Clinical Reasoning Assessment Part A.
Douglas Adams, 51 year old male.
Past history: Type 1 diabetes, Hypertension
Allergies: Penicillin.
Current medications: Humalog Mix 25: 26 units mane and 16 units nocte. Perindopril: 4 mg mane, Aspirin: 100 mg daily.
Social History: Douglas drinks socially 1-2 times a week and consumes 3 standard drinks, he smokes 1 pack of cigarettes a day. He lives in a small apartment by himself and joined a walking group 4 weeks ago with his accounting firm.
Weight :100kg four weeks ago at clinic visit. Height: 185cm.
Presenting complaint: Douglas was admitted with confusion for investigation after a friend visited and found him confused and disorientated at home. He was transported to emergency via ambulance. His Glasgow coma score was 14/15 in emergency.
Current situation: Douglas has been admitted to the ward. When he arrives in the ward the staff completes his weight and height. Weight is 94kg and height 185cm. His Glasgow coma score on admission remained at 14/15. His vital signs are HR –
82bpm, BP – 110/87mmHg, RR-18, T – 36.8. A CT has been planned for Douglas and you inform him that his test will be later this morning. He is having QID Blood Sugar Levels (BSL) and 4/24 neurological obs. His BSL prior to breakfast is 5.2 mmol/L and his mane medications were administered as ordered.
Later that morning, Douglas rings the buzzer to ask what time he will see the doctor and when he will be going for his test. He appears slightly sweaty and has a slight hand tremor. You note that the breakfast was only partly eaten and Douglas says that he’s not really hungry. Douglas appears pale and his speech is slightly slurred. He does not know where he is. His vital signs are: HR – 88bpm, BP –
105/80mmHg, RR-18, T – 36.5.
Assessment Part A – Word Count 1000 words
Please refer to subject guide for requirements of the assessment.
Clinical Reasoning
Data identification & collection from the scenario
Formulation of all relevant hypotheses with rationales. Each hypothesis must be:
relevant for the next 4 hours of their hospital stay & (ii) supported by evidence gathered from patient data
50 Marks
Marks 40-50
• Majority of appropriate data identified and collected (80%)
• Majority of hypothesis identified relevant to data in scenario
• demonstrated an excellent understanding of links between the necessary concepts.
• correct information given (80%+)
• well supported with sufficient and appropriate references
Marks 35-39.5
• Most of appropriate data identified and collected (70%)
• Most of hypothesis identified relevant to data in scenario
• demonstrated a very good understanding of links between the necessary concepts.
• correct information given(70%)
• well supported with sufficient and appropriate references
Marks 30-34.5
• Most of the appropriate data identified and collected (60%)
• Most of hypothesis identified relevant to data collected
• demonstrated a good understanding of links between the necessary concepts.
• some areas not well explained
• correct information given (60%)
• supported with references
Marks 25-29.5
• some of the data identified and collected (50%)
• some hypothesis identified not all relevant to data in scenario
• demonstrated limited understanding of links between the necessary concepts.
• some areas poorly explained
• correct information given (50%)
• poorly supported with references
Marks 0-24.5
• data not identified or identified incorrectly
• hypothesis not identified and/or no relevance to data in scenario
• demonstrated lack of understanding of links between concepts.
• many areas poorly explained
• incorrect information given
• poorly supported with references
Provides several relevant questions that would form the basis for the collection of further subjective data and identifies further focused physical assessment that would be conducted in order to negate or confirm hypotheses.
Discussion of rationales related to pathophysiology for identified assessments.
Use of literature to support argument as evidence & explanation of your clinical reasoning.
50 Marks
Marks 40-50
• depth in discussion of the relevant focused assessment
• depth in discussion of subjective assessment
• demonstrated clear and consistent evidence of critical appraisal of reference material
• evidence of synthesis of information
• well supported with sufficient and appropriate material from relevant and credible source
Marks 35-39.5
• Some depth in discussion of the relevant focused assessment
• Some depth in discussion of the relevant subjective assessments
• demonstrated some evidence of critical appraisal of reference material
• some evidence of synthesis of information
• well supported with sufficient and appropriate material from relevant and credible sources
Marks 30-34.5
• Some depth in discussion of the relevant focused assessment
• Some depth in discussion of subjective areas for assessment
• demonstrated inconsistent evidence of critical appraisal of reference material
• inconsistent evidence of synthesis of information
• supported with references, some inappropriate material and/or from poor quality sources
Marks 25-29.5
• lacked depth in reporting of the relevant focused assessment
• lacked depth in reporting of the relevant subjective assessment
• demonstrated limited evidence of critical appraisal of reference material
• limited evidence of synthesis of information
• poorly supported with references much inappropriate material and/or from poor quality sources
Marks 0-24.5
• Focused assessment not relevant and lacked depth in reporting
• Subjective assessment not relevant and lacked depth in reporting
• inadequate evidence of synthesis of information
• no evidence of critical appraisal of reference material
• poorly supported with references
• much inappropriate material and/or from poor quality sources
Marks will be deducted from total mark if:
The introduction does not adequately address the topic and scope of the paper and the key aspects are not adequately identified. Up to 2 marks deducted
Actual marks deducted:
The conclusion does not adequately summarise the key aspects of the paper. Up to 2 marks deducted
Writing is not fluent and there are typing or grammatical errors. Up to 2 marks deducted
Referencing is not consistently accurate for:
in-text citations Up to 2 marks deducted
reference list Up to 2 marks deducted
COMMENTS:
FINAL Mark
