Roger Taylor is a 76-year-old retired builder who lives in a two story building with wife, Mary, and 2 dogs. He takes the dogs for a walk most days, but the walks have become shorter and shorter as the left knee is becoming more painful. Roger and Mary have two adult sons who live locally and they have 4 grandchildren, two boys and two girls and most weekends he goes out fishing with his two grandsons. Roger is independent in ADL’s, has his driver’s licence and drives his car almost daily. He takes Mary shopping and every Friday they go out for a meal at the local bowling club. Roger wears glasses, hearing aids and a full set of dentures. He is 179 cm tall and weighs 96kg. He also drinks a couple of beers in the afternoon almost every day, but he has never been a smoker. Last Wednesday Roger was admitted for an elective left knee replacement.
Roger’s medical history:
Polio as a child
Hypertension and
Diabetes mellitus
His medications are as follows:
Lisinopril 5mg daily
Cardura 4mg daily
Metformin 500mg nocte
On his admission his vital signs were
BP 135 / 84 mmHg
HR 78 bpm (regular)
RR 18 bpm
Temp 36.5°C
Sats: 99% (RA)
Pain 5-6 /10, left knee
BGL 4.9 mmol/L
Alert
The operation went well and Roger returned to the ward in the evening. Post-operative Roger was prescribed:
PCA
Oxycotin 10mg bd
Paracetamol qid
Coloxyl with Senna 120mg nocte
The following morning after
eakfast Roger was out of bed with the support of two physiotherapists.
Vital signs in the morning
BP 128/82 mmHg
HR 83 bpm (regular)
RR 18 bpm
Temp 36.8°C
Sats: 97% (RA)
Pain 2-3/10, left knee
BGL 5.3 mmol/L
Alert
In the afternoon day one post operatively Roger started to become confused, restless and would not follow instructions. He was agitated and constantly trying to get out of bed. As Mary was visiting, she tried to get Roger to settle and have his evening meal with little success. The PCA was removed due to confusion.
Vital signs in the afternoon
BP 131/83 mmHg
HR 95 bpm (regular)
RR 21 bpm
Temp 37.1°C
Sats: 98% (RA)
Pain not recorded
BGL 5.8 mmol/L
Alert but confused
Roger was given 2mg Ativan at bedtime and he settled for a while before becoming more agitated and continued to try to get out of bed. He was frequently urinating in a urinal during the night, approximately 100ml each time. In the morning a bladder scan was performed and urinary retention of 600ml was reported. A Foley catheter was inserted and secured, however as Roger was confused, he began pulling on the Foley catheter and frank blood was found in the urine.
You are the nurse that will take over care for Roger on the morning of the third day.
As a nurse follow the clinical reasoning cycle and write your answers in the template provided.
NRS387 Assessment Task 1: Clinical Reasoning Cycle Complex Scenario
Instructions
This template has developed for you to use to complete Assessment Task 1: Clinical Reasoning Cycle Complex Scenario.
It includes the case scenario information and space for you to complete each part of the assessment task. The portions of the template that you must complete are highlighted in yellow.
Please refer to the Subject Outline for details on the task, marking criteria and standards, presentation and referencing requirements.
Make sure that you add a reference list to the end of this document and include in-text referencing to acknowledge your sources throughout the document in accordance with the referencing requirements in your Subject Outline.
PLEASE DELETE ALL INSTRUCTIONS AND TEXT THAT ARE IN ITALIC (just leave the first column in the table ‘empty’ – if you do not delete the instructions and italic text, your word count will be approximately 500 words over the word count)
Student Name: Enter your name
Student Number: Enter your numbe
Subject Code: NRS387
Subject Name: Clinical Reasoning in Nursing 5
Assessment item: 1
Assessment title: Clinical Reasoning Cycle Complex Scenario
Due date: 29th March 2023
Word count (excluding reference list and tables):
Assessment Task 1: Clinical Reasoning Cycle Complex Scenario (1800 words)
Describe
Provide an overview of the scenario (consider the person and context. Location – people – situation 150 words
Describe
Collect cues
Collect relevant assessment data and identify additional assessment data that may be required.
100 words
Process Information
compare any abnormal assessment findings with normal or expected findings and describe why the findings are of importance. Reference needed.
(The number of boxes is not an indication of the number of assessment findings required)
250 words
Collect cues
Process information
Normal/ Abnormal
The finding indicates …..
Additional assessments required
Synthesise
identify the main clinical issues for the patient.
75
Main clinical issue
Outline the pathophysiology of the presenting health challenge.
Reference needed 175
Pathophysiology
Establish (SMART) goals
Identify three person-centred desired outcomes for this patient that are relevant to the scenario 200
Goal 1
Goal 2
Goal 3
Select a course of action
Outline 3 nursing interventions that will assist the patient to meet the desired outcomes and provide basic evidence-based rationales for each. These interventions should be prioritised according to clinical urgency. Reference needed in the rationale XXXXXXXXXX
Evaluate outcomes Explain the process for evaluating the desired outcomes in this scenario. 150
Select a course of action (intervention)
Intervention 1 for goal 1
Intervention 2 for goal 2
Intervention 3 for goal 3
Rationale 1
Rationale 2
Rationale 3
Evaluate outcomes
Outcome 1
Outcome 2
Outcome 3
Reflect
Consider what you have learned from completing this task and how it will contribute to your future practice. (You should use an established model of reflection and reference it)
300
Reflection
References (start on a new page)
Student Name: (enter your name) Student Number: (enter your number) NRS387 Assessment Item 1
Assessment item 1 - Clinical Reasoning Cycle Complex Scenario
Value: 50%
Due Date: 29th March 2023
Return Date: 21st April 2023
Length: 1800 words
Group Assessment: No
Submission method options: Turnitin Assignment Portal
TASK
This assessment task requires you to utilise the case study provided on the NRS387 subject Interact2 site and use the template provided under assessment 1 to address each of the following points:
Describe – provide an overview of the scenario (consider the person and context. Location – people – situation (approx. 150 words)
Collect Cues – Collect relevant assessment cues and identify additional assessment data that may be required (approx. 100 words)
Process Information – compare any abnormal assessment findings with normal or expected findings and describe why the findings are of importance. Reference/s needed (approx. 250 words)
Synthesise – Identify the main clinical issues for the patient. Identify and provide an overview of the pathophysiology of the main health challenge evident in the case study. Reference/s needed (approx. 250 words)
Establish goals -identify three (3) person-centered desired outcomes for this patient that are relevant to the scenario (approx. 200 words)
Select a course of action – outline three (3) nursing interventions, one (1) for each goal, that will assist the patient to meet the desired outcomes and provide basic evidence-based rationales for each. These interventions should be prioritised according to clinical urgency. Reference/s needed. (approx. 150 words/intervention, 250 words
ationale)
Evaluate outcomes – Explain the process for evaluating the desired outcomes in this scenario (approx. 150 words)
Reflect – reflect on what you have learned from completing this task and how it will contribute to your future practice. (You should use an established model of reflection and reference it) (approx. 300 words)
You are to support your work with academic sources, use in-text references and provide a reference list.
All sources must be co
ectly referenced in-text and in the reference list in accordance with APA 7th Edition referencing style.
SUBJECT LEARNING OUTCOMES
This assessment task will assess the following learning outcome/s:
· be able to identify and apply assessment frameworks and techniques to the care of infants, children, adolescents, adults and older people in a simulated environment.
· be able to identify and demonstrate selected evidence-based nursing interventions to promote safety, healing and caring in practice for infants, children, adolescents, adults and older people in a simulated environment.
· be able to apply the Clinical Reasoning Cycle to interpret assessment findings, plan, justify and evaluate care in the context of complex clinical scenarios in a simulated environment.
GRADUATE LEARNING OUTCOMES
This task also contributes to the assessment of the following Charles Sturt Graduate Learning Outcome/s:
· Academic Literacy and Numeracy (Skill) - Charles Sturt Graduates demonstrate the literacy and numeracy skills necessary to understand and interpret information and communicate effectively according to the context.
· Professional Practice (Knowledge) - Charles Sturt Graduates possess the knowledge and understanding of the discipline and the nature of professionalism required for the given profession or discipline in contemporary societies.
PRESENTATION
All items of assessment must be word processed and not handwritten. In addition:
· Leave 2 cm margins and double line space your work
· Font must be 12pt, unless otherwise indicated.
· All pages must be numbered.
· Student name and number must be included in the header or footer of every page of every assignment.
· A title page must accompany your written assessment task and include the subject name and code, title of the assessment task, due date, lecturer’s name, student name and student number.
· Assessment must be uploaded as a MS WORD document.
Below are further written information to guide you in the assessment task. Each marking criteria will be explored.
Criteria
High Distinction
XXXXXXXXXX%)
Distinction
XXXXXXXXXX%)
Credit
XXXXXXXXXX%)
Pass
XXXXXXXXXX%)
Fail
XXXXXXXXXX%)
Marks
Describe
–provide an overview of the scenario
You have used a holistic approach to analyse the patient situation, and derived
components of the patient's context that will impact care.
XXXXXXXXXXmarks)
You have used a holistic
approach to examine the
patient situation.
A description of the facts
and the patient's context
has been included.
(6.1 – 7 marks)
You have used a
holistic approach to describe the patient situation.
The facts and the patient's context have
een included.
(5.1 – 6 marks)
You have
described the
patient situation,
including some
aspects of the
patient’s social
circumstances.
(4 - 5 marks)
You have not
described the
patient situation
or you have
paraphrased
the content of the case study to describe some of the facts.
(0 – 3.9 marks)
/8
Describe – provide an overview of the scenario (consider the person and context. Location – people – situation (approx. 150 words)
In this section I want you to be able to describe who Roger is, why is he in hospital, what are the factors that influence how Roger is feeling now when you are taking over care. Using a holistic approach, how has Roger’s persona and lifestyle influenced how he is now and is that what you expect from what you can read about him?
Criteria
High Distinction
XXXXXXXXXX%)
Distinction
XXXXXXXXXX%)
Credit
XXXXXXXXXX%)
Pass
XXXXXXXXXX%)
Fail
XXXXXXXXXX%)
Marks
Collect cues
Collect relevant
assessment cues and identify
additional
assessment tools
that may be
equired.
Relevant assessment cues have been identified, following an analysis of the case study. Identified cues have been presented systematically. Additional relevant assessment tools have been identified to address subtle cues. A rationale for additional assessment tools is included.
XXXXXXXXXXmarks)
Relevant assessment cues have been identified, following an analysis of the case study. Identified cues has been prioritised systematically. Additional relevant assessment tools have been identified to address subtle cues.
(7.6 – 9 marks)
Relevant assessment cues have been identified. Some subtle cues have
een overlooked.
Identified cues have been Presented systematically.
Additional relevant
assessment tools have been identified.
(6.6 – 7.5 marks)
Relevant assessment cues have been identified. Some cues have been missed but will not impact immediate care. Additional relevant assessment tools have been identified XXXXXXXXXXmarks)
Relevant assessment and important cues have been missed.
Additional relevant
assessment tools have not been identified o
additional assessment tools of questionable
elevance to the case study.
(0 – 4.9 marks)
/10
Processing
Compare any
abnormal
assessment
findings with
normal o
expected findings
and describe why
the findings are
of importance
Recognises subtle
deviations from
expected patterns in identified cues and assess why the findings are of importance.
Supported by high quality references.
XXXXXXXXXXmarks)
Recognises patterns and
deviations in the
identified cues and
describe why these
findings are of
importance. Supported by
quality references.
(7.6 – 9 marks)
Recognises
obvious patterns
and deviations in
the identified
cues. Deviations
from
expectations
have been
identified and
supported by
eferences.
(6.6 – 7.5 marks)
Obvious patterns
and deviations in
the identified
cues have been
identified. A
description of the
importance of these findings are
included with
limited
eferencing.
XXXXXXXXXXmarks)
Patterns and
deviations from
expectations are not
clearly identified. O
there is no
description of the
importance of these
findings. No
eferences.
(0 – 4.9 marks)
/10
Collect Cues – Collect relevant assessment cues and identify additional assessment data that may be required (approx. 100 words)
What are the cues you need to collect in order to provide appropriate care for Roger? Remember that normal vital signs are also cues Explore both signs and symptoms
Process Information – compare any abnormal assessment findings with normal or expected findings and