SCHOOL OF NURSING & MIDWIFERY NSG3RDP/ NSG3RDM – Recognizing 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
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 utilized 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 Commission 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-andQuality-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. 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 intext 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 intext 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