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Scenario 2: Robert Brown Consider the patient situation Mr Robert Brown is a 30 year old male who was hit by a car that failed to give way whilst he was crossing at a pedestrian crossing. The impact...

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Scenario 2: Robert Brown
    Consider the patient situation
    Mr Robert Brown is a 30 year old male who was hit by a car that failed to give way whilst he was crossing at a pedestrian crossing. The impact caused him to be thrown into a nea
y garden bed. Passers-by came to his aid immediately. They helped him up and noticed he was bleeding from a laceration to the back of the head. He sustained no other obvious injuries. An ambulance was called. He has been at hospital for nearly 24 hours and was transfe
ed to your ward overnight. It is now 0800 and you have just come on shift. You enter his room and he seems to be unsure of where he is (requires orientation) and keeps asking other patients the location of his dog (whom Robert was walking at the time of the accident).
    Collect Cues
    Review:
Examine existing documentation via the assessment resources folder in MyLO.
    
    Gather new information (patient assessment):
Upon undertaking an assessment of Mr Brown you obtain the following new information:
Vital signs
BP: 160/95
Pulse: 111bpm
RR: 18
SaO2: 98%
Temp 36.6
Other data
GCS: 13 (patient seems confused/agitated) and keeps ru
ing at his head and mumbling that it hurts. Whilst his movements seem purposeful, he does not obey commands or accurately answer specific questions). There appears to be no GCS documentation since transfer to the ward.
Patient in bed opposite refers to Mr Brown and tells you: ‘that poor young bloke, he’s been up half the night. He keeps going on about his dog and gets lost when he goes to the bathroom’
Wound chart: no further documentation evident. However, upon looking at Mr Browns head wound from a distance, dressing appears blood soaked and has partly come off. There are smears of blood on his pillow.
    
    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
    
    
insert text here
    
insert text here
    
    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).
    
    
insert text here
    
    Predict:
What may happen to your patient if you take NO action and why? (100 words)
    
    
insert text here
    Identify the Problem/s
    List in order of priority at least three key nursing problems (not included in word count)
    
    
insert text here
    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
    
insert text here
    
    
    
    Problem 2
    Goal
    Related actions
    Rationale
    
insert text here
    
    
    
    Evaluate outcomes & Reflect on new learning
    Briefly describe how you would evaluate the effectiveness of the care provided and reflect on how this encounter has informed your nursing practice if you were to encounter a similar situation in the future (150 words).
    
    
insert text here
    

Consider the patient
situation
patient data

Collect Cues Review:
Examine existing documentation

patient data

Gather new information (patient assessment):

patient data

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
insert text here




insert text here


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).
insert text here



Predict:
What may happen to your patient if you take NO action and why? (100 words)
insert text here




Identify the
Problem/s
List in order of priority at least three key nursing problems (not included in word count)

insert text here


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 the 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 care provided (ie 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).

insert text here



Adapted from:
Levett-Jones, T 2013 Clinical Reasoning: Learning to think like a Nurse, Pearson, Australia (Pages 7-8).

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
Answered Same Day Apr 02, 2020

Solution

Soumi answered on Apr 04 2020
151 Votes
Scenario 2: Robert Brown
    Consider the patient situation
    Mr Robert Brown is a 30 year old male who was hit by a car that failed to give way whilst he was crossing at a pedestrian crossing. The impact caused him to be thrown into a nea
y garden bed. Passers-by came to his aid immediately. They helped him up and noticed he was bleeding from a laceration to the back of the head. He sustained no other obvious injuries. An ambulance was called. He has been at hospital for nearly 24 hours and was transfe
ed to your ward overnight. It is now 0800 and you have just come on shift. You enter his room and he seems to be unsure of where he is (requires orientation) and keeps asking other patients the location of his dog (whom Robert was walking at the time of the accident).
    Collect Cues
    Review:
Examine existing documentation via the assessment resources folder in MyLO.
    
    Gather new information (patient assessment):
Upon undertaking an assessment of Mr Brown you obtain the following new information:
Vital signs
BP: 160/95
Pulse: 111bpm
RR: 18
SaO2: 98%
Temp 36.6
Other data
GCS: 13 (patient seems confused/agitated) and keeps ru
ing at his head and mumbling that it hurts. Whilst his movements seem purposeful, he does not obey commands or accurately answer specific questions). There appears to be no GCS documentation since transfer to the ward.
Patient in bed opposite refers to Mr Brown and tells you: ‘that poor young bloke, he’s been up half the night. He keeps going on about his dog and gets lost when he goes to the bathroom’
Wound chart: no further documentation evident. However, upon looking at Mr Browns head wound from a distance, dressing appears blood soaked and has partly come off. There are smears of blood on his pillow.
    
    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
    
    · Normal respiratory rate
· Slightly low temperature
    · High blood pressure (160/95)
· High pulse rate
· High systolic pressure
    
    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).
    
    Mr Brown is diagnosed with high Blood pressure and high systolic pressure due to arterial hypertension. He is profusely bleeding as he had head injury. In this case, due to hypertension, non-epinephrine is released, hence the patient is responding to stressful stimuli and there might be abnormal levels of relationship between sodium and blood pressure. Brown is suffering from stage two level hypersensitivity, due to pressure overload of left ventricular hypertrophy. According to Grabner et al. (2015), the left ventricular hypertrophy impairs the diastolic functions in the body with delayed filling and slowing ventricular relaxation. Increased pulse rate and blood pressure are due to the abnormal blood circulation leading to pressure on the walls. Consequently, abnormal blood circulation is reported in Mr Brown’s case is because of the loss of blood, due to profuse bleeding. Abnormal bleeding is suggestive of the low levels of clotting factors; in turn, this condition is resulting in vascular stiffness, systemic vascular resistance and vascular responsiveness to stimuli. As argued by Yang et al. (2015), increased systolic pressure and pulse rate are the main markers of severe arterial damage (target organ...
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