Topic: Nursing care of a patient with a medical condition
Length: 2000 words ± 10%. Markers will stop reading at the maximum allowable word count. This word count includes the text in the template provided to you. Your reference list is NOT included in your word count.
Contribution to overall grade: 40%
Written Assessment 2: Tasks
Firstly you will need to choose one of two case studies below.
1. Case scenario one – Vanessa Anderson
- Case scenario two – Alex Braes
After you have picked a case study you will need to answer some questions related to two stages of the clinical reasoning cycle.
Part 1 of your assessment question will require that you firstly collect cues/ information (stage 2 of the clinical reasoning cycle) and take action (stage 6 of the clinical reasoning cycle).
Part 2 of your assessment question will require you to reflect on and process new learning (Step 8 of the clinical reasoning cycle).
Based on the ISBAR handover (see details below), other information included below and current reliable evidence for practice, address the following tasks. Do not make up or assume information in relation to or about your chosen patient. Only use what you know from the information you received today.
This assignment has been split into two parts.
Part 1:
Based on your chosen case scenario and in grammatically correct sentences, complete stage 2 (collect cues/information) and stage 6 (take action) of the clinical reasoning cycle to;
- Collect cues/information: Identify three (3) priority nursing assessments that you would conduct at the commencement of your shift. For each assessment you have identified explain the following;
Consider and recall your knowledge explaining the underlying pathophysiology around the concerns you discuss.
- What consequences can occur if this assessment is not completed accurately?
- What chart or document could you use to assist with/record your assessments?
(500 words)
Take action: Utilising stage 6 of the clinical reasoning cycle, discuss your nursing actions. These must include;
The most appropriate course of action to achieve your goals of care. Address your nursing diagnoses, using current evidenced based practice.
Discuss who is best placed to undertake the required interventions and why.
Detail your chosen parameters, to include who should be notified and when.
(500 words)
Part 2:
Step 8 of the Clinical Reasoning Cycle requires a nurse to reflect on process and new learning. Based on your chosen case study, critically reflect on the role and responsibilities of the registered nurse. Your reflection must demonstrate how your thinking or assumptions have been challenged, and the deeper insights you have gained. You should use a reflective cycle to guide your reflection, such as the Gibbs Reflective Cycle. Your reflection should be informed by the latest research and guidelines (at least 5 peer reviewed journal articles/NSQHS standards, Code of Conduct, Nursing Standards, Code of Ethics).
The following points must be discussed.
Critically analyse pain and medication management in the treatment of your patient, included associated risk management.
Critically reflect on your role, responsibility, scope of practice to include legal and ethical frameworks in the management of patient care in an acute care setting.
(1000 words)
Choose one of the below case studies. Both case studies are real life cases, with some embellishments.
Written Assessment 2: Case scenario one – Vanessa Anderson
Shift handover:
| Identify: | Miss Vanessa Anderson, HRN: 123456, DOB: 25 /12/2004 |
| Situation: | Vanessa is a 16yo, healthy active female living in NSW who was admitted after experiencing a traumatic head injury after being struck on the R) side of her head, behind her ear, by a golf ball at approx 0825 Sunday morning. Paramedics attended and brought her into ED. She was sent for an urgent CT which diagnosed depressed focal right temporal skull fracture. Bone fragments in brain matter and dural lacerations present. She has been complaining of a headache and has a GCS of 14-15. She has been transferred to the RDH Neurological ward for continuing care, it is now 1300. |
| Background: | Vanessa lives with her parents and has an older brother Jason. She plays golf 3-4x a week and is in yr11 at High School. Pmh – Asthma – Seretide and Ventolin Allergies – Shellfish and nuts 60kgs, normal BMI |
| Assessment: | Airway: Own, patent Breathing: RR 23, O2 Sats 98% on RA. Circulation: HR 68bpm, BP 120/65 mmHg. Disability: GCS 14/15, she is intermittently confused, PEARL 3mm, BGL 5.0mmol/L Exposure: Temp 36.5 oC, She has 1 x PIVC inserted to her R) ACF, it is patent. |
| Recommendations/Read back: | Medical orders Routine ward assessments and observations4/24 full neuro observationsAdminister analgesia as prescribed Diet and fluids as toleratedTED stockings and DVT prophylaxis Medication orders Panadeine Forte 1000mg/ 60mg QID Oxycodone 5mg PRN (Max dose 30mg in 24hrs)Dilantin 100mg IV over 6hrs Nursing orders Devise a plan of care for your patient |
The following events transpired over the course of the next few shifts.
| Monday 0830 | Medical review. GCS 15.Continue with regular Panadeine Forte Oxycodone changed to 5-10mg 3hrly PRNYou return on Monday for the nightshift, and you are allocated to care for Vanessa. |
| 2100hrs | On handover at 2100hrs you are told that Vanessa last had the following analgesia. 1900 – Panadeine Forte2000 – PRN Oxycodone 10mg You perform your assessment and note the following: Airway: Own, patent Breathing: RR 16, O2 Sats 95% on RA. Circulation: HR 62bpm, BP 105/58 mmHg. Disability: GCS 14/15, she is intermittently confused, PEARL 3mm, BGL 6.0mmol/L Exposure: Temp 36.2 oC, |
| 2300hrs | Vanessa rings the bell and complains of a continual headache with 9/10 pain, you administer: 2300 – PRN Oxycodone 10mg |
| 0000hrs | You review Vanessa and she complains of no improvement in her headache, pain is 9/10, you administer her scheduled Panadeine Forte. |
| 0100hrs | At 0100 Vanessa rings her bell for assistance, she tells you, in a distressed voice that she cannot move. You attempt to do a full set of neurological observations and ask Vanessa to lift her arms, she cannot, she is frightened. There is no shaking, no stiffness to her limbs and her breathing is normal. She feels warm to touch and has a normal skin colour. You do not assess any other limbs nor do you assess her GCS. You do not believe she is in immediate danger and assume she has had a bad dream. You offer reassurance and leave the room as you have a new admission you must attend to urgently. Within 10 minutes you return to Vanessa and perform a full set of neurological observations, with no deficits noted, you are happy with your original assumption that she had a bad dream. |
| 0200hrs | Vanessa rang the bell to ask for assistance to use the toilet, she can mobilise with some assistance. Her pain remains unresolved, you give her PRN Oxycodone 10mg. |
| 0400hrs | You have routine and neurological observations to conduct but as she was ok when you walked her to the toilet 2hrs ago you decide to not conduct these. Her Dad arrived on the ward at 0345 and he is fast asleep in the chair in her room, you decide not to disturb them as she is finally settled after her analgesia. |
| 0530hrs | You go to check on Vanessa and find her unresponsive. You initiate a MET call. |
| 0635hrs | Vanessa is pronounced dead, despite all attempts to resuscitate her. |
| Coroners review – cause of death. | Post-mortem: Blunt head injury and mechanism of death most likely a seizure. Unable to be formally determined. Difficult to determine whether analgesia contributed – may have caused respiratory depression. |
| Formal finding – Respiratory arrest due to depressant effect of opioid medication |
Additional resources:
Vanessa’s Law – https://www.parliament.nsw.gov.au/bill/files/2995/ LA%202R.pdf
Articles:
https://www.smh.com.au/national/how-system-fatally-failed-vanessa-20080125–gdry4u.html
https://www.abc.net.au/news/2008-01-24/hospital-errors-killed-golfball- teen-coroner/1022244 https://www.mja.com.au/journal/2008/188/8/royal-north-shore-hospital- inquiry-analysis-recommendations-and-implications
Inquest: http://docplayer.net/60683283-Inquest-into-the-death-of-vanessa- anderson.html
15min video https://patientsafetyfornursingstudents.org/resources/ medication-safety/
Written Assessment 2: Case scenario two – Alex Braes
The below details the history of Alex’s multiple presentations before you are given handover.
| Wednesday 0318 | Alex attends ED with his Dad, complaining of knee pain. No observations were taken and Alex was told to go home and come back later in the morning for an ultrasound. |
| 800 | Alex returns to ED with his Dad for the ultrasound. They assumed Drs would review his results, but ED was so busy that no one was available to see him. His vitals were not checked and again they were told to go home and come back later. |
| 1800 | Alex and his Dad return to the hospital. They are reviewed by a Dr with his ultrasound results. It states that he ‘may have a torn tendon’. He was told to rest, ice, and elevate his leg and to come back in 2wks if the pain wasn’t better. Again, no one checked his vitals. |
| Thursday 1000 | Alex called his Dad early in the morning, who was at work telling him the pain was worse and he was unable to walk. His Dad immediately came home and called an ambulance. No ambulance was available. His Dad took him to emergency for a fourth time. Alex was in so much pain he could not get out of the car so his Dad asked the triage nurse for a wheelchair. It took 25minutes for this to be brought to his Dad. |
| 1139 | Alex was observed by the triage nurse through the window and was asked to wait. Alex asked his Dad for a pillow as he felt like he was going to pass out. His Dad went and spoke to the nurse and asked her for a pillow, she didn’t provide one but left her post to check on him. She noticed Alex was sweaty and moved him into a bed in the emergency department. |
| 1217 | 33hrs after Alex’s initial presentation to emergency, his vitals were taken. |
The triage nurse gives you this handover.
| Identify: | Mr Alex Braes, HRN: 123567, DOB: 07/05/ 2003 |
| Situation: | Alex is a 18-year-old male from a community in remote NSW He has been admitted to the emergency department with knee pain. His Dad was worried as he has been complaining of increased pain and now cannot weight bear. Alex feels like he is going to pass out. You are caring for him in the ED. |
| Background: | He lives with his parents. Recent ultrasound shows ? tendon tear to the R) knee. |
| Assessment: | Airway: Own, patent Breathing: RR 30, Sats 92% on RA. Circulation: HR 125 bpm, BP 90/55 mmHg. Disability: GCS 13/15 Exposure: Temp 38.5 oC Alex has 2 x IVC’s inserted to both ACF’s. Venous Blood Gas attended shows Potassium 3.1mmol/L pH 7.10 Lactate 4mmol/L |
| Recommendations/Read back: | Medical orders Routine assessments and observationsStrict fluid monitoringAdminister Intravenous fluids as prescribed TED stockings and DVT prophylaxis IV Fluid orders Gelofusin 1000mls STATIntravenous compound sodium lactate (CSL) 1000mls over 2 hours Medication orders Tazocin 4.5g IV TDS Immediate STAT dose Nursing orders Devise a plan of care for your patient |
| 1228 | Alex’s vital signs were quickly getting worse and a rapid response team was called. By this time, Alex needed resuscitation. He was semi- conscious, he was rambling and he was not responding to simple questions. When Alex was stripped off the source of infection was discovered. He had an infected toenail on his R) great toe which had developed into necrotising fasciitis. His kidneys were starting to fail and the decision was to immediately transfer him. |
| 1325 | The director of medical services was informed by the senior treating Dr that this was the sickest patient he had ever seen in his time at Broken Hill. |
| 1347 | A request was made to transfer Alex to the Royal Adelaide, the closest hospital. The Royal Adelaide confirmed there were no beds available. |
| 1405 | RFDS were informed their service was needed, but they were unable to transport him due to the only available pilot having already reached their maximum flying hours and the night pilot had called in sick. |
| 1432 | A bed was found at the Royal Prince Alfred Hospital in Sydney. As there was no way of flying Alex out asap the air ambulance left Sydney. It is a 5hr round trip. |
| 1730 | Alex deteriorated suddenly whilst in ED and the decision was made to intubate him so that he could be stabilised on the flight to Sydney. |
| 2130 | Alex finally left the hospital via air ambulance with his Mum on board. She reported that the paramedics struggled to stabilise him during the flight and had to frequently call doctors for advice on how best to manage his care. |
| Friday 1250 | Alex arrived in Sydney. Upon arriv he went into cardiac arrest |
| 200 | 18yr old Alex Braes was pronounced dead. |
| The hospital now conducts vital observations on every patient. The inquest remains ongoing, it is expected to reconvene in April 2022 when findings are expected to be delivered. Alex died on 22nd September 2017. |
◦ Additional resources:
‘How your postcode can determine the quality of care you get’ – Four Corners. *Watch from 19:47 :https://www.youtube.com/watch?v=- EWEjTSeunk&ab_channel=ABCNewsIn-depth
The death of Alex Braes still haunts doctors who didn’t even know him – ABC News
Senior doctor gives evidence about Alex Braes’ final hours on day two of inquest – ABC News
Inquest into Alex Braes, Broken Hill teen who died of infected toenail, resumes (msn.com)
‘Can pain kill you?’: Teen’s final words after he was turned away from NSW hospital (smh.com.au)
General Assessment Information
| Assessment purpose | Learning objectives |
| Assessment 2 is the only written academic assignment in unit for students to demonstrate they: Are developing the ability to locate, interpret, integrate, synthesize and apply nursing knowledge from unit to a relevant nursing practice scenario in medical surgical settings Are developing appropriate critical thinking, clinical reasoning and sound clinical decision-making processes and strategies essential for safe, evidence-based and competent nursing practice in medical surgical settings Are able to focus their attention to the needs of the individual patient as the key concern of nursing practice in medical surgical settings Are able to explain and justify or defend their nursing care decisions Have a developing understanding of the role and scope of practice of the registered nurse in the Australian health care context Are progressing towards the level of professional written communication required for nursing practice in Australia Are demonstrating ethical and professional practice by adhering to the University’s academic integrity standards and plagiarism policy | This assessment addresses the unit learning outcomes; 1, 2, 3, 4 and 5 |
Learning Outcomes
- Consolidate, integrate, and apply evidence-based knowledge, skills and clinical reasoning in the nursing assessment and management of patients in an acute care setting.
- Demonstrate the ability to utilise clinical reasoning processes to plan, prioritise, monitor, and evaluate nursing plans of care.
- Critically discuss appropriate pain and medication management in the treatment of the medical/surgical patient including associated risk management.
- Identify and critically discuss culturally safe, age-appropriate strategies for promoting patient health and wellness.
- Critically reflect on the role, responsibilities, and scope of practice of the registered nurse including the legal and ethical framework, in the nursing management of patients in acute care settings.
◦ Preparation
Timely completion of study materials including modules 1 – 6 with participation or review of online collaborate sessions, pre-recorded lectures or internal classes.
◦ Presentation Guidelines
As a computer-generated document in Word format.
1.5 spaced using Arial or Calibri font in size 11 or 12
In clear, coherent Australian English that demonstrates progression towards the standard for written communication for professional nursing practice in Australia
Using appropriate professional terminology Contents page, title page, introduction and conclusion are NOT required
Unless otherwise indicated, no acronyms, abbreviations and/or nursing jargon
Unless otherwise indicated, grammatically correct sentences and topic paragraphs are required.
No more than 10% over or under the stated word count. Marking will cease at the 10% over mark.
Use of trade names is not acceptable. Only generic terms or names are to be used when referring to specific medications or other prescribed treatments or resources that may be used in nursing practice
◦ Referencing
Students are reminded of their academic responsibilities and professional nursing practice requirements when using the work of others in assignments.
Reminder marks are allocated for academic integrity. See the marking criteria for Assessment 2 for full details. Breaches of academic integrity will be lodged on the University system and may have serious consequences for students.
All information is to be interpreted and restated in your own original words demonstrating your ability to interpret, understand and paraphrase material from your sources
APA 7th referencing style is to be used for both in-text citations and end of assessment reference list.
All resources for assignments should be from quality, reliable and reputable journals relevant to nursing practice and the Australian healthcare industry. Please DO NOT use patient information leaflets or websites.
All resources must be dated between 2012 and 2022
There must be at least 10 peer-reviewed journal articles and/or evidence-based practice guidelines cited in your assignment. Do not use any health facility or local health service policies or procedures
Only 1 current Australian medication textbook and 1 current Australian medical surgical nursing textbook to be referenced.
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