The findings are as follows.

CRICOS Provider No. 00103D RTO Code 4909