Assessment Task 3: Extended Clinical Reasoning Case Study – Medical-Surgical Nursing

Unit Code: NRSG378 Unit Title: Principles of Nursing: Extended Clinical Reasoning Assessment Type: Individual Written Case Study Word Limit: 2,000 words (±10%) Weighting: 50% Due Date: Wednesday, 4 June 2025, 2:00 pm AEST via Turnitin on LEO Learning Outcomes Assessed: LO1: Critically analyse complex clinical scenarios using extended reasoning frameworks; LO2: Integrate pathophysiological, pharmacological, and psychosocial data into care planning; LO3: Prioritise ethical and evidence-based interventions for acutely unwell patients; LO4: Evaluate care outcomes and reflect on professional development; LO5: Demonstrate person-centred communication in multidisciplinary contexts.

Task Overview

Apply the Clinical Reasoning Cycle (Levett-Jones, 2018) to an acute medical-surgical case involving decompensated heart failure. Demonstrate extended reasoning by linking assessment data to pathophysiology, prioritising three nursing issues, and justifying interventions with ethical, legal, and evidence-based rationale. This task builds on prior units, focusing on the holistic impact of acute illness. Select if aligned with your placement; consult LIC if unallocated by Week 5. Avoid repeating prior cases.

Case Scenario: Mr. Reginald Harris – Acute Exacerbation of Congestive Heart Failure

Mr. Reginald Harris, 72-year-old widower, admitted to the medical ward via ED with acute decompensated heart failure (CHF). Presented with 48-hour history of increasing dyspnoea on minimal exertion, orthopnoea, and bilateral leg swelling after non-compliance with fluid restriction and missing diuretic doses. Lives alone; limited mobility due to osteoarthritis.

Past Medical History: Diagnosed CHF (ejection fraction 35%) five years ago; hypertension; type 2 diabetes (HbA1c 8.2%); ex-smoker (30 pack-years); BMI 28. Takes frusemide 40mg BD, ramipril 5mg daily, metoprolol 50mg BD, metformin 1g BD. Recent weight gain 4kg in one week.

Current Presentation (Day 1 Admission): Short of breath at rest, anxious, reports “can’t catch breath.”

Assessment Findings:

• Vital signs: Temp 37.2°C, RR 28/min (laboured), HR 110 bpm (irregular), SpO2 88% on 6L/min O2 via mask, BP 160/95 mmHg, Pain 4/10 (chest tightness), GCS 15/15.
• Physical: Pale, cool peripheries; bilateral crackles to mid-lung fields; 3+ pitting oedema to knees; JVP elevated 5cm; weight 85kg (baseline 81kg); dry mouth, urine output 20mL/hr via IDC.

Investigations: BNP 1,200 pg/mL (elevated); Na 128 mmol/L, K 3.2 mmol/L; ECG: AF with rate 110; CXR: pulmonary oedema; Echo: EF 32%.

Nursing Notes: IV cannula 20G left forearm; NBM for 4 hours pending GTN infusion; family visited, concerned about discharge planning; non-compliant with low-sodium diet per wife.

You are the Registered Nurse coordinating care.

Task Requirements

Use the Clinical Reasoning Cycle (Levett-Jones, 2018) to structure analysis. Process cues from scenario, prioritise issues, set goals, implement/evaluate interventions, and reflect. Incorporate multidisciplinary aspects (e.g., cardiology input) and address social determinants (e.g., isolation).

Required Sections:

1. Introduction (200 words): Introduce scenario, framework, and overview of key issues (e.g., fluid overload, electrolyte imbalance, anxiety).
2. Consider the Patient’s Situation (250 words): Detail history, admission context, and biopsychosocial factors (e.g., non-adherence, grief).
3. Collect, Process, and Present Cues (300 words): Organise subjective/objective data; highlight abnormalities (e.g., hyponatraemia, AF). Link to pathophysiology.
4. Process Information and Identify Three Nursing Issues (350 words): Prioritise based on ABCs/Maslow (e.g., impaired gas exchange, excess fluid volume, ineffective health management); justify with NMBA competencies.
5. Establish Goals (200 words): Develop SMART goals for each issue (e.g., SpO2 >92% within 6 hours).
6. Take Action – Nursing Interventions (500 words): Detail 2–3 evidence-based strategies per issue (e.g., oxygen titration, fluid monitoring, education); rationalise priority, link to data/history, address ethical/legal elements (e.g., capacity for consent).
7. Evaluate Outcomes (100 words): Assess intervention impact; propose adjustments.
8. Reflect on the Process (100 words): Analyse reasoning gaps; discuss learning for future practice.

Use 12+ peer-reviewed sources (2019–2025); Harvard referencing. Ensure person-centred language.

Rubric Criteria

Submission Instructions

Label: “StudentID_NRSG378_Ass3_CaseStudy.docx”. Upload to LEO Turnitin. Late: 10%/day. Integrity: <15% similarity. Extensions: 48 hours prior with evidence. Q&A recording on LEO Week 9.

Learning Materials/Resources

Longhini, J., Gauthier, K., Konradsen, H., Palese, A., Kabir, Z. N. and Waldréus, N. (2025) The effectiveness of nursing interventions to improve self-care for patients with heart failure at home: a systematic review and meta-analysis. BMC Nursing, 24(286). doi:10.1186/s12912-025-02867-7.

Yu, S., Wei, D. and Shi, N. (2023) Comprehensive nursing intervention improves quality of life and reduces hospitalization time and expense in elderly patients with severe heart failure undergoing rh-BNP treatment. American Journal of Translational Research, 15(8), pp.5239–5248.

Ordóñez-Piedra, J., Ponce-Blandón, J. A., Robles-Romero, J. M., Gómez-Salgado, J., Jiménez-Picón, N. and Romero-Martín, M. (2021) Effectiveness of the Advanced Practice Nursing interventions in the patient with heart failure: a systematic review. Nursing Open, 8(4), pp.1879–1891. doi:10.1002/nop2.847.

Marques, C. R. d. G. et al. (2022) Educational nursing intervention in reducing hospital readmission and the mortality of patients with heart failure: a systematic review and meta-analysis. Journal of Cardiovascular Development and Disease, 9(12), p.420. doi:10.3390/jcdd9120420.