Clinical Reasoning and the Deteriorating Patient
Length: 1800 words
Submission method options: EASTS (online)
This assessment will require the student to apply the clinical reasoning cycle to a complex scenario and discuss the nursing role.
Using the Case Study provided on the NRS312 Subject Interact 2 site (under ‘Assessment Resources’), you will apply the Clinical Reasoning Cycle to the Case Scenario.
Your critical analysis should address the following:
While sub-headings can be used to structure this assessment, tables and dot points are not permitted.
Your responses must be supported by peer-reviewed evidence, commensurate with the level of evidence-based practice expected of a beginning practitioner.
You must support your discussion with a MINIMUM of 10 recent (less than 7 years old) and credible sources. Credible sources include the following:
This paper is a piece of formal academic writing and should therefore adhere to academic writing conventions. Sub-headings are acceptable but point form and tables should not be used.
Subject learning outcomes
This assessment task will assess the following learning outcome/s:
Graduate learning outcomes
This task also contributes to the assessment of the following CSU Graduate Learning Outcome/s:
This paper is a piece of formal academic writing and should therefore adhere to academic writing conventions. Sub-headings are acceptable but point form and tables should not be used. The paper must be word processed and not handwritten. Leave 2 cm margins and double line space your work, so that there is ample space for markers to comment. In addition,
NRS312 2018-30 Clinical Case Study for Assessment 2
Situation: You are a first-year graduate RN in a general surgical department. Mary Smith, 82 years old, is one of your 8 patients and underwent a left total knee replacement under general anaesthesia 6 hours ago.
Past medical history: osteoarthritis of both knees, with limited range of movement and pain on weight bearing in the left knee. She has Type 2 Diabetes Mellitus, diagnosed 3 years ago, essential hypertension, fatty liver disease with moderate enlargement, and diabetic neuropathy in both feet with intermittent mild neuropathic pain and no neurological deficit. Mary weighs 100kgs.
Medications: Metformin 1000mg twice daily, Empagliflozin 10mg once daily, Metoprolol 25mg twice daily, Atorvastatin 10mg once daily, Karvezide 300/12.5 once daily, fish oil 5000mg daily, Hypericum 1 tablet daily.
You approach her bedside and note she is fully alert, GCS 15/15, her surgical wound dressing is dry with no ooze and her PCA has not been accessed in the past hour. Mary states her pain is 7/10 in her Left knee and she feels lightheaded. She has not wanted to eat and has tried sips of water and she feels nauseated.
There is a 18G IV catheter in her right hand and 200mL of isotonic saline remaining in the IV bag, running at 80mL per hour via a pump. The PCA circuit is attached to this line.
Vital signs 60 minutes ago: BP 123/70, radial pulse 55, RR 18, SpO2 96%, FiO2 0.21, T 36.2, peripheral capillary refill 2 seconds, warm digits.
Vital signs now: BP105/56, radial pulse 66 regular, RR20, SpO2 93%, FiO2 0.21, T36.4 tympanic. BGL11.5mmol/L, Peripheral capillary refill is 3 seconds plus pale cool digits.
NRS 312 is currently undergoing some changes, and I ask for your patience as these are worked through.
I have reviewed the forum in relation to Assessment Two: Clinical Reasoning and the Deteriorating Patient and would like to offer the below answers to common questions.
A date or time is not required in relation to when the patient went to theatre, just consider it is 6 hours ago when you assess her now.
The capillary refill being tested is that of the toes, due to the fact that the patient has recent knee surgery. However, the fingers could/should also be assessed as part of a complete assessment.
Do not make up any information if it is not provided in the case study, Do not assume she is catheterised, what would need to be reviewed if she was or wasn’t as part of your assessment?
In text references are not included in the word count, nor is your reference list
Appendices are NOT permitted in this assessment
Sub headings are suitable to use, however dot points are not
Finally, it appears the first question is causing the most confusion and after much discussion there will be minor changes posted to the assessment in a revised subject outline, by Monday 4th March.
The changes will be evidenced in the marking rubric.
These changes will be:
You will be required to review the case study, develop a discussion of each stage clinical reasoning cycle AND apply these stages to the patient Mary Smith,
For example: Mr James Green is a 55 year old man who is a new admission to the ward following a motorbike accident resulting in a fractured left tibia and fibula. This offers health care workers a first impression of the patient (Grey, 2015p.2).
The word limit for this assessment is now a maximum of 2000 words.
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