Written Assignment: Case study
Weight: 40%
Length: 1000 words
Task:
Read the case studies below, choose one case study to discuss by answering the associated questions. You do not need an introduction or conclusion and headings are advised. You must use academic writing and reference your work using APA referencing. Your ISBAR may be presented in table form. Please do not use bullet points, use well-structured paragraphs and ensure you have edited the text.
Case Study 2: Cardiac
Mr Jae-Kwang Lee, a 65-year-old male who presented to the Emergency Department stating his chest felt heavy. At the triage desk he was holding his chest, when asked if the heaviness went anywhere he said yes and then proceeded to rub his left arm. When questioned further during the triage process he had associated symptoms of shortness of
eath and dizziness. He had not had pain as severe as this before, he said he "has been having pains in his chest for a few months but it stops when I sit down, but it didn't stop this time, I have been waiting for it to stop, it started yesterday". Mr. Lee was taken into the Emergency Department and connected to cardiac monitoring, a 12 lead ECG was taken which showed a Non-ST-elevated Myocardial Infarction (NSTEMI). His first set of observations are as follows:
Temp: 36.5
HR: 110
BP: 108/73
RR: 21
SpO2: 95%
Mr. Lee also had blood tests taken including UEC, FBC, CK-MB, Trop T, Coags. Mr. Lee was also given sublingual GTN for pain 300mcg x2 - 5 minutes apart without effect, he was then given morphine 5mg, in 2.5mg increments with effect.
Due to the business of the Department, it was decided to transfer my Lee to the Coronary Care unit to wait for a cardiology review. You accept the care of Mr. Lee.
2 hours into your shift, you are assessing Mr. Lee and note that Mr. Lee has become tachycardic, hypotensive and hypoxic his observations are as follows:
Temp: 36.5
HR: 133
BP: 87/53
RR: 25
SpO2: 88%
BGL: 4.6mmol
As his oxygen saturation's are at 88%, you start him on oxygen via a simple face mask at 6LO2. Mr. Lee is awake but lethargic. He responds appropriately to questions.
Questions
1. Identify the elements which signify a deterioration in this patient’s condition. Identify whether these elements of deterioration indicate a rapid response or a clinical review as per the NSW Health Between the Flags? Justify your decision with the data from the case and relevant support.
2. Using a table construct your communication with the Doctor regarding this patients deterioration employing the ISBAR tool [this section does not need to be referenced].
3. Discuss the pathophysiology of the patients signs of deterioration as they relate to a diagnosis of cardiogenic shock.
Marking Ru
ic
ssessment Task: Case Study
Assessment weight: 40%
Link to unit learning outcomes: LO 1, 2, 4 & 5
Criteria:
Q1 – Between the flags CERS
HD
D
C
P
Fail
Mark (%)
Assessment content (variable criteria and weighting)
Demonstrates understanding of the deteriorating patient; initiation of a review criteria with rational provided.
Exhibits clinical reasoning skills
Successfully demonstrates understanding of the deteriorating patient; through the initiating of the co
ect review criteria with extensive rational provided.
Succinctly and consistently exhibits higher- order clinical reasoning skills
Demonstrates with only minor digressions, an understanding of the deteriorating patient; through the initiating of the co
ect review criteria with a sound rational.
Exhibits strong higher-order clinical reasoning skills
Reflects with some digression on the understanding of the deteriorating patient; however, the co
ect review criteria are initiated, attempt at rational evident.
Generally exhibits limited higher-order clinical reasoning skills
Reflects but digresses on the understanding of the deteriorating patient; the appropriate review may or may not be initiated, little to no rational given.
Exhibits simplistic clinical reasoning skills
Insufficient understanding of the deteriorating patient the co
ect review criteria is not initiated.
Minimal simplistic clinical reasoning skills
/15
Criteria:
Q2 – ISBAR handover
HD
D
C
P
Fail
Demonstrates effective communication and the importance of an accurate ISBAR handover.
Successfully and accurately delivers an ISBAR handover with succinct and precise communication
Demonstrates with only minor digressions an accurate and succinct ISBAR handover including all relevant information.
Communicates with some digression, however successfully includes all appropriate information in the ISBAR handover.
Digresses during the ISBAR handover and demonstrates an average understanding of this process of communication
Insufficient communication and does not demonstrate an understanding and importance of an accurate ISBAR handover.
/15
Criteria:
Q3 – Pathophysiology
HD
D
C
P
Fail
Demonstrates an understanding of the pathophysiology; links pathophysiology to the patient’s cu
ent condition
Exhibits clinical reasoning skills
Successfully demonstrates a thorough understanding of the patient’s pathophysiology; extensively links pathophysiology to the patient’s cu
ent condition
Succinctly and consistently exhibits higher- order clinical reasoning skills
Demonstrates with only minor digressions an understanding of the pathophysiology of the patient; readily links pathophysiology to the patient’s cu
ent condition
Exhibits strong higher-order clinical reasoning skills
Reflects with some digression on the understanding of the pathophysiology of the patient; some attempt to link pathophysiology to the patient’s cu
ent condition
Generally exhibits limited higher-order clinical reasoning skills
Reflects but digresses significantly on the understanding of the pathophysiology of the patient; Minimal links of pathophysiology to the patient’s cu
ent condition
Exhibits simplistic clinical reasoning skills
Insufficient understanding of the pathophysiology of the patient; Does not link the pathophysiology to the patient’s cu
ent condition
Minimal simplistic clinical reasoning skills
/30
Criteria:
Synthesis of Literature
HD
D
C
P
Fail
Demonstrated ability to review the literature and select appropriate sources
Demonstrated ability to appraise and analyse the literature
Extensive review of recent and relevant literature from peer reviewed and reputable sources.
Critical and comprehensive appraisal of the literature/ professional sources linked extensively throughout the paper with strong analysis and links to discussion.
Suggested 20 + sources
Broad review of recent and relevant literature from peer reviewed and reputable sources.
Critical appraisal of the literature/ professional sources soundly linked throughout the paper with sound analysis and links to discussion.
Suggested 15 + sources
Adequate review of recent and relevant literature from peer reviewed and reputable sources.
Appraisal of the literature/ professional sources linked throughout the paper with analysis and links to discussion.
Suggested 12 + sources
Some review of relevant literature from some peer reviewed and reputable sources. Possible use of less credible sources.
Minimal appraisal of the literature/ professional sources with some or few links throughout the paper. Some attempt at analysis
Suggested 8 + sources
Little to no review of recent and relevant literature from peer reviewed and reputable sources. Use of less of less credible sources evident.
Little to no appraisal of the literature/ professional sources. Little to no analysis of the literature.
/20
Criteria:
Writing – 10%
HD
D
C
P
Fail
Mark (%)
Writing and APA (fixed criteria and weighting)
Follows requirements for structure, presentation
grammar and spelling.
Accurately and consistently adheres to essay format writing conventions, grammatical conventions with no e
ors and is a logical / well and succinctly structured assignment
Mostly accurate and consistent adherence to essay format writing conventions, adheres to grammatical conventions with few e
ors and is a logical and well-structured assignment
Partial but close adherence to essay format writing conventions, adheres to grammatical conventions, but with frequent e
ors, mainly a well- structured assignment, lacking cohesion in places
Minimal adherence to essay format writing conventions, minimal adherence to grammatical conventions with multiple e
ors, a weakly structured assignment, frequently lacking cohesion
Little attempt to adhere to essay format writing conventions, multiple grammatical e
ors with minimal attention to writing / spelling conventions that significantly distract the reader from the content. A poorly structured assignment, lacking cohesion
/10
Criteria
APA – 10%
HD
D
C
P
Fail
Mark (%)
Follows requirements for referencing (APA 6th Edition) and the application of evidence
Accurately and consistently adheres to APA referencing conventions for the in-text and reference list
Explicitly acknowledges all sources used throughout the assignment
Mostly offers accurate and consistent APA referencing conventions for the in-text and reference list
Principally acknowledges sources used throughout the assignment
A number of inaccurate and inconsistent APA references in the in-text and reference list
Mostly acknowledges sources used throughout the assignment
Multiple inaccurate and inconsistent APA references in the in-text and reference list
Minimal acknowledgment of sources used throughout the assignment
Did not adhere to the APA referencing conventions and/or made catastrophic, multiple and consistent APA e
ors throughout
Little or no acknowledgment of sources used throughout the assignment
/10
Total /100%