Written assignment: Deteriorating patient project 3,000 words (30%) Assignment goal: The aim of this assignment is to build on your prior clinical experience, knowledge and skills, enabling you to assess and manage a patient with a complex disease process with the potential for clinical deterioration. There will be an emphasis on the following elements: · The underlying disease process (pathophysiology) · Clinical assessment findings · Evidence based management The learning outcomes for this assignment are aligned with unit learning outcomes: 2, 4, 5, 7 & 9. INSTRUCTIONS: This assignment is based on the case scenario of a patient developed by you. We have planned this assignment this way because it empowers you to draw on prior knowledge and experience. It will also stimulate your thinking about how patients present clinically and how this links to their disease process and ultimately your management of them. 1. Start this assignment by developing a profile of a patient presenting to a health care facility with sepsis. You can make your patient profile as simple or complex as you like, but there are some requirements listed below. The most important part of this is; your patient profile should be plausible (realistic). Create an ISBAR template and insert your patient details into it, this should go into the appendix of your assignment and it will be marked. Include the following details: · The name and age of your patient. · The reason why they presented to a healthcare facility or “their story”. This should be a few sentences. The patient story should clearly identify the potential source of infection and include at least two presenting symptoms. You can use chapter 63 in your prescribed text for help with this. An example is provided here: ( YOU MUST CREATE YOUR OWN CASE, THIS IS AN EXAMPLE ONLY) “Joan is a 72-year-old female. She was bought into the emergency department by her daughter who was concerned that Joan had not been managing as well as she usually does and seemed to be a bit confused. On assessment, Joan was confused, GCS 14/15, febrile 39 0C and complained of incontinence and nocturia.” · Past medical history (two conditions) · Current medications (a minimum of two) · Baseline assessment findings for your patient on initial presentation (At least two of the vital signs must meet the diagnostic criteria for sepsis (refer to chapter 63 in your prescribed text for this)) · Your recommendations – what initial management should your patient receive? (identify two) 2. Start with an introduction to your assignment. Don’t include all the case details, we will find these in your IBSAR template. Your introduction should inform the reader what they are going to read about in your paper. It’s also useful to include some interesting fact/information/statement to get the reader’s attention. 3. Provide a definition of sepsis and discuss two of the diagnostic criteria (assessment findings) for sepsis identified in your patient. Explain how your two criteria link to the underlying pathophysiology of sepsis. 4. Your patient was initially managed in the emergency department (ED). Discuss the initial management of a patient presenting with sepsis. Include in your response: · An overview of the approach to patient assessment (you do not need to describe each step in detail). · Discuss two initial collaborative (nursing/medical) interventions, using evidence based literature to support a rationale for each intervention. 5. You are taking a handover from the ED nurse in preparation to receive the patient on the ward. You realise the nurse hasn’t mentioned any diagnostic test results. Choose two diagnostic tests relevant to your patient. Explain each one and provide a rational for their use in a patient with sepsis and what result you would expect for your patient. 6. The nurse has also forgotten some important clinical assessment information. Choose two clinical assessment findings that would indicate to you that this patient is safe for transfer to the ward and provide a rationale for choosing each finding. 7. Your patient arrives on the ward; you are concerned about your patient developing septic shock and you want to be able to prevent this or detect it early. To be able to do this you need to have a solid understanding of the pathophysiology of septic shock. · Explain the pathophysiology of septic shock. Include in your response the key pathophysiological mechanisms in septic shock (these can be identified in the septic shock flow chart in chapter 63 of your prescribed text. Guide your response according to this flow chart) 8. Choose three assessment findings that would indicate your patient was deteriorating. Explain each of these and provide rationales. 9. You finish your shift and your patient has remained stable due to your vigilant care and close monitoring. Unfortunately, you return the following morning to find your patient deteriorated to septic shock overnight. a. Discuss the use of inotropes (vasopressors) in the management of septic shock, include rationales and evidence from the literature. b. Discuss one form of invasive monitoring for a patient with septic shock. Include the information this monitoring will provide and a rationale for using it from the literature. 10. Summarise your key points in a conclusion. 11. Evaluate your work – You are required to honestly evaluate your own work by completing the marking rubric available on Moodle, including allocating a perceived mark for each criterion. In the comments section you need to write one (1) strength and one (1) weakness of your assessment. The feedback your marker will provide will be in response to your self-feedback and will focus on the discrepancy between the mark you have allocated your assessment and the mark allocated by your examiner. There are no marks allocated for completing the self-evaluation. 12. Submit your assignment! You have one opportunity to submit your work through Turnitin prior to submission. 13. You have finished! What you need to do in a nutshell: · Introduction · Define sepsis, discuss two diagnostic criteria for sepsis identified in your patient and explain the related pathophysiology of these. · Provide an overview of the initial assessment approach in the ED. · Discuss two initial collaborative (nursing/medical) interventions, using literature to support your rationale for each one. · Explain two diagnostic tests, providing a rationale for their use in sepsis and what result you might expect for your patient. · Choose two clinical assessment findings that would indicate your patient is safe for transfer to your ward and provide a rationale for each finding. · Explain the pathophysiology of septic shock. · Choose three assessment findings that would indicate your patient was deteriorating and provide rationales. · Discuss the use of inotropes and provide a rationale for their use in a patient with septic shock. · Discuss one form of invasive monitoring, the information it will provide and provide a rationale for using it in a patient with septic shock. · Conclusion · Complete rubric, including comments · ISBAR template in appendix Format: You MUST use the following headings to present your work: · Introduction (approx. 150 words) · Sepsis: definition, assessment and management ( approx. 800 words) · Handover: diagnostic tests and safe parameters (approx. 400 words) · Septic shock: pathophysiology and assessment ( approx. 1000 words) · Septic shock: management ( approx.400 words) · Conclusion (approx. 150 words) In the appendix: · ISBAR template with your patient profile. (approx.100 words) · Rubric for self- assessment, one strength and one weakness of your work. Presentation guidelines: Some hints and tips for success: · This is an academic assignment, use references to support your discussion points throughout. · Use third person throughout, avoid using “I” or “You”. · Provide a brief overview of your patient’s presentation, but don’t ‘list’ all of their details and history in the introduction. · Use the headings so your work can be presented clearly. · Do some reading around sepsis and septic shock before you start. · Use up to date recent literature and guidelines, particularly when discussing the management of your patient · For the patient profile, read about sepsis first and then this part will make sense · Make sure your patient is realistic to be awarded marks for this part. If you use the example case provided instead of developing your own, you will not be awarded marks for this part · Minimum 12 peer reviewed journals as references.