NURS20170

Patient Deterioration in the Clinical Setting

Assessment One: Written case study

Type: Written case study

Due Date: 5pm (AEST) Wednesday 30th August 2023 (Week 7) for all students

Weighting: PASS/FAIL

Length: 1,000 words

Unit Coordinator: Dr Amy-Louise Byrne

Aim

The aim of this assessment is for you to demonstrate your knowledge, understanding and critical thinking using a deteriorating patient case study.

Instructions

Provide a written essay answering the prompts below about the provided case study. To complete this assessment, you are provided with a reflective framework (What, Why, How?). Please follow the steps below to complete this assessment task.

1. Provide a brief introduction outlining the aim of your assessment task (approximately 50 words).

2. Identify the point of care, where escalation of deterioration should have occurred (50 – 100 words): Using the case study, clinical notes and Early Warning Tool (QADDS) provided, write a brief statement identifying the time point(s) of Gordon’s deterioration.

3. Identify and explore process and new learning (800 words): Using the framework below, provide a critical, logical, objective and evidence-informed written piece on the case study including the following:

· What? Using evidence-based literature, identify what nursing actions that should have been taken based on the trend in Gordon’s assessment data.

· Why? Analyse the initial response to Gordon’s deterioration and discuss potential factors as to why the deterioration was initially missed, or not appropriately managed.

· How? Identify two strategies that could have been implemented by the nursing staff to ensure the appropriate recognition and response to deterioration, thereby ensuring patient safety. Use current evidence to justify your strategies.

4. Provide a concise conclusion summarising the main concepts in your assessment (approximately 50 words).

Literature and references

In this assessment use at least five contemporary references (5 years or less) sourced from the CQUniversity library to substantiate your discussion. You may 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, healthcare organisations, or peak national bodies, for example, the Australian College of Nursing. Note, websites such as Stat Pearls, Life in the Fastlane, and Wikipedia are not suitable for this assessment task.

Requirements

· Have a cover page to your assignment that includes your name, student number, unit code, workplace, and in-text word count.

· Use a conventional and legible size 12 font, such as Times New Roman, with 2.0 line spacing and 2.54cm page margins (standard pre-set margin in Microsoft Word).

· Include page numbers on the top right side of each page in a header.

· Use formal academic language, with third person prose.

· Use the headings Introduction, What, Why, How and Conclusion.

· Start your reference list on a separate page to the body of your assignment.

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

· The word count is considered from the first word of the introduction to the last word of the conclusion. The word count excludes the reference list but includes in-text references and direct quotations. Avoid direct quotes as this reflects the knowledge of others and not your unique interpretation of the evidence.

Resources

· Decision-making framework (DMF) (NMBA, 2020).

· Nursing and Midwifery Board of Australia (NMBA) registered nurse standards for practice (2016).

· National Safety and Quality Health Service (NSQHS) Standards (2017) or Aged Care Quality Standards (2022).

· Patient Safety Competency Framework (PSCF) (Levett-Jones et al., 2017).

· We recommend that you access your discipline specific Nursing Resource Guide.

· We recommend you use EndNote to manage your citations and reference list. More information on how to use EndNote is available at the CQUniversity Library website.

· You may wish to submit a draft to Studiosity.

· 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.

Submission

Submit your assessment via the unit Moodle site in Microsoft Word format only.

Marking Criteria

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

To achieve a passing grade for this unit you are required to pass this assessment item. If you do not receive a passing grade, you may be eligible for one re-attempt. A re-attempt is where you are given a second opportunity to demonstrate your achievement of one or more of the unit’s learning outcomes before you can progress to new learning or participate in subsequent learning activities. You may be given the opportunity to re-attempt an assessment but will only achieve a mark no greater than the minimum for a pass standard for the assessment. You must:

· have shown a reasonable attempt to complete the initial assessment task

· be granted a re-attempt by your Unit Lead/Coordinator

· make changes to the nominated assessment task which you have failed and resubmit the revised work for marking within seven consecutive days, no assessment extensions will be approved.

Please note: Only one opportunity for a re-attempt for this assessment is allowed.

Learning Outcomes Assessed

4. Initiate interventions based on diagnostic results of clinical assessment tools and evaluate your nursing actions.

5. Analyse person-centred care of the deteriorating patient through critical self-reflection of professional practice.

Case Study

Gordon is an 84-year-old farmer, who lives at home independently with his wife. Gordon has a history of right and left knee reconstruction (10 and 5 years ago respectively), hypertension and Myelodysplastic Syndrome (MDS) for which he sees a private haematologist.

On Friday, Gordon presented to the local GP complaining of an earache. Amoxicillin 500mg oral antibiotics were prescribed three times per day. Two days later, on Monday morning, Gordon is woken from sleep with a severe pounding headache and earache. He is taken to the local hospital emergency department, where he is prescribed initial treatment of intravenous fluids (IV) and oral antibiotics, and undergoes a computed tomography (CT) scan of his head, a urine sample and blood cultures. He is transferred to the ward for ongoing treatment, under the medical team with a provisional diagnosis of ear infection.

On day two of his admission, at midnight, Gordon calls the nursing staff, stating he has 6/10 pain in his ear and head. He states he feels nauseated, weak and generally unwell. The nursing staff complete a set of observations, administer oral Paracetamol 1gram and encourage Gordon to rest.

Gordon wakes at 6am feeling increasingly nauseated and weak. He feels cold and states he has 10/10 pain in his ear. He is flushed in the face, and has a rash over his anterior abdomen and thorax, extending to his arms and legs. The nursing team complete a set of observations and provide Paracetamol 1gram for pain relief and for his fever. As it is time for handover, the nursing team inform Gordon they will be back. Handover is completed by 7:45am, and the morning nurses come to assess Gordon. He is now acutely unwell, moaning in pain and fidgeting with his blankets and IV line. After completing a set of observations at 8am, the nursing team trigger an emergency response call.

The emergency response team arrive, and complete a comprehensive assessment, recognising that Gordon is likely septic. They take bloods, commence IV fluids and prescribe IV antibiotics, Piperacillin/Tazobactum. The emergency team step down, and attempt to make contact with the ward medical team, however they are not able to get a hold of anyone. Later, the nursing staff are able to get in contact with a Junior Medical Officer (JMO), however they have six people to see in the emergency department, and as Gordon has just been seen by the emergency response team, the JMO decides to see her other patients first.

Gordon’s family arrive at 9am and find him to be uncomfortable. The family explain to the staff that he has an allergy to Amoxicillin (rash) and that they had notified the ED team of this when he was admitted. This was not recorded in the medical documentation. The family are distressed about his sudden decline and enquire as to what his plan of care is. The nurse again pages the medical team; however, they are not able to attend the ward.

On day six, the family were notified that due to his MDS, Gordon is neutropenic, and the source of the infection is osteomyelitis at the back of the ear/skull. Gordon has an extended hospital stay of 4 weeks.