clinical reasoning quote
CNA155 AT2 Case-study 2020 Zac Smyth is 18-year-old university student who lives on-campus as his parents reside in another state. Zac is studying engineering and enjoys university life. Zac has a part-time job working at the local supermarket for 15 hours each week. Zac has no immediate family in the state, but he has a friend of his parents that he sees from time to time. Zac usually goes home to his family during his breaks but due to his work commitments Zac has not seen his mum, dad, and younger brother for the past 4 months. Last evening Zac went out to the local pub with a few friends from university. There was a new band playing at the pub and Zac was especially excited to be going. To save money Zac and his friends met up at a friend’s house for ‘pre-drinks’. During this time Zac drank around four full strength beers. When Zac and his friends arrived at the pub, they headed straight for the bar to get another beer. Zac and his friends were having a great night, the music was good, and the pub was busy. Later in the evening Zac started talking to a friendly young woman, shortly after Zac was approached by a man who aggressively accusing Zac of talking to his girlfriend. Zac apologised and returned to his group of friends. Approximately an hour later Zac said goodbye to his friends as he decided to head home. As Zac was leaving the pub, he was followed out by the man who had earlier confronted him. The man was still verbally aggressive and ended up pushing Zac to the ground, resulting in Zac hitting his head on the cement curb of the road. The security guard saw this incident and intervened. Whilst Zac was not punched, he did sustain a laceration to the back of his head. The security guard noticed quite a bit of bleeding and rang an ambulance. When the ambulance arrived, Zac had a GCS of 15 and could recall the whole incident. Zac appeared to have no other injuries. The paramedics undertook vital sign which they stated were ‘normal’ and applied a bandage to Zac’s head wound. The security guard stated that he ‘didn’t think Zac lost consciousness’. On arrival to the emergency department, the triage nurse undertook a set of vital signs, GCS and assessed the wound. The triage nurse also took a history from Zac. Vital signs: Blood Pressure: 141/88 mmHg Heart Rate: 90 beats/minute Respiratory Rate: 17 breaths/minute Pulse Oximetery: 99% on room air Temperature: 36.0 c (tympanic) GCS: Eyes 4 Verbal 4 Motor 6 Head wound: 4cm laceration to the occipital region, small amount of blood oozing from the wound. May require sutures/staples. Triage: 18-year-old male, brought in by ambulance following an alleged altercation where patient struck head on road curb at 2300 hrs. Patient is denies loss of consciousness but unable to recall all events. Pt appears alert but teary. On examination, 4cm laceration noted with slow ooze from wound. Dressing insitu. Vital signs and GCS recorded at 2325 hrs as per chart. No other obvious injuries. Pt denies drug use, states has had approximately ‘five beers since 7pm’. Breath alcohol taken at 2330 hours 0.06%. Pt reports pain to be 5/10 at occipital region, no analgesia taken prior to presentation. Pt states is usually fit and well. Past medical history: Childhood asthma, up-to-date with immunisations (last tetanus 12 months ago). Not on any medications and no known allergies. How to approach this assessment item Ensure that you answer the questions and avoid simply providing generic information. You must continually link back to the patient and their condition. Do not expect the marking staff to make the connections between the information that you provide. You must make them explicitly yourself so that it is clear that you understand every element of what you have written. Also, don't lose the patient in your answer - their condition and the positive health outcomes that you intend for them need to be the clear focus throughout. Please consider yourself to be the registered nurse on duty, and the first nurse to provide care to the patient after he was triaged. Ensure that you remain within your scope of practice as a registered nurse. It is expected that you will identify and describe a minimum of three nursing assessments of greatest priority, and justify your decision by linking the assessments back to the cues and underlying pathophysiology of the patient's presentation. Headings and tables may be used in this assignment. If you do utilise tables, remember that the information within the table will need to be discussed in greater detail and linked back to the your patient. Please ensure you support your statements and assertions with either contemporary (less than ten years since publication) literature or appropriate clinical guidelines. This is important as the references add value to your statements. We are providing you with a version of the marking rubric that will be applied to this assessment item. It provides a break-down of the weighting of marks for each criterion and indicates the requirements for each grade. You may wish to use this to assist you in understanding, more fully, the expectations that we have in terms of content and quality. CNA155 AT2 2020 Clinical Reasoning Report Objective/Criteria Performance Indicators HD 7 – 5.6 marks DN 5.5 – 4.9 marks CR 4.8 - 4.2 marks PP 4.1 – 3.5 marks NN 3.4 - 0 marks Consider the patient: 7 Marks Explains what is significant about the patient’s profile i.e. age, health specific issues, medical history and risk factors, making links to the presenting situation. Views the person against a background of their own age, health specific issues, medical history, and risk factors where applicable. Considers health- specific issues/medical history. Makes links to why this is significant. Forms an initial impression and makes a basic assumption about what might be occurring at the time. Recalls facts about the case accurately with sensible interpretation of the significance of the person’s profile i.e. age, health specific issues, medical history and risk factors. Gains an initial impression and makes a basic assumption about what might be unfolding. Recalls facts about the case accurately with reasonable interpretation of the significance of the person’s profile i.e. age, health specific issues, medical history and risk factors. Gains a good initial impression of the person in the case. Recalls the facts in the case accurately but with vague interpretation of the significance of the person’s profile i.e. age, health specific issues, medical history and risk factors. Forms a basic impression of the person in the case. Recalls facts within the case only, with or without accuracy. Does not make an interpretation of the patients profile i.e. age, health specific issues, medical history and risk factors. Does not develop an initial impression of the person in the case. HD 11 – 8.8 marks DN 8.7 – 7.7 marks CR 7.6 – 6.6 marks PP 6.5 – 5.5 marks NN 5.4 - 0 marks Collect Cues/Information: 11 Marks Reviews information available. Demonstrates a clear understanding of new assessments required for the situation. Demonstrates clinical reasoning in identifying the most pertinent new nursing assessments required. Links assessments to a clear understanding of what is going on with the patient from a functional and structural perspective within the brain. Recalls knowledge of the bio scientific principles underlying the case. Reviews all information currently available. Correctly determines cues that are relevant to collect, decides on new nursing assessment data to be collected, states the assessment techniques/tools of highest priority to be used. Can link assessments and cue collection on knowledge from a nursing and bioscience perspective of the patient’s situation. Reviews in detail most information currently available. Correctly determines most of the cues that are relevant to collect, decides accurately on most of the new nursing assessment data to be collected. States accurately most techniques and tools of priority to be used. Cue collection is accurately based on nursing and bioscience knowledge relating to the patients situation Reviews most information available. Determines reasonable cues that are relevant to collect and decides on reasonable new nursing assessment data to collect. States reasonable techniques and tools for assessment. Cue collection is based on reasonable nursing and bioscience knowledge relating to the patient’s situation. Reviews some of the information available. Determines some cues that are relevant to collect. Decides on some new nursing assessments data that is relevant to collect. States some techniques or tools of assessment. Cue collection is based on some nursing and bioscience knowledge relating to the patient’s situation. Lists cues provided in the case, no review. Cannot determine which cues are relevant to collect. New assessments are either not relevant or not suggested. Does not state the techniques or tools to be used in new cue collection. No links to the patient’s situation. HD 9 – 7.2 marks DN 7.1 – 6.3 marks CR 6.2 – 5.4 marks PP 5.3 – 4.5 marks NN 4.4 - 0 marks Process Information: 9 Marks Demonstrates understanding of the most important and relevant cues related to the neurological system in this case. Able to cluster cues in relation to the suspected problem in the case. Able to make a suggestion based on analysis of the case to make logical inferences about what the patient is experiencing. Narrows down all the important information and the relevant cues in the case. Clusters all cues and recognises patterns relating to the suspected problem underlying the case. Forms an accurate and logical opinion about what the patient is experiencing. Narrows down on