NSG3RDP/ NSG3RDM – Recognising and Responding to the Deteriorating Patient

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NSG3RDP/NSG3RDM Semester One 2020
SCHOOL OF NURSING & MIDWIFERY
NSG3RDP/ NSG3RDM – Recognising and Responding to the Deteriorating Patient
Assessment activity 1 – 2000 words (35% of overall subject mark)
Due date: 11.5.2020 (09.00)
Subject Intended Learning Outcomes (SILOS)
1. Explain common pathophysiology, as it relates to assessment data and pharmacology, that can result in deterioration of an individual’s condition in order to develop appropriate interventions.
2. Apply the clinical reasoning cycle to provide person-centred care for individuals experiencing a deterioration in health in order to provide safe nursing care.
3. Develop an awareness of and contribute to the risk management strategies of a healthcare agency, in order to implement incident reporting procedures and apply risk management procedures.
Context
Serious adverse events, such as unexpected death, intensive care admission and cardiac arrest, are often preceded by observable physiological, clinical abnormalities and deterioration. Other serious events, such as suicide and aggression, are also often preceded by observed or reported changes in a person’s behaviour or mood that can indicate deterioration in their mental state.
Early identification of deterioration may improve outcomes and decrease interventions required to stabilise patients whose condition deteriorates in a health service organisation.
The warning signs of clinical deterioration are not always identified or responded to appropriately. The organisational and workforce factors that contribute to a failure to recognise and respond to a deteriorating patient are complex and overlapping (Australian Commission on Quality and Safety in Health Care, 2017)
NSG3RDP/NSG3RDM Semester One 2020
Task
In this assessment you are required to further explore the trauma case study introduced in topic two and three of your LMS and workshop materials for NSG3RDP/RDM.
You will be provided with an ISBAR handover and a National Observation Chart (NOC) for Joanna Cleese. (These documents will be attached at the end of this instruction sheet)
Using the provided information and current academic literature please provide a response to the following three questions
Instructions
Please answer the following questions as instructed
• Question 1 (750 words)
The condition of your patient Joanna Cleese described in the ISBAR handover, appears to be changing. (Please refer to the attached documentation)
Using the information that you have identified from the NOC and the ISBAR case study handover:
1. Discuss the possible causes of Joanna’s changing condition, supporting your response with contemporary literature and the associated significant cues, signs and symptoms listed in the case study.
2. Explain what possible further deterioration could occur for this patient, with a detailed evidenced -based response.
(Please support your justification and rationales with quality peer-reviewed literature).
• Question 2 (750 words)
There are many tools that can be utilised when assessing a patient. When assessing a deteriorating patient accurate assessment is essential. Compare and contrast the following methods of patient assessment and their appropriate applications for the deteriorating patient.
1. Primary (ABCDE)
2. Head to toe assessment
(Please support your discussion with evidenced based literature).
• Question 3 (500 words)
A change in a patient’s heart rate, blood pressure, temperature and respiratory rate can all be an indication of clinical deterioration. It has been suggested that a changing respiratory rate is the earliest indication of clinical deterioration and yet it is often not measured correctly, or not measured at all. Using evidence-based literature to support your arguments:
1. Discuss why a changing respiratory rate is an important indicator of clinical deterioration.
2. Explain how the respiratory rate can be measured reliably and accurately.
NSG3RDP/NSG3RDM Semester One 2020
**Discussions are to be supported with relevant and contemporary literature.
**References: Reference list and appendices are excluded from the word count.
**References to be no older than ten years
**10% word limit allowed.
Resources
Australian Conmission on Quality and Safety in Health Care. (2017). National Quality and Safety Health Care Standards Edition Two,. Retrieved from https://www.safetyandquality.gov.au/wp-content/uploads/2017/11/National-Safety-and-Quality-Health-Service-Standards-second-edition.pdf
How to find scholarly literature: http://latrobe.libguides.com/finding-information
How to reference using APA6: http://latrobe.libguides.com/referencing/referencing_tool
Submission process
Please use the submission template provided to document information. The document, which includes the completed submission template should be submitted as ONE Word document.
Your assignment should be submitted via the Turnitin assignment submission link located in the LMS site for this subject by the due date and time. The submission process is an automatic acknowledgement that you have complied with the guidelines for student responsibility for academic integrity: http://www.latrobe.edu.au/students/academic-integrity/explanation
If you have any questions about the assignment please contact the subject coordinator Jen Austerberry either by emailing j.austerberry@latrobe.edu.au or calling: 94964457 or 0417562176.
Extensions and special consideration
Students must seek a formal extension to submit after the due date where there are extenuating circumstances. Please read the instructions on the following web page http://www.latrobe.edu.au/?a=668155
You submit your request for an extension of the due date from this webpage.
If you have a personal issue or illness that is affecting your study, you may need to apply for special consideration. It is recommended that you discuss your situation with the course coordinator (Liz Pascoe) as soon as possible.
Eligibility to apply for Special Consideration does not automatically imply eligibility to receive it. Certain criteria must be satisfied in order to receive Special Consideration. Please refer to the policy information and on-line form located at: http://www.latrobe.edu.au/special-consideration
NSG3RDP/NSG3RDM Semester One 2020
Late submission
There are policies and procedures to guarantee fair, consistent and transparent treatment of late submission of assessment tasks provide equity around extensions to submission dates and penalties associated with not submitting assessment by the due date and time.
5% of the total possible marks will be deducted each day (or partial day) delayed submission, for a maximum of up to five (5) working days after the due date. Assessment tasks will not be accepted after the following occurrences:
• the fifth (5th) working day after the due date; or
• feedback on the assessment task has been returned to any student by the Teaching Team member.
The policy relating to late submissions can be located at: https://policies.latrobe.edu.au/document/view.php?id=148
NSG3RDP/NSG3RDM Semester One 2020
School of Nursing & Midwifery: NSG3RDP/NSG3RDM Assessment One
CRITERIA
Excellent (> 80 %)
Very good (70% – 79%)
Good (60% – 69%)
Fair (50% – 59%)
Poor (<50%)
MARK
Question One
Discusses the possible causes of Joanna’s changing condition
Explains what possible further deterioration could occur
USE OF LITERATURE TO SUPPORT DISCUSSION
(35% of total mark)
28 + marks
Clearly and consistently discuss possible causes of the Joanna’s changing condition
Clearly and consistently explains what possible further deterioration could occur
Demonstrated an excellent understanding of links between the necessary concepts.
Demonstrated clear and consistent evidence of critical appraisal of reference material
Evidence of synthesis of information and logical development of arguments
24 – 27 marks
Clearly and mostly consistently discuss possible causes of the Joanna’s changing condition
Clearly and mostly consistently explains what possible further deterioration could occur
Demonstrated a very good understanding of links between the necessary concepts.
Demonstrated some evidence of critical appraisal of reference material
Some evidence of synthesis of information and logical development of arguments
Literature predominantly used effectively to support key ideas
21 – 23 marks
Good but inconsistent attempt to consistently discuss possible causes of the Joanna’s changing condition
Good but inconsistent attempt to consistently explain what possible further deterioration could occur
Demonstrated good understanding of links between the necessary concepts.
Demonstrated inconsistent evidence of critical appraisal of reference material
Inconsistent evidence of synthesis of information and logical development of arguments
Literature inconsistently used to support key ideas
18 – 22 marks
Fragmented and inconsistent attempt to discuss possible causes of the Joanna’s changing condition
Fragmented and inconsistent attempt to explain what possible further deterioration could occur
Demonstrated limited understanding of links between the necessary concepts.
Demonstrated limited evidence of critical appraisal of reference material
Limited evidence of synthesis of information and logical development of arguments
Literature poorly used to support key ideas
<17 marks
Demonstrated lack of understanding of possible causes of the Joanna’s changing condition
Demonstrated lack of understanding of what possible further deterioration could occur
Demonstrated lack of understanding of links between the necessary concepts.
No evidence of critical appraisal of reference material
No evidence of synthesis of information and logical development of arguments
Overreliance on direct quotes Key ideas not supported by the literature
/35
NSG3RDP/NSG3RDM Semester One 2020
Question Two
Compares and contrasts
1. Primary (ABCDE)
2. Head to toe assessment
USE OF LITERATURE TO SUPPORT DISCUSSION
(35% of total mark)
28 + marks
Clearly and consistently compared the two methods of assessment
Demonstrated an excellent understanding of links between the necessary concepts.
Demonstrated clear and consistent evidence of critical appraisal of reference material
Evidence of synthesis of information and logical development of arguments
24 – 27 marks
Clearly and mostly consistently compared the two methods of assessment
Demonstrated a very good understanding of links between the necessary concepts.
Demonstrated some evidence of critical appraisal of reference material
Some evidence of synthesis of information and logical development of arguments
Literature predominantly used effectively to support key ideas
21 – 23 marks
Good but inconsistent attempt to compare the two methods of assessment
Demonstrated good understanding of links between the necessary concepts.
Demonstrated inconsistent evidence of critical appraisal of reference material
Inconsistent evidence of synthesis of information and logical development of arguments
Literature inconsistently used to support key ideas
18 – 22 marks
Fragmented and inconsistent attempt to compare the two methods of assessment
Demonstrated limited understanding of links between the necessary concepts.
Demonstrated limited evidence of critical appraisal of reference material
Limited evidence of synthesis of information and logical development of arguments
Literature poorly used to support key ideas
<17 marks
Demonstrated lack of understanding of the two methods of assessment
Demonstrated lack of understanding of links between the necessary concepts.
No evidence of critical appraisal of reference material
No evidence of synthesis of information and logical development of arguments
Overreliance on direct quotes Key ideas not supported by the literature
/35
Question Three
Discusses why a changing respiratory rate is an important indicator of clinical deterioration.
Explains how the respiratory rate can be measured reliably and accurately
USE OF LITERATURE TO SUPPORT DISCUSSION
28 + marks
Clearly and consistently discusses the changing respiratory rate significance and explains the means of achieving assessment accuracy
Demonstrated an excellent understanding of links between the necessary concepts.
Demonstrated clear and consistent evidence of critical appraisal of reference material
24 – 27 marks
Clearly and mostly consistently discusses the changing respiratory rate significance and explains the means of achieving assessment accuracy Demonstrated a very good understanding of links between the necessary concepts.
Demonstrated some evidence of critical appraisal of reference material
Some evidence of synthesis of information and logical
21 – 23 marks
Good but inconsistent attempt to consistently discuss the changing respiratory rate significance and explain the means of achieving assessment accuracy
Demonstrated good understanding of links between the necessary concepts.
Demonstrated inconsistent evidence of critical appraisal of reference material
18 – 22 marks
Fragmented and inconsistent attempt to discuss the changing respiratory rate significance and explain the means of achieving assessment accuracy
Demonstrated limited understanding of links between the necessary concepts.
Demonstrated limited evidence of critical appraisal of reference
<17 marks
Demonstrated lack of understanding of the significance of the respiratory rate or the means of achieving accuracy.
Demonstrated lack of understanding of links between the necessary concepts.
No evidence of critical appraisal of reference material
NSG3RDP/NSG3RDM Semester One 2020
(25% of total mark)
Evidence of synthesis of information and logical development of arguments
development of arguments
Literature predominantly used effectively to support key ideas
Inconsistent evidence of synthesis of information and logical development of arguments
Literature inconsistently used to support key ideas
material
Limited evidence of synthesis of information and logical development of arguments
Literature poorly used to support key ideas
No evidence of synthesis of information and logical development of arguments
Overreliance on direct quotes Key ideas not supported by the literature
ACADEMIC INTEGRITY & FORMATTING
(5% of total mark))
4+ marks
Correct use of APA V6 in-text and end-text format.
Use of submission template and specified formatting. No spelling typing or grammatical errors
Within 10%-word limit.
4 marks
Correct use of APA V6 in-text and end-text format, minor errors.
Use of submission template and specified formatting. Minor spelling, typing & grammatical errors.
Within 10%-word limit.
3 marks
Occasional errors in APA V6 format.
Use of submission template and specified formatting. Minor spelling, typing & grammatical errors.
Within 10%-word limit
2 marks
References provided but incorrect use of APA V6 format.
Use of submission template. Inconsistent use of specified formatting. Consistent spelling, typing and grammatical errors.
Within 10%-word limit
≤1 mark
Referencing does not adhere to APA V6 format.
Specified presentation & formatting not used. Spelling, typing and grammatical errors throughout the paper which impact on fluency and coherency.
Exceeds 10%-word limit.
/30
/100
NSG3RDP/NSG3RDM Semester One 2020
Attached documentation
Handover ISBAR
Setting Emergency Department
Time frame: Three hours post arrival by ambulance. (1730hrs)
Patient identification
Joanna Cleese
55-year-old female
Social history
Lives alone Widowed Three adult children
Works in IT as a computer programmer
Situation/Setting the scene
Initial Investigations/treatment
Joanna was up on a ladder cleaning the gutters when she fell approximately two metres onto a concrete path.
Joanna was found by her neighbour immediately following the fall, lying face down on her left side on the concrete path.
Initially Joanna was unresponsive for 2-3 minutes before responding to voice in a confused manner.
An ambulance was called by the neighbour and Joanna was transported to La Trobe Emergency Department.
Injuries include
Haemopneumothorax
Fractured ribs 3-6
Fractured left neck of femur (NOF)
Fractured left radius and ulna
Head laceration
Generalised bruising to left chest and shoulder temporal area, left abdomen, thigh and left arm
Chest/abdomen/pelvic/ left arm and leg x-rays
Head CT scan
Intercostal catheter (ICC) inserted 5th intercostal space mid axillary line
Two wide bore intravenous cannulas’
Intravenous (IV) fluid administration
Intravenous pain management
Left wrist splinted
Left leg external traction
Background/Past medical and
surgical history
Medications
Hypertension
Recently diagnosed Type 2 Diabetes
Obesity BMI 40
NSG3RDP/NSG3RDM Semester One 2020
Allergies
Ramipril 5mgs BD orally
Metformin 500mgs BD orally
Penicillin
Assessment information
Airway patent
Patient verbalising
RR 26
ICC insitue 20cm suction, absence of swing or bubbling
200mls frank blood drained initially, nil further drainage
O2 Sat 94% nasal prongs 2lpm O2
Temp 36.5
GCS 14 confused to time and place
P/S 8/10 chest, leg and abdomen
HR 120
BP 90/55
Recommendations/ Important considerations
Patient awaiting transfer to general surgical ward.
Remains nil by mouth (NBM)
Surgical repair of #NOF planned for next day
Continues IV fluids, analgesia
Hourly observations.
Included documentation
National patient observation chart
NSG3RDP/NSG3RDM Semester One 2020

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