Don Mariano Marcos Memorial State University

South La Union Campus

COLLEGE OF COMMUNITY HEALTH AND ALLIED MEDICAL SCIENCES

Agoo, La Union, Philippines

NURSING CARE MANAGEMENT

(NCM 106 RLE)

MODULE 2
CARING FOR CLIENTS WHO ARE ACUTE/CRITICALLY ILL
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MODULE 2
CARING FOR CLIENTS WHO ARE
ACUTE/CRITICALLY ILL

Content Page
Introduction 3
Learning Outcomes 3
Module Organizer 3
Case Scenario 1: Acute/Critically Ill Patient in Hemodynamic
5
Monitoring
Case Scenario 2: Acute/Critically Ill Patient in Circulatory
8
Assist
Case Scenario 3: Acute/Critically Ill Patient in Mechanical
11
Ventilation
Module Summary 16
Module Evaluation 16
References 17
Appendices 18

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MODULE 2

CARING FOR CLIENTS WHO ARE ACUTE/CRITICALLY ILL

INTRODUCTION

This self- learning module on related learning experience presents the principles and
techniques of nursing care management of acute/critically sick clients.

The case scenarios are set at Ilocos Training and Regional Medical Center Surgical
Intensive Care Unit (SICU), Respiratory ICU, Medical Intensive Care Unit (MICU)

Your related learning experience on this topic is composed of 64 hours.

LEARNING
OUTCOMES

After studying the module, you should be able to:

1. Utilize the nursing process in the care of clients who are acute/critically ill.
2. Perform a holistic health assessment based on the case scenarios provided
3. Utilize assessment information to formulate client-centered plan of care
4. Explain appropriate nursing interventions per problem identified
5. Apply bioethical concepts/ principles, core values, and nursing standards in
the care of clients with cellular aberrations

MODULE ORGANIZER

There are three case scenarios in the module. Work on the exercises carefully.

Spaces are given for you to write your answers. You may wish to use additional sheet/s
of paper if necessary. The forms for Nursing Care Plan and Drug Study are attached on the
appendices. Rubrics in evaluating your outputs are also included.

Submit your outputs to us your tutors at the CCHAMS office. You may also wish to send
an electronic copy of your outputs to our email or to our NCM 106 RLE Google classroom using
your official DMMMSU email.

Aside from the main content, there are supplementary materials included in this
module to strengthen your learning represented by the following icons:

Books or Journals

Video Links

Website Pages

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In case you encounter difficulty, discuss this with us during the face-to-face meeting
as per schedule, if the situation permits. If not, contact your instructors on Mondays and
Tuesdays from 8:00 am to 5:00 pm through Facebook messenger, Google classroom or Google
email.

Good luck and have fun learning!!!

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CASE 1
CLIENT IN MECHANICAL
VENTILATION

Case Scenario
A 42-year-old male client is status post VA, motor vehicle (crashed) accident, and
was brought to the ITRMC Emergency Department transported by the Municipality of Bauang
ambulance EMS.

EMS provides the following report:

Arrived on scene to witness 2 vehicle collision. Patient’s car appears to have struck
the other car from behind in Baccuit Sur Bauang La Union at around 11 pm on October 10,
2020. The patient was found in the driver’s seat without seat belt engaged, and with positive
alcohol breath. The patient’s eyes were open and he was responsive to the team. He was
mumbling incomprehensible words when questioned and following commands in all four
extremities. Visible contusions on front of forehead where it likely strucked the steering
wheel. The patient was removed from the vehicle and placed in the ambulance. Initial vitals
HR 114, BP 134/90, RR 24, SpO2 88% on room air. Patient was placed on nasal cannula.
Patient became less responsive on route to hospital and SpO2 continued to fall, patient was
placed on non-rebreather mask and SpO2 stabilized at 94%. Blood glucose 110. Patient only
opening eyes to repeated stimulation and intermittently following commands. Arrived at the
Emergency department of ITRMC for continuity of care.

Emergency Room

In the hospital, he was attached to cardiac monitoring with continuous pulse oximetry
and a full set of vital signs is taken. 12-lead electrocardiogram and lab work are quickly
obtained. Then, nurses performs their head-to-toe assessment of the patient, including a full
neurologic examination.

Physical Exam is performed with the following pertinent findings:

• Head: Hematoma on forehead without laceration; no drainage noted

• Neck: Unable to state pain, no grimace to palpation; no overt signs of trauma
• Cardiac: Irregular rhythm with no extra heart sounds; 1+ pulses, brisk capillary refill
• Pulmonary/Thorax: Fine crackles at bilateral bases; increased work of breathing
• GI: soft, non-tender, not distended abdomen; active bowel sounds throughout
• GU: no signs of trauma; no discharge or lesion present
• Integumentary: Scattered ecchymosis on limbs and trunk; no open wounds
• Neurologic: Eyes open to noxious stimuli, no verbal response, withdraws to pain in
upper extremities and flexes to pain in lower extremities
• CN: Pupils equal and brisk, corneal reflex and VOR intact, grimace to pain
equal bilaterally, gag intact
• Motor: withdraws to pain in upper/lower extremities
• Sensory: Responds to painful stimuli in all four extremities

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• Cerebellar: Patient unable to cooperate with exam

• Reflexes: normal reflexes in all four extremities
Due to the patient’s decreased level of consciousness, the patient is unable to
participate in some aspects of the exam, so it is modified to still obtain as much information
as possible. Subjective history is limited at this time due to the patient’s mental status.
When family arrives, they state he was a former half pack per day smoker who quit 5 years
ago. He was an occasional alcohol drinker but without use of recreational drugs. No previous
hospitalization for 2 years and not on any medications. No known food and drug allergy.

Vitals Signs

Heart rate 128, blood pressure 100/60, respiratory rate 25, Temp 37.7°C, SpO2 92% on
non-rebreather mask.

Primary survey reveals patent airway with no signs of current obstruction. Breathing is
tachypneic and regular with increased effort displayed by accessory muscle use. Circulation
with tachycardia and mild hypotension. 1+ distal pulses bilaterally and skin is warm and dry.

ECG reveals sinus tachycardia of 129 but resolved without any prior medical
management at the ER. Sinus @ 98 bpm.

TASK 1

Using the ABC, Identify the life threatening injuries of the patient. Why?

• Airway – “A”
• Breathing – “B”
• Circulation – “C”

Diagnostics & Medical Management:

Laboratory Results as Follows:

Na K BUN Cr AST/ALT Glucose Ca Mg PO4 Trop

141 3.1 32 1.4 38/42 129 7.9 1.9 3.1 0.24

WBC Hgb Hct Plt aPTT INR pH pCO2 PaO2 HCO3

12.3 11.9 35.3 199 24.3 3.1 7.31 49 68 24

The CT scan is completed and the patient is accepted by the Neuro ICU team. The
patient is brought up to the ICU and a hand of care is given at bedside between the
Emergency Room Nurses and ICU Nurses.

The radiology report states a right frontal intraparenchymal hemorrhage (IPH) with
posterior occipital contusion. Vasogenic edema and midline shift is seen. The patient is
started on hypertonic saline for the edema.

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The decision is made with the medical team to place a ventriculostomy for drainage
and ICP monitoring if possible.

How Ventriculostomy is done:

https://www.youtube.com/watch?v=x49rY0tZpVI

• Patient was endorsed to the surgical ICU Unit from Recovery Room of Operating Room
Complex.

Care of Patient Status Post Ventriculostomy:

https://www.youtube.com/watch?v=wsvvctVASmM&t=113s

You are the receiving nurse from the Surgical ICU Unit:

Endorsement:

Patient 42 years old male, a victim of vehicular accident on October10, 2020 in Bauang
La Union. Admission date: 10/10/2020 @ 11:30 pm. Initially at the ER, GCS of m5v1e2, both
eyes reactive to light at 2 mm ertl. With no noted body weakness in all extremities but with
evident bruises in all extremities. Admitted in the medical ICU wherein close neurologic
monitoring done. IVF of pnss 1 l x 8 hours, on 02 support of non-rebreathing mask at 10 lpm.
Medications started are: totilac 100 ml every 6 hours, ceftriaxone 1-gram iv q8h, tranexamic
acid 500 mg iv q8h and one dose of vit k/amp given. At the operating room, patient was
intubated and on general anesthesia during operation. Operation started at 3:10 am to 4:00
am. At the recovery room, Patient was intubated and hooked to t-piece at 60 % spiron, with
intact NGT and IFC draining to amber urine. Patient is placed flat on bed and tube vent is
placed at 10 cm level draining to yellowish fluid of 10 cc. Post-op site has dry and has intact
dressing. Patient started with IVF of PNSS 1L + 40 meqs KCL to run for 8 hours at 800 cc
level, paracetamol 600 mg iv every 4 hours for 3 days was started. Because of increasing
restlessness, it was referred to anesthesia and started with fentanyl 2 mg iv every 2 hours for
restlessness. After one hour in the recovery room, patient has improved sensorium at GCS 12,
m5vte3-4, 2 mm ertl. Patient was then extubated and hooked to 02 cannula at 2-3 lpm well
tolerated for an hour. Latest vs, bp-100/60 mmhg, t-37.5, 02sats-96, rr-20, cr-82 sinus.
Special endorsement: Place patient flat on bed at tube vent @ 10 cm level, Note for
discharges. Maintain patient on NPO until further orders. IVF to follow: PNSS 1 L + 40 meqs Kcl
x 8 hours then IVF of PNSS 1L + 20 meqs kcl x 8 hours then PNSS 1L x 8 hours rate. Monitor
input and output every hour. Watched out for decreased in sensorium, increasing restlessness,
signs and symptoms of IICP, sign and symptoms of bleeding, difficulty of breathing and
decreasing urinary output. For head ct scan tomorrow am.

TASK 2
With the given data on the scenario, furnish the Kardex in the chart.

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TASK 3
Make a drug study on the medications given to the patient.

CASE 2 Use of Critical Thinking in Caring for Clients with

Gastro Intestinal Disorders

PROFILE
Alia Sofia Binte, 3 years old, Date of Birth: 08/08/2017,

Date of Admission: September 5, 2020

Admitting Diagnosis: Acute Lymphocytic Leukemia stage 2, Chemotherapy-Induced Infectious

Colitis, to rule out sepsis, status post colostomy

SOCIAL HISTORY

Alia is the first-born child in a middle-class family residing in the rural

area. Her father is a worker in the plastic factory while her mother is a housewife. Her father
is 40 years old and known to be hypertensive and diabetic. Her mother was a Radiologic
therapist in the hospital before she was born. Her father has history of cancer in the family
wherein her brother fell ill because of cancer in the liver.

HISTORY OF PAST AND PRESENT ILLNESS

History of Past Illness: According to her mother, she had normal pregnancy with
regular check up in the hospital where she worked. Alia was born full-term and was in a
healthy state. She was breastfed exclusively for 6 months and has normal new born screening.
She was an active child with normal milestone. It was when she was one year old that she had
frequent hospitalization because of pneumonia. There was a time that she stayed a month in
January 2019 in the hospital because of pneumonia wherein they suspected her to have
problem in her immune system and blood.

History of Present Illness: Prior to admission, patient has been diagnosed with
leukemia stage 2 for a year now. 4 cycles of chemotherapy have been administered since
March 2019. Last chemotherapy was on August 30, 2020. Two days after her last

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chemotherapy, patient has experienced loose bowel movement with blood for 3 times for 2
days which is associated with fever. Loss of appetite and lethargy were observed from the
patient which prompt consult. On the emergency room, patient was weak looking and
lethargic. Upon assessment, she followed command, oriented and with spontaneous eye
opening. Both pupils equally react to light. Eyes are normal with tears when crying. Mouth
and oral mucosa were dry and opted not to drink milk when served. Skin was dry and with
poor skin turgor. Both lung fields were clear with no complaints of difficulty of breathing.
Both extremities were warm to touch and with good capillary refill on nail beds. Radial pulse
and femoral pulse were rapid with PR of 160 bpm. The mother claimed that the patient has
pain on the abdomen but can’t specify where.

Abdominal Assessment:

Upon Inspection: Abdomen non-globular, no abnormal discoloration or mass see, with normal
diaphragmatic breathing noted.

Auscultation: With hyperactive bowel sounds on four quadrants.

Palpation: non-tender, no mass, but complain pain in all quadrants upon palpation

Percussion: normal bowel sounds

Vital Signs: BP-80/50, t-39, cr-160, rr-25, 02sat-98 on room air, WT- 12 kg HT-94 cm

Diagnostics:

CBCPC, CXR, fecalysis, Abd Xray, Abd ultrasound, CT scan and EGD.

CBC revealed leukocytosis with anemia. CXR result shown normal finding. Fecalysis shows e-
coli Infections. CRP and ESR are elevated

Loss of bowel wall architecture and thumbprinting consistent with

colitic presentation.

No evidence of perforation.

Abdominal Ultrasound

Increased symmetrical wall thickening and submucosal echogenicity. On color Doppler, there
may be increased mural flow. Evident features of colitis.

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EGD Result with Biopsy

Bowel mucosa shows friability, diffuse profound ulcers and

with signs of bleeding

Colonic biopsy of the above patient: Prominent inflammation

of the lamina of the small intestines.

Progress Notes:

On the 28th day of hospital admission, patient has tolerated trial feeding of soft diet
with NGT supplementation. Patient is active and is oriented with episode of restlessness when
procedure is done. Ileostomy is pinkish in color, shiny and moist. Patient has completed 14
days of antibiotic therapy of piperacillin tazobactam 250 mg every 8 hours., metronidazole
250 mg every 8 hours for 7 days, Latest ct scan result, intra-abdominal lining is less inflamed
without any abscess. Blood transfusion of PRBC 3 units had been administered.

On your shift:

Nearly one month in the hospital, patient has improved. Patient can now tolerate solid
food with NGT feeding supplement of Pediasure 5 scoops in ½ glass of water every 6 hours.
She has colostomy bag on place which is pinkish in color, shiny and moist. Mother has been
taught to do colostomy cleaning and currently doing NGT feeding at the hospital. Patient is
ready for discharge.

On this case scenario:

TASK 1
1. Make a step by step procedure on how to administer enteral feeding.

TASK 2

1. Make a step by step procedure on the care of colostomy.

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TASK 3

Make a Home Care Plan for the patient to be instructed to the mother
as a primary care provider.

CASE 3 Use of Critical Thinking in Caring for Clients with

Respiratory Disorders

PROFILE
Juan Dela Cruz, 78 years old, from Sto Tomas, La Union

Birthdate: 8/8/1948, Weight of 65 Kg., Height 174 cm.

HISTORY OF PRESENT ILLNESS

 Patient has no family history of asthma as claimed. Previously worked as
an OFW in Saudi Arabia as an aircon technician for 10 years. He was a
smoker for 20 years with approximately 10 sticks per day but stopped
last 2018. He is a social drinker and can only consume one bottle of
SanMig light. When he was younger, he worked as a part time company
sorter in a nearby tobacco manufacturing company for 5 years. His
father was a farmer and his mother was a housewife. He has mild
asthma which started when he was young and believed to have resolved
naturally without any medications as he aged. A re-occurrence of
asthma attack happened last January 2019, when he was also diagnosed
with chronic bronchitis and pneumonia.

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Doctors Order

Doctors Notes Doctors Order Nurse Compliance

Carri admi req endo disc
ed nister ues rsed harg
out ed ted ed
Prior to patient admission, he has a Admit patient in RICU-COVID ICU
known case of COPD with episodes Initiate Universal Precaution
of asthma in acute exacerbation Secure Consent for Admission
that leads to hospitalization. Last Inform AMD
admission date was on January Hook to cardiac monitor
2020 for 3 days because of dyspnea Hook to nasal cannula @ 2LPM
and/ difficulty breathing. Patient
was managed with salbutamol + Inset IVF of PNSS 1L strictly KVO rate
ipratropium nebulization every 6 Give:
hours, budesonide nebulization 1. Tolubuterol respitrol patch on
every 12 hours, started cefixime anterior chest now
antibiotics 400 mg 2x a day, 2. Furosemide 20 mg IV now
fluimucil effervescent 600 mg in ½ 3. Hydrocortisone 250 mg iv now
glass water 2x/day and doxofylline then 100 mg every 6 hours
1 tab twice a day. Patient was until further orders
discharged with
Home Medications as follows:
1. Doxofylline 1 tab twice a
day, Labs:
2. Spiolto Respimat ( ECG now
Tiotropium bromide + ABG now
Olodaterol Hydrochloride) 2 CXR, now
puffs once a day CBC, PC, Electrolyte Profile, Creatine
3. Acetylcysteine 1 tab in ½ Procalcitonin
glass of water once a day Covid-PCR test
4. Cefixime 400 mg 2x/day for
4 more days. Maintain patient on NPO
5. Montelukast Sodium Monitor Input and Output and record
5mg/.tab, 1 tab to be taken For Close Monitoring
at bedtime Will Follow-up

Prior to consult patient ate shrimps

for dinner. He has episodes of
allergic reaction of rashes from
eating shrimps before but resolved
naturally. After 2 hours, he had
difficulty of breathing which
prompt consult.

Chief Complaints: Dyspnea and/

Difficulty of Breathing

At ER: 10/4/2020, 10:00 pm

Patient was diaphoretic, weak and

pale looking. He follows command,
but disoriented to date and place,
with spontaneous eye opening,
both pupils at 2 mm equally
reactive to light. There is a noted
beginning cyanosis on fingernails on
hands.
Patient claimed, “nasakit detoy
barukongko, jak makaanges nga
nasyaat, nasakit nu umanges nak.”

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Upon inspection, patient has nasal

flaring with the use of
sternocleidomastoid muscle during
inspiration with slight jugular vein
distention. No cough noted. Patient
has equal chest expansion on both
fields, with no bruising or redness
on both chest walls.
Upon palpation, there is no noted
nodules, areas of tenderness or
deformity in the chest.
Upon percussion, there is normal
chest vibrations with equal
diaphragmatic excursions.
On auscultation, patient has
unequal breath sounds, there is
decreased breath sounds on the
right lung parenchyma more on
basal region, (+) basal crackles on
right lung and wheezing on both
lung fields.

Vital Signs:
T-37.8, cr-130 (sinus rhythm), rr-
22, 02sat-80, bp-160/100 mmhg

10:3O PM (RICU)
Patient claimed, “awan nagbaliwan Hooked to facemask at 5 LPM
na, nadagsen latta. 02sats-80-82 % Give Sodium Bicarbonate 50 meqs as
. bolus now then 50 MEqs every 6 hours
Follow-up other blood results
ABG: RESPIRATORY ACIDOSIS Will follow-up

ECG: Sinus tachycardia 125 bpm

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CXR: With Minimal consolidation on

right basal lung fields. Possible
pleural effusion.

10:35 pm Hooked to non-rebreathing mask at

Patient is in increasing restless.
02sats 90 %, rr-23, BP-140/90
mmhg
10LPM.
Administer another furosemide 20 mg
iv now
Start aminophylline drip:
Aminophylline 250 mg/10 ml amp to
be incorporated in 250 d5water to
start at 10cc/hr
Watched out for Arrhythmias,
hypotension, tachycardia &
convulsions.
Close monitoring
Will follow-up

 Proper Use of PPE in RICU in times of COVID 19.

https://www.youtube.com/watch?v=wR25COr2FSs

You are the Nurse in the ICU:

TASK 1
You are going to facilitate Universal Precaution to patients admitted in the
RICU:
Give the full sequence and description, using flow chart, of
proper donning of PPE in times of COVID in the RICU.

TASK 2

Perform a cephalocaudal assessment on the patient given the information

above.

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TASK 3

Make a sample FDAR Nurses Notes based on the assessments made.

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MODULE SUMMARY

In module 2, you have learned about caring for clients who are acute/critically ill .

There are three case scenarios in module 2.

Case 1 focuses on giving care to an adult client on mechanical ventilator.

Case 2 deals on how to care for a client with respiratory disorder.

Case 3 presents a situation of a child with gastrointestinal disorder.

Yehey! You have just finished Module 2.

MODULE EVALUATION

Before moving to the next topics, we would like to hear your honest feedback
with this module. This will not in any way affect your grade for this course.

Kindly rate the following areas with a scale of 1 to 5, with 5 as the highest and
1 as the lowest.

Criteria Rating

1. Completeness of Content

2. Relevance of Content

3. Clarity of the text and message

4. Alignment of the assessment activities with the

learning outcomes

Comments and Suggestions:

____________________________________________________________________

____________________________________________________________________

____________________________________________________________________

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REFERENCES

MedlinePlus(2020).Acidosis Retrieved from

https://medlineplus.gov/ency/article/001181.htm.

NCBI.(2020).Respiratory Acidosis. Retrieved from

https://www.ncbi.nlm.nih.gov/books/NBK482430.

Nursing Times (2018). Caring for neurosurgical patients with external ventricular
drains.
Retrieved from https://www.nursingtimes.net/clinical-archive/neurology/caring-for-
neurosurgical-patients-with-external-ventricular-drains-26-03-2018/.

MayoClinic.(2020).Heart Attack. Retrieve from

https://www.mayoclinic.org/diseases-conditions/heart-attack/diagnosis-
treatment/drc-20373112.

WebMd.(2018).Heart Attack. Retrieve from

https://www.webmd.com/heart-disease/guide/heart-disease-heart-attacks#1.

WebMd.(2020). Status Asthmaticus. Retrieve from

https://www.webmd.com/asthma/guide/status-asthmaticus.

American Heart Association. (2020). Retrieve from

https://www.heart.org/en/health-topics/heart-attack/treatment-of-a-heart-
attack

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APPENDIX A

NURSING CARE PLAN FORM

Don Mariano Marcos Memorial State University

South La Union Campus
COLLEGE OF COMMUNITY HEALTH AND ALLIED MEDICAL SCIENCES
Agoo, La Union
Tel. 072.682.0663/ichams.dmmmsu-sluc.com
Embracing World Class Standards NURSING DEPARTMENT Care to learn, Learn to care

NURSING CARE PLAN

Explanation of Goals and

Assessment Intervention Rationale Evaluation
the Problem Objectives

*Note: Landscape Layout

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APPENDIX B

DRUG STUDY FORM

Don Mariano Marcos Memorial State University

South La Union Campus
COLLEGE OF COMMUNITY HEALTH AND ALLIED MEDICAL SCIENCES
Agoo, La Union
Tel. 072.682.0663/ichams.dmmmsu-sluc.com
Embracing World Class Standards NURSING DEPARTMENT Care to learn, Learn to care

DRUG STUDY

Drug Name
Side Effects
(Generic name, Drug Mechanism Nursing
and Adverse Contraindications
Brand Name, Dose, Classification of Action Responsibilities
Reactions
Route, Dosage)

*Note: Landscape Layout

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APPENDIX C

RUBRIC FOR CASE STUDY (Problem Solving)

EXCEEDS MEETS NEARLY MEETS DOES NOT MEET

CRITERIA SCORE
EXPECTATIONS EXPECTATIONS EXPECTATIONS EXPECTATIONS
20 15 10 5
Identifies, labels, Identifies, labels, Identifies, labels, Unable to identify,
Identification of and understands all and understands all and understands all label, and
the Main Issues/ relevant main issues but one or two but three or four understand relevant
Problems and/or problems relevant main issues relevant main issues main issues and/or
and/ or problems and/or problems problems
24 18 12 6
Insightful and Thorough analysis Superficial analysis Incomplete analysis
Analysis of thorough analysis of of most of the of some of the of the problems/
Issues all the programs/ problems/questions problems/ questions questions presented
questions presented presented in the presented in the in the case
in the case case case
16 12 8 4
Excellent inquiry Good inquiry into Limited inquiry into Incomplete or no
into the problems/ the the problems/ inquiry into
questions with problems/questions questions with problems/questions
Linkage of clearly documented with clearly clearly documented with clearly
Course Readings linkages to the documented linkages to the documented
and Other material read in linkages to the material read in linkages to the
Resources to class, other material read in class, or other material read in
Problem/ assigned resources, class, and/or other assigned resources, class, other assigned
Question previously gained assigned resources, previously gained resources,
knowledge, and previously gained knowledge, or out- previously gained
outside resources knowledge, and/or side resources knowledge, and/or
outside resources outside resources
20 15 10 5
Each response is Each response is Each response is Each response is
correct, well-written, mostly correct, or minimally correct, incorrect, or poorly
Effective appropriately well-written, or well-written or written, or
Response and/ or referenced, and appropriately appropriately unreferenced, and
Solutions to Case relevant to referenced, and referenced, or irrelevant to
Study Questions question(s) or relevant to irrelevant to question(s) or
problem(s) question(s) or question(s) or problem(s)
presented problem(s) problem(s) presented
presented presented
TOTAL (80)
Reference: Robin Donohoe Dennison, J. R. (2015). Evaluation Beyond Exams in Nursing Education: Designing Assignments and Evaluting .with Rubrics. New York City: Springer Publishing Company.page 167-173

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APPENDIX D
RUBRIC FOR CASE STUDY (Pathophysiology)

EXCEEDS MEETS NEARLY MEETS DOES NOT MEET

CRITERIA SCORE
EXPECTATIONS EXPECTATIONS EXPECTATIONS EXPECTATIONS
28 21 14 7
The The The The
pathophysiology pathophysiology pathophysiology pathophysiology
contains no errors contains only a few contains several includes many
or misconceptions. minor errors but is minor errors or at minor or major
Accuracy accurate on all key least one major errors or
error or misconceptions.
misconception but is Inaccurate on many
accurate on most key concepts
key concepts
24 18 12 6
The The The The
pathophysiology pathophysiology pathophysiology pathophysiology
Comprehensiveness demonstrates in- demonstrates good demonstrates demonstrates only
depth knowledge of knowledge of the moderate superficial
Etiology the topic. The topic. The knowledge of the knowledge of the
Clinical Presentation pathophysiology pathophysiology topic. The topic. The
Diagnostic Studies contains all key contains most key pathophysiology pathophysiology
Nursing Diagnosis concepts. Complex concepts but does contains only a few contains hardly any
thinking about the not demonstrate key concepts and key concepts, and
central concept is complex thinking those presented are those that are
evident. weakly developed presented are not
developed.
20 15 10 5
The The The The
pathophysiology is pathophysiology is pathophysiology is pathophysiology is
nonlinear and nonlinear. The nonlinear but the generally linear or
treelike. Concepts concepts and links concepts and links disorganized. The
and links are easy are easy to follow are difficult to follow. pathophysiology
to follow and and understand. The fails to demonstrate
understand. The The pathophysiology connections among
Organization and pathophysiology pathophysiology demonstrates only a concepts. It is
Structure demonstrates all demonstrates most few connections difficult to identify
appropriate connections among among concepts. the central concept.
connections among concepts. A few Many linking words The
concepts and linking linking words are are omitted or pathophysiology is
words accurately omitted or inappropriate. Most difficult to read.
describe inappropriate. Most of the
relationships. The of the pathophysiology is
pathophysiology is pathophysiology is difficult to read
clearly legible. clearly legible.
16 12 8 4
The The The The
pathophysiology is pathophysiology is pathophysiology is pathophysiology is
based on multiple based on multiple based on based solely on
(more than 10) references, references limited to personal opinion,
references, including material textbooks or lay literature, or
including material from professional commercial (e.g., commercial
from professional journals and .com) websites. websites. There are
journals and noncommercial There are several multiple errors in
Sources
noncommercial (e.g., .gov, .edu, errors in APA APA citations and
(e.g., .gov, .edu, .org) websites. At citations and references.
.org) websites. least two current references
Multiple current research articles
research articles are are included in
included in references. There
references. There are only one or two
are no errors in APA minor errors in
citations or APA citations or

NCM 106 (RLE): Module II 21 BSN Level IV

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references. references.

12 9 6 3
The The The The
pathophysiology pathophysiology pathophysiology pathophysiology
illustrates creativity illustrates creativity illustrates minimal shows limited or no
in layout, use of in layout, use of creativity in layout, creativity.
shapes, use of shapes, use of use of shapes, use
Creativity color, and color, and of color, or
interconnectedness. interconnected- interconnectedness.
Color is used to ness. Color is used Color is used
improve clarity. to improve clarity primarily for
Appropriate visual aesthetics rather
and/or audio than clarity
embeds enhance
concept
TOTAL (100)
Reference: Robin Donohoe Dennison, J. R. (2015). Evaluation Beyond Exams in Nursing Education: Designing Assignments and Evaluting .with Rubrics. New York City: Springer Publishing Company.page 182-184

NCM 106 (RLE): Module II 22 BSN Level IV

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APPENDIX E

RUBRIC FOR CASE STUDY (Prioritization of Problems)

EXCEEDS MEETS NEARLY MEETS DOES NOT MEET

CRITERIA SCORE
EXPECTATIONS EXPECTATIONS EXPECTATIONS EXPECTATIONS
24 18 12 6
Properly identifies Properly identifies Properly identifies Diagnoses are not
five or more nursing four or fewer three or fewer NANDA approved,
Nursing diagnoses that are nursing diagnoses diagnoses that are appropriate for
Diagnosis clearly supported by that are clearly clearly supported by patient, or not
the data and reflect supported by the the data and reflect prioritized. Diagnosis
Includes relevant accurate clinical data and reflect accurate clinical may not be clearly
NANDA- approved judgement. They accurate clinical judgment. They may supported by
diagnoses written are appropriate for judgement. They not be appropriate assessment data.
in proper form the patient, well are appropriate for for the patient, well
(stem related to prioritized, NANDA the patient, well prioritized, NANDA
and as evidenced approved, and prioritized, NANDA approved or written
by) written in correct approved, and in correct format.
format. written in correct
form.
28 15 14 7
Identifies, classifies, Identifies, classifies, Identifies, classifies, Unable to identify,
Prioritization of and prioritizes all and prioritizes all and prioritizes all classify and prioritize
the Identified actual and potential but one or two but three or four actual and potential
Problems problems actual and potential actual and potential problems
problems problems
8 6 4 2
There are no There are minimal There are some There are multiple
mechanical errors mechanical errors mechanical errors mechanical errors
Format, Spelling,
such as spelling, such as spelling, such as spelling, such as spelling,
Grammar
formatting, and formatting, and formatting, and formatting and
grammar. grammar. grammar grammar

TOTAL (60)
Reference: Robin Donohoe Dennison, J. R. (2015). Evaluation Beyond Exams in Nursing Education: Designing Assignments and Evaluting .with Rubrics. New York City: Springer Publishing Company.page 167-173

NCM 106 (RLE): Module II 23 BSN Level IV

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APPENDIX F

RUBRIC FOR CASE STUDY (Nursing Care Plans)

EXCEEDS MEETS NEARLY MEETS DOES NOT MEET

CRITERIA SCORE
EXPECTATIONS EXPECTATIONS EXPECTATIONS EXPECTATIONS
24 18 12 6
Assessment Correctly identifies Correctly identifies Correctly identifies Correctly identifies
ten clear, specific eight clear, specific, six clear, specific, four clear, specific,
Interview: includes and relevant and relevant and relevant relevant interview
subjective and interview and interview and interview and and physical data
historical data physical data points. physical data points. physical data points. points. Data are
All data are All data are Data are marginally unorganized, and
Physical organized and are organized and/ or organized, and relevance to nursing
Assessment: related to a nursing are mostly related to relevance to nursing diagnosis is unclear.
includes objective diagnosis. a nursing diagnosis. diagnosis is unclear.
data

20 15 10 5
Properly identifies Properly identifies Properly identifies Diagnoses are not
five or more nursing four or fewer three or fewer NANDA approved,
Nursing diagnoses that are nursing diagnoses diagnoses that are appropriate for
Diagnosis clearly supported by that are clearly clearly supported by patient, or not
the data and reflect supported by the the data and reflect prioritized. Diagnosis
Includes relevant accurate clinical data and reflect accurate clinical may not be clearly
NANDA- approved judgement. They accurate clinical judgment. They may supported by
diagnoses written are appropriate for judgement. They not be appropriate assessment data.
in proper form the patient, well are appropriate for for the patient, well
(stem related to prioritized, NANDA the patient, well prioritized, NANDA
and as evidenced approved, and prioritized, NANDA approved or written
by) written in correct approved, and in correct format.
format. written in correct
form.
16 12 8 4
Outcomes/ At least five short- Four short- and Three or fewer Goal portion is
Planning and long- term goals long- term goals are short- and long- incomplete or
are identified that identified that clearly term goals are completely unrelated
Includes patient clearly related to the related to the identified. Goals to the nursing
and family short- nursing diagnosis, nursing diagnosis, may not relate to the diagnosis.
and long- term are written in a are written in a nursing diagnosis,
goals based upon patient- focused patient- focused may not be written
the diagnosis. manner, and are manner, and are in a patient- focused
Goals must be realistic. Each goal realistic. Each goal manner or are
patient focused, contains clear contains clear unrealistic. Each
realistic and have criteria for criteria for goal is missing clear
clear measurable measurement and a measurement and a criteria for
criteria with a time frame for time frame for measurement and a
target date/ time evaluation. evaluation. time frame for
evaluation.
16 12 8 4
Implementation Identifies at least Identifies fewer than Identifies fewer than Interventions are
three specific three specific three specific unclear or do not
Nursing interventions for interventions for interventions for clearly focus on the
interventions or each outcome each outcome each outcome etiology of the
actions that directly criterion in order to criterion in order to criterion related to nursing diagnosis or
relate to the help the patient/ help the patient/ the etiology of the relate to the patient
etiology of the family reach the family reach the nursing diagnosis. goals outcomes.
nursing diagnosis desired goal desired goal. Not all interventions Rationales provided
and the patient may be specific. do not demonstrate
goal and desired Rationalizations are an understanding of
outcome. Each included but they the purpose of the

NCM 106 (RLE): Module II 24 BSN Level IV

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intervention must may be weak, or interventions or no

include referenced references are references are
rationale (including incomplete or from provided.
source, page sources that may
number if not be reliable.
applicable)
16 12 8 4
Evaluation Evaluation portion Clearly states how Evaluation portion Evaluations portion
contains data that each outcome does not is incomplete or
Outlines the are listed as criteria would be evaluated. consistently contain does not relate to
methods to be in goal statement Able to correctly data that are listed diagnosis, goal
used in evaluating and lists identify criteria for as criteria in goal statement, or
outcome criteria, expectations for goal being met, statement. May also interventions
expectations for meeting the goal. partially met, or not describe goal as
goals being met, Clear explanation of unmet. Identifies met, partially met, or
and what would criteria for goals revisions for care not met. May also
determine that goal being met, partially plan but may not not include revision
is met, partially met, or not met. include accurate or new evaluation
met, or unmet. Includes plan for rationale for date/time.
Explain how the continuation or revision, or
plan of care would revision, clearly references may be
be revised or referenced rationale from sources that
continued in each for revisions from may not be reliable,
case, including a reliable sources, or a new date is not
new realistic and a new provided for
evaluation date/ evaluation date/ reevaluation.
time time
8 6 4 2
No errors in APA Minimum errors in May have some Multiple errors in
citations or APA citation and errors in APA APA citations and
references. There references. There citations and references. There
Format, Spelling, are no mechanical are minimal references. There are multiple
Grammar errors such as mechanical errors are some mechanical errors
spelling, formatting, such as spelling, mechanical errors such as spelling,
and grammar. formatting, and such as spelling, formatting and
grammar. formatting, and grammar
grammar
TOTAL (100)
Reference: Robin Donohoe Dennison, J. R. (2015). Evaluation Beyond Exams in Nursing Education: Designing Assignments and Evaluting .with Rubrics. New York City: Springer Publishing Company.page 167-173

NCM 106 (RLE): Module II 25 BSN Level IV

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APPENDIX G
RUBRIC FOR CASE STUDY (Drug Study)

EXCEEDS MEETS NEARLY MEETS DOES NOT MEET

CRITERIA SCORE
EXPECTATIONS EXPECTATIONS EXPECTATIONS EXPECTATIONS
8 6 4 2
There are no There are minimal There are some There are multiple
mechanical errors mechanical errors mechanical errors mechanical errors
Format, Spelling
such as spelling, such as spelling, such as spelling, such as spelling,
and Grammar
formatting, and formatting, and formatting, and formatting and
grammar. grammar. grammar grammar

32 24 16 8
Content 95- 100 % of data 50 – 95 % of the < 50 % of the data All of the data are
are accurate and data are accurate are accurate and incorrect/ No output;
Generic Name correct; 95 – 100 % and correct; 50 – correct; < 50 % Grossly incomplete/
Brand Name complete 95% complete complete No output
Dosage Little to no data are Some data are Most data are
Drug Classification lacking missing missing
Mechanism of
Action
Indication
Side and Adverse
Effects
Nursing
Responsibilities

TOTAL (40)

NCM 106 (RLE): Module II 26 BSN Level IV