Assessment One
 
Type: Oral presentation 
Due date: Thursday 4th April (Week 5) 2355 AEST (Australia Eastern Standard Time) 
Weighting: 50% 
Length: 8-10 minutes 
Unit Coordinators: Trish Johnson, Stephen Yu, and Lucinda Brown 
 
Aim 
This assessment aims to demonstrate critical thinking and clinical reasoning in the care of a person with an acute alteration in health presenting to the Emergency Department (ED). The information required to undertake this assessment is covered in Modules 1- 4.  
 
Scenario Patient presentation to ED (Emergency Department) of Mrs Alison Smithson 
 
Monday morning at 0930 hours 
Mrs Alison Smithson is a 79-year-old female who lives alone in a small flat close to Caring Hospital, where you are currently working as a graduate nurse in the Emergency Department (ED). Alison was brought to the ED via ambulance following a fall at her home. The ambulance was contacted by the neighbour Bill, as he could not get Alison to answer the door.  
 
The ambulance officers found Alison lying on the floor near the toilet, unable to move due to significant pain in her left hip and ribs. She seemed mildly dazed, had a small graze on her left forehead, and was noted to be incontinent of urine. Her observations at the scene indicated that she was tachypneic and hypothermic. 
 
The ambulance officers insert a 16g Intravenous (IV) cannula and commence an IV infusion of Normal Saline (NS) 1 litre running at 82 mls/hour. They administered 2.5mg of IV morphine before transporting her to the hospital. She presents with a fractured left neck of femur (NOF) and possible fractured ribs, confusion, and a possible urinary tract infection. The ambulance officers inform you that the neighbour stated that Alison was normally fit and active, had no history of dementia, and was currently taking Metoprolol 50mg daily. She has no allergies, and her vaccinations are all up to date. Alison is divorced and lists her next of kin as her brother Luke who lives interstate. Based on the information provided, Allison was triaged as a category three before being moved to a cubicle for further assessment and management. 
 
ED 1000 hours 
The ED Registrar has reviewed Alison and ordered the following: Bloods for Full Blood Count (FBC), Urea and Electrolytes (U&Es), and Liver Function Tests (LFT). Bedside testing for lactate, venous blood gases, and Troponin, IV Paracetamol 1 gram, X-ray of Left hip, pelvis, and chest, and Computed Tomography (CT) head. She is to be seen by the orthopaedic team shortly for review. 
Your buddy Registered Nurse (RN) Troy asks you to begin the further assessments required for Alison and informs you that he will be with you to assist once he finishes with another patient. You then introduce yourself to Alison and explain to her the nursing activities that you will be performing. You note that she seems slightly confused as to her surroundings. You undertake a set of observations and record the following: Respiratory rate (RR): 28 per minute, SpO2: 93% on room air, Blood Pressure (BP):116/88mmHg, Pulse Rate (PR): 72 per minute and regular, Temperature: 35.9"C, Glasgow Coma Score (GCS): 14, Pain score, using numeric scale as 6/10, with complaints of pain on her left side in the lower thoracic area.  
 
Shortly afterward, another RN Sabina arrives to assist you as Troy has been called away to see another patient. Sabina asks for a full handover as she has just come to help from another area and has no information regarding Alison’s situation. Sabina is interested in educating and supporting new graduate nurses, so she also asks you to explain the rationale for the interventions that have been implemented so far. 
 
Instructions 
You will need to present an overview of a patient experiencing an acute alteration in health presenting to the ED and provide a structured handover to the RN. 
To do this, you are required to develop an 8–10-minute oral presentation using PowerPoint (PPT) slides to address the points below.  
Your PowerPoint slides need to provide the main points only of your discussion, set out clearly and logically That is, you will talk about your points and expand on them throughout your discussion. 
Present your PPT verbally as a video presentation. Instructions for compiling and submitting your presentation are provided on the unit Moodle site under the Assessment Tile/Assessment One (1). 
 

Literature and references 
In this assessment use at least five contemporary references (<5 years) to support your discussion. All work should be in your own words. You may also use seminal scholarly literature where relevant. Suitable references include peer-reviewed journal articles as well as textbooks and credible websites. When sourcing information, consider the 5 elements of a quality reference: currency, authority, relevance, objectivity, and coverage. Information sourced from the internet must be from reputable websites such as from government, university, or peak national bodies: for example, the Australian College of Nursing.  
 
Requirements  
Use a conventional font such as Times New Roman or Arial and ensure that the font size is appropriate (legible and readable) on ppt slides. 
You can present in the first-person perspective.  
Use formal academic language. 
Use the seventh edition American Psychological Association (APA) referencing style. The CQUniversity Academic Learning Centre has an online APA Referencing Style Guide. 
 
Resources 
You can use unit-provided materials and other credible sources (e.g., journal articles, and books) to reference your argument. The quality and credibility of your sources are important.  
We recommend that you access your discipline-specific library guide: the Nursing and Midwifery Guide; 
 
Submission 
Submit your assessment via the unit Moodle site as per instructions.  
 
Marking Criteria 
Refer to the marking rubric on the Moodle site for more details on how marks will be assigned. 
 
Learning Outcomes Assessed  
1. Explain the pathophysiological changes that occur when a person experiences acute alterations in health.  
2. Apply the decision-making framework for the Nursing and Midwifery Board of Australia (NMBA) (2020) to prioritise and justify care for the person experiencing acute alterations in health.  
3. Examine the role of the nurse and other members of the interdisciplinary team in the care of a person in a complex care environment.  
4. Analyse and apply the best available evidence, for safe, quality practice for a person experiencing an acute alteration in health.  

UNIT CODE: NURS13141 

ASSESSMENT 1 MARKING RUBRIC 

Assessment Two (2) 
Type: Case Study 
Due date: Thursday 23rd May (Week 11) 2355 AEST (Australian Eastern Standard Time) 
Weighting: 50% 
Length: 1200 words (+/- 10%) 
Unit Coordinators: Trish Johnson, Stephen Yu, and Lucinda Brown 
 
Aim 
The aim of this assessment is for you to demonstrate your knowledge regarding the management of a person with an acute alteration in health.  
Instructions:

 
Case Study - Mrs Alison Smithson  
Time and Location: 0720, Orthopaedic Ward 
 
You are a graduate RN assigned to the care of Mrs Alison Smithson. The night duty nurse gives you the following ISBAR handover at the bedside. 
 
Identity: This is Mrs Alison Smithson, a 79-year-old lady who identifies as female and uses she/her pronouns. Her UR number is 123456 and her Date of Birth is 01/01/1945. 
 
Situation:  Alison was admitted to the Orthopaedic ward at 2200 hours yesterday for routine post-operative management of an open reduction and internal fixation of a fractured left neck of femur (NOF), following a fall at home.  She also has fractured the third and fourth ribs on her left side. 
She is currently in a stable condition but due to her age and surgery, she may be at risk of deterioration.  
 
Background: Alison lives at home alone. She was brought into the Emergency Department by ambulance and pre-operation it was noted that she had mild confusion with a Glasgow Coma Score of 14. She had been incontinent of urine post-fall and had a small graze on her left forehead. She has a history of hypertension which is managed by medication.  Alison has a drain in her left leg, and she has an indwelling catheter (IDC) in situ which is on free drainage. She has a 14g Intravenous cannula in her Right antecubital fossa (ACF) which has Sodium Chloride 0.9% running 12th hourly. She has a Patient Controlled Analgesia (PCA) prescribed for pain relief. Alison is tolerating oral fluids and can commence a light diet today. Alison currently has knee-high Thrombo-Embolic Deterrent (TED) stockings on both legs. 
 
Assessment: Alison has been stable and comfortable overnight, all observations are within normal limits, and her Glasgow Coma Score (GCS) is 15. Alison’s wound is clean and dry, and her drain tube drained a small amount of frank blood overnight.  
 
Recommendations: Alison will be reviewed by the physiotherapist this morning and until then will be strict rest in bed. She will need daily enoxaparin, and will be reviewed by the surgical team this afternoon. 
 
0800: You introduce yourself to Alison and discuss with her the nursing care needed this morning. While you are waiting for assistance from another RN with her bed bath, you observe that her facial colour has changed from pink to grey. Alison clutches her chest and says, “I suddenly feel terrible”.  
 
Instructions: (1200 words + 10%) 

Please outline four (4) prioritised and appropriate nursing actions (250 words per action) and one (1) Multi-Disciplinary Team action (200 words) in the care of Alison in managing this sudden deterioration in health. Include the rationale and evidence for each action. Use the headings Nursing Action or (Multidiscipline Action); Rational and Evidence under each action point
 
Literature and references 
In this assessment use at least 7 contemporary references (<5 years journal articles and <7 years for books) to support your discussion. References must be valid and relevant. You may also use seminal scholarly literature where relevant. Suitable references include peer-reviewed journal articles as well as textbooks and credible websites.  
When sourcing information, consider the 5 elements of a quality reference: currency, authority, relevance, objectivity, and coverage. Grey literature sourced from the internet must be from reputable websites such as from government, university, or peak national bodies: for example, the Australian College of Nursing. Please note that websites such as Stat Pearls, Life in the Fastlane, and Wikipedia are generally not suitable for this assessment task. Lecture notes are not primary sources of evidence and should not be used in this assessment.   
 
Requirements  
Use a conventional and legible size 12 font, such as Times New Roman or Arial, with double line spacing and 2.54cm page margins (standard pre-set margin in Microsoft Word). 
Write in the third-person perspective.  
Use formal academic language. 
Use the seventh edition American Psychological Association (APA) referencing style. The CQUniversity Academic Learning Centre has an online APA Referencing Style Guide. 
The word count excludes the reference list but includes in-text references and direct quotations.  
   
Resources 
You can use unit-provided materials and other credible sources (e.g., journal articles, and books) to reference your argument. The quality and credibility of your sources are important. 
We recommend that you access your discipline-specific library guide: the Nursing and Midwifery Guide; 
Submit a draft before the due date to review your Turnitin Similarity Score before making a final submission. Instructions are available here.   
 
Submission 
Submit your assessment via the unit Moodle site in Word format only. 
 
Marking Criteria 
Refer to the marking rubric on the Moodle site for more details on how marks will be assigned. 
 
Learning Outcomes Assessed   
1. Explain the pathophysiological changes that occur when a person experiences acute alterations in health.   
2. Apply the decision-making framework for nursing (Nursing Midwifery Board Australia (NMBA) 2020) to prioritise and justify care for the person experiencing acute alterations in health.   
3. Examine the role of the nurse and other members of the interdisciplinary team in the care of a person in a complex care environment.   
4. Analyse and apply the best available evidence for safe quality practice for a person experiencing an acute alteration in health.