Assignment Task

Select a case for analysis depicting a patient whom you have cared for and who has demonstrated an acute change in clinical status (deterioration) that required immediate assessment and escalation in treatment.

Select a main patient problem that was evident.

• This assessment task enables you to deeply engage with the literature around the health status of an acutely ill patient. 
• Select a patient whom you have cared for who has demonstrated an acute change in clinical status.
• Describe the patient assessment linking identified changes to underlying pathophysiology abiding by ethical requirements. 
• Describe and relate the relevant pathophysiology to the patient’s primary problem and select one nursing and one medical intervention.
• Demonstrate critical engagement with the relevant evidence-based research by presenting work that shows critical analysis of the selected topic.

Topics

Think about a situation in your career where you witnessed a patient deteriorate. It doesn’t have to be a medical emergency, in fact, the interventions implemented may have prevented further deterioration. Some of the examples I have seen used include the list below. 

• Hypovolaemia
• Haemorrhage post-surgery
• Reduced level of consciousness/respiratory depression due to opioid
• APO
• Sepsis
• Heart failure (acute on chronic)
• Pneumonia
• Neonate with a acute respiratory distress
• Acute onset AF

I don’t understand what a nursing strategy is. Can you give me an example? This could be anything that a nurse initiates. The list below are some of the examples that have been used in the past but keep in mind the list is not exhaustive.

• Positioning of Patient
• Fluid balance monitoring
• Nursing strategies to reduce pain or reduce dyspnoea
• Monitoring respiratory status – deep breathing and coughing exercises, respiratory assessments
• Management of ICC
• Management of oxygen therapy

For example: To address the hypoxia that had resulted from aspiration post-extubation in the operating room, the patient was turned onto her left side. This nursing intervention allowed for drainage of the affected pulmonary lobe and improved ventilation to perfusion matching (reference). This paper will now present the relationship between patient positioning and the physiology underpinning aspiration pneumonia.

Research your selected scenario. Ensure you access recent publications (≤ 5 years) in order to support your discussion.

As part of your research focus on the following;

• Pathophysiological processes underpinning assessment findings and changes in vital signs.
• Applied pathophysiology underlying the key problem experienced by the patient.

Investigate two management strategies (one nursing and one medical) that addressed the patient problem linking these to the altered physiology. Locate current research on both interventions so that you can support your discussion with evidence. Compare current research publications on the topic.

 Points to consider

• We are not looking for a great amount of detail on your patient. The detail about the case can be presented in 1-2 paragraphs. No identifiable patient details are to be included in the paper. Rather you may want to refer to the patient as for example "Chloe Smith (pseudonym)".
• If you wish to include test results / patient parameters, present these in the form of an analysis rather than a list so that we can see that you are able to interpret these.
• For example The patient presented to the Emergency Department (ED) with hypotension as evidenced by a mean arterial pressure of 48mmHg. Oxygen saturation levels were low at 89% indicating hypoxemia and .
• As part of your introduction, present the scenario, refer to the key problem encountered and highlight the interventions chosen.
• Draw on current literature to support your patient assessment and how clinical deterioration was detected (See key points below).
• Present your key problem outlining the underlying pathophysiology and compensatory mechanisms at play.
• Having selected one nursing and one medical intervention discuss these in detail ensuring you demonstrate that you understand the relationship between the identification of the problem and the subsequent management provided.

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