Assessment 2: Clinical Paper
Due Date: Wednesday, 18 April by midnight (2400)
Word limit: 2400 word (+/- 10%)
After reading and reflecting on the information provided, the students will answer each of the following three questions:
1. Based on part A of the scenario, discuss what assessment findings were concerning, why those findings may be abnormal in this patient and what further assessment you may need to conduct to gain more information. Additionally, identify three problems this patient s assessment revealed that you will address in your nursing plan of care. These problems must be discussed in order of priority (i.e, which is most significant and why).
2. Provide a thorough and detailed explanation of the nursing actions (what will you do and why) for each problem you identified in Question #1. Your answer must include the rationales for these interventions and appropriate evaluation criteria (how you will know if the nursing action was successful).
3. In part B of your scenario, your patient s condition changes. Discuss the possible causes for this situation. Describe your initial assessment and subsequent nursing actions for this sudden deterioration.
The clinical paper will be marked using the criteria below. Either essay style or report style format is acceptable for this assessment: students may elect to use headings, tables or appendices as appropriate. Correct APA referencing must be used to support all factual statements. Please see UC Referencing Guide (6th Ed).
Students will be encouraged to begin to research early and widely for this assessment. You are encouraged to access professional journals and other credible resources, including nurse experts in the clinical setting, in addition to their recommended texts. Google searches or Wikipedia are not acceptable reference sources for academic writing.
Assessment Criteria and Marks Available
Marking Criteria Marks Weighting
Part A: Analyses the assessment data provided in this case study and determines three priorities of nursing care.
Discusses appropriate assessment data for this patient case and identifies probable reason for abnormal findings
Presents the additional subjective and objective data needed for further assessment of this patients condition
Identifies three problems/nursing care priorities for this patient based on the assessment findings and discusses them in order of priority
Demonstrates an understanding of the case and an ability to link theory to practice through informed nursing actions.
Provides a thorough and detailed explanation of the nursing interventions/ actions for each nursing problem/care priority identified
Presents appropriate rationale for each nursing action
Discusses appropriate and measurable evaluation criteria for the nursing actions
Part B: Demonstrates an ability to prioritise patient care during an unplanned change in patient s condition and provide rationales for these actions.
Discuss possible causes for the patient s deterioration
Describes the essential initial assessment criteria when evaluating the patient s changed condition
Identifies appropriate initial nursing actions and lists them in order of priority
Clearly written in appropriate academic format, well presented and demonstrates appropriate use of a range of credible sources to support case study analysis.
Uses essay or report style format; within acceptable word limit; sentences and paragraphs are well constructed, free from spelling and grammatical errors.
APA method referencing (in-text and reference list) is consistent and accurate as per the UC Referencing Guide (6th Ed).
General guidelines for a written paper:
1. Presentation: The paper should be word-processed, with double line spacing on a single side of A4 paper. Each A4 page should have a 2.5 cm margin on all sides. Pages should be numbered.
2. Structure: Academic writing style must be maintained throughout the paper. The paper must have an introduction, body (which presents the issues and discusses/analyses them), a conclusion and a reference list at the end. There are many texts available about organising and presenting papers in the library and bookshop.
Clarity and Expression: Concepts should be analysed and discussed clearly and concisely. The paper must demonstrate correct grammatical expression and spelling. It is very useful to ask someone else to proof read your paper to eliminate errors.
4. Use of resources: you are expected to read widely and use a variety of credible evidence to support your discussion. Your work must be supported by current (less than 10 years) published literature and properly referenced. Resources must not be limited to texts only. It is an expectation that you use database searches to obtain recent professional journal articles. The library at the University of Canberra is a useful source of information and assistance with conducting a review of literature, researching and database use.
Case Study 4
John Lotus is 50 year old Type 1 diabetic who was admitted last night for pneumonia. He had felt unwell for several days before going to the Emergency Department (ED) yesterday with a fever and a productive cough. His blood glucose levels were elevated upon admission (18mmol/L) and he was given a single dose of Actrapid in the ED. His chest x-ray shows areas of consolidation in the right lung; his ECG is normal sinus rhythm.
John has been diagnosed with diabetes mellitus for many years and manages his disease quite well. His wife states he has been under a lot of stress at work recently and just returned from an overseas business trip last week.
You start your morning shift and note that John is still sleeping. His uneaten breakfast is in front of him. He is slumped down in the bed, audibly wheezing. His skin appears moist and his lips are dry. You wake him for his observations: Heart rate “ 100; Respiratory rate “ 22; Blood pressure “ 100/75; Oxygen Saturation “ 94%; Temperature “ 39.0. John states his chest hurts when he coughs and he is too tired to eat. He rolls over to go back to sleep.
His medication chart indicates that he is on IV antibiotic therapy four times a day (QID) and that the initial dose was given in the emergency department last night. He has orders written for Mixtard 50/50 subcutaneously twice a day (BD), paracetamol 1gm orally four times a day (QID), an analgesic for pain relief, and Ventolin 2 puffs every 4 hours, all of which were given by the night nurse at 0630. He has no allergies.
John lives in Canberra with his wife and three young children.
John s roommate calls you over to complain that the breakfast trays didn t arrive until after 0800 and that his toast is cold. You attend to this patient s concerns and end up helping him shower. When you get back to John, you note that he is pale, diaphoretic and not responding when you call his name loudly. The bed linens are soaked with sweat.=2=2
Use of resources: you are expected to read widely and use a variety of credible evidence to support your discussion. Your work must be supported by current (less than 10 years) published literature and properly referenced. Resources must not be limited to texts only. It is an expectation that you use database searches to obtain recent professional journal articles. The library at the University of Canberra is a useful source of information and assistance with conducting a review of literature, researching and database use.
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