Deteriorating patient case study

In order to undertake this 1500-word essay you will need to research the topic using current and relevant peer reviewed literature and review of:

  • The lecture and tutorial material associated with the relevant topic.
  • 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. 3. Blackboard resources related to assessment 2.


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Task outline.

The assessment task requires you to:

Part A: Recognizing and responding to clinical deterioration Review The National Safety and Quality Health (NSQH) Standards;
NMBA Professional Standards:


Recognising and Responding to Acute Deterioration. Recognising clinical deterioration is considered to be a critical component to providing quality clinical care. The NSQH identifies that health service organisation must have processes for clinician to detect acute physiological deterioration such as individualized monitoring plan and documentation of agreed observations to track changes and detect deterioration. Using the contemporary evidence identify an evidence-based approach that effectively tracks and detects deterioration in patients. Include in your response a discussion of the evidence related to how the intervention promotes detection of deterioration and reduces the incidence of failure to recognise and respond to clinical deterioration.

Part B: Pathophysiology of the signs and symptoms of clinical deterioration. From the chosen case study, identify and provide a rationale for two (2) signs or symptoms of clinical deterioration associated with the pathophysiology of thepatients’ presenting problem.

Part C: Priority problem Following on from your discussion, and related to the patients signs and symptoms of 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 priority problem for the case.

Part D: Clinical interventions to address the priority problem Discuss two (2) evidence based clinical interventions to address the identified priority problem and how to evaluate the efficacy of these interventions.


References Presented on a new page and compliant with APA requirements both intext and in the final reference list.

Page numbers for all citations are to be presented in-text.

A minimum of 24 references to be used to support the discussion from scholarly sources. (Nil textbooks or websites are to be used as a citation). References to be no older than 7 years (2015-2019)

Length: 1500 words (word length includes in-text referencing and excludes your reference list)

Presentation requirements: This assessment task must:

  • Be a written academic essay containing an introduction (100 words), body (1300 words) and conclusion(100words), addressing the assessment task.
  • The following subheadings are permitted: Recognising and responding to clinical deterioration, Pathophysiology of the signs and symptoms of clinical deterioration, Priority problem and Clinical interventions to address the priority problem
  • A minimum of 24 relevant references to be cited from valid, contemporary journal articles older than 6 years. • The use of websites as references is NOT permitted.
  • The submitted essay should NOT contain tables or figures
  • The use of dot points are NOT permitted.
  • APA 7 th edition style referencing, with page numbers included for intext citations

Case study

Assignment Hints 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 interventions;
  • The application of clinical data and research to identify three (3) core interventions and assessments that address the stated clinical priority.
  • Demonstration of your clinical reasoning for your priority problem and interventions.
  • Demonstrating your understanding and application of evidence based care i.e. the research you have to support your discussion and ideas regarding clinical interventions and assessment outcomes.


Scenario: Benjamin Roberts is a 22-year-old male who has been admitted to the respiratory unit secondary to an exacerbation of cystic fibrosis. Background: Ben reports being unwell for the past three days characterised by congestion and productive cough producing greenish sputum, and night sweats. Ben’s last admission to the respiratory ward was approximately 8 months ago for a general medical review of his cystic fibrosis and since that time he has been generally well. Ben works part time as a computer system engineer and lives in an inner-city apartment with his partner James. Past medical history: Cystic fibrosis (genetic profile: CFTR – chromosome 7 transmembrane conductance regulator), Previous FEV1 89% (November 2019), pancreatic insufficiency, cystic fibrosis related diabetes, Gastro-oesophageal reflux disease, Vancomycin Resistant Enterococcus positive, portal hypertension Regular medications – pulmozyme, creon forte, mixtard 30/70, esomeprazole, Salbutamol, Kalydeco, multivitamin

A sputum culture has been taken on admission and the pathology report indicates the presence of Pseudomonas aeruginosa. The registrar has prescribed intravenous piperacillin/tazobactam, and hypertonic saline nebulisers.

You are caring for Ben on the night shift which you commenced at 21:30 hours. At 22:00 hours you are reviewing Ben and note he is sitting in bed watching TV with a bedside fan on. He has a peripherally inserted central catheter in the right cephalic vein, you note that he has clubbing present to his fingers (noted below), and he is peripherally warm to touch. He tells you he is “rather fatigued” and feels “generally hot and is planning to have a shower”.

You take his vital signs as they are follows;

You administer 4 unit of actrapid according to his insulin sliding scale and tell him you will check on him latter, and as you leave he is collecting his belongings to have a shower. At 23:00 hours Ben presses the buzzer. He is sitting on the side of the bed post his shower.

He appears short of breath and his work of breathing has increased. He tells you that he feels very short of breath and possibly a nebuliser will be helpful to clear some sections. You assist him into bed, check his oxygen saturations which are 90% on 2 L via nasal prongs, administer a hypertonic saline nebuliser and allow him some time to recover from the physical exertion of having a shower.

At midnight you return to check on Ben. He is due piperacillin/tazobactam which you have prepared and you take another set of vital signs – his temperature is 39 degrees Celsius, he is diaphoretic, respiratory rate is 32 breaths/minute and the ProCare monitor reports the below vital signs:



You advise your colleague who is the team leader for the night shift who looks up Ben’s recent pathology results which indicate a white blood cell count of 12.4 ×10 9 litre (normal range 4.0-11 ×10 9 litre), C reactive protein 125 (normal range 3 to 5 mg/L), Sputum culture positive for Pseudomonas aeruginosa, blood cultures – results pending. This morning’s chest x- ray (below) indicates the presence of bilateral infiltrates, which is consistent with the increased mucus production and decreased air entry bilaterally on auscultation.




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