Case Study Essay-: Only For Medical essay writers

     

1. The assessment tasks requires you to:
   1. Identify and discuss two (2) signs or symptoms of clinical deterioration associated with the presenting problem, from chosen case study. This discussion should consider the potential impact of case study data (e.g. pathology results, past medical history) on the health status of the patient in the chosen case.
   2. Following on from your presented discussion associated with point one (1), develop a clinical plan of care which identifies:
    

One (1) priority of clinical care and; 

Discuss three (3) nursing interventions that directly address the identified clinical priority. The discussion should refer to relevant clinical assessments. Measurable outcome parameters for each intervention will be discussed to justify the intervention and evaluate its efficacy. Discussion is to be supported with contemporary research. 

– Assessment Task # Page 3 of 15

Assessment Task 1

Assessment name: Case Study: The Deteriorating Patient

Task description: For this essay you are required to select ONE case scenario related to the clinical deterioration of a patient:

Option 1: Traumatic Brain Injury
Option 2: Septic Shock

What you need to do: In order to undertake this 1500 word essay you will need to research the topic using current and relevant peer reviewed literature and review of:

The lecture and tutorial material associated with the
relevant topic.

Your knowledge and understanding related to:
1. The physiology and pathophysiology of the primary

diagnosis and associated clinical data identified within
the chosen case study;

2. The physiological assessments relevant to the
features within the case study.

The assessment tasks requires you to:

1. Identify and discuss two (2) signs or symptoms of clinical
deterioration associated with the presenting problem, from
chosen case study. This discussion should consider the potential
impact of case study data (e.g. pathology results, past medical
history) on the health status of the patient in the chosen case.
2. Following on from your presented discussion associated with
point one (1), develop a clinical plan of care which identifies:

One (1) priority of clinical care and;

Discuss three (3) nursing interventions that directly address the
identified clinical priority. The discussion should refer to relevant
clinical assessments. Measurable outcome parameters for each
intervention will be discussed to justify the intervention and evaluate
its efficacy. Discussion is to be supported with contemporary
research.

Length: 1500 words +/-10% (word length includes in-text referencing and
excludes your reference list)

Estimated time to
complete task:

Approximately 30 hours

Weighting: 50%

How will I be assessed: As a percentage using a 7-point grading scale rubric

Due date: Friday September 21st submitted via Turnitin in your
Blackboard site by 23:59 hours. More information about Turnitin is
available on the FAQs about Turnitin page.

Presentation
requirements:

This assessment task must:

Be a written academic essay containing an introduction, body

– Assessment Task # Page 4 of 15

and conclusion, addressing the task.
Use QUT APA referencing for citing academic literature (see

http://www.citewrite.qut.edu.au/).
Assignment cover sheet must be included as the first page of

your docum

ent.

Be submitted in electronic form via Turitin.
A minimum of 15 relevant references to be cited from valid,

contemporary journal articles or books no older than 7 years.
The use of websites as references is NOT permitted.
The submitted essay should NOT contain tables, figures or

appendices.
The uses of dot points are NOT permitted.

Your assignment should be prepared as follows:
Has a cover sheet with the assessment title, your name, student

number, tutor name and word count. Coversheet template is
recommended.

Include a ‘footer’ on each page with your name, student number,
unit code and page number.

3 cm margins on all sides, double-spaced text
Times new roman, font size 12
APA style referencing (see http://www.citewrite.qut.edu.au/)
Headings can be used to structure your assignment logically (if

applicable)

be submitted in electronic format via Turnitin.

Learning outcomes
assessed:

1. Consolidate knowledge of key NMBA Registered Nurse
Standards for Practice, National Safety and Quality Health
Services Standards, and National Health Priorities to enable
effective decision planning and action in a range of complex
clinical situations across the lifespan.

2. Apply knowledge of anatomy, physiology and pathophysiology to

support evidence based decision making associated with
planning and action.

3. Demonstrate structured decision making and clinical reasoning to
review a range of health situations, synthesise evidence and
data, determine priorities and formulate plans of care and
interventions in line with timeframes and agreed goals.

What you need to
submit:

One word document that contains the following items:
1. Assignment Cover Sheet & responses to Question 1 & 2
2. Must be submitted in electronic form via Turitin by the assigned

date.

Resources needed to
complete task:

Case studies and clinical documents available within this
document.

– Assessment Task # Page 5 of 15

Documents such as additional readings available on your
blackboard site.

Access to the prescribed texts for this unit as outlined in the unit
details.

QUT Cite|Write APA guide.
Turnitin Tip Sheets.

Academic Integrity

The School of Nursing takes academic integrity very seriously. All work
submitted must be your own work and work not previously submitted for
other study. The work of others needs to be correctly acknowledged and
referenced according to the APA guidelines.

There are serious consequences that will be imposed should you be found to
breach academic integrity. Make sure you are familiar with the MOPP C/5.3
Academic Integrity and view the Academic Integrity video and explore the
Academic Case Studies available on your Blackboard site.

Maintaining academic integrity is your responsibility. If in doubt, check it
carefully.

Assignment Hints
This assignment requires you to critically consider the signs and symptoms
associated with clinical deterioration in relation to the patient’s primary clinical
diagnosis, with consideration to:

The change in health status associated with the primary clinical diagnosis;
How the patients clinical history may impact on assessment data and core

interventions;
The identified clinical priority which should clearly emerge from your

discussion of the primary health alteration.
The application of clinical data and research to identify three (3) core

interventions and assessments that address the stated clinical priority.
Evaluation data supported by research to effectively determine success of

the intervention. The SMART goals format may be of assistance in guiding
you in structuring this.

Demonstration of your clinical reasoning for your selected case study.
Demonstrating your understanding and application of evidence based care

i.e. the research you have to support your discussion and ideas regarding
clinical interventions and assessment outcomes.

Format example:
The introduction to your paper should provide the reader with background

regarding the primary pathophysiological concepts being discussed, a brief
overview of the case study (summation of the primary points), the objective of
the paper (what you intend to address), and the rationale for the paper (why is
it important to apply and understand the content).

– Assessment Task # Page 6 of 15

The body should include:
o Discuss the physiology of the health alteration and how the signs and

symptoms you have identified reflect these changes (you may wish to
consider the clinical data provided to support your discussion of ideas
e.g. blood results, medical imaging and/or past medical history).

o Research you have undertaken is discussed in relation to the change
in the health status of your patient, and the one (1) priority of clinical
care.

o A discussion of research relevant to nursing interventions that address
the clinical priority that you have identified. What can be implemented
that would help address the priority of care, and why such
interventions are likely to be helpful based on your research.
Remember this should address key considerations for deteriorating
patient, therefore nursing interventions such pressure area care may
not be a major clinical priority in this context.

The research you have undertaken should assist you in identifying and
discussing the key assessment parameters: e.g. what are the current
research recommendations, how will you evaluate the impact of an
intervention on the patient (this should be measurable e.g. oxygen saturations
are greater than 95% and a justification for why 95% is the chosen target)

Conclusion: The conclusion should bring together the main objective of the
paper (which you outlined in the introduction), provide a summation of the key
points that you discussed (do not introduce need content into the conclusion),
and provide a concluding comment regarding the clinical application of the
concepts.

This unit has three main texts assigned to it, which should form the basis of your
initial research and conceptual development relating to the assessment concepts,
these are:

– Assessment Task # Page 7 of 15

Case Option 1: Traumatic Brain Injury

James “Jimmy” Parsons is a 26 year old flight engineer who was admitted post-
operatively to the High Dependency Unit approximately 46 hours ago. He was out
with friends on Saturday night when he was involved in an altercation out the front of
a bar with another group of males who had been making lude remarks about female
acquaintances of Mr Parsons. During this altercation, it is alleged that one of the
individuals punched Mr Parsons in the face, and as a result he lost consciousness,
fell, and hit the back of his head on the pavem

ent.

On arrival to the Emergency Department he underwent an urgent CT brain scan
which revealed a sub-dural hemorrhage with 1cm mid-line shift and petechial
hemorrhages, which was drained intra-operatively. A Codman’s intracranial
pressure monitoring device was placed in order to monitor ICP levels post
operatively. Mr Parson’s blood alcohol levels were noted to be elevated on
assessment at the ED and his blood toxicology screen was negative for illicit
substances. Over the immediate post-operative period he has been deemed to be
stable and he has been extubated approximately 6 hours ago and is currently on
Hiflow Nasal Prongs (HFNP).

Past medical History
Type 1 Diabetes, smoker (7-10 cigarettes per day), social drinker (6-10 beers on
weekends), wisdom teeth removal x 4 (2010).

On assessment:
He is lying supine (head of bed elevated 30%), Codman’s ICP monitoring insitu, GCS
10/15 (E3, V3, M4), Pupils equal and reactive to light and accommodating. There is
visual evidence of raccoon eyes (see below image) and battle sign (right sided) (refer
to below image).

– Assessment Task # Page 8 of 15

Vitals

Time 08:00hrs 10:00hrs

ICP (mmHg) 10 12

Temp (°C) 36.9 37.2

Respirations
(breaths/min)

18 (eupnic) 23 (increased work of breathing,
associated with agitation)

Blood pressure and
Mean Arterial
Pressure (MAP)
(mmHg)

128/92 (98) 122/68 (86)

Heart rate
(beats/min)

87 96

SpO2 (Fio2) 97% (Fio2 30%,
30L high flow
nasal prongs
(HFNP))

96 (FiO2 30%, 30L, HFNP)

BGL 6 (Actrapid
infusion at
2units/hr)

6.4 (Actrapid infusion at 2 units/hr)

At 13:00 hours Mr Parson’s becomes tachycardic with a HR 118 without a clear
precipitating cause, a 12 lead ECG confirms the rhythm to be sinus tachycardia.

– Assessment Task # Page 9 of 15

At 13:10 his BP is 108/54mmHg (MAP 72), Heart rate 118-123 beats/min, temp
37.8°C (mildly diaphoretic), ICP 21mmHg, Sp02 95% (HFNP FiO2 30%, 30L),
respiratory rate 11breaths/min with apneic periods (on auscultation air entry is
decreased to both the left and right bases), BGL 12.1 mmol/L (Actrapid infusion at 2
units/hr), pupils equal (right side 4mm, slow reaction to light, left 4mm – brisk reaction
to light). An urgent arterial blood gas is taken:

Temperature corrected result (37.8°C)

Results Reference range

pH 7.31 7.35-7.45

PaCO2 51 35-45

PaO2 88 80-100

Na 132 135-145

Cl- 105

Ca++ 1.11

Gluc 12.4

Lac 1.9 <2

Hb 89

SaO2 89

HCO3 23 22-24

Pa02/FiO2 ration
293

– Assessment Task # Page 10 of 15

Case Option 2: Shock
Jedda Merindah 33 year old male of indigenous heritage who has been admitted to
the Hematology/Oncology unit. Jedda was admitted post a medical emergency call
for hypotension, via the oncology day unit where he was receiving chemotherapy for
his Acute Myeloid Leukemia (AML).

Background:
AML – induction phase chemotherapy treatment

Patient reports nil temperatures – self monitors at home

Routine blood cultures taken from Hickman’s line 1 week ago – nil growth to date.

Past Medical History
Acute Rheumatic Fever as a child – previous echocardiogram reveals no structural
abnormalities, mild dilation of the left ventricle, normal ejection fraction.

Depression – Citalopram 10mg daily

Previous suicide attempt (2003) – drug overdose

Hypercholesterolemia – Atorvastatin 40mg

On assessment:
Neuro: GCS 15/ 15, pupils equal and reactive to light, appears anxious and restless.

Cardiovascular: HR 118 beats/min- ECG reveals atrial fibrillation, non -invasive blood
pressure 92/65mmHg, 250ml NaCl 0.9% fluid challenge given in ED, Febrile
(38.8°C), diaphoretic, capillary refill time (CRT) < 3 sec., cool peripheries, Hickman’s line in situ, central venous catheter line inserted by ED senior registrar.

Respiratory: Decreased air entry to left and right bases, non-productive cough,
tachypneoic 28 breaths per minute, using accessory muscles, Fi02 44% via Hudson
mask, SpO2 >95%.

– Assessment Task # Page 11 of 15

GIT: nil reports of vomiting, decreased nutritional intake secondary to mouth ulcers,
some loose bowel actions over last 2/7 days, nil malena, abdomen lax and non-
tender, BGL 9.6mmol.

Renal: Decrease urinary output, patient reports dark in colour, IDC insertion pending.

Blood pathology results:

Results Reference ranges

Hb 89 130-180 g/L

White cell count 3.4 4-11 (x10*9/L)

Platelets 114 150-300
(x10*9/L)

Sodium 140 135-145 mmol/L

Potassium 4.7 3.5-5 mmol/L

Creatinine 138 60-120 µmol/L

Urea 11.2 3.6-9.3 µmol/L

Albumin 31 35-52 g/L

APTT 47 25-35 sec.

INR 2.4 0.8-1.2 units/kg

ode> – Assessm
ent #

P
age 12 of 15

NSB236 Assessm
ent Task 1 R

ubric
Nam

e:

Learning outcom
es assessed: 1,2,& 3

W
eighting: 50%

Criteria
7

6
5

4
3

2 – 1
C

ritical thinking and
know

ledge
W

eighting: 25%

Assignm
ent content:

critical explanation
reflects a
com

prehensive
interpretation and
critical explanation of
the assessm

ent data;
Com

prehensive
understanding of the
central issues of the
case – all key
pathophysiological
concepts and
physical assessm

ent
issues addressed to
determ

ine priorities
of care;
Dem

onstrated a
com

prehensive
depth of reasoning
and logical and
analytical thinking.

Assignm
ent content:

critical explanation
reflects good
interpretation and
critical explanation of
the assessm

ent data;
Good understanding of
the central issues of
the case – alm

ost all
key pathophysiological
concepts and
assessm

ent issues
addressed to
determ

ine priorities of
care;
M

ostly dem
onstrated a

depth of reasoning and
logical and analytical
thinking.

Assignm
ent content:

critical explanation
reflects sound
interpretation and som

e
critical explanation of the
assessm

ent data;
Sound understanding of
the central issues of the
case – m

ost key
pathophysiological
concepts and assessm

ent
issues addressed to
determ

ine priorities of
care;
Soundly dem

onstrated a
depth of reasoning and
logical and analytical
thinking.

Assignm
ent content:

critical explanation
reflects basic
interpretation and som

e
or no critical explanation
of the assessm

ent data –
content not overly
discerning;
Fair understanding of the
central issues of the case –
som

e key
pathophysiological
concepts and assessm

ent
issues addressed to
determ

ine priorities of
care;
Adequately dem

onstrated
depth of reasoning and
logical and analytical
thinking .

Assignm
ent content:

lim
ited critical

explanation reflects
poor interpretation
and no critical
explanation of the
assessm

ent data –
content not
discerning;
Poor understanding of
the central issues of
the case – not all key
pathophysiological
concepts and
assessm

ent issues
addressed to
determ

ine priorities
of care;
You have not
adequately
dem

onstrated depth
of reasoning and
logical and analytical
thinking.

Assignm
ent content:

no critical explanation
reflects poor
interpretation and no
critical explanation of
the assessm

ent data –
content not discerning;
N

o understanding of
the central issues of
the case – lim

ited
dem

onstrated
understanding of
pathophysiological
concepts and
assessm

ent issues to
determ

ine priorities of
care;
You have not
dem

onstrated depth of
reasoning and logical
and analytical thinking.

– Assessm
ent #

P
age 13 of 15

Applied know
ledge of

pathophysiology to
inform

clinical
reasoning, clinical
priority, assessm

ent
and outcom

e m
easures

W
eighting: 25%

Com
prehensive

application of
pathophysiological
and physiological
concepts w

hich
dem

onstrated an
understanding of
links betw

een the
patient condition,
and assessm

ents to
form

ulate plans of
care and
interventions.
O

utcom
e m

easures
discussed are
com

prehensively
supported by
contem

porary
evidence and m

akes
association w

ith
physiological
concepts.

Good application of

pathophysiological and
physiological concepts
w

hich dem
onstrated

an understanding of
links betw

een the
patient condition,
assessm

ents and
outcom

e m
easures

discussed to form
ulate

a plan care of care and
interventions.

The approaches are
supported to a high
level by contem

porary
evidence and m
akes
association w

ith
physiological concepts.

Sound application of
pathophysiological and
physiological concepts
w

hich dem
onstrated an

understanding of links
betw

een the patient
condition, assessm

ents
and outcom

e m
easures

discussed to form
ulate a

plan of care and
interventions.

The approaches are
supported to a good level
by contem

porary
evidence and m
akes
association w
ith
physiological concepts.

Fair application of
pathophysiological and
physiological concepts
w

hich dem
onstrated a fair

understanding of links
betw
een the patient
condition, assessm
ents
and outcom
e m
easures

discussed to form
ulate a

plan care and
interventions.

The approaches are
supported to a satisfactory
level by contem

porary
evidence and m
akes
association w
ith
physiological concepts.

Poor application of
pathophysiological
and physiological
concepts w

hich
dem

onstrated little
understanding of links
betw

een the patient
condition,
assessm

ents and
outcom
e m
easures

discussed to plan care
and appropriate
interventions.

The approaches are
supported by citation
of research w

hich
m

ay/m
ay not be

contem
porary, but

lacks insight and
understanding of the
association w

ith
physiological
concepts.

N
o application of

pathophysiological and
physiological concepts
w
hich dem
onstrated

no understanding of
links betw

een the
patient condition,
assessm
ents and
outcom
e m
easures

discussed to plan care.

The approaches
om

itted physiological
assessm

ents for
outcom

es, m
ay not

adequately consider
the correlation of
physiological
assessm

ent and
outcom

es in relation to
critical physiological
concepts.

Application of evidence
W

eighting: 25%

Dem
onstrates skilful

and insightful use of
high quality, credible
and relevant sources
to develop ideas,
rationalise
approaches and
decision m

aking that
are appropriate to
the clinical scenario.

There is an excellent
dem

onstration of
conceptual
understanding of

Dem
onstrates skilful

use of high quality,
credible and relevant
sources to develop
ideas, rationalise
approaches and
decision m

aking that
are appropriate to the
clinical scenario.

There is a good
dem

onstration of
conceptual
understanding of

Dem
onstrates consistent

use of credible, relevant
sources to support ideas
and decision m

aking that
are situated w

ithin the
thought question.

There is a w
ell-grounded

dem
onstration of

conceptual
understanding of content.

Dem
onstrates an attem

pt
to use credible and/or
relevant sources to
support ideas and decision
m

aking that are
appropriate for the
thought question.

There is a satisfactory
dem

onstration of
conceptual understanding
of content.

Dem
onstrates an

attem
pt to use

sources to support
ideas and decision
m

aking in the w
riting.

M
ay have a num

ber
of 3-4 direct quotes
that could have been
paraphrased to
dem

onstrate
synthesis and
understanding of
content.

Lim
ited evidence used

to support ideas,
poorly cited and or
paraphrased.

Dem
onstrates lim

ited
critical application and
understanding of
content being applied.
Frequent use of direct
quotes.

The discussion does
not dem

onstrate a
strong grasp of

– Assessm
ent #

P
age 14 of 15

content.
content.

The conceptual
understanding of the
content requires
further developm

ent.

conceptual
understanding to
support decision
m

aking.

Academ
ic w

riting
W

eighting: 25%

Com
prehensive,

Clear and logical
presentation; good
developm

ent of an
argum

ent.

U
sed correct

term
inology and

professional
language consistently
w

ith the case study.

U
ses language that

skillfully
com

m
unicates

m
eaning to readers

w
ith clarity and

fluency. Clear,
readable, prose.
Good use of
transitions; no
problem

s w
ith

spelling, punctuation,
or gram

m
ar.

Infrequent and m
inor

m
echanical

problem
s. Errors do

not im
pair

readability.

Did not use direct
quotes

All relevant aspects

Clear and logical
presentation; good
developm
ent of an
argum

ent.
U

sed correct
term

inology and
professional language
for m

ost of the
handover the case
study.

U
ses language that

effectively
com

m
unicates
m
eaning to readers
w
ith clarity and

fluency. Clear,
readable, prose. Som

e
issues w

ith transitions;
no to m

inim
al (2-4)

problem
s w

ith spelling,
punctuation, or
gram

m
ar. Infrequent

and m
inor m

echanical
problem

s. Errors do
not im

pair readability.

Rarely used direct
quotes;

Adhered to prescribed
w

ord lim

it.

Presentation is organized
but does not present a
clear argum

ent for a
given position.

U
sed correct term

inology
and professional
language for som

e of the
handover the case study.

U
ses straightforw

ard
language that generally
conveys m

eaning to
readers. O

ccasional
errors and m

inor
problem

s w
ith m

echanics
of language. O

ccasional
aw

kw
ard sentences and

poor transitions reduce
readability.

Som
etim

es used (1-2)
direct quotes ;

Adhered to prescribed
w

ork lim
it

Infrequent errors in APA
style; errors involve only
m

inor aspects of APA
style – no errors in style
for citations &

references.

M
inor problem

s of
organization or logic;
N

eeds w
ork on creating

transitions betw
een ideas.

U
sed correct term

inology
and professional language
for part of the handover
the case study.

U
ses language that

generally conveys
m

eaning to readers w
ith

clarity, although w
riting

m
ay include som

e errors.
Frequent problem

s w
ith

m
echanics of language.

Aw
kw

ard sentence
construction. Poor or
absent transitions.
Frequently difficult to
understand.

Som
etim

es used direct (3-
4) quotes;

Attem
pted to use APA

style but errors are
frequent and include
errors in citations and
references.

W
ord lim

it under/over the
10%

allow
ance.

Logical flow
and

organisation is
ham

pered by poor
expression of ideas
and gram

m
atical

errors
M

echanics of w
riting

im
pedes the

discussion of ideas
and the subm

ission
w

ould benefit from

further editing.
You have not used
correct term

inology
and professional
language for the
m

ajority of the
handover the case
study.
O

veruse (4-5) of
direct quotes;
N

ot w
ithin required

w
ord lim

it. (15%
over

or under prescribed
w

ork lim
it).

N
o logical order to the

inform
ation provided;

sentences ram
bling;

ideas are repeated.

Correct term
inology

and professional
language used
infrequently the case
study.

U
ses language that

som
etim

es im
pedes

m
eaning because of

errors in usage.
Problem

s w
ith the

m
echanics of language

serious enough to
interfere w

ith effective
com

m
unication.

Frequent errors in
punctuation, spelling,
sentence structure,
etc.

O
veruse of direct

quotes (>5);

Did not adhere to
w

ord lim
it and is under

or exceed by >/<15%

M
inim

al use of APA
style; m

ultiple errors in

– Assessm
ent #

P
age 15 of 15

of APA style are used
correctly. Title page
properly form

atted,
use of intext
citations, form

at of
references cited.

Adhered to
prescribed w

ord
lim

it.

use of APA style.

Issues identify
associated w

ith
breaches to academ

ic
integrity.