Written Assessment 2 - Guidelines
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NUR251 Written Assessment 2
Topic: Nursing care of a patient with a medical condition
Due date: Week 09 Sunday 30th October 2022, 23:59 (ACST)
Length: 2000 words ± 10%. Markers will stop reading at the maximum
allowable word count. This word count includes the text in the template
provided to you. Your reference list is NOT included in your word count.
Contribution to overall grade: 40%
Written Assessment 2: Tasks
Firstly you will need to choose one of two case studies below.
1. Case scenario one – Vanessa Anderson
2. Case scenario two - Alex Braes
After you have picked a case study you will need to answer some
questions related to two stages of the clinical reasoning cycle.
Part 1 of your assessment question will require that you firstly collect
cues/information (stage 2 of the clinical reasoning cycle) and take action
(stage 6 of the clinical reasoning cycle).
Part 2 of your assessment question will require you to reflect on and
process new learning (Step 8 of the clinical reasoning cycle).
Based on the ISBAR handover (see details below), other information
included below and cu
ent reliable evidence for practice, address the
following tasks.
Do not make up or assume information in relation to or about you
chosen patient. Only use what you know from the information you
eceived today.
This assignment has been split into two parts.
Part 1:
Based on your chosen case scenario and in grammatically co
ect
sentences, complete stage 2 (collect cues/information) and stage 6 (take
action) of the clinical reasoning cycle to;
1) Collect cues/information: Identify three (3) priority nursing assessments
that you would conduct at the commencement of your shift. For each
assessment you have identified explain the following;
Why it is necessary for the patient’s condition and nursing care?
Consider and recall your knowledge explaining the underlying
pathophysiology around the concerns you discuss.
What consequences can occur if this assessment is not completed
accurately?
What chart or document could you use to assist with
ecord you
assessments?
(500 words)
2) Take action: Utilising stage 6 of the clinical reasoning cycle, discuss
your nursing actions. These must include;
The most appropriate course of action to achieve your goals of care.
Address your nursing diagnoses, using cu
ent evidenced based
practice.
Discuss who is best placed to undertake the required interventions
and why.
Detail your chosen parameters, to include who should be notified and
when.
(500 words)
Part 2:
Step 8 of the Clinical Reasoning Cycle requires a nurse to reflect on
process and new learning. Based on your chosen case study, critically
eflect on the role and responsibilities of the registered nurse. You
eflection must demonstrate how your thinking or assumptions have been
challenged, and the deeper insights you have gained. You should use a
eflective cycle to guide your reflection, such as the Gi
s Reflective
Cycle. Your reflection should be informed by the latest research and
guidelines (at least 5 peer reviewed journal articles/NSQHS standards,
Code of Conduct, Nursing Standards, Code of Ethics).
The following points must be discussed.
Critically analyse pain and medication management in the treatment
of your patient, included associated risk management.
Critically reflect on your role, responsibility, scope of practice to
include legal and ethical frameworks in the management of patient
care in an acute care setting.
(1000 words)
Choose one of the below case studies. Both case studies are real life
cases, with some embellishments.
Written Assessment 2: Case scenario one – Vanessa Anderson
Shift handover:
Identify: Miss Vanessa Anderson, HRN: 123456, DOB:25/12/2004
Vanessa is a 16yo, healthy active female living in
NSW who was admitted after experiencing a
traumatic head injury after being struck on the R)
side of her head, behind her ear, by a golf ball at
approx 0825 Sunday morning.
Paramedics attended and
ought her into ED.
She was sent for an urgent CT which diagnosed
Situation: depressed focal right temporal skull fracture.
Bone fragments in
ain matter and dural
lacerations present.
She has been complaining of a headache and has
a GCS of 14-15.
She has been transfe
ed to the CDU Neurological
ward for continuing care, it is now 1300.
Background:
Vanessa lives with her parents and has an olde
other Jason. She plays golf 3-4x a week and is
in yr11 at High School.
Pmh – Asthma – Seretide and Ventolin
Allergies – Shellfish and nuts
60kgs, normal BMI
Assessment:
Airway: Own, patent
Breathing: RR 23, O2 Sats 98% on RA.
Circulation: HR 68bpm, BP 120/65 mmHg.
Disability: GCS 14/15, she is intermittently
confused, PEARL 3mm, BGL 5.0mmol/L
Exposure: Temp 36.5 oC,
She has 1 x PIVC inserted to her R) ACF, it is
patent.
Recommendations/Read
ack:
Medical orders
Routine ward assessments and observations
4/24 full neuro observations
Administer analgesia as prescribed
Diet and fluids as tolerated
TED stockings and DVT prophylaxis
Medication orders
Panadeine Forte 1000mg/60mg QID
Oxycodone 5mg PRN (Max dose 30mg in
24hrs)
Dilantin 100mg IV over 6hrs
Nursing orders
Devise a plan of care for your patient
The following events transpired over the course of the next few
shifts.
Monday
0830
Medical review.
GCS 15.
Continue with regular Panadeine Forte
Oxycodone changed to 5-10mg 3hrly PRN
You return on Monday for the nightshift, and you are
allocated to care for Vanessa.
2100hrs
On handover at 2100hrs you are told that Vanessa last had the
following analgesia.
1900 - Panadeine Forte
2000 – PRN Oxycodone 10mg
You perform your assessment and note the following:
Airway: Own, patent
Breathing: RR 16, O2 Sats 95% on RA.
Circulation: HR 62bpm, BP 105/58 mmHg.
Disability: GCS 14/15, she is intermittently confused, PEARL 3mm,
BGL 6.0mmol/L
Exposure: Temp 36.2 oC,
2300hrs
Vanessa rings the bell and complains of a continual headache with
9/10 pain, you administer:
2300 – PRN Oxycodone 10mg
0000hrs
You review Vanessa and she complains of no improvement in he
headache, pain is 9/10, you administer her scheduled Panadeine
Forte.
At 0100 Vanessa rings her bell for assistance, she tells you, in a
distressed voice that she cannot move.
You attempt to do a full set of neurological observations and ask
Vanessa to lift her arms, she cannot, she is frightened. There is no
shaking, no stiffness to her limbs and her
eathing is normal. She
0100hrs
feels warm to touch and has a normal skin colour. You do not
assess any other limbs nor do you assess her GCS.
You do not believe she is in immediate danger and assume she has
had a bad dream. You offer reassurance and leave the room as you
have a new admission you must attend to urgently.
Within 10 minutes you return to Vanessa and perform a full set of
neurological observations, with no deficits noted, you are happy
with your original assumption that she had a bad dream.
0200hrs
Vanessa rang the bell to ask for assistance to use the toilet, she
can mobilise with some assistance.
Her pain remains unresolved, you give her PRN Oxycodone 10mg.
0400hrs
You have routine and neurological observations to conduct but as
she was ok when you walked her to the toilet 2hrs ago you decide
to not conduct these.
Her Dad a
ived on the ward at 0345 and he is fast asleep in the
chair in her room, you decide not to distu
them as she is finally
settled after her analgesia.
0530hrs
You go to check on Vanessa and find her unresponsive.
You initiate a MET call.
0635hrs Vanessa is pronounced dead, despite all attempts to resuscitateher.
Coroners
eview –
cause of
death.
Post-mortem:
Blunt head injury and mechanism of death most likely a
seizure. Unable to be formally determined.
Difficult to determine whether analgesia contributed – may
have caused respiratory depression.
Formal finding - Respiratory a
est due to depressant effect of
opioid medication
Additional resources:
Vanessa’s Law -
https:
www.parliament.nsw.gov.au
ill/files/2995/LA%202R.pdf
Articles:
https:
www.parliament.nsw.gov.au
ill/files/2995/LA%202R.pdf
https:
www.smh.com.au/national/how-system-fatally-failed-
vanessa XXXXXXXXXXgdry4u.html
https:
www.abc.net.au/news/ XXXXXXXXXX/hospital-e
ors-killed-
golfball-teen-corone
1022244
https:
www.mja.com.au/journal/2008/188/8
oyal-north-shore-
hospital-inquiry-analysis-recommendations-and-implications
Inquest: http:
docplayer.net/ XXXXXXXXXXInquest-into-the-death-of-
vanessa-anderson.html
15min video
https:
patientsafetyfornursingstudents.org
esources/medication-safety
Written Assessment 2: Case scenario two - Alex Braes
The below details the history of Alex’s multiple presentations before you
are given handover.
Wednesday
0318
Alex attends ED with his Dad, complaining of knee pain.
No observations were taken and Alex was told to go home and
come back later in the morning for an ultrasound.
0800
Alex returns to ED with his Dad for the ultrasound.
They assumed Drs would review his results, but ED was so busy
that no one was available to see him.
His vitals were not checked and again they were told to go
home and come back later.
1800
Alex and his Dad return to the hospital.
They are reviewed by a Dr with his ultrasound results. It states
that he ‘may have a torn tendon’. He was told to rest, ice, and
elevate his leg and to come back in 2wks if the pain wasn’t
etter.
Again, no one checked his vitals.
Thursday
Alex called his Dad early in the morning, who was at work telling
him the pain was worse and he was unable to walk.
His Dad immediately came home and called an ambulance. No
ambulance was available.
https:
www.smh.com.au/national/how-system-fatally-failed-vanessa XXXXXXXXXXgdry4u.html
https:
www.abc.net.au/news/ XXXXXXXXXX/hospital-e
ors-killed-golfball-teen-corone
1022244
https:
www.mja.com.au/journal/2008/188/8
oyal-north-shore-hospital-inquiry-analysis-recommendations-and-implications
http:
docplayer.net/ XXXXXXXXXXInquest-into-the-death-of-vanessa-anderson.html
https:
patientsafetyfornursingstudents.org
esources/medication-safety
1000 His Dad took him to emergency for a fourth time.
Alex was in so much pain he could not get out of the car so his
Dad asked the triage nurse for a wheelchair.
It took 25minutes for this to be
ought to his Dad.
1139
Alex was observed by the triage nurse through the window and
was asked to wait.
Alex asked his Dad for a pillow as he felt like he was going to
pass out.
His Dad went and spoke to the nurse and asked her for a pillow,
she didn’t provide one but left her post to check on him.
She noticed Alex was sweaty and moved him into a bed in the
emergency department.
1217 33hrs after Alex’s initial presentation to emergency, his vitalswere taken.
The triage nurse gives you this handover.
Identify: Mr Alex Braes, HRN: 123567, DOB: 07/05/2003
Situation:
Alex is a 18-year-old male from a community in
emote NSW
He has been admitted to the emergency
department with knee pain.
His Dad was wo
ied as he has been complaining
of increased pain and now cannot weight bear.
Alex feels like he is going to pass out.
You are caring for him in the ED.
Background:
He lives with his parents.
Recent ultrasound shows ? tendon tear to the R)
knee.
Airway: Own, patent
Breathing: RR 30, Sats 92% on RA.
Circulation: HR 125 bpm, BP 90/55 mmHg.
Disability: GCS 13/15
Assessment:
Exposure: Temp 38.5 oC
Alex has 2 x IVC’s inserted to both ACF’s.
Venous Blood Gas attended shows Potassium
3.1mmol/L
pH 7.10
Lactate 4mmol/L
Recommendations/Read
ack:
Medical orders