CNA255: Scenario 1- Ms Nancy Huang Case Study

CNA255: Scenario 1- Ms Nancy Huang Case Study

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 demonstrates understanding of the relationship 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.

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Mostly accurate application of knowledge that indicates a reasonable 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 registered 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 reasoning with some capacity to think like a registered nurse, but scope for more depth.

Demonstrates a satisfactory approach to application of some elements of the clinical reasoning with some capacity to think like a registered 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. CNA255: Scenario 1- Ms Nancy Huang Case Study

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- based 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, but scope to consider additional evidence. Errors evident in referencing 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 errors.

Communicates with a strong academic writing style with clear evidence of planning, and presented in a logical and fluent manner.

Minimal spelling/grammar errors.

Communicates with a mostly academic writing style with some evidence of planning. Generally expressed in a clear and fluent manner.

Evidence of spelling/grammar errors that impact on flow of paper.

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

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

 

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 irritable 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 irritable and her husband decided to call an ambulance once they arrived 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. CNA255: Scenario 1- Ms Nancy Huang Case Study
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 irritable 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 broad understanding of what is/may be occurring 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). CNA255: Scenario 1- Ms Nancy Huang Case Study

 

CNA255: Scenario 1- Ms Nancy Huang Case Study