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CNA253/255 Clinical reasoning case-study rubric Assessment Criteria HD DN CR PP NN Explains relevant underlying physiology/ pathophysiology related to the health status of the individual and...

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CNA253/255
Clinical reasoning case-study ru
ic

Assessment Criteria HD DN CR PP NN
Explains relevant
underlying physiology/
pathophysiology related
to the health status of the
individual and
demonstrates
understanding of the
elationship between the
health issues presented.

40%
Demonstrates a high-
level of application of
knowledge to the case,
that accurately and
comprehensively
explains the students'
understanding of the
underlying
pathophysiological
mechanisms related to
the patient's condition.

Accurate application of
knowledge that indicates
a high-level
understanding of relevant
pathophysiological
mechanisms related to
the patient's condition.

Mostly accurate
application of knowledge
that indicates a
easonable level of
understanding of relevant
pathophysiological
mechanisms related to
the patient's condition.
Some scope to detail
additional relationships
within the case study.

Demonstrates a
satisfactory application of
mostly accurate
knowledge regarding
some of the relevant
pathophysiological
mechanisms. Scope for
additional depth and
analysis.

Provides insufficient
and/or confused
knowledge that does not
clearly demonstrate an
understanding of relevant
pathophysiological
mechanisms.
Demonstrates ability to
appropriately apply the
clinical reasoning cycle to
inform and evaluate
nursing care

40%
Demonstrates an
exceptional
understanding and
application of all
components of the
clinical reasoning cycle
to the case that
indicates an emerging
capacity to think like a
egistered nurse. The
plan of care detailed
provides evidence of
high-level thinking
around relevant course
of actions and impact/s
on future nursing
practice.
Demonstrates a strong
understanding of the
application of most
components of the
clinical reasoning cycle to
the case that indicates an
emerging capacity to
think like a registered
nurse. Details an
appropriate, relevant
course of actions and
impact/s on future
nursing practice.
Demonstrates a clear but
sometimes limited
understanding of the
application of clinical
easoning with some
capacity to think like a
egistered nurse, but
scope for more depth.

Demonstrates a
satisfactory approach to
application of some
elements of the clinical
easoning with some
capacity to think like a
egistered nurse, but
scope for more depth.



Paper is not aligned with
the clinical reasoning
cycle and/or
demonstrates poor
understanding of its
application and does not
clearly address and/or
acknowledge the patient
problem.

Uses appropriate scholarly
literature to substantiate
findings throughout. Uses
Harvard referencing style.

10%
Accurately references all
sources using the
Harvard style.
Outstanding use of
appropriate academic
literature that
substantiates thinking
and arguments that
considers evidence-
ased practice relevant
to the case.

Accurately references the
majority of sources using
the Harvard style.
Uses scholarly literature
and expands upon key
points of discussion that
include evidence-based
practice.


Accurately references the
majority of sources using
the Harvard style.
Uses some relevant
scholarly literature, but
scope to expand further.

Draws upon some
scholarly literature to
substantiate discussion,
ut scope to consider
additional evidence.
E
ors evident in
eferencing style.


Inaccurate and/or
inconsistent referencing
style.
No or minimal use of
appropriate scholarly
literature to substantiate
findings.

Writes in a clear and
concise academic style
that is succinct, logical and
coherent.

10%
Communicates with a
highly evolved academic
writing style with strong
evidence of planning.
The paper is
exceptionally logical,
insightful and balanced
and is consistently
expressed in a clear and
fluent manner with
minimal or no
spelling/grammar
e
ors.



Communicates with a
strong academic writing
style with clear evidence
of planning, and
presented in a logical and
fluent manner.
Minimal
spelling/grammar
e
ors.
Communicates with a
mostly academic writing
style with some evidence
of planning. Generally
expressed in a clear and
fluent manner.
Evidence of
spelling/grammar
e
ors that impact on
flow of paper.

Communicates with a
asic writing style that is
easonably
coherent and clear but
has scope for
improvement in line with
academic convention.
E
ors in
spelling/grammar impact
on flow of paper.

Not presented in an
academic manner.
Multiple
spelling/grammar e
ors
which significantly impact
on readability.


Scenario 1: Ms Huang
Triage Notes
Date: Today
Chief Complaint: Confusion
Patient admitted via ambulance for reported confusion and emotional state and concerns for her
well-being. Husband not able to provide history due to language ba
ier, patient appears to be
fluent in English, but providing confused responses. Translator not cu
ently available. BP
92/50mmHg Temp 37.9 degrees, HR 120bpm. Recent consultation with GP for chest infection.
Admitted as Category 3 to Bay 7 for further assessment and diagnosis.
Signed D. Moss. Registered Nurse (Triage).

CNA255: Scenario 1- Ms Nancy Huang
    Consider the patient situation
    Ms Nancy Huang is a 29 year old university student undertaking her honours year in physics. Nancy was diagnosed as a type 1 diabetic three years ago. She normally manages her diabetes reasonably well since making a number of lifestyle changes combined with regular insulin. Nancy has been very stressed, as she has not been able to finish her thesis on time due to having to recently return to China unexpectedly to attend a family funeral. Since returning a few days ago, she has seen her GP, as she was unwell, and was diagnosed with a viral chest infection that was managed conservatively. She subsequently fell further behind in her studies. Nancy decided to pull a few ‘all-nighters’ to get her thesis finished and decided to consume excessive amounts of coffee and soft drinks in order to stay awake to finish her thesis. The next day her husband noticed Nancy was particularly i
itable and becoming emotional as she could not concentrate on finishing her thesis. Nancy was insisting on being driven to the university to speak to her lecturer. On the drive in, they had to stop 4 times for Nancy to use the bathroom. She became even more i
itable and her husband decided to call an ambulance once they a
ived at the university, who then transported her to hospital. The time is now 1400 and Nancy has just been admitted into the emergency bay. You are the first RN to assess her. She is awaiting medical review.
    Collect Cues
    Review:
See available patient information via MyLO. Little documentation available at this point as newly admitted.
    
    Gather new information (patient assessment):
Upon undertaking a further assessment of Ms Huang you obtain the following new information:
Log book
Her husband provides you with a logbook that was provided to Nancy by her endocrinologist. It shows that Nancy has been diligently recording her BGL levels and insulin regime for some months. You note there are no entries for the last few days.
Vital signs
BP: 90/50
HR: 120 beats per minute
Sp02: 94%
RR: 20, coarse air entry, moist productive cough.
Temp: 37.9 degrees.
Other information
Patient i
itable and agitated. Speaking in a confused mixture of English and Mandarin. Husband in attendance.
GCS 13 (confused)
BGL 24
Poor skin turgor.
Frequent urination
Urinalysis positive for glycosuria, specific gravity XXXXXXXXXXNo ketones present.
Soft abdomen, no rebound tenderness. Bowel sounds present.
    
    Recall:
Recall and apply your existing knowledge to the above situation to ensure you have a
oad understanding of what is/may be occu
ing before proceeding with the rest of the cycle (self-directed)
    Process Information
    Interpret:
List the data that you consider to be normal/abnormal below (not included in word count)
    
    Normal
    Abnormal
    
    
    
    
    Relate & Infer:
· Relate the two most significant abnormal findings to the underlying physiology/pathophysiology to justify why it is considered abnormal in this context.
· Based on your interpretation of all the information/cues presented, form an overall opinion on what may be happening and justify your answer (400 words).
    
    
    
    Predict:
What may happen to your patient if you take NO action and why? (100 words)
    
    
    Identify the Problem/s
    List in order of priority at least three key nursing problems (not included in word count)
    
    
    Establish Goals & Take Action
    From the above (identify problems), use the top 2 nursing problems identified and for each of these establish one goal and then list related actions you would undertake, including detailing any relevant nursing considerations (350 words)
    
        Problem 1
    Goal
    Related actions
    Rationale
    
    
    
    
    Problem 2
    Goal
    Related actions
    Rationale
    
    
    
    
    Evaluate outcomes & Reflect on new learning
    Briefly describe how you would evaluate the effectiveness of the care provided (i.e. what do you want to happen?) and reflect on how this encounter has informed your nursing practice if you were to encounter a similar situation in the future (150 words).
    
    
    
2
Answered Same Day May 11, 2020

Solution

Soumi answered on May 14 2020
136 Votes
CNA255: Scenario 1- Ms Nancy Huang
    Consider the patient situation
    Ms Nancy Huang is a 29-year-old university student undertaking her honours year in physics. Nancy was diagnosed as a type 1 diabetic three years ago. She normally manages her diabetes reasonably well since making a number of lifestyle changes combined with regular insulin. Nancy has been very stressed, as she has not been able to finish her thesis on time due to having to recently return to China unexpectedly to attend a family funeral. Since returning a few days ago, she has seen her GP, as she was unwell, and was diagnosed with a viral chest infection that was managed conservatively. She subsequently fell further behind in her studies. Nancy decided to pull a few ‘all-nighters’ to get her thesis finished and decided to consume excessive amounts of coffee and soft drinks in order to stay awake to finish her thesis. The next day her husband noticed Nancy was particularly i
itable and becoming emotional as she could not concentrate on finishing her thesis. Nancy was insisting on being driven to the university to speak to her lecturer. On the drive in, they had to stop 4 times for Nancy to use the bathroom. She became even more i
itable and her husband decided to call an ambulance once they a
ived at the university, who then transported her to hospital. The time is now 1400 and Nancy has just been admitted into the emergency bay. You are the first RN to assess her. She is awaiting medical review.
    Collect Cues
    Review:
See available patient information via MyLO. Little documentation available at this point as newly admitted.
    
    Gather new information (patient assessment):
Upon undertaking a further assessment of Ms Huang you obtain the following new information:
Log book
Her husband provides you with a logbook that was provided to Nancy by her endocrinologist. It shows that Nancy has been diligently recording her BGL levels and insulin regime for some months. You note there are no entries for the last few days.
Vital signs
BP: 90/50
HR: 120 beats per minute
Sp02: 94%
RR: 20, coarse air entry, moist productive cough.
Temp: 37.9 degrees.
Other information
Patient i
itable and agitated. Speaking in a confused mixture of English and Mandarin. Husband in attendance.
GCS 13 (confused)
BGL 24
Poor skin turgor.
Frequent urination
Urinalysis positive for glycosuria, specific gravity 1.030. No ketones present.
Soft abdomen, no rebound tenderness. Bowel sounds present.
    
    Recall:
Recall and apply your existing knowledge to the above situation to ensure you have a
oad understanding of what is/may be occu
ing before proceeding with the rest of the cycle (self-directed)
    Process Information
    Interpret:
List the data that you consider to be normal/abnormal below (not included in word count)
    
    Normal
    Abnormal
    
    Body temperature
Respiratory Rate (RR)
SpO2
    Blood Pressure (BP)
Heart Rate (HR)
Blood Glucose Level (BGL)
Skin elasticity
Glasgow Coma Scale (GCS)
Frequent Urination
    
    Relate & Infer:
· Relate the two most significant abnormal findings to the underlying physiology/pathophysiology to justify why it is considered abnormal in this context.
· Based on your interpretation of all the information/cues presented, form an overall opinion on what may be happening and justify your answer (400 words).
    
    Ms Nancy Huang has presented a number of abnormal findings that require attention. However, amongst the ones enlisted above, the two most serious concerns are frequent urination, extremely low BP, which is 90/50 and her high BGL, which is 24 mmol/L cu
ently. According to James et al. (2014), the normal reading for BP should be 120 systolic pressure and 80 diastolic pressure. However, abnormalities occur when blood pressure on the walls of the arteries are remarkably low. In this condition, the systolic pressure deteriorates below 90 mmHg, while the diastolic pressure...
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