case study: Ms. Melody King presented to the Emergency department with 2-3 days of severe Right Lower Quadrant abdominal pain, which required emergency laparoscopic surgery for removal of a ruptured appendix.

1.Melody King, 36, Peritonitis following ruptured appendix
Ms. Melody King presented to the Emergency department with 2-3 days of severe Right Lower Quadrant abdominal pain, which required emergency laparoscopic surgery for removal of a ruptured appendix.
She has a past medical history of asthma and depression, with her current prescribed and compliant medications list which includes:
• Ventolin
• Seretide
• Sertraline
Melody’s observations were as follows:
• BP 95/45mmHg
• HR 120
• Temp 38.3°Celcius
• RR 22/min and shallow
• SpO2 95% on room air
She complained of increasing nausea and centralised abdominal pain 7-8 on a scale of 0 to10. Physical assessment showed a distended abdomen and generalised abdominal guarding. To investigate her condition further, pathology results reveal a raised white blood cell (WBC) count and CRP.
You are the RN caring for Melody post-operatively on the surgical ward.

2.Students will complete a case study which discusses the provision of ethical, legal, evidence based, holistic person-centred care including the establishment of realistic and relevant goals through the theoretical examination of a particular nursing specialty case study using the Clinical Reasoning Cycle (Levett-Jones, 2013).
The Clinical Reasoning Cycle
Student are expected to use the Clinical Reasoning Cycle (Levett-Jones, 2018) as a framework to plan and evaluate person-centred care. You are being asked to think through the case scenario and then discuss how data was collected and the type of data collected, identify problems and nursing issues, identify and state the objectives and discuss how care was provided in order to address the issues and evaluate the interventions carried out: (analyse and identify a nursing issues/problems/needs, set objectives, discuss the nursing interventions and evaluate the interventions of care carried out). As per lecture notes, students are expected to apply the clinical reasoning cycle to address the case scenario:
• Consider the person’s situation
• Collect, process and present related health information
• Identify and prioritise at least three (3) nursing problems/issues based on the health assessment data that you have identified for the person at the centre of care.
• Establish goals for priority of nursing care related to the nursing problem/issues identified
• Discuss the nursing care of the person; link it to assessment data and history.
• Evaluate your nursing care strategies to justify the nursing care provided
• Reflect on the person’s outcomes

Adapted from Tracy Levett-Jones, et al. (2010)

Application of the Clinical Reasoning Cycle
Based on the stages of the clinical reasoning cycle, the outline of the essay should have:
Title Page: (not included in the essay)
• Unit Title: NRSG370 – Clinical Integration – Speciality Practice
• Student Name:
• Student ID Number:
• Speciality Area:
• Scenario:
• Total number of words:
• Essay should be formatted
1. Introduction
• introduces/outlines/situates the topic of the essay
• clearly describes the way in which the essay will proceed
• the essay is structured in a logical sequence so that the content flows (headings may be used to develop the structure of the paper)

2. Content
a) Consideration of facts from the patient or situation
Consider the case scenario of your choosing based on your clinical elective as per assessment “Choose the one that best reflects your specialty placement” this is where you determine what information should be collected and how information is going to be collected.

b) Collection of information
You need to discuss the type of information collected and why this information was collected based on the scenario for the clinical elective. For instance, the type of information collected should consider and include the history, current presenting issues and treatment plan, observations, results of investigations done medical records etc.

c) Processing gathered information (analysing and interpreting)
• The most important thing is to analyse the information that you have collected and identify areas of nursing care needs and problems. In this section, your discussion should reflect analysis and interpretation of the patient’s current health status using your established knowledge of physiology, pharmacology, pathology, culture, and ethics to establish needs and issues drawn from the information. This stage allows you to demonstrate synthesis of theory and experience acquired in previous and concurrent nursing units.

d) Identify the problem
• Identify and state the problems/needs or issues you have identified. It is important to identify the problems/needs/issues and the potential cause to determine the reason behind the patient’s current issue. Examples:
• Dehydration as a result of loose bowel motion x 4 and vomiting x 2 during am shift
• Falls risk as a result of confusion and unsteady gait
• Loss of weight as a result of poor oral intake for one week
• Pain due to post -operative procedure – laparotomy
• Hyperglycaemia due to poor diet and lack of knowledge on diabetes
Please note these are examples only, the nature of the problems you identify will depend on the nature of the case study and your analysis and interpretation of the situation.

e) Establish goals
• Here, you determine the nursing goals for the patient’s situation. Identify and prioritise at least three (3) nursing problems/issues based on your assessment and collected data.

f) Take action
• Here you discuss the nursing interventions or measures you will undertake in order to address the three nursing issues or problems. These measures should take in consideration the ethical, legal, evidence based, holistic -person-centred approach.

g) Evaluation and Reflection
• Evaluate the effectiveness of the nursing interventions you have discussed (presumably which could have been carried out or actually carried out) and reflect on how the interventions could have been improved or done better- State the potential measures that could have been considered or could have been carried out to address the problem. This phase allows you to critically analyse what has been done and how best the care was carried out or could have been improved.

3. Conclusion
• the essays ends with a cogent, defendable conclusion that summarises the discussion

4. References
• Provide a list of references used in your discussion

THE MARKING CRITERIA
Please refer to the marking criteria
Here are some of the points in conjunction with the marking criteria which you should consider when applying the marking criteria to your case study essay:

1) Sequencing: 5%
• introduces/outlines/situates the topic of the essay
• clearly describes the way in which the essay will proceed
• the essay is structured in a logical sequence so that the content flows (headings may be used to develop the structure of the paper)

2) Content: 50%
• Refer to the stages of the clinical reasoning cycle
• Clearly identifies and prioritises 3 relevant nursing issues/ problem
• the case study essay focus has been addressed and discussed as per clinical reasoning cycle
• the case study essay content has clear links to contemporary nursing practice of the clinical elective area and discusses the provision of ethical, legal, evidence-based, holistic person-centred care, including the establishment of realistic and relevant goals
• the case study paper demonstrates a depth of understanding of the topic and significant issues as per scenario and clinical elective area.

3) Critical thinking, reasoning and evaluation of evidence: 30%
o the essay demonstrates a high degree of critical thought and insight by:
o providing a justification/rationale for the argument/discussion
o demonstrating you have reflected on the complex issues surrounding the three problems identified
o discussing the topic from differing perspectives, ethical, legal, evidence-based, holistic person-centred care thereby providing a balanced discussion of the problems.
o analysis is related to nursing care and issues/problems, and is presented and supported by adequate and appropriate evidence.

4) Paragraph, structure/intelligibility: 5%
• Organisation and presentation of content
• There are clear linking sentences that link each paragraph to the next area consistently

5) Sources & Referencing: 10%
• credible and relevant references are used. A broad range of in-text citations has been used
• accurate use of APA referencing style in all instances. the referencing style used throughout the paper is congruent with the APA style
• the reference list is accurate (i.e. no missing page numbers, volumes, correct title etc), complete (i.e. no references in the body of the paper are missing from the reference list) and consistent with the APA referencing style.

• there is evidence in the paper that the student has searched widely for information related to the topic/issue
• the student has acknowledged all sources of information used

This essay is post operation care.Students will complete a case study which discusses the provision of ethical, legal, evidence based, holistic person-centred care including the establishment of realistic and relevant goals through the theoretical examination of a particular nursing specialty case study using the Clinical Reasoning Cycle (Levett-Jones, 2013).

this essay is about post operation 3 nursing care priorities by usingthe Clinical Reasoning Cycle (Levett-Jones, 2013).

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