Application of health assessment, planning, implementation and evaluation of
professional nursing care to a clinical deterioration patient scenario
Weighting: 40%
Purpose: This assessment task is designed to develop the student’s ability to integrate theory into
practical clinical knowledge using a patient case scenario. This task is intended to encourage
students to practise writing and presenting researched material in a logical and concise manner that is
academically rigorous.
Therefore, each student is to demonstrate critical thinking, development of
argument, discerning use of resources and the application of the principles of academic writing.
Referencing, spelling and grammar, and overall presentation will also be assessed.
Word Count: 2500 words (+/- 10%)
Description
This assessment task allows students to demonstrate theoretical clinical knowledge around nursing
assessment, pathophysiology of factors impacting on clinical deterioration, planning of nursing care,
nursing and medical management, and evaluation of care. Students are required to answer the case
scenario questions provided.
Students should attempt all questions in the case study:
…You are a Graduate Nurse commencing your afternoon shift on a surgical ward. You have arrived in
recovery to collect your patient, Mr Yousef Kahil.
• 72-year-old Male who has had a Hartmann’s procedure resulting in the formation of a
colostomy.
• Past Medical History: Newly diagnosed bowel cancer, hypertension, hypercholesterolemia,
current
smoker (20 pack per day), Chronic Obstructive Pulmonary Disease.
• Nil Known Allergies.
You are handed over that the procedure went well with no complications. Mr Kahil was stable
throughout the recovery period. His observations pretransfer to the ward are;
Question 1: Describe the Hartmann’s Procedure including definition, indications, and
complications. Ensure you apply this discussion to Mr Kahil. (400 words)
• Alert and coherent
• Temperature: 35.9 and warm on palpation
• Pulse: 72 bpm and regular
• Blood Pressure: 110/72mmHg (MAP 65mmHg)
• Respiration: 16 bpm
• SpO2: 99% on 1lt intranasal delivery
• Pain: 1/10 (localised to abdomen, dull in characteristics)
Mr Kahil is transported back to your ward for ongoing management. When you arrive on the ward you
notice that Mr Kahil appears to be diaphoretic and cool to touch. You immediately complete a set of
vital signs:
• Drowsy
• Temperature: 35.1 and cool on palpation
• Pulse: 102 bpm and regular
• Blood Pressure: 91/58mmHg (MAP 60mmHg)
• Respiration: 14 bpm
• SpO2: 92% on 1lt intranasal delivery
• Pain: 1/10 (localised to abdomen, dull in characteristics)
Question 2: Review the above vital signs of Mr Kahil. Using your knowledge of the common
causes of clinical deterioration in the postoperative patient; state which likely reversible cause
(one of the 4H’s & 4T’s) Mr Kahil is experiencing and describe its pathophysiological cause
resulting in Mr Kahil’s deterioration. Ensure you include a discussion of the pathophysiology of the
reversible cause and link to the above vital signs. (600 words)
Question 3: Discuss THREE specific nursing assessments that would be prioritised for Mr
Kahil’s deterioration (excluding vital signs). For EACH nursing assessment, ensure your
discussion includes a description of these assessments in the context of Mr Kahil’s condition AND
clear rationale as to why these assessments would be priority. (450 words).
Question 4: Discuss THREE specific nursing interventions that YOU as a Registered Nurse
could initiate to manage Mr Kahil’s deterioration. For EACH intervention, ensure your discussion
includes link to evidence-based practice AND provides rationale as to how it would improve the
physiological outcomes of Mr Kahil’s condition. (450 words)
Questions 5: Mr Kahil is prescribed a bolus of intravenous isotonic crystalloid fluids. Describe
the indication for and physiological effect of administration of bolus fluids. Ensure you link to
the pathophysiology occurring in Mr Kahil’s deterioration and how intravenous fluids may assist. (450
words)
Question 6: Describe THREE nursing evaluations that you would complete in response to the
assessments and interventions you have completed. For EACH evaluation, provide a brief
rationale as to how these evaluations will assist in preventing the further clinical deterioration of Mr
Kahil. (150 words).