Subject Code & Title :- Nursing 6 Nursing care D – Clinical Deterioration
Assessment Type :- Assignment
Weighting :- 40 %
Word Limit :- 1500 words
Assessment 3: Written Assessment – Case Study
NSG3201 Nursing 6 Nursing care D – Clinical Deterioration Assignment
LEARNING OUTCOMES:
Identify common types, causes and consequences of deterioration and outline associated clinical
manifestations and collaborative treatments.
Utilise a systematic approach to recognize clinical deterioration, escalate management and prioritise
nursing care.
Implement nursing interventions to respond to, and manage clinical deterioration including communication and delegation.
Evaluate communication strategies and techniques that are used to manage clinical deterioration including the role of the rapid response team.
CASE STUDY
You are a nursing student working in an acute medical ward You and your buddy nurse have just been handed over a new patient from the morning shift.
I: Mr XXX is a 68 year old man He is day two into his admission He is designated goals of care A He has no known allergies. You confirm the patient identity.
S: Mr XXX has been diagnosed with community acquired pneumonia. He is still suffering from nausea and vomiting and not really eating or drinking much.
B: Prior to admission Mr XXX had suffered three days of nausea and vomiting lethargy and increasing shortness of breath. He was brought into the emergency department by his wife who was becoming concerned.
Mr XXX has a past medical history of hypertension GORD and benign prostate hyperplasia. At home he takes metoprolol 25mg daily and pantoprazole 40mg daily.
A: The nurse hands over that Mr XXX’s chest x-ray displays some consolidation to his R) lower lobe. He is covid negative by PCR. The nurse states that he has decrease air entry to both lower lobes and R) sided crackles upon auscultation. She states that Mr XXX is unable to deep breath and cough properly but his cough sounds moist and is non-productive. Mr Jheka has remained in bed this shift but is able to walk short distances independently. He has one 18g IV cannula in his R) cubital fossa and an in-dwelling catheter size 16f.
His latest set of vital signs are as follows:
HR: 90 bpm and regular
BP: 100/60
SaO2: 94% on room air
Temp: 37.1
RR: 22 breaths per minute
R: Unfortunately the previous nurse has been busy, her other patient had a MET call and has required significant interventions. She has stated that there are some outstanding medications for administration and the observations need some catch up. The morning metoprolol was not administered as his BP was ‘a bit low.’
You review the medication chart as follows:
After hand over your buddy nurse says she needs to review the other MET call patient as a priority.
She asks that you assess Mr XXX to make sure he’s ok.
1400hrs: You introduce yourself to Mr Jheka and perform a set of vital signs and measure the urine output as follows:
Q. 1:
Describe the primary and secondary assessment you would perform on Mr XXX, making note of any areas of priority considering his known condition.
CASE STUDY CONTINUED:
During your assessment you made note of some interesting findings:
CNS: Mr XXX seems drowsy but is able to communicate. He is PEARL size 3, GCS 15. He states his pain is 4/10 on his chest but it does not radiate. This increases to 9/10 when you ask him to deep breath and cough. He is reluctant to do this due to the pain.
CVS: Pulse is weak but regular. He is cool to his peripherals and his capillary return is 3-4 seconds.
RESP: Coarse AE with crackles to both bases. He is speaking in short sentences of 3-4 words to catch his breath His cough sounds moist but is not able to produce sputum.
GIT: Bowel sounds present. Abdo soft. BNO 3/7. States that he is nauseous but has not vomited because he is not eating or drinking much. His oral inspection reveals dry lips and mucus membranes.
RENAL: IDC draining dark brown urine.
SKIN: Skin is dry with poor turgor.
Q.2:
Part A: With reference to the case study and previous findings identify the condition that Mr XXX may be suffering from or developing Linking the assessment data to pathophysiology provide clear rationale as to how this may have developed.
Part B: If left untreated please identify and justify the potential further deterioration Mr XXX may suffer. In your justification include signs and symptoms you would expect to observe. Provide clear rationale to each deterioration point, analyzing how and why this would occur.
Q.3:
Part A: You decide that Mr Jheka’s condition needs escalation. Examine and describe the appropriate escalation process and provide a concise ISBAR to handover the patient.
Part: B: Identify and analyze three appropriate and prioritized nursing or medical interventions for the management of to prevent further deterioration. Provide evidence based rationale linked to the case to support the proposed interventions.
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