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NSG3RDP Semester One 2022 SCHOOL OF NURSING & MIDWIFERY NSG3RDP– Recognising and Responding to the Deteriorating Patient Assessment activity XXXXXXXXXXwords (35% of overall subject mark) Due date: May...

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NSG3RDP Semester One 2022



SCHOOL OF NURSING & MIDWIFERY

NSG3RDP– Recognising and Responding to the Deteriorating Patient
Assessment activity XXXXXXXXXXwords (35% of overall subject mark)
Due date: May 10th 2022


Subject Intended Learning Outcomes (SILOS)

1. Explain common pathophysiology, as it relates to assessment data and pharmacology, that can
esult in deterioration of an individual's condition in order to develop appropriate interventions.
2. Apply the clinical reasoning cycle to provide person-centred care for individuals experiencing a
deterioration in health in order to provide safe nursing care.
3. Develop an awareness of and contribute to the risk management strategies of a healthcare
agency, in order to implement incident reporting procedures and apply risk management
procedures.

Context


Serious adverse events, such as unexpected death, intensive care admission and cardiac a
est, are
often preceded by observable physiological, clinical abnormalities and deterioration. Other serious
events, such as suicide and aggression, are also often preceded by observed or reported changes in a
person’s behaviour or mood that can indicate deterioration in their mental state.
Early identification of deterioration may improve outcomes and decrease interventions required to
stabilise patients whose condition deteriorates in a health service organisation.
The warning signs of clinical deterioration are not always identified or responded to appropriately.
The organisational and workforce factors that contribute to a failure to recognise and respond to a
deteriorating patient are complex and overlapping (Australian Commission on Quality and Safety in
Health Care, 2017)
NSG3RDP Semester One 2022

Task

In this assessment you are required to further explore the trauma case study introduced in topic two
of your LMS and workshop materials for NSG3RDP/RDM.
You will be provided with an ISBAR handover and a National Observation Chart (NOC) for Joanna
Cleese. (These documents will be attached at the end of this instruction sheet)

Using the provided information and cu
ent academic literature please provide a response to the
following three questions
Instructions
Please answer the following questions as instructed

• Question XXXXXXXXXXwords)
The condition of your patient Joanna Cleese described in the ISBAR handover, appears to be
changing. (Please refer to the attached documentation)
Using the information that you have identified from the NOC and the ISBAR case study
handover:
1. Discuss the possible causes of Joanna’s changing condition, supporting your
esponse with contemporary literature and the associated significant cues, signs
and symptoms listed in the case study.
2. Explain what possible further deterioration could occur for this patient, with a
detailed evidenced -based response.
(Please support your justification and rationales with quality peer-reviewed literature).

• Question XXXXXXXXXXwords)
There are many tools that can be utilised when assessing a patient. When assessing a
deteriorating patient accurate assessment is essential. Compare and contrast the following
methods of patient assessment and their appropriate applications for the deteriorating
patient.
1. Primary (ABCDE)
2. Head to toe assessment
(Please support your discussion with evidenced based literature).

• Question XXXXXXXXXXwords)
A change in a patient’s heart rate, blood pressure, temperature and respiratory rate can all
e an indication of clinical deterioration. It has been suggested that a changing respiratory
ate is the earliest indication of clinical deterioration and yet it is often not measured
co
ectly, or not measured at all. Using evidence-based literature to support your
arguments:
1. Discuss why a changing respiratory rate is an important indicator of clinical
deterioration.
2. Explain how the respiratory rate can be measured reliably and accurately.
NSG3RDP Semester One 2022



**Discussions are to be supported with relevant and contemporary literature.

**References: Reference list and appendices are excluded from the word count.

**References to be no older than ten years

**10% word limit allowed.

Resources

Australian Commission on Quality and Safety in Health Care XXXXXXXXXXNational Quality and Safety
Health Care Standards Edition Two. Retrieved from
https:
www.safetyandquality.gov.au/wp-content/uploads/2017/11/National-Safety-and-
Quality-Health-Service-Standards-second-edition.pdf



GENERAL ASSESSMENT REQUIREMENTS
SUBMITTING WRITTEN WORK WITH TURNITIN
Turnitin is a web-based text-matching software system used at La Trobe University to assist you in
writing your assignments and checking for similarity with existing published work. Please remember to
allow adequate time to submit your assignment to Turnitin. It is your responsibility to have your
assignment submitted by the assessment due date. Not receiving an originality report is not an
acceptable reason for requesting an assignment extension unless it is a required part of the assessment.

POLICIES, PROCEDURES AND GUIDELINES
The University has a comprehensive policy framework to which both staff and students must adhere.
You should familiarise yourself with those policies, procedures and guidelines likely to affect you
especially the following:

• Academic Integrity
• Academic Progress Review
• Assessment Policy
• Adjustments to Assessment, including extensions to submission dates and Special Consideration
• Validation and Moderation, including applications for review and re-mark
ADJUSTMENTS FOR ASSESSMENT
You may be affected by a range of adverse circumstances while you are preparing for or undertaking an
assessment task. There are avenues for adjustments to your assessment depending on the
circumstances you face. For more detailed information refer to the Assessment Procedure –
Adjustments.

REQUEST AN EXTENSION OF TIME TO SUBMIT AN ASSIGNMENT TASK
Where you know in advance that you will not be able to submit an assessment task by the due date due
to adverse circumstances that have affected you during the preparation of the task, you will need to
equest an extension of time to submit. This must be done at least three days prior to the due date.
http:
www.safetyandquality.gov.au/wp-content/uploads/2017/11/National-Safety-and-
https:
policies.latrobe.edu.au/document/view.php?id=221
https:
policies.latrobe.edu.au/document/view.php?id=220
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policies.latrobe.edu.au/document/view.php?id=216
https:
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https:
policies.latrobe.edu.au/document/view.php?id=380
https:
policies.latrobe.edu.au/document/view.php?id=140
https:
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https:
policies.latrobe.edu.au/document/view.php?id=380
https:
www.latrobe.edu.au/students/admin/forms
equest-an-extension
https:
www.latrobe.edu.au/students/admin/forms
equest-an-extension
NSG3RDP Semester One 2022

Penalties normally apply if you submit an assessment after the due date. Poor time management is not
an acceptable reason for an extension.
To apply, go to https:
www.latrobe.edu.au/students/admin/forms
equest-an-extension
equest

SPECIAL CONSIDERATION
If you have experienced serious short term, adverse and unforeseen circumstances that substantially
affect your ability to complete an assessment task to the best of your potential, you may be eligible to
apply for Special Consideration. To do this or find more information, go to
http:
www.latrobe.edu.au/special-consideration
https:
www.latrobe.edu.au/students/admin/forms
equest-an-extension
equest
http:
www.latrobe.edu.au/special-consideration
NSG3RDP Semester One 2022



Late submission
There are policies and procedures to guarantee fair, consistent and transparent treatment of late
submission of assessment tasks provide equity around extensions to submission dates and penalties
associated with not submitting assessment by the due date and time.

https:
intranet.latrobe.edu.au/teaching-and-learning/teaching-support-and-tools/assessment-policy
NSG3RDP Semester One 2021




School of Nursing & Midwifery: NSG3RDP/NSG3RDM Assessment One
CRITERIA Excellent (> 80 %) Very good (70% - 79%) Good (60% - 69%) Fair (50% - 59%) Poor (<50%) MARK
Question One
Discusses the possible
causes of Joanna’s
changing condition
Explains what possible
further deterioration
could occur


USE OF LITERATURE TO
SUPPORT DISCUSSION

(35% of total mark)
28 + marks
Clearly and consistently
discuss possible causes of
the Joanna’s changing
condition
Clearly and consistently
explains what possible
further deterioration
could occur
Demonstrated an
excellent understanding
of links between the
necessary concepts.
Demonstrated clear and
consistent evidence of
critical appraisal of
eference material
Evidence of synthesis of
information and logical
development of
arguments

XXXXXXXXXXmarks
Clearly and mostly
consistently discuss possible
causes of the Joanna’s
changing condition
Clearly and mostly
consistently explains what
possible further deterioration
could occur
Demonstrated a very good
understanding of links
etween the necessary
concepts.
Demonstrated some
evidence of critical appraisal
of reference material
Some evidence of synthesis
of information and logical
development of arguments
Literature predominantly
used effectively to support
key ideas
XXXXXXXXXXmarks
Good but inconsistent
attempt to consistently
discuss possible causes of the
Joanna’s changing condition
Good but inconsistent
attempt to consistently
explain what possible further
deterioration could occur
Demonstrated good
understanding of links
etween the necessary
concepts.
Demonstrated inconsistent
evidence of critical appraisal
of reference material
Inconsistent evidence of
synthesis of information and
logical development of
arguments
Literature inconsistently used
to support key ideas
XXXXXXXXXXmarks
Fragmented and
inconsistent attempt to
discuss possible causes of
the Joanna’s changing
condition
Fragmented and
inconsistent attempt to
explain what possible
further deterioration could
occur
Demonstrated limited
understanding of links
etween the necessary
concepts.
Demonstrated limited
evidence of critical
appraisal of reference
material
Limited evidence of
synthesis of information
and logical development of
arguments
Literature poorly used to
support key ideas
17 marks
Demonstrated lack of
understanding of possible
causes of the Joanna’s
changing condition
Demonstrated lack of
understanding of what
possible further
deterioration could occur
Demonstrated lack of
understanding of links
etween the necessary
concepts.
No evidence of critical
appraisal of reference
material
No evidence of synthesis
of information and logical
development of
arguments
Ove
eliance on direct
quotes Key ideas not
supported by the
literature














35
NSG3RDP Semester One 2021
Question Two
Compares and
contrasts
1. Primary (ABCDE)
2. Head to toe
assessment


USE OF LITERATURE TO
SUPPORT DISCUSSION

(35% of total mark)
28 + marks
Clearly and consistently
compared the two
methods of assessment
Demonstrated an
excellent understanding
of links between the
necessary concepts.
Demonstrated clear and
consistent evidence of
critical appraisal of
Answered 5 days After Apr 26, 2022

Solution

Dr. Saloni answered on May 02 2022
110 Votes
11
Case Study of Joanna
Question 1
The rationale of common pathophysiology attributed to assessment results and pharmacology can contribute to the deterioration of an individual’s wellbeing and the formation of essential interventions. Joanna is a known high blood pressure patient who has previously been diagnosed with type 2 diabetes and is hypersensitive to penicillin, ramipril, and metformin. One of the leading causes of disability and death in contemporary times is
ain damage, whether induced by spontaneous bleeding or trauma. Even though these patients' mortality and mo
idity are primarily due to their underlying disease, clinical complications can occur, with respiratory impairment being the most prevalent (Bedoya et al., 2019).
Furthermore, Joanna’s respiratory rate fluctuated and rose afterward. This could be due to a
ain injury. Damage to the
ain areas controlling respiration would therefore result in respiratory problems. Several experimental and clinical studies have shown that lung injury develops soon following
ain injury. Suffering from
ain damage who do not have acute lung injury have variations in respiratory system dynamics, primarily raised airway resistance, respiratory elastance, as well as hypoxemia (Borg Sapiano et al., 2018).
This would be the primary cause of the fluctuating and abnormal oxygen saturation level in the case of Joanna. Patients suffering from a concussion or an extreme
ain injury may experience blood pressure variations immediately following the injury. Untreated hypotension after injuries worsens clinical outcomes. Hypotension directly caused by head trauma is an ominous and rare outcome; it is more commonly induced by shock as a consequence of other injuries (Chua et al., 2020).
Joanna's heart rate was constantly fluctuating and eventually increased at last. Moreover, her blood pressure was constantly fluctuating. Overactivity of the sympathetic nervous system is a frequent cause of fast heart rate. Conversely, the parasympathetic nervous system may ove
eact and lower one's heart rate (McDonald et al., 2018). A steady decrease or increase in heart rate, on the other hand, is less prevalent than contextual heart rate symptoms, including exercise intolerance or palpitations. Moreover, sepsis could be another reason for Joanna’s condition. Sepsis is caused by the innate immune system ove
eacting to an injury or infection, causing serious damage to one's tissues and vital organs. The upsurge in respiratory rate and pulse rate would have been primarily associated with the metabolic requirement for oxygen supply and lactic acid elimination (Ge
y et al., 2020).
Considering the further potential deterioration, increased respiratory rate, thereby hyperventilation, raises intrathoracic pressure, lowers venous return, lowers cardiac output, lowers coronary blood circulation, and, eventually, lowers the chances for survival. Inordinate rapid
eathing in such patients can indeed cause cere
al vasoconstriction, lowering cere
al perfusion as well as potentially declining neurologic retrieval (Patel et al., 2018). Inordinate respiratory rate diminishes venous return and also preload, possibly causing further dangerous declines in blood pressure in patients who are not in complete cardiac a
est but are in shock. Secondary contusions can form in tissues su
ounding or opposite the coup as a result of secondary impact whenever the
ain rebounds and astonishes the skull. The high tensile forces cause neuronal axons and blood vasculature injury, as well as oligodendrocytes, resulting in ischemic
ain damage and
ain edema (Padilla & Mayo, 2018).
Previous research has provided little understanding of the determinants of death for people who experienced preliminary hospitalisation for traumatic
ain injuries. According to numerous studies, external factors like injury, suicide, and seizures have all been incriminated as causes of mortality in these individuals. According to some other research, the leading causes of mortality are respiratory and circulatory illnesses. Secondary
ain injury, outlined as diffuse
ain edema, cere
al necrosis, and herniation caused by hypotension, cere
al edema, and hypoxia that preceded the primary injury, was found in slightly more than 50 percent of neurotrauma instances at autopsy (Gawronski et al., 2018).
Hypotension in fulminant or impending shock can result in multi-organ failure. Since hypotension induces a dearth of blood circulation to the body's organs, the organs start to collapse. This can lead to a heart attack, a stroke, bowel ischemia, or kidney failure. The outcome of long-lasting hypotension is shock and fatality (Chua et al., 2020). Decreased cere
al perfusion can cause altered levels of consciousness, such as drowsiness, lightheadedness, agitation, confusion, coma, and syncope. Low blood pressure is a common condition of shock in severely ill individuals. Shock is an intricate physiological process that can be fatal. It causes cell starvation, organ dysfunction, cell death, organ damage, and fatality. It is generally triggered by hypovolaemia,...
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