Explain common pathophysiology

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NSG3RDP Semester One 2023
SCHOOL OF NURSING & MIDWIFERYSample Page
NSG3RDP/RDM – Recognising and Responding to the Deteriorating
Patient Assessment activity 2 – 2000 words (30% of overall subject
mark) Due date: May 8th 2023
Subject Intended Learning Outcomes (SILOS)
1. Explain common pathophysiology, as it relates to assessment data and pharmacology, that can
result in deterioration of an individual’s condition in order to develop appropriate interventions.
2. Apply the clinical reasoning cycle to provide person-centred care for individuals experiencing a
deterioration in health in order to provide safe nursing care.
3. Develop an awareness of and contribute to the risk management strategies of a healthcare
agency, in order to implement incident reporting procedures and apply risk management
procedures.
Context
Serious adverse events, such as unexpected death, intensive care admission and cardiac arrest, are
often preceded by observable physiological, clinical abnormalities and deterioration. Other serious
events, such as suicide and aggression, are also often preceded by observed or reported changes in a
person’s behaviour or mood that can indicate deterioration in their mental state.
Early identification of deterioration may improve outcomes and decrease interventions required to
stabilise patients whose condition deteriorates in a health service organisation.
The warning signs of clinical deterioration are not always identified or responded to appropriately.
The organisational and workforce factors that contribute to a failure to recognise and respond to a
deteriorating patient are complex and overlapping (Australian Commission on Quality and Safety in
Health Care, 2017)
NSG3RDP Semester One 2023
Task
In this assessment you are required to further explore the paediatric respiratory case study
introduced in topic one of your LMS and workshop materials for NSG3RDP/RDM.
You will be provided with an ISBAR handover and a National Observation Chart (NOC) for 5-yearold Rosie Jones. (These documents will be attached at the end of this instruction sheet)
Using the provided information and current academic literature please provide a response to the
following three questions.
Instructions
Please answer the following questions as instructed
• Question 1 (750 words)
The condition of your patient Rosie Jones described in the ISBAR handover, appears to be
changing. (Please refer to the attached documentation)
Using the information that you have identified from the NOC and the ISBAR case study
handover:
1. Discuss the possible causes of Rosie’s changing condition, supporting your
response with contemporary literature and the associated significant cues, signs
and symptoms listed in the case study.
2. Explain what possible further deterioration could occur for this patient, with a
detailed evidenced -based response.
(Please support your justification and rationales with quality peer-reviewed literature).
• Question 2 (750 words)
There are many tools that can be utilised when assessing paediatric patients. When
assessing a deteriorating child, accurate assessment is essential. Compare and contrast the
following methods of paediatric patient assessment and their appropriate applications for
the deteriorating patient.
1. Primary (ABCDE)
2. Head to toe assessment
(Please support your discussion with evidenced based literature).
• Question 3 (500 words)
A change in a patient’s heart rate, blood pressure, temperature and respiratory rate can all
be an indication of clinical deterioration. It has been suggested that a changing respiratory
rate is the earliest indication of clinical deterioration and yet it is often not measured
correctly, or not measured at all. Using evidence-based literature to support your
arguments:
1. Discuss why a changing respiratory rate is an important indicator of clinical
deterioration.
2. Explain how the respiratory rate can be measured reliably and accurately in Rosie.
NSG3RDP Semester One 2023
**Discussions are to be supported with relevant and contemporary literature.
**References: Reference list and appendices are excluded from the word count.
**References to be no older than ten years
**10% word limit allowed.
Resources
Australian Commission on Quality and Safety in Health Care. (2017). National Quality and Safety
Health Care Standards Edition Two. Retrieved from
https://www.safetyandquality.gov.au/wp-content/uploads/2017/11/National-Safety-andQuality-Health-Service-Standards-second-edition.pdf
GENERAL ASSESSMENT REQUIREMENTS
SUBMITTING WRITTEN WORK WITH TURNITIN
Turnitin is a web-based text-matching software system used at La Trobe University to assist you in
writing your assignments and checking for similarity with existing published work. Please remember to
allow adequate time to submit your assignment to Turnitin. It is your responsibility to have your
assignment submitted by the assessment due date. Not receiving an originality report is not an
acceptable reason for requesting an assignment extension unless it is a required part of the assessment.
POLICIES, PROCEDURES AND GUIDELINES
The University has a comprehensive policy framework to which both staff and students must adhere.
You should familiarise yourself with those policies, procedures, and guidelines likely to affect you
especially the following:
• Academic Integrity
• Academic Progress Review
• Assessment Policy
• Adjustments to Assessment, including extensions to submission dates and Special Consideration
• Validation and Moderation, including applications for review and re-mark
ADJUSTMENTS FOR ASSESSMENT
You may be affected by a range of adverse circumstances while you are preparing for or undertaking an
assessment task. There are avenues for adjustments to your assessment depending on the
circumstances you face. For more detailed information refer to the Assessment Procedure –
Adjustments.
REQUEST AN EXTENSION OF TIME TO SUBMIT AN ASSIGNMENT TASK
Where you know in advance that you will not be able to submit an assessment task by the due date due
to adverse circumstances that have affected you during the preparation of the task, you will need to
request an extension of time to submit. This must be done at least three days prior to the due date.
NSG3RDP Semester One 2023
Penalties normally apply if you submit an assessment after the due date. Poor time management is not
an acceptable reason for an extension.
To apply, go to https://www.latrobe.edu.au/students/admin/forms/request-an-extension/request
SPECIAL CONSIDERATION
If you have experienced serious short term, adverse and unforeseen circumstances that substantially
affect your ability to complete an assessment task to the best of your potential, you may be eligible to
apply for Special Consideration. To do this or find more information, go to
http://www.latrobe.edu.au/special-consideration
Late submission
There are policies and procedures to guarantee fair, consistent, and transparent treatment of late
submission of assessment tasks provide equity around extensions to submission dates and penalties
associated with not submitting assessment by the due date and time.
https://intranet.latrobe.edu.au/teaching-and-learning/teaching-support-and-tools/assessment-policy
NSG3RDP Semester One 2023

School of Nursing & Midwifery: NSG3RDP/NSG3RDM Assessment One
CRITERIA Excellent (> 80 %) Very good (70% – 79%) Good (60% – 69%) Fair (50% – 59%) Poor (<50%) MARK
Question One
Discusses the possible
causes of Rosie’s
changing condition
Explains what possible
further deterioration
could occur
USE OF LITERATURE TO
SUPPORT DISCUSSION
(35% of total mark)		 28 + marks
Clearly and consistently
discuss possible causes of
the Rosie’s changing
condition
Clearly and consistently
explains what possible
further deterioration
could occur
Demonstrated an
excellent understanding
of links between the
necessary concepts.
Demonstrated clear and
consistent evidence of
critical appraisal of
reference material
Evidence of synthesis of
information and logical
development of
arguments		 24 – 27 marks
Clearly and mostly
consistently discuss possible
causes of the Rosie’s
changing condition
Clearly and mostly
consistently explains what
possible further deterioration
could occur
Demonstrated a very good
understanding of links
between the necessary
concepts.
Demonstrated some
evidence of critical appraisal
of reference material
Some evidence of synthesis
of information and logical
development of arguments
Literature predominantly
used effectively to support
key ideas		 21 – 23 marks
Good but inconsistent
attempt to consistently
discuss possible causes of the
Rosie’s changing condition
Good but inconsistent
attempt to consistently
explain what possible further
deterioration could occur
Demonstrated good
understanding of links
between the necessary
concepts.
Demonstrated inconsistent
evidence of critical appraisal
of reference material
Inconsistent evidence of
synthesis of information and
logical development of
arguments
Literature inconsistently used
to support key ideas		 18 – 20 marks
Fragmented and
inconsistent attempt to
discuss possible causes of
the Rosie’s changing
condition
Fragmented and
inconsistent attempt to
explain what possible
further deterioration could
occur
Demonstrated limited
understanding of links
between the necessary
concepts.
Demonstrated limited
evidence of critical
appraisal of reference
material
Limited evidence of
synthesis of information
and logical development of
arguments
Literature poorly used to
support key ideas		 <17 marks
Demonstrated lack of
understanding of possible
causes of the Rosie’s
changing condition
Demonstrated lack of
understanding of what
possible further
deterioration could occur
Demonstrated lack of
understanding of links
between the necessary
concepts.
No evidence of critical
appraisal of reference
material
No evidence of synthesis
of information and logical
development of
arguments
Overreliance on direct
quotes Key ideas not
supported by the
literature		 /35

NSG3RDP Semester One 2023

Question Two
Compares and
contrasts
1. Primary (ABCDE)
2. Head to toe
assessment
USE OF LITERATURE TO
SUPPORT DISCUSSION
(35% of total mark)		 28 + marks
Clearly and consistently
compared the two
methods of assessment
Demonstrated an
excellent understanding
of links between the
necessary concepts.
Demonstrated clear and
consistent evidence of
critical appraisal of
reference material
Evidence of synthesis of
information and logical
development of
arguments		 24 – 27 marks
Clearly and mostly
consistently compared the
two methods of assessment
Demonstrated a very good
understanding of links
between the necessary
concepts.
Demonstrated some
evidence of critical appraisal
of reference material
Some evidence of synthesis
of information and logical
development of arguments
Literature predominantly
used effectively to support
key ideas		 21 – 23 marks
Good but inconsistent
attempt to compare the two
methods of assessment
Demonstrated good
understanding of links
between the necessary
concepts.
Demonstrated inconsistent
evidence of critical appraisal
of reference material
Inconsistent evidence of
synthesis of information and
logical development of
arguments
Literature inconsistently used
to support key ideas		 18 – 20 marks
Fragmented and
inconsistent attempt to
compare the two methods
of assessment
Demonstrated limited
understanding of links
between the necessary
concepts.
Demonstrated limited
evidence of critical
appraisal of reference
material
Limited evidence of
synthesis of information
and logical development of
arguments
Literature poorly used to
support key ideas		 <17 marks
Demonstrated lack of
understanding of the two
methods of assessment
Demonstrated lack of
understanding of links
between the necessary
concepts.
No evidence of critical
appraisal of reference
material
No evidence of synthesis
of information and logical
development of
arguments
Overreliance on direct
quotes Key ideas not
supported by the
literature		 /35
Question Three
Discusses why a changing
respiratory rate is an
important indicator of clinical
deterioration.
Explains how the respiratory
rate can be measured reliably
and accurately
USE OF LITERATURE TO
SUPPORT DISCUSSION		 20 + marks
Clearly and consistently
discusses the changing
respiratory rate
significance and explains
the means of achieving
assessment accuracy
Demonstrated an
excellent understanding
of links between the
necessary concepts.
Demonstrated clear and
consistent evidence of
critical appraisal of
reference material		 17.5-19.5 marks
Clearly and mostly
consistently discusses the
changing respiratory rate
significance and explains the
means of achieving
assessment accuracy
Demonstrated a very good
understanding of links
between the necessary
concepts.
Demonstrated some
evidence of critical appraisal
of reference material
Some evidence of synthesis
of information and logical		 16-17 marks
Good but inconsistent
attempt to consistently
discuss the changing
respiratory rate significance
and explain the means of
achieving assessment
accuracy
Demonstrated good
understanding of links
between the necessary
concepts.
Demonstrated inconsistent
evidence of critical appraisal
of reference material		 13 – 15 marks
Fragmented and
inconsistent attempt to
discuss the changing
respiratory rate significance
and explain the means of
achieving assessment
accuracy
Demonstrated limited
understanding of links
between the necessary
concepts.
Demonstrated limited
evidence of critical
appraisal of reference		 <12.5 marks
Demonstrated lack of
understanding of the
significance of the
respiratory rate or the
means of achieving
accuracy.
Demonstrated lack of
understanding of links
between the necessary
concepts.
No evidence of critical
appraisal of reference
material		 /25

NSG3RDP Semester One 2023

(25% of total mark) Evidence of synthesis of
information and logical
development of
arguments		 development of arguments
Literature predominantly
used effectively to support
key ideas		 Inconsistent evidence of
synthesis of information and
logical development of
arguments
Literature inconsistently used
to support key ideas		 material
Limited evidence of
synthesis of information
and logical development of
arguments
Literature poorly used to
support key ideas		 No evidence of synthesis
of information and logical
development of
arguments
Overreliance on direct
quotes Key ideas not
supported by the
literature
ACADEMIC INTEGRITY &
FORMATTING
(5% of total mark))		 5 marks
Correct use of APA V7 in
text and end-text format.
Use of submission
template and specified
formatting. No spelling
typing or grammatical
errors
Within 10%-word limit.		 4 marks Correct
use of APA V7 in- text and
end-text format, minor
errors.
Use of submission template
and specified formatting.
Minor spelling, typing &
grammatical errors.
Within 10%-word limit.		 3 marks
Occasional errors in APA V7
format.
Use of submission template
and specified formatting.
Minor spelling, typing &
grammatical errors.
Within 10%-word limit		 2 marks
References provided but
incorrect use of APA V7
format.
Use of submission
template. Inconsistent use
of specified formatting.
Consistent spelling, typing
and grammatical errors.
Within 10%-word limit		 ≤1 mark
Referencing does not
adhere to APA V7
format.
Specified presentation
& formatting not used.
Spelling, typing and
grammatical errors
throughout the paper
which impact on fluency
and coherency.
Exceeds 10%-word limit.		 /5
/100

NSG3RDP Semester One 2023
Attached documentation
Handover ISBAR
Setting: Paediatric Ward
Time frame: 2100 hrs

Patient identification Rosie Jones
DOB 23/11
UR 8679543
5-year-old female
Social history
Lives with family in Numurkah
Situation/Setting the scene
Initial
Investigations/treatment		 Rosie has been brought into the emergency department by
her mother.
Given that it is Saturday evening Rosie’s mum Jane was not
able to take her to their usual GP.
Rosie has been unwell for a few days with earache and
cold-like symptoms.
She has not been her usual active and cheerful self,
particularly in the last 24 hours.
Jane took Rosie to the GP two days ago and she was
commenced on oral antibiotics for a possible otitis media.
In ED:
Rosie to be admitted to paediatric ward
Oxygen if saturation below 92%
Salbutamol via spacer 3 doses 20 minutely.
Review 10-20 minutes after 3rd dose.
If improving reduce frequency, if no change continues 20
minutely.
Ipratropium via spacer 20 minutely in first hour.
Oral prednisolone 1mg/kg/d.
Half hourly observations
Fluids and diet as tolerated
Monitor urine output
Background/Past
medical and surgical
history
Medications
Allergies		 Born at term
All immunisations up to date
Ear infections x 4. Grommets inserted 6 months ago
Weight 18 kgs
Amoxicillin 90mgs TDS
No known drug allergies

NSG3RDP Semester One 2023

Assessment information First Assessment in ED at 1600hrs:
Airway patent
Patient verbalising
RR 36
Generalised inspiratory and expiratory wheeze
Pale
HR 120
Temp 36.6
AVPU Alert, quiet cuddling into Sherin
Audible wheeze
Mild increase in respiratory effort.
Slight evidence of accessory muscle use
Nil rib recession
Speaking in short phases
Decreased intake and output
Not wanting to engage with nurse when questioned
Second assessment Now at 2100 hrs:
CNS
Quiet and withdrawn. Occasional grunting
(Mother in attendance. Resting in chair beside bed)
CVS
HR 140
Pale
Capillary refill<3secs
Resp
Quiet chest
Decreased air entry to bases
Generalised inspiratory and expiratory wheeze
RR 42
O2sat 93%
Moderate increase in respiratory effort.
Moderate evidence of accessory muscle use
Marked rib recession
Slight nasal flaring
Not speaking to nursing staff
Metabolic
Temp 37
GIT
Minimal intake
Renal
Has not voided since admission to surgical ward
Recommendations/
Important
considerations		 Hourly observations overnight.
Ongoing medications as per medication chart.
Oxygen if O2sat below 92%
Included documentation
National patient observation chart

NSG3RDP Semester One 2023

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