Assessment Task Booklet
Assessment name: Case Study: The Deteriorating Patient
Task description: For this essay you are required to go through the case scenario related
to the clinical deterioration of a patient with Cardiogenic Shock.
The assessment tasks requires you to:
1. Review The National Safety and Quality Health (NSQH)
Standards; Recognising and Responding to Acute Deterioration.
Recognising clinical deterioration is consider as a critical
component to providing quality clinical care. The NSQH
identifies eight factors that contribute to a failure to recognise
and responding to clinical deterioration, and these include:
• Not monitoring physiological observations
consistently, or not understanding changes in
• Knowledge deficit of signs and symptoms that
could signal deterioration
• Limited of awareness of the potential for a person’s
mental state to deteriorate
• Knowledge deficit of delirium, and the benefits of
early recognition and treatment
• Knowledge deficit of formal systems for responding
• Knowledge deficit of skills to manage patients who
• Failure to communicate clinical concerns, including
in handover situations
• Attributing physical or mental symptoms to an
existing condition, such as dementia or a mental
Identify one (1) factor that is relevant to your case study
1a. Using evidence beyond the NSQH standard, discuss why failure
to recognise and respond to clinical deterioration occurs, along
with identifying contributing factors within the clinical
environment that may lead to or result in failure to recognise or
respond to clinical deterioration.
1b. Identify an evidence-based approach that would aid in
reducing incidences of failure to recognise and respond to
clinical deterioration for future delivery of clinical care.
2. From the case study identify and discuss two (2) signs or
symptoms of clinical deterioration associated with the
pathophysiology of the patients’ presenting problem.
3. Following on from your discussion, and related to the patients
deterioration, identify one (1) priority problem associated with
the patient’s clinical presentation, and through the application
of contemporary research provide a justification as to why the
problem is a clinical priority within the case.
4. Discuss two (2) evidence based clinical interventions to
address the priority problem and how to evaluate the
efficacy of these interventions.
• A minimum of 25 contemporary references no older
than 7 years.
• The reference list is to be presented in accordance to
QUT APA 7th edition requirements and identify eight (8)
papers that are considered by the author (you) to be
of high importance.
• These eight (8) papers are to include a three (3) sentence
annotation that outlines their significance (please refer to
the example provided within this resource).
• Indicate these in your list using ** (see example provided
The responses that are not referenced to valid, academic
sources will receive a mark of zero (0). You MUST include
the page number that indicates the actual page in your
source where you located the evidence to support your key
point in the citation, not a page range. Failure to do this will
attract a zero grade for that response.
Note: markers will be randomly checking references to see
that you have accurately represented the source.
What you need to do: In order to undertake this essay, you will need to research the topic
using current and relevant peer reviewed literature, in conjunction with
• The lecture, tutorial and support materials associated with
the relevant topic located on blackboard.
• Review the Quality Commission on Safety and Quality in
Health Care; Standard: Recognising and Responding to
• Your knowledge and understanding related to:
1. The physiology and pathophysiology of the primary
diagnosis and associated clinical data identified within
the chosen case study;
2. The physiological assessments relevant to the
features within the case study.
This assessment task is an individual assessment item and should be
reflective of your own independent work.
Length: 1700 words +/-10% (word length includes in-text referencing and
excludes your reference list and annotations).
Due date: Saturday August 22nd
Presentation This assessment task must:
• Be a formal written academic essay containing an introduction,
body and conclusion, addressing the task, its specified
requirements and adhering to the prescribed word limit.
• Use QUT CiteWrite APA referencing for citing academic literature
• Assessment cover page should include, student name, ID
number, tutorial day and time, tutorial leaders name, case study
title, and word count (actual).
• A minimum of 25 relevant references to be cited from valid,
contemporary journal articles only, no older than 7 years.
• Include a footer on each page with your name, student number,
unit code and page number.
• 3 cm margins on all sides, double-spaced text
• Use font, such as Times New Roman, Arial or Calibri; font size 12
• CiteWrite APA 7th Edition style referencing
• The use of websites as references is NOT permitted (excluding
StatPearls and MIMMS Online)
• The citation of textbooks are NOT included in the minimum
referencing requirements (for example if you cite two (2)
textbooks, you will still need 25 references to be cited from valid,
contemporary journal articles, no older than 7 years).
• The submitted essay should NOT contain tables, figures or
• The use of dot points is NOT permitted.
• Subheadings are NOT permitted in this essay
Learning outcomes 1. Consolidate knowledge of key NMBA Registered Nurse
Standards for Practice, National Safety and Quality Health assessed: Services Standards, and National Health Priorities to enable
effective decision planning and action in a range of complex
clinical situations across the lifespan.
2. Apply knowledge of anatomy, physiology and pathophysiology to
support evidence-based decision making associated with
planning and action.
3. Demonstrate structured decision making and clinical reasoning to
review a range of health situations, synthesise evidence and
data, determine priorities and formulate plans of care and
interventions in line with timeframes and agreed goals
This assignment requires you to critically consider the signs and symptoms
associated with clinical deterioration in relation to the patient’s primary clinical
diagnosis, with consideration to:
• The change in health status associated with the primary clinical diagnosis;
• How the patients clinical history may impact on assessment data and core
• The identified clinical priority which should clearly emerge from your discussion
of the patient’s health history and should be a clear and evident clinical priority.
• The application of clinical data and research to identify two (2) core
interventions and assessments that address the stated clinical priority.
• Demonstrating your clinical reasoning within the given case study.
• Demonstrating your understanding and application of evidence-based care
i.e. the research you have selected to support your discussion and key points
regarding clinical interventions and assessment outcomes.
• There MUST be two (2) clinical interventions discussed to address the
• Of the two interventions, a MAXIMUM of one (1) intervention can be solely
related to a pharmacological agent. The second intervention may be nurse
initiated and led or a collaborative intervention.
• All interventions should consider the nursing role within the provision of the
Example of an annotated reference list:
N.B this is an example of an annotated reference list. Please ensure that you are
familiar with the APA requirements for this assessment item. (**: papers of
**Besedovsky, L., Ngo, H.V., Dimitrov, S., Gassenmaier, C., Lehmann, R.
& Born, J. (2017). Auditory closed-loop stimulation of EEG slow
oscillations strengthens sleep and signs of its immune-supportive
function. Nature Communications. 8(1):1984.
The study investigated the electroencephalographic slow oscillations and
the effect of auditory stimulus and their physiological implications on sleep
amongst healthy individuals.
Freedman, N.S., Gazendam, J., Levan, L., Pack, A.I. & Schwab, R.J.
(2001). Abnormal sleep/wake cycles and the effect of environmental
noise on sleep disruption in the intensive care unit. American
Journal of Respiratory and Critical Care Medicine.163(2):451-7.
**Horsten, S., Reinke, L., Absalom, A.R. & Tulleken, J.E. (2018).
Systematic review of the effects of intensive-care-unit noise on sleep
of healthy subjects and the critically ill. British Journal of
The systematic review evaluated the impact of environmental noise as a
sleep disturbing factor. The meta-analysis identified considerable
variability between studies and risks of bias. Noise reduction has a positive
impact on healthy individuals.
Muzet A. (2007). Environmental noise, sleep and health. Sleep Medicine
**Trivedi, M.S., Holger, D., Bui, A.T., Craddock, T.J. & Tartar, J.L. (2017).
Short-term sleep deprivation leads to decreased systemic redox
metabolites and altered epigenetic status. PloS one.12(7):e0181978.
Researchers demonstrated the presence of oxidative stress and ATP deletion
in healthy individuals who are subjected to sleep deprivation.
NSB236 Assessment Task 1 Rubric
Criteria 7 6 5 4 3 2 – 1
1. Demonstrates an Comprehensive A high-quality A good and convincing A satisfactory Limited application Little/no application
analysis and and compelling application of application of application of of contemporary of
synthesis of application of contemporary contemporary contemporary research that contemporary
evidence-based contemporary research that research that research that articulates a research that
literature and research that articulates a articulates a clear articulates a discussion of articulates a
clinical data articulates a compelling discussion of factors discussion of factors factors contributing discussion of factors
related to clinical compelling discussion of factors contributing to clinical contributing to clinical to clinical contributing to clinical
deterioration: discussion of contributing to deterioration and deterioration and deterioration and deterioration and
Discusses the factors clinical deterioration evidence-based evidence-based evidence-based evidence-based
contributing factors contributing to and evidence-based approaches to reduce approaches to approaches to approaches to
to clinical clinical approaches to risk safeguard the patients. safeguard safeguard
deterioration deterioration and mitigate risk
aligned to NSQHS evidence-based Small sections AND/OR AND/OR AND/OR
factors and approaches to descriptive with
identifies an mitigate risk. application of An emphasis on Rudimentary Descriptive with limited
approach to evidence-based referring to allied discussion of application of evidencemitigate future approaches missing in healthcare services to interventions and based approaches
risks few areas meet identified needs. referrals to allied
Small sections services.
Weighting 20% descriptive with
application of evidence- AND/OR Has not met/adhered
based approaches to the requirements of
missing in several Descriptive with the assessment.
areas limited application
more than half
2. Applied Demonstrates a Demonstrates a Demonstrates a good Demonstrates a Demonstrated Demonstrates
knowledge of critical high level of critical explanation and satisfactory limited critical little/no critical
pathophysiology explanation that explanation that reflects sound explanation and explanation and explanation that
to determine reflects a reflects a significant interpretation with reflects a basic reflects a reflects
priorities and comprehensive interpretation and some critical interpretation and basic/limited rudimentary/little
formulate plans interpretation and some critical interpretation and interpretation and
NSB236 – Assessment 1: The deteriorating patient Page 9 of 14
of care: Discusses explanation of the explanation of the explanation of the explanation of the limited critical little/no critical
the signs and assessment data. assessment data; assessment data; assessment data – explanation of the explanation of the
symptoms of content not overly assessment data – assessment data –
clinical AND AND AND discerning. rudimentary content not discerning
deterioration in the understanding and and primarily
context of the Comprehensive High level Sound understanding AND/OR is descriptive. descriptive.
primary diagnosis. understanding of understanding of the of the central issues of
the central issues central issues of the the case – most key Satisfactory AND/OR AND/OR
of the case – all case – almost all pathophysiological understanding of the
Weighting: 25% key key concepts and central issues of the Demonstrates Little/no
pathophysiological pathophysiological assessment data case – some key limited understanding of the
concepts and concepts and addressed to pathophysiological understanding of central issues of the
physical assessment data determine concepts and the central issues case – demonstrates
assessment data addressed to sign/symptoms of assessment issues of the case in more rudimentary/limited/no
addressed to determine deterioration addressed to determine than half – not all understanding of
determine sign/symptoms of sign/symptoms of key pathophysiological
sign/symptoms of deterioration; AND deterioration. pathophysiological concepts and
deterioration. concepts and assessment issues to
AND Demonstrates a good AND assessment issues determine
AND depth of reasoning addressed to sign/symptoms of
Demonstrates a and logical and Adequately determine deterioration.
Demonstrated a high level of analytical thinking. demonstrated depth of sign/symptoms of
comprehensive reasoning and reasoning and logical deterioration. AND/OR
depth of logical and and analytical thinking.
reasoning and analytical thinking. AND/OR
logical and Has not met the
analytical You have not assessment/academic
thinking. adequately requirements as
demonstrated outlined in the task
depth of reasoning document.
and logical and
Comprehensive A high-quality A good and convincing A satisfactory Limited application Little /no application
application of application of application of of of pathophysiological and compelling 3. Critical thinking, pathophysiological pathophysiological and pathophysiological pathophysiological and physiological application of clinical and physiological physiological concepts and physiological and physiological concepts which pathophysiological reasoning, and concepts which which demonstrated concepts which concepts which demonstrated no and physiological knowledge: demonstrated an an understanding of demonstrated a demonstrated understanding of links concepts which Demonstrates an understanding of links between the satisfactory limited between the patient demonstrated an understanding of links between the patient condition, understanding of understanding of condition, assessments understanding of
NSB236 – Assessment 1: The deteriorating patient Page 10 of 14
problem, linking to
evaluation of the
links between the
and the priority
the two nursing
patient condition, assessments and the links between the
assessments and priority problem patient condition,
the priority problem. identified. assessments and the
The discussion is A well-developed
based on a highly discussion presented Clinically acceptable to
articulate and to justify the relevance provide an
compelling and appropriateness of argument/justification
application of the two nursing supporting the
research to justify interventions. relevance and
the interventions appropriateness of the
that directly address AND two nursing
the problem interventions.
statement. Provided a strong
application of clinical AND
AND knowledge to identify
evaluation criteria to Applied some clinical
Demonstrates a indicate the success of knowledge to identify
high standard of both nursing evaluation criteria to
clinical knowledge Interventions. indicate the success of
to accurately identify both nursing
evaluation criteria to AND intervention.
indicate the success
of both nursing
The approaches are interventions. AND/OR supported to a good
AND level by contemporary The approaches are
evidence and makes supported to a
The approaches are association with satisfactory level by
supported to a high physiological contemporary evidence
level by concepts. and makes association
contemporary with physiological
evidence and concepts.
links between the and the priority
patient condition, problem.
the problem AND/OR
AND/OR for the problem
Interventions interventions and
identified are physiological
discussed at a assessments for
superficial level outcomes
with limited clinical
AND/OR Evidence or
There is conceptual
limited/superficial understanding of
evidence of a content contributing to
critical discussion flawed clinical
to justify the reasoning.
evaluation criteria. AND/OR
AND/OR Unable to apply clinical
There is evidence as to how the
of misconceptions interventions relate to
or lacks insight and the management of the
understanding of chosen priority
the association with problem.
. The content presented
places the patient at a
significant risk of an
adverse and/or sentinel
NSB236 – Assessment 1: The deteriorating patient Page 11 of 14
Failed to meet the
requirements of the
4. Application of Demonstrates Demonstrates skilful Demonstrates Demonstrates an Demonstrates an Limited evidence used evidence: to skilful and use of high quality, consistent use of attempt to use attempt to use to support ideas, enable effective insightful use of credible and credible, relevant credible and/or sources to support poorly cited and or decision planning high quality, relevant sources to sources to support relevant sources to ideas and decision paraphrased.
and credible and develop ideas, ideas and decision support ideas and making in the structured decision AND/OR relevant sources rationalise making that are decision making that writing. making and clinical to develop ideas, approaches and situated within the are appropriate for the The discussion does reasoning, AND/OR rationalise decision making that thought question. thought question. not demonstrate a synthesise approaches and are appropriate to May have a strong grasp of
evidence and data, AND AND decision making the clinical scenario. number of 3-4 conceptual to determine that are There is a well- There is a satisfactory direct quotes that understanding to priorities and AND appropriate to the grounded demonstration of could have been support decision formulate plans of clinical scenario. There is a good demonstration of conceptual paraphrased to making. Frequent use care demonstration of conceptual understanding of demonstrate of direct quotes AND
conceptual understanding of content. synthesis and AND/OR Weighting: 15% There is an understanding of content. understanding of AND/OR excellent content. AND content. Breaches to academic
demonstration of AND Content is generally AND/OR integrity are present.
conceptual Content is paraphrased and may AND/OR understanding of Content is paraphrased and include 1-2 direct Content is not well
content. paraphrased and accurately reflects the quotes. The presented paraphrased and Has not met the
AND accurately reflects ideas/concepts of the ideas accurately indicates some assessment
the ideas/concepts published works. reflect the limitations in requirements
Content is of the published AND ideas/concepts of the conceptual (research not
paraphrased and works. published works. understanding and contemporary, has not
accurately reflects Has sourced 15 AND/OR application of met minimum
the ideas/concepts contemporary ideas. requirements for
of the published AND research articles Has sourced 15 AND/OR references, has not met
works. (journal only), and contemporary requirements for
provided an accurate research articles annotated references ,
NSB236 – Assessment 1: The deteriorating patient Page 12 of 14
Has sourced 15 annotation 8 of the (journal only), and 1-2 citations are used websites, and
AND contemporary published research provided an accurate not deemed to be resources that not of a
research articles articles annotation (8) of the contemporary. scholarly nature)
Has sourced 15 (journal only) and published research AND/OR contemporary provided an articles
research articles accurate annotation 15 contemporary
(journal only), and 8 of the published research articles
provided an research articles. (journal only), and
accurate provided an
annotation 8 of the accurate
published research annotation; 7 or
articles less of the
Academic writing Comprehensive, Presented a high Presentation is Minor problems of Logical flow and Poor logical order to level and quality organisation is Clear and logical organized and organization or logic; the information discussion that is hampered by poor Weighting: 15% presentation; presents a clear Needs work on creating provided; sentences clear and logical expression of ideas compelling and argument for a given transitions between poorly structured and presentation, very and grammatical articulate position. ideas. phrased; ideas are good development errors. development of an repeated; of an argument. argument. comprehension of AND AND AND/OR content is impeded.
AND AND Uses professional Uses language that Mechanics of AND/OR language that generally conveys writing impedes the Excellent syntax: High level of Syntax generally conveys meaning to readers Uses language that discussion of ideas language that skills: Uses meaning to readers. with clarity, although sometimes impedes and the submission skillfully language that Occasional errors and writing may include meaning because of would benefit from communicates effectively minor problems with some errors. errors in usage. further editing. meaning to communicates mechanics of Occasional problems Problems with the
readers with clarity meaning to readers language. Occasional with mechanics of mechanics of
and fluency. Clear, with clarity and awkward sentences language. AND/OR language serious
readable, prose. fluency. Clear, and poor transitions enough to interfere with
Excellent use of readable, prose. reduce readability. Overuse (4+) of effective
transitions; no Some issues with AND/OR communication. direct quotes, problems with transitions; no to Some awkward Frequent errors in spelling, minimal (2-4) AND/OR sentence Not within punctuation, spelling, punctuation, or problems with Sometimes used (1-2) construction. required word sentence structure, etc.
grammar. spelling, direct quotes ; Transitions may need limit. (15% over or Infrequent and punctuation, or AND/OR further development. under prescribed minor mechanical grammar. Infrequent AND Conceptual work limit). problems. Errors and minor
NSB236 – Assessment 1: The deteriorating patient Page 13 of 14
do not impair
Did not use direct
aspects of APA
style are used
formatted, use of
problems. Errors do
Did not use direct
All relevant aspects
of APA style are
used correctly. Title
formatted, use of
format of references
Adhered to the
prescribed word limit
Infrequent errors in
APA style; errors
involve only minor
aspects of APA style
– no errors in style for
citations & references.
content is not lost by
the standard of writing.
Sometimes used direct
Attempted to use APA
style but errors are
occasional and include
errors in citations and
Word limit under/over
the 10% allowance.
Attempted to use
APA style but
errors are frequent
and include errors
in citations and
Overuse of direct
quotes (>5) or inability
to demonstrate ability
to paraphrase content.
Did not adhere to the
for the assessment (e.g
word limit and is
under or exceed by
>/<15%, multiple errors
in APA, and
Assessment: The deteriorating patient
• Body assessing assessment task – 4 key elements
• References (this should the title not bibliography or reference list)
• Include a footer on each page with your name, student number, unit code and page
• 3 cm margins on all sides,
• double-spaced text
• Use font, such as Times New Roman, Arial or Calibri
• font size 12
• CiteWrite APA 7 th Edition style referencing
Things not permitted
The use of websites as references is NOT permitted (excluding StatPearls and
• The citation of textbooks are NOT included in the minimum referencing requirements (for
example: if you cite two (2) textbooks, you will still need 15 references to be cited from
valid, contemporary journal articles, no older than 7 years).
• The submitted essay should NOT contain tables, figures or appendices.
• The use of dot points is NOT permitted.
• Subheadings are NOT permitted in this essay
Should contain the following
• Context – summary/synthesis of the key point of the case not a repetition of the case
• Objective – what you plan to address
• Rationale – Why should these thing be considered
Do not write
In first person – it is a formal academic paper
Avoid starting the introduction with “this essay”
Proof read and edit – errors in the opening paragraph set a poor tone for the remainder of
Assessment task part 1
Review: The National Safety and Quality Health (NSQH) Standards; Recognising and
Responding to Acute Deterioration. Recognising clinical deterioration is consider as a
critical component to providing quality clinical care.
The NSQH identifies eight factors that contribute to a failure to recognise and responding
to clinical deterioration, and these include:
• Not monitoring physiological observations consistently, or not understanding
changes in physiological observations
• Knowledge deficit of signs and symptoms that could signal deterioration
• Limited of awareness of the potential for a person’s mental state to deteriorate
• Knowledge deficit of delirium, and the benefits of early recognition and treatment
• Knowledge deficit of formal systems for responding to deterioration
• Knowledge deficit of skills to manage patients who are deteriorating
• Failure to communicate clinical concerns, including in handover situations
• Attributing physical or mental symptoms to an existing condition, such as dementia or
a mental health condition.
Consider: Is any one of these dot points applicable to your chosen case study?
Using evidence beyond the NSQH standard;
• discuss why failure to recognise and respond to clinical deterioration occurs, along
identifying contributing factors within the clinical environment that may lead to or
result in failure to recognise or respond to clinical deterioration.
• Identify an evidence-based approach that would aid in reducing incidences of
failure to recognise and respond to clinical deterioration for future delivery of
Assessment task part 2
From the chosen case study identify and discuss;
• two (2) signs or symptoms of clinical deterioration associated with the
pathophysiology of the patients’ presenting problem.
• The pathophysiology that contributes to the deterioration related to the primary
• Consider how the patients past medical history may need to be considered
• Identify key information – not obscure content
• Develop a well research and convincing argument for the choosen signs and
• Do not describe
Following on from your discussion, and related to the patients deterioration
Identify one (1) priority problem associated with the patient’s clinical presentation
Consider your ABC’s
Airway – oxygenation, ventilation
Breathing – oxygenation, diffusion and perfusion
Circulation – oxygenation and perfusion
• Ensure you apply clinical evidence derived from the case study to support it as a
problem. The problem needs to be an actual problem not a potential problem.
• Through the application of contemporary research provide a justification as to
why the problem is a clinical priority within the case.
This generally requires you to integrate clinical information, diagnosis and past medical
history and apply a pathophysiological approach to make a convincing case.
Discuss two (2) evidence based clinical interventions to address the priority problem and
how to evaluate the efficacy of these interventions.
• Apply the evidence that supports the interventions
• Do not describe interventions or tell us how to perform an intervention
• Interventions can be collaborative or independent
• One intervention can be medication based (not clustered with collaborative)
• One intervention can be collaborative (not both)
• Need to consider how to assess the effect of the intervention and justified with
evidence – e.g Heart rate less 40; apply the evidence that supports it as the physiological
• Always consider what the assessment may be picking to recognise an adverse
The conclusion should
• Address the objectives outlined in the introduction
• Bring together the main rationale outlined in the introduction
• Summarise the main points presented in the paper and what that means in the
overall context of patient care
• Include new ideas and information
• new references that have not been previously cited.
• A minimum of 25 contemporary references no older than 7 years.
• The reference list is to be presented in accordance to QUT APA 7 th edition
• Use cite write if you have had issues with referencing previously
The responses that are not referenced to valid, academic sources will receive a mark
of zero (0). You MUST include the page number that indicates the actual page in
your source where you located the evidence to support your key point in the citation,
not a page range. Failure to do this will attract a zero grade for that response. Note:
markers will be randomly checking references to see that you have accurately
represented the source.
• identify eight (8) papers that are considered by the author (you) to be of high
– What does this mean? Annotation should be the 8 most cited references
in your paper.
– Annotation should include what was the objective of the paper, main
finding and why it was an important reference in your paper.
– maximum of 3 sentences for the annotation and is not included in the word
• Do not copy and paste – it will be deemed plagiarism.
Review your rubrics to see what is required
Identify the thing you should avoid
Not following the task and adhering to requirements means grades are lost.
– e.g. Criteria 1: Has not met/adhered to the requirements of the assessment
(grade 2 or 1)
– Critieria 4: Breaches to academic integrity are present.(grade 2 or 1)