Aim

The aim of this assessment is to demonstrate your critical thinking and clinical reasoning to manage the care of a person with an acute alteration in health. The information required to undertake this assessment is covered in Modules 1-5 of this Unit. The assessment is based on the following scenario.

Case Scenario: Patient presentation to ED (Emergency Department) of Mrs Ellen Brennan (Scenario 1)

Ellen Brennan is a 74-year-old female. Ellen is the primary carer for her 79-year- old husband Bill, who is in the early stages of dementia. She has Type 2 diabetes, hyperlipidaemia and hypertension. Her current medications are:

· Metformin Hydrochloride 500mg before the morning and evening meal

· Simvastatin 10mg nocte

· Atenolol 50mg mane

· Aspirin (Cartia) 100mg mane

You are a new graduate RN on duty in this Emergency Department. Ellen presents to the ED at 0840 hours via ambulance that was called by Ellen’s son Kevin. When visiting his mother earlier this morning, Kevin noticed she was unable to stand-up straight and was constantly bent forward and holding her abdomen. Ellen informs you that she had a fall yesterday and hit her head. She has a large haematoma on the left side of her forehead and a graze on her left knee. She complains that she has a burning pain in the chest and sharp pains in her stomach. She also has been experiencing diarrhoea since lunchtime yesterday after she had eaten a roast chicken sandwich and has not eaten anything since. Ellen says she has been taking two Ibuprofen tablets every 6 hours since she had the abdominal pain but the pain in her stomach is getting worse, now rating 6/10. She also complains of a bad headache. She says she has been taking her regular medications but feels very unwell. She appears withdrawn and sad; she is also crying. Ellen has an IV cannula in the back of her left hand with Sodium Chloride 0.9% being administered at 125ml/hour. Enroute to the hospital Ellen vomited 170mls of dark (coffee ground) coloured fluid. Ellen has equal rise and fall of the chest and is cool to touch. Ellen is now triaged and moved to a cubicle in the ED.

The physical assessment data for this patient is: temperature 37.3 C, BP 100/55 mmHg, radial pulse 80 and regular, respirations 22, oxygen saturation 96% in room air, and PEARRLA. Pain 6/10 in abdomen. Peripheral BGL reading was 3.0mmol/L. On auscultation, lungs were clear and air entry was equal on both sides. Palpation of abdomen identified tenderness over bilateral upper abdominal quadrants. She has not voided since yesterday evening.

She states that she is worried about her husband and who will care for him if she remains in hospital. When asked how she has been feeling, she adds that she has been feeling incredibly sad lately and has been crying a lot. Bill and Kevin arrive at the hospital to check on Ellen at 0930. Kevin tells you his father can stay with his family tonight however he is unsure what he will do if Ellen is admitted for more than one or two nights. Kevin says his wife Debbie is unable to care for Bill long term as they have 3 young children aged 6 months to 4 years to care for, and she works part-time in the evenings. The only other family member is unable to help as she lives overseas.

In this assessment, you will demonstrate your ability to think critically, examine complex patient cues, and use clinical reasoning to direct the care for the patient. You will need to succinctly present an overview of a patient experiencing an acute alteration in health and provide a handover in the emergency department to enable multidisciplinary care for Ellen. To do this, you are required to develop a 12-to-15-minute oral presentation using PowerPoint slides to address the points below:

1. Your PowerPoint slides need to provide the main points only of your discussion, set out clearly and in logical flow. Guidelines for presenting PowerPoint presentations effectively are provided on the unit Moodle site.

2. Present your PowerPoint verbally as a video presentation using Zoom with recording on. This will need to be uploaded to the unit Moodle site. Instructions for doing this are provided on the unit Moodle site.

Literature and References

In this assessment use at least 4 contemporary references (<5 years) to support your discussion. You may also use seminal scholarly literature where relevant. Suitable references include peer-reviewed journal articles as well as textbooks and credible websites. When sourcing information, consider the 5 elements of a quality reference: currency, authority, relevance, objectivity, and coverage. Grey literature sourced from the internet must be from reputable websites such as from government, university, or peak national bodies: for example, the Australian College of Nursing.

Requirements

· You may write and present in the first-person perspective.

· Use professional language.

· Use the seventh edition American Psychological Association (APA) referencing style. The CQUniversity Academic Learning Centre has an online APA Referencing Style Guide.

Resources

· You can use unit provided materials and other credible sources (e.g., journal articles, books) to reference your argument. The quality and credibility of your sources are important.

· We recommend that you access your discipline specific library guide: the Nursing and Midwifery Guide;

Submission

Submit your assessment via the unit Moodle site as per instructions by Friday 8^th April 5.00pm.

Marking Criteria

Refer to the marking rubric on the Moodle site for more detail on how marks will be assigned.

Learning Outcomes Assessed

1. Explain the pathophysiological changes that occur when a person experiences acute alterations in health.

2. Apply the decision-making framework for nursing (NMBA 2020) to prioritise and justify care for the person experiencing acute alterations in health.

3. Examine the role of the nurse and other members of the interdisciplinary team in the care of the person in the complex care environment.

4. Analyse and apply the best available evidence, for safe, quality practice for a person experiencing an acute alteration in health.

UNIT CODE NURS13141

ASSESSMENT 1 MARKING RUBRIC

Key: ¹ must include reference to Nursing and Midwifery Board of Australia (NMBA). (2020). Decision-making framework for nursing and midwifery

Aim

The aim of this assessment is for you to demonstrate your knowledge of managing a person with an acute alteration of health in complex care environments. Please read the case scenario below, which follows on from Assessment 1 and is a continuation of Ellen Brennan’s hospital journey.

Mrs Ellen Brennan (Scenario 2)

Provisional diagnosis and initial medical treatment: After review by the ED doctor, a provisional diagnosis of gastro oesophageal reflux disease is made.

Ellen has been ordered:

· 1000ml IV 4% Dextrose and 1/5 Normal Saline over 12 hours

· 12 lead ECG and telemetry. Her ECG shows sinus rhythm.

· Oral Esomeprazole 20mg daily

· Mylanta 20ml orally q4h PRN

· IV morphine 5mg q6h/PRN

· Metformin Hydrochloride 500mg before the morning and evening meal

· Simvastatin 10mg nocte

· Atenolol 50mg mane

· Aspirin (Cartia) 100mg mane

· Light diabetic diet and qid blood glucose readings via glucometer

· 4 hourly observations

· ward urinalysis

· stool chart and occult blood testing of each stool specimen.

· Ellen is to fast from 2400 hours in preparation for an endoscopy the next day.

Ellen is transferred to the medical ward at 1500 hours.

It is now 0700hrs the next day. You have commenced your shift as a new graduate RN on the medical ward and are assigned to care for Ellen.

0730hours – Blood was collected from Ellen for Full Blood Count (FBC), Urea and Electrolytes (U&E), Liver Function Tests (LFTs), X-match. She was showered and prepared for the Operating Room. Her oral morning medications were withheld as she was fasting from 2400 hours with only sips of water allowed until 2 hours before procedure. Her BGL was 4.5 mmol/L.

0830hours - Ellen is taken to the endoscopy suite.

0925 hours - Ellen has an endoscopy. The results of the endoscopy show she has a gastric ulcer. The doctor documented in Ellen’s chart a revised diagnosis of bleeding gastric ulcer.

1000hours - Ellen arrives back on the ward. Her husband and daughter-in-law Debbie are present.

1010 hours -Ellen vomits a large amount of dark (coffee ground) coloured fluid. This is measured to be 240mls. Her observations after this episode are BP (Blood Pressure) 72/40mmHg, pulse 138 and irregular, respirations 24 per min, oxygen saturations 88% on room air with noisy breathing. She appears disorientated to time and place. She is pale and her skin is clammy to the touch. Her telemetry monitor shows atrial fibrillation.

Instructions

In this assessment, you will demonstrate the ability to succinctly present an overview of a patient experiencing an acute alteration in health and prepare a plan of care.

From the information provided in this case study:

1. Using the clinical reasoning cycle, discuss your processing of the identified cues, and the possible pathophysiological issues that Ellen may be experiencing. (600 words)

2. Identify and prioritise three nursing interventions for Ellen. Provide an evidence-based rationale for each nursing decision. Share your reflection on the decision-making framework that you applied prior to providing each nursing intervention. (600 words)

3. Identify and prioritise two interdisciplinary team interventions needed to provide care for Ellen. Provide an evidence-based rationale for each intervention and identify the member/s of the interdisciplinary team that you need to collaborate with to undertake these interventions. (600 words)

Literature and References

In this assessment use at least 10 contemporary references (<5 years) to support your discussion. You may also use seminal scholarly literature where relevant. Suitable references include peer-reviewed journal articles as well as textbooks and credible websites. When sourcing information, consider the 5 elements of a quality reference: currency, authority, relevance, objectivity, and coverage. Grey literature sourced from the internet must be from reputable websites such as from government, university, or peak national bodies: for example, the Australian College of Nursing.

Requirements

· Use a conventional and legible size 12 font, such as Times New Roman or Arial, with 1.5 line spacing and 2.54cm page margins (standard pre-set margin in Microsoft Word).

· Write in the third-person perspective.

· Use professional language

· Use the seventh edition American Psychological Association (APA) referencing style. The CQUniversity Academic Learning Centre has an online APA Referencing Style Guide.

· The 1800 words count excludes the reference list but includes in-text references and direct quotations.

Resources

· You can use unit provided materials and other credible sources (e.g., journal articles, books) to reference your argument. The quality and credibility of your sources are important.

· We recommend that you access your discipline specific library guide: the Nursing and Midwifery Guide;

· Submit a draft before the due date to review your Turnitin Similarity Score before making a final submission. Instructions are available here.

Submission

Submit your assessment via the unit Moodle site as per instructions by Monday 30^th May, 5.00pm.

Marking Criteria

Refer to the marking rubric on the Moodle site for more detail on how marks will be assigned.

Learning Outcomes Assessed

1. Explain the pathophysiological changes that occur when a person experiences acute alterations in health.

2. Apply the decision-making framework for nursing (NMBA 2020) to prioritise and justify care for the person experiencing acute alterations in health.

3. Examine the role of the nurse and other members of the interdisciplinary team in the care of the person in the complex care environment.

4. Analyse and apply the best available evidence, for safe, quality practice for a person experiencing an acute alteration in health.

Key ¹must include reference to Nursing and Midwifery Board of Australia (NMBA). (2020). Decision-making framework for nursing and midwifery