Assessment Overview

This assignment requires you to demonstrate critical thinking and clinical reasoning in the evaluation of nursing care for individuals living with complex health conditions.

You must select ONE of the case studies provided and address the required questions in 1500 words (+/- 10%).

Task Instructions

Answer the following questions based on your selected case study:

1. Nursing Concerns

Identify the actual and potential nursing concerns for the person in your chosen case.
Provide a clear rationale to support your clinical decision-making.

2. Priority Nursing Interventions

Identify four priority nursing interventions required to support the person.
Explain the rationale for each intervention, reflecting sound clinical reasoning.

Your responses should consider:

• The context of care delivery
• Requirements for escalation of care
• Age-appropriate, person-centred, and family-centred care principles
• Multidisciplinary team (MDT) involvement
• Relevant pathophysiology and pharmacology

No introduction or conclusion is required.

Topic Learning Outcomes Assessed

TLO 2: Apply clinical reasoning to manage fundamental nursing care safely across diverse settings.
TLO 3: Demonstrate medication safety skills, critical thinking, and evaluation of care in patient scenarios.

Presentation Requirements

• Use the provided template for structure.
• Write in third-person narrative.
• Submit as a Word document (.doc/.docx) – PDF not accepted.
• Use Arial, Calibri, or similar, size 11 or 12, with 1.15 line spacing.
• Use clear, coherent Australian English.
• Use professional terminology.
  Avoid acronyms, abbreviations, and nursing jargon.

Referencing Guidelines

• Use APA 7th edition for all in-text citations and reference list.
• Ensure all resources cited are accessible to markers.
• Use peer-reviewed, reliable, nursing-relevant, and Australian-appropriate sources.
• Avoid consumer-based websites.
• Maintain standards of academic integrity and professional nursing practice.

Case Studies 

Medical History

• GBM
• Seizures (secondary to tumour)
• Dysphagia – PEG in situ
• Left-arm paraesthesia

Recent Clinical Findings

• Enlarged, inoperable GBM
• Transitioned to palliative care at home (Flinders University Community Palliative Care Team)
• Increasing headaches
• Anxiety, especially at night
• Asking questions about death
• Withdrawn behaviour

Medications (via PEG unless noted)

• Levetiracetam 230 mg BD
• Dexamethasone 4 mg QID
• Paracetamol 345 mg QID
• Morphine 4.6 mg PRN (every 4 hours)
• Midazolam 5 mg IN PRN (seizure plan)

Case 2: Akmal Muhammad

Medical History

• Asthma
• Post-Traumatic Stress Disorder (PTSD)
• Type 1 Diabetes Mellitus (T1DM) – insulin pump + CGM

Current Concerns

• Appears pale, lethargic
• Excessive thirst
• Frequent urination
• Headache
• Fruity breath odour (possible DKA)
• Difficulty managing insulin pump recently

Medications

• Hydrocortisone 100 mg IV, 6-hourly
• Salbutamol 12 puffs MDI hourly PRN
• Ipratropium 8 puffs MDI 4-hourly PRN
• Humalog insulin via pump (continuous)

Case 3: Charlotte Berman

Medical History

• Down syndrome
• Osteoarthritis
• Ventricular septal defect
• Depression
• Dysphagia – long-term PEG
• Significant hearing impairment
• Limited verbal communication

Current Concerns

• Coughing during/after PEG feeds
• Fatigue
• Refusal to get out of bed
• Agitation with care
• Temp 38.5°C, RR 28, diaphoretic skin (possible aspiration pneumonia)

Case study Template

Identify the Actual and Potential Nursing Concerns for This Person, and Explain the Rationale Behind Your Clinical Decision-Making

Identify Four Priority Nursing Interventions That Will Need to Be Undertaken to Support This Person, and Explain the Rationale Behind Your Clinical Decision-Making

Identify the Actual and Potential Nursing Concerns for This Person, and Explain the Rationale Behind Clinical Decision-Making

Actual nursing concerns

• Respiratory compromise/aspiration pneumonia. Rationale: coughing during and after PEG feeds, pyrexia (38.5°C), tachypnoea (RR 28) and diaphoresis indicate an infective respiratory process and possible aspiration of feed into the lungs.
• Impaired airway protection and dysphagia. Rationale: long-term PEG and recent coughing with feeds suggest reduced swallow safety and altered airway protective reflexes.
• Hypoxia risk. Rationale: increased respiratory rate and possible consolidation may produce hypoxaemia requiring oxygen therapy and monitoring.
• Altered behaviour and agitation during care. Rationale: fatigue, increased agitation may reflect hypoxia, infection, pain, or distress from communication barriers (hearing impairment, limited verbal ability).
• Nutrition and hydration compromise. Rationale: PEG feed intolerance or aspiration may reduce nutrition delivery and increase risk of dehydration and malnutrition.
• Risk of pressure injury and functional decline. Rationale: decreased mobility and reluctance to get out of bed increase risk of pressure injury and deconditioning.
• Medication safety concerns. Rationale: polypharmacy (antidepressant, PRN paracetamol) and enteral route issues (absorption/interactions via PEG) require careful review.
• Communication barriers affecting person-centred care. Rationale: significant hearing impairment and limited speech make assessment of symptoms and consent more difficult, increasing risk of unmet needs.

Potential nursing concerns

• Progression to sepsis or respiratory failure. Rationale: untreated aspiration pneumonia may progress rapidly in older adults with comorbidities.
• PEG site infection or dislodgement. Rationale: PEG in situ and recent feed issues increase site complication risk.
• Delirium or worsening behavioural symptoms. Rationale: infection, hypoxia, pain, and sensory impairment can precipitate delirium which may manifest as agitation.
• Medication errors (enteral dosing issues). Rationale: crushing or administering medicines via PEG without verification risks incorrect dosing or interactions.

Clinical decision-making is guided by immediate safety (airway, breathing, circulation), recognition of infection risk, need for objective monitoring (observations, oxygen saturations), and application of person-centred strategies (communication aids, family involvement) while preparing for escalation if deterioration occurs.

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