Clinical Reasoning and the Deteriorating PatientValue:50%Due Date:08-Apr-2019Return...

Question

Clinical Reasoning and the Deteriorating Patient

Value:50%Due Date:08-Apr-2019Return Date:02-May-2019Length:1800 wordsSubmission method options:EASTS (online)

Task

back to topThis 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:

Analyse the case study and develop a discussion of the application of each element of the Clinical Reasoning Cycle as outlined by Levett-Jones, T. (Ed.). (2017).Clinical Reasoning: Learning to think like a nurse(2nd ed.). Frenchs Forest, NSW: Pearson Australia.

Use the clinical data provided to identify moments of deterioration and four (4) evidence-based nursing interventions that are appropriate at the moments of deterioration. Include your reasoning, justification and rationale utilising 'the slippery slope'.

Use the ISBAR communication tool provided in the I2 site under Assessment Item 2 to develop a handover script to the Medical Officer you are calling (No more than 250 words).

While sub-headings can be used to structure this assessment, table.

Criteria

High Distinction

(85 - 100)

Distinction

(75 - 84)

Credit

(65 - 74)

Pass

(50 - 64)

Fail

(0 - 49)

Weighting

1. Applies the Clinical Reasoning Cycle to the Case Study

25.5-30

All of the relevant information from the case study has been accurately applied to each element of the Clinical Reasoning Cycle.

22.5-25

Most ofthe relevant information from the case study has been accurately applied to each element of the Clinical Reasoning Cycle.

19.5-22

The most critical information from the case study has been accurately applied to each element of the Clinical Reasoning Cycle.

15-19

The most critical information from the case study has been applied to each element of the Clinical Reasoning Cycle.

There may be some minor inaccuracies.

0-14.5

One or more elements of the clinical reasoning cycle and/or critical information from the case study has been omitted

and/or

The discussion contains several inaccuracies.

/30

2. Identifies moments of clinical deterioration to plan and justify nursing actions.

25.5-30

Identifies 4 nursing interventions that are safe, evidence-based and appropriate for the relevant moments of deterioration.

Each intervention is supported by a comprehensive and accurate rationale that establishes strong links to the clinical data and Slippery Slope.

22.5-25

Identifies 4 nursing interventions that are safe, evidence-based and appropriate for the relevant moments of deterioration.
Each intervention is supported by a detailed and accurate rationale that clearly explains how it is linked to the clinical data and the Slippery Slope.

19.5-22

Identifies 4 nursing interventions that are safe, evidence-based and appropriate for the relevant moments of deterioration.
The rationales provided are accurate with most explaining how they relate to the relevant clinical data and the Slippery Slope. More detail is required to establish clearer links.

15-19

Identifies 4 nursing interventions that are safe, evidence-based and appropriate for the relevant moments of deterioration.
The rationales provided are mostly basic and/or brief with that make some links between the interventions, the relevant clinical data, and the Slippery Slope.

0-14.5

Identifies less than 4nursing interventions, and/or the interventions identified are unsafe.
Rationales are absent, inadequate or do not consider clinical data and the Slippery Slope.

/30

3. Application of the ISBAR framework to develop handover script.

17 - 20

Comprehensively and concisely communicates all relevant patient information to the interdisciplinary team member using the ISBAR format.

Application of ISBAR framework that shows the student hasexamined and addressed the major issues involved.

15 - 16.5

Comprehensively communicates all relevant patient information to the interdisciplinary team member using the ISBAR format.

Application of ISBAR framework that shows the student has explained and addressed the major issues involved.

13 - 14.5

Communicates most of the relevant patient information to the interdisciplinary team member using the ISBAR format.

Application of ISBAR framework that shows the student has described and addressed the major issues involved.

10 - 12.5

Communicates key patient information to the interdisciplinary team member using the ISBAR format.

Application of ISBAR framework that shows the student has outlinedand addressed the major issues involved.

0 - 9.5

Communicates minimal or irrelevant patient information to the interdisciplinary team member.

Handover script does not use ISBAR framework.

Handover script evidences an insufficient understanding of the patient’s healthcare needs.

/20

4. Communicates

effectively using

academic writing

and professional

language.

8.5-10

Formal academic language and correct professional terminology has been used to create a cohesive, concise

and analytical piece of

work.The assessment is logically and systematically

structured with consistent adherence to grammatical conventions. All presentation guidelines have been applied.

7.5-8

Formal academic

language and correct

professional terminology

has been used to create a

cohesive and coherent

piece of work. The assessment is logically

structured and mostly adheres to grammatical

conventions. All

presentation guidelines have been applied.

6.5-7

Formal academic language has been used to create a logically structured and coherent piece of work, with

adherence to grammatical conventions, although some errors remain. All presentation guidelines

have been applied.

5-6

Formal academic language

has been used to create a

partially structured piece

of work. Paragraphs are

rudimentary and an attempt has been made to adhere to grammatical

conventions, although

errors are evident. Most

presentation guidelines

have been applied.

0-4.5

Formal and informal language has

been used to create a partially

structured piece of work that includes multiple

grammatical errors impacting on the clarity of the discussion. Presentation guidelines have not been adhered to.

/10

5. Applies

evidence/information

from credible

sources and with

academic integrity

8.5-10

The assessment is supported by an extensive range of current (less than 7 years), peer-reviewed, scholarly sources of health information and research (16 or more

appropriate sources),which has been evaluated and synthesised to support all
assertions.

APA referencing

conventions for both in-text citations and the reference list have been accurately and consistently applied.

7.5-8

The assessment is supported

by a wide range of current (less than 7 years), peer-reviewed, scholarly sources of health information and research (14 or more appropriate

sources),which have been integrated to

support most assertions

made.

APA referencing

conventions for both

in-text citations and the

reference list have been

almost always accurately

and consistently applied.

6.5-7

The assessment is supported

by a wide range of current (less than 7 years), peer-reviewed, scholarly sources of health information and research (12 or more appropriate sources),

which have been incorporated to support key points.

APA referencing

conventions for both in-text

citations and the

reference list are applied

with minor errors evident.

5-6

The assessment is supported by

an adequate range (at least 10 valid sources) of current (less than 7 years), peer-reviewed, scholarly sources of health information and research(minimum of10 appropriate sources), which have been summarised to support key points.

An attempt has been made

to adhere to APA referencing conventions for both in- text citations and the reference list, but with several errors and inconsistencies.

0-4.5

The assessment is supported with

inappropriate or irrelevant sources.

Less than 10 sourcesof information

have been used to support the

discussion and/ or multiple

unsupported generalisations have

been made.

Sources outdated (older than 7 years)

Sources used are not peer-reviewed, scholarly sources of health information and research.

Adherence to APA referencing

conventions for both in-text citations

and the reference list is minimal or

non- existent.

/10

6. Turnitin

Turnitin report indicates proper attention to editing; paraphrasing and referencing of other people’s work. Similarity index is 15% or below excluding Reference List

Turnitin report indicates high similarity index, exceeds 16% excluding the Reference List.
The student will be reported for Academic Misconduct

Soumi · Accepted Answer

Running Head: CLINICAL REASONING AND THE DETERIORATING PATIENT	1
CLINICAL REASONING AND THE DETERIORATING PATIENT	12
CLINICAL REASONING AND THE DETERIORATING PATIENT
Table of Contents
Introduction	3
Clinical Reasoning Cycle	3
Considering the patient situation	3
Collection of information	4
Processing gathered information	4
Identifying the problem	5
Establishing goals	5
Taking an action	6
Evaluation	6
Reflection	6
Moment of deterioration and nursing intervention	7
Deteriorating symptoms	7
Nursing intervention	7
ISBAR tool	8
Conclusion	10
References	11
Introduction
Nurses play a very crucial role in taking care of the patients. Delaying in treatment or careless monitoring of the patient becomes the reason for the worsening of their condition. Taking care of more than one patient in a general ward may lead to a poor quality care. Failure to rescue is one of the biggest causes of death in hospitals. Patients, who undergo surgery, often face this threat if poor quality care is given to them. Once the surgery is done, it is necessary to regular monitor the patient as they are very vulnerable and often failed to bear the pain. This can increase their anxiety and change their vitals. Hence, the present essay tries to determine the deteriorated condition of an 82-year-old female patient, who recently undergoes left knee surgery. Her conditions after admitting to general surgery ward become worse. Reason behind this condition will be examined in this essay.
Clinical Reasoning Cycle 
Clinical reasoning cycle is a method of identification of the condition of the patient. As suggested by Hunter and Arthur (2016), clinical reasoning cycle can be defined as a process, using which nurses can collect cues about the condition of the patient. They can process the information and analyse the patient’s root problem or situation to plan and implement their interventions. As mentioned by Levett-Jones (2017), it enables the nurses to evaluate the outcomes of intervention, reflect on and learn from the entire process.
Considering the patient situation
	An 82-year old woman named Mary Smith is admitted to general surgical ward six hours after undergoing left knee replacement surgery under general anaesthesia. When approached to her bedside, she was fully alert; her Glasgow coma scale was 15/15. Her surgical wound dressing was dry; there was no sign of oozing. Her PCA has not been accessed in the past hour. She has 7/10 pain in her left knee and she feels lightheaded. She avoids eating and feels nauseated. Her vital signs are Blood Pressure 105/56, radial pulse 66 (regular), Respiratory Rate (RR) 20, SpO2 is 93%, FiO2 is 0.21, T36.4 tympanic, Blood sugar level is 11.5mmol/L, and peripheral capillary refill is 3 seconds, peripheral pale and cool digits. 
Collection of information
	Mary had suffered from osteoarthritis of both knees. She had limited range of movement and pain on weight bearing in the left knee. She has Type-2 diabetes mellitus, which was diagnosed three years ago. She has hypertension and fatty liver disease that led to the moderate enlargement of liver. She suffered from diabetic neuropathy in both feet, which is responsible for intermittent mild neuropathic pain. 
She does not have any neurological deficit. Her weigh is 100 kgs. She is administered with medications such as metformin 1000mg twice daily, empagliflozin 10mg once daily, metoprolol 25mg twice daily, atorvastatin 10 mg once daily, Karvezide 300/12.5 once daily, fish oil 5000mg daily and hypericum 1tablet daily. Her vital signs when admitted to the surgical general ward were blood pressure 123/70, radial pulse is 55, respiratory rate is 18, SpO2 96%, FiO2 is 0.21, T36.2, peripheral capillary refill at 2 seconds and warm digits. 
	She has 18G IV catheter in her right hand and 200mL of isotonic saline remaining in the IV bag that runs at 80 mL per hour via pump. The PCA circuit is attached to this line. 
You then analyse the findings using your established knowledge of physiology, pharmacology, pathology, culture, and ethics to establish cues and draw information.
Processing gathered information
Patient controlled analgesia (PCA) had not been monitored for past one hour, which is a sign of carelessness. As suggested by Freeman et al. (2015), PCA enables the patient to control their pain. After the surgery, pain is usually high at the affected area. Mary complained of having pain score of 7/10, which is relevant high. As suggested by Hatch et al. (2016), patient with neuropathic condition can undergo sepsis or deep venous thrombosis especially after post operation if pain is not controlled. Pain can lead to abnormal blood pressure. As noted by Asmat, Abad & Ismail (2016), empty stomach leads to light-headedness and increase in the blood sugar, which is relatively high Mary in comparison to the blood sugar when admitted to the ward. 
As mentioned by Watt, Horgan and McMillan (2015), cytokines are released in the inflammatory region, post-surgery, leading to anxiety. It prevents patients from breathing, then sepsis and later septic shock. Capillary refill is taking three second, which is sign of shock. All the vital signs and symptoms show that the condition of patient is deteriorating due to poor fluid intake, poor quality care post-surgery. The lack of monitoring of PCA is unable to detect the symptoms of sepsis. Lack of immediate nursing intervention would have worsened the situation.

Clinical Reasoning and the Deteriorating Patient Value: 50% Due Date: 08-Apr-2019 Return Date: 02-May-2019 Length: 1800 words Submission method options: EASTS (online) Task back to topThis assessment...

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