Question: Aabish Ali is a 19year old student studying physiotherapy. She was diagnosed with Asthma as a child and has taken inhalers daily since then which keep it under control.

Scenario

Aabish Ali is a 19year old student studying physiotherapy. She was diagnosed with Asthma as a child and has taken inhalers daily since then which keep it under control. Her peak flow is 500 L/min. She is currently having some occurrence of waking up and tightness in her chest overnight which she has attributed to anxiety and stress over her upcoming exams.

Last night Aabish was found collapsed in the street by a passer-by who called an ambulance. The paramedics stated that Aabish had an audible wheeze when they were assessing her prior to bringing her to hospital. Aabish’s family have been informed of her admission to hospital and they are on their way.

Aabish is very upset. She is struggling to breathe and is unable to talk in full sentences. Her observations in A&E are:

Bp: 88/63mmHg

HR: 115bpm

RR: 28bpm, using accessory muscles

Sp02: 88% on room air

Chest auscultation: Wheeze

Temp: 36°C

Urine Output: Unsure when last passed urine

ACVPU – C GCS: E3 V4 M6

BSL: 4.5mmol/L

CRT: 4 seconds, peripherally cool to touch

Guidance for working through the scenario

1. Use the principles of ABCDE assessment and NEWS 2 scoring to establish the acute condition of Aabish and to assess if she is at risk of deteriorating.
2. Analyse the assessment data and related pathophysiology to plan the next steps of Aabish’s in terms of medical or surgical interventions and involvement of the multi-disciplinary team. Explain any abnormal signs and symptoms. Link the abnormal signs and symptoms to Aabish’s diagnosis and the underlying pathophysiology and/or compensatory mechanisms.
3. Identify and discuss the ethical-legal principles that apply to the clinical assessment of Aabish. Consider and discuss any capacity issues with reference to legal and ethical frameworks. Analyse the rationale as to why these principles should be applied. Discuss how you will utilise communication strategies and the ethico-legal principles that apply Aabish.
4. Examine the efficacy of strategies you might use to communicate with the multi-disciplinary team, families, carers.
5. Examine your clinical assessment of Aabish and your interpretation of the assessment data and using the evidence base, consider the actions you might take. Discuss the relevant interventions, treatment, including further investigations that Aabish requires. Using guidelines and evidence-based literature provide a rationale for each intervention, management and evaluation of care.

You are required to submit a 2,500 word structured critically reflective report based on a formative simulated activity which addresses all the points to consider.

Using the information in the patient scenario and your reflection on your communication within the simulation your brief will examine your knowledge and skills necessary to assess and deliver safe and effective care when a person is acutely ill, with reference to the patient’s underlying pathophysiology, relevant clinical guidance, and legal/ethical frameworks. It will appraise your ability to recognise people who are acutely ill and at risk of deteriorating, undertake timely structured assessments, interpret clinical data, and use situational judgement to escalate findings, prioritise care needs and to plan, deliver and evaluate evidence-based, person-centred care as part of the interdisciplinary team. Your brief must address all the Points to Considers.

Points to Consider 1:  Apply a structured assessment approach to recognise the acutely ill person or when a person’s condition is at risk of deterioration. This means you should use the principles of ABCDE assessment to establish the acute condition of the person or to assess if they are at risk of deteriorating.  Identify normal and abnormal signs and symptoms.

Points to Consider 2: Interpret assessment data in relation to pathophysiology and commonly encountered health conditions and use situational judgement to escalate findings and prioritise. This means, explain any abnormal signs/symptoms. Link the abnormal signs and symptoms to the patient’s diagnosis and the underlying pathophysiology and/or compensatory mechanisms. With reference to evidence based literature, you should analyse the assessment data to plan the next steps of their care in terms of medical or surgical interventions and involvement of the multi-disciplinary team.

Points to Consider 4: Examine the effectiveness of strategies used to communicate and work in partnership with people, families, carers and members of the interdisciplinary team. This means you assess how successful your communication with colleagues, patient, MDT etc With reference to evidence based literature you should evaluate any strategies used.

Points to Consider 5: Apply ethical-legal principles to the care of the acutely ill person. This means that you should discuss capacity issues with reference to legal and ethical frameworks. Identify the ethical-legal principles that applied to the clinical assessment scenario and analyse the rationale as to why these principles should be applied. Discuss how you will utilise communication strategies and the ethico-legal principles that apply to the care of an acutely ill person.

1. Introduction (approx. 250 words)

• A brief overview of the scope of the structured brief (what do you intend to do), identification and rationale for using a structure ABCDE approach.
• Provide a short overview of the scenario you participated in within the simulation, the patient’s diagnosis, including relevant pathophysiology.
• Include the aspects of the clinical assessment you are going to address, providing rationale for the assessment model
• Identify the ethical-legal principles that will applied to your patient scenario.
• Identify which reflective tool you are going to use (if you decide to use one)

2. Main body(approx. 2000 words)

• Identify normal and abnormal physiological signs within the patient scenario. Explain how these signs relate to the patient’s diagnosis and underlying pathophysiology and/or compensatory mechanisms.
• Analyse assessment data to determine next steps in the care of the patient and the involvement of the multi-disciplinary team.
• Examine your clinical assessment of the patient and interpretation of the assessment data. Discuss and provide a rationale for any interventions, treatment and further investigations that the patient requires.
• Examine the efficacy of any strategies you used to communicate with the patient, the multi-disciplinary team or any significant others e.g. next of kin, carer in your simulation. Discuss what communication strategies there are.
• Identify the ethical-legal principles that applied to the clinical assessment scenario and analyse the rationale as to why these principles should be applied. Discuss how you will utilise communication strategies and the ethical-legal principles that apply to the care of an acutely ill person.
• Provide a brief overall evaluation of your ABCDE assessment on the patient scenario

3. Conclusion (approx. 250 words)

• Provide an overall conclusion that refers to the evidence and effectively concludes your discussion and arguments. Briefly discuss the importance of assessment, intervention and escalating findings.  Briefly summarise the importance of using a systematic approach to prioritise care needs and to plan, deliver and evaluate evidence-based, person-centred care as part of the interdisciplinary team.

This task requires you to use evidence based literature and relevant clinical guidelines/ reports such as those produced by NICE, the UK Sepsis Trust, BTS, JBDS etc. You are advised to use approximately 20-25 different references.