Assessment Benchmark: A Benchmark to assess the quality of performance

Student Name: Student ID: Group: Date: Type of Assessment This summative assessment will enable your Assessor to make a judgement of competency based on the submission of your completed assignments against the requirements of this unit of competency. Assessors must use these benchmarks to make a judgement on whether competency has been achieved and to determine if the participant has performed to the standard expected to meet the unit requirement and learning outcomes. The following are the reasonable adjustments for this unit: Trainer/Assessor must select which of

Student Name: Student ID:
Group: Date:
Type of Assessment
This summative assessment will enable your Assessor to make a judgement of competency based on the submission of
your completed assignments against the requirements of this unit of competency.
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The Assessment Benchmark developed for each unit of competency is the evidence criteria used to judge the quality of
performance (i.e. the assessment decision-making rules). Assessors must use these benchmarks to make a judgement on
whether competency has been achieved and to determine if the participant has performed to the standard expected to
meet the unit requirement and learning outcomes. Competency results for each unit are recorded in the Record of
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student’s requirement. The following are the reasonable adjustments for this unit:
Trainer/Assessor must select which of the following is suitable for this unit and DELETE rows that are not
applicable
Reasonable Adjustment for this unit College Based On-Line Delivery
The assistance of a Learning Support Teacher for LLN issues
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areas deemed NS will achieve competency for this assignment.
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ASSESSMENT: Practical – Case Study
19th January 2017 Page 1

S/NS result given. A satisfactory result must be attained.
STUDENT INSTRUCTION:
This case study has three (3) scenarios and twenty five (25) associated questions. Please read the three (3)
scenarios carefully and answer ALL of the questions. Use the correct medical terminology when answering
questions.
All of the assessment is to be completed on this word document, saved and submitted via the online portal
within the unit on blackboard.
MARKING CRITERIA:
Sections Questions
Case study 1 Q 1-9
All must be answered correctly to attain a satisfactory
result
Case study 2 Q 10-17
All must be answered correctly to attain a satisfactory
result
Case study 3 Q 18-25
All must be answered correctly to attain a satisfactory
result
Reference text:
Waugh, A & Grant, A 2014, Ross and Wilson, Anatomy and Physiology in Health and Illness, 12th edn, Churchill
Livingstone Elsevier Australia, NSW.
Clarke, L, Gray, S, White, L, Duncan, G & Baumle, W 2016, Foundations of Nursing – Enrolled/Division 2 Nurses,
Cengage Learning, Australia.
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Case Study 1
Scenario 1 – Mr. Frank Hardy (Questions 1-9 refer to this scenario)
Mr. Frank Hardy has been in hospital for three (3) days. He was admitted because of high blood pressure
(hypertension) and a possible stroke (cerebrovascular accident). After further investigations during his
admission, it has been identified that Mr. Hardy has had a cerebrovascular accident affecting his left side.
After reviewing Mr Hardy’s chart you find that he has a significant medical and social history:
Medical History:
 Age: 68 years old
 Current smoker, with a fifty year history of smoking 30 cigarettes daily
 Weight: 135kg
 Height: 180cm
 Hypertension
Social History:
 Mr Hardy is a widow (1 year ago) and lives alone
 There are no children or current support systems
 Mr Hardy has no current services in his home (such as home help, meals on wheels)
Mr. Hardy is currently reluctant to mobilise due to a mild weakness in his left side. Mr Hardy has been
seen by the physiotherapist and given a walking stick to aid with his mobility. He appears to be very
quiet and not willing to engage with staff. He has declined hygiene cares since admission three (3) days
ago. When you review Mr Hardy’s care plan you note that the following cares need to be completed:
 Hygiene cares
 Assist with mobility
 Observations
In relation to the above scenario, please answer the following nine (9) questions regarding Mr. Hardy’s
care both in and out of the hospital and your role as the Enrolled Nurse (EN) providing care for Mr.
Hardy.
1. Mr Hardy has ‘hypertension’ which means high blood pressure. List the parameters for a ‘normal’
blood pressure range and the ranges for hypertension.
The blood pressure readings is denoted by systolic (upper number) and diastolic (lower number) readings in
mm Hg. For the normal readings systolic reading is less than 120 while diastolic is less than 80. Hence normal
blood pressure range is less than 120/80. When the systolic reading is 140 or higher than that or situations
when diastolic reading is 90 or more 90 then it is said to have high blood pressure stage. When systolic is
more than 180 and/or diastolic reading is higher than 120 then it can be said to have hypertensive crisis and
immediate care is needed.
2. You have performed vital signs on Mr. Hardy, they are;
 BP135/ 90mmHg, RR 26bpm, P 95bpm, T 40oC.
If the observations listed below are considered the normal for adults, identify which of these
observations are variations from normal levels that have the potential to cause problems with Frank’s
health.
T: 36.2 – 37.3oC
P: 60 – 100bpm
RR: 16 – 24bpm
BP: 120/80mmHg
The blood pressure of Mr. Hardy is higher than the normal range and cna be considered as the initial range of
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hypertensive blood pressure. Thus improper attention can cause several complications or even death. The
pulse rate is in normal range but the increased blood pressure has also increased respiratory rate. The body
temperature of Mr. Hardy is also higer than normal range whcih can affect the blood pressure changes.
However the criticalness of blood pressure and respiratory rates are extremely severe.
3. The term pathophysiology explains the processes and functioning within the body which result in the
signs and symptoms of a disease/s. The ‘relationship’ between body systems is the contributing
factor/s that work together in our bodies to try and maintain homeostasis. Explain the relationship
between Mr Hardy’s respiratory rate and temperature.
The temperature has direct impact on breathing rate. The temperature reading of Mr. Hardy is recorded
as 40oC which is not in the normal range. The temperature increase has direct association with the
respiratory rate as well as heart beat. When temperature of body increases then speed and rate of
cellular respiration is also increased and as a result respiratory rate is increased. To maintain the cellular
process against increased body temperature respiratory rate of Mr. Hardy is also slightly higher than the
normal values.
4. Identify your scope of practice in this situation. List your role responsibility in comparison to a
Registered Nurse (RN) role.
RN tend to provide primary care to the patient so taht respirartory and hypertensive conditions can be
improved. They manages medications and education for smoking cessation so that cardiovascular risks can be
avoided and complications of cerebrovascular accident can be controlled. Contrary to this enrolled nurses
have scope to develop effective care plans and nursing assessments so that care outcomes can be determined
for the patients as well as carers. Enrolled nurse also works in supervision of RN so that different teams can
work together and observation, care and mobility needs of patient can be addressed.
5. As an Enrolled Nurse, identify the reporting hierarchy that you would follow in order to ensure that
this information is relayed appropriately.
For relaying information properly enrolled nurses follow a specific hierarchy of reporting. The registered
nurses assess the condition and needs of Mr. Hardy by observating patients and discussions from
clinical nurse. Thus RN provides instruction to enrolled nurses so that they can provide support
through devleoping effective care plans and coordiantion with mulidisciplinary and other other team
members. In addition to this for seeking any assistance enrolled nurses also communciate and work in
coordination wiht the nursing assistance. The nursing assistants further report to enrolled nurses so
that they can update the care plan and staus of patient.
6. Explain and discuss the following three (3) health care professionals’ scope of practice/role in the care
and management when referred to Mr. Hardy.
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 Dietician
 Physiotherapist
 General Practitioner (GP)
 Dietician:
The dietician provide nutritional chart for Mr. Hardy so that he can recover immediately and
weakenss issues can be resolved. The dieticians also assure that food given to patient is suitable and safe and
does not cause any allergetic reactions against medications provided to patient.
 Physiotherapist:
Mr. Hardy faces difficulty in mobility due to storke and thus physiotherapist provides assistance in
improving mobility functions. They also monitor the improvement process in Mr. Hardy’s phyiscal movement
so that medication and diet plan can be improved accordingly.
 GP:
Gp advice and review the treatment options and medications for Mr. Hardy so that his health outcomes and
hypertensive issues can be solved.
7. Mr. Hardy has a significant medical and social history. From the case study list four (4) potential
factors that could have been responsible for the CVA (stroke). In your answer ensure that for each
factor you provide a brief explanation of how/why it could have impacted on Mr. Hardy’s current
condition.
1. Mr. Hardy has high blood pressure which is one the major factor for causing CVA.
2. He lives alone and thus loneliness enhances tension, anxiety and thus there is no regulation and
monitoring of the blood pressure.
3. Mr. Hardy has been heavy smoker and thus it enhances the risk of CVA due to increasing respiratory
and life style issues.
4. Mr. Hardy is also overwieght and due to alone living he pay less attention to healthy life style and
weight management which increase the CVA risk.
8. A functional deficit is a sign or a symptom associated with an illness in a body system or a variation
from normal. These functional deficits can also be identified as potential risk factors when performing
an intervention. Mr. Hardy has several of these risk factors. Using correct medical terminology, list
two (2) potential deficits associated with Mr Hardy’s CVA.
1. Mobility deficit can increase the dependecy of Mr Hardy and thus he may face difficulty in making
movements of face, hands or legs. Mr Hardy may also required assistance in performing routine
functions such as walking and other motor functions.
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2. Another potential deficit faced by Mr Hardy is cognitive ability. He may find it hard to process the
information and to effectively communicate with the others. For example he does not engage with
staff members who provide physical support to him and also neglect hygiene care.
9. As per organisational policy you are taking blood from Mr Hardy for his routine tests. When finished
you note that you leave his arm with a large contusion (bruise). Identify the term used to describe
complications that are caused by treatment from healthcare professionals.
For taking blood samples care must be taken so that bruise does not cause internal bleeding. The interanl
bleeding can also trigger the riks of increasing blood pressure and riks of stroke. Thus it is very essential that
such complications must be addressed. In addition the impact anti-coagulation and anti-platelet medicines
must also be monitored. These medicines increase the risk of internal bleeding which must be identified and
treated so that complexities can be controlled and prevented.
End of section one
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Case Study 2
Scenario 2 – Mrs. Heather Bishop (Questions 10-17 refer to this scenario)
Mrs Heather Bishop is an eighty (80) year old woman who is living in the residential aged care facility you
are working in. Before meeting her you quickly review her chart for her medical and social history:
Medical History:
 Weight 50Kg
 Height 170cm
 80 years old
 Menopause at 38yrs of age
 Osteoporosis
Social History:
 Widowed (10 years ago)
 1 Daughter that visits regularly
She is mobile with a walking frame and supervision, however has had difficulty hearing lately. Mrs Bishop is
orientated and alert, and she has no cognitive deficits. As Mrs Bishop walks to the shower, she states that
she is ‘dizzy’ and loses her grip on her walking frame. She falls on her right side, you call for help, make her
comfortable and take a set of observations;
 BP: 110/60mmHg, T: 36.5oC, P: 100bpm, RR: 28bpm
You are assisted by colleagues to move her back to the bed, then the resident doctor arrives. The doctor
diagnoses a fractured hip, at the neck of femur (NOF). Mrs Bishop is transferred to a hospital for further
treatment and investigations.
10. If the observations listed below are considered the normal parameters (range) for adults, identify
Heather’s abnormal observations.
T: 36.2 – 37.3oC
P: 60 – 100bpm
RR: 16 – 24bpm
BP: 120/80mmHg
The blood pressure and temperature recorded for Mrs Heather Bishop are in normal range. The pulse rate are
100 bpm and thus there is need to observe her pulse rate as it may increase due to fall and trauma. The
respiratory rate of the Mrs Bishop are higher and is abnormal. The higer age and sudden fall may have caused
the trauma and shock to her and thus it may have caused the inrcease in respiratory rate.
11. Consider Mrs Bishop’s recent hearing loss. Identify and briefly explain the pathophysiology of the
degenerative ear condition that commonly causes hearing loss.
Mrs Bishop is 80 years old and presbycusis is one of the most common cause of hearing loss with age. In this
condition sensory organ responsbile for hearing is degenerated. Along with this spinal ganglion cells and
cochlear potential are also reduced and degenerated with increasing age which cause to degenerative ear
condition. With presbycusis movement of cochlear conductive is also affected and thus hearing issues are
observed.
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12. Mrs Bishop has a significant medical and social history. From the case study list four (4) potential risk
factors that could have been responsible her osteoporosis.
1. The hormonal changes and deficiences after the menopause phase is one of the reason for
osteoporosis.
2. Due to higer age she is also vulnerable to reduced bone mass and thus it weakes her bones. The age
factor is one of the most significant factor for causing osteoporosis.
3. Mrs Bishop has been living alone and thus it is also possible that lack of calcum and protein rich diet
could have been one of the reason for reduced bone mass and occurance of osteoporosis.
4. From several years Mrs Bishop has been physically inactive and does not perform any kind of physical
exercises. Thus it reduces the balancing and strenght of bones and acts as potential risk factor for
osteoporosis.
13. Discuss the pathophysiology of osteoporosis and relate this to Mrs Bishop’s fractured Neck of Femur
(#NOF).
Osteoporosis is known as the disease in which bones becomes weak and thus there is an increased risk
of bone fractures or breaking. With the age bone mass is reduced and bone tissues becomes more
vulnerable to microarchitectural deterioration which enhances the risk of fractures. Due to the same
reason fall of Mrs Bishop caused NOF because low bone mass is one of the critical risk factor for causing
fractures. The fracture occure due to combination of fall as well as reduced fragility of bones. The
hormonal deficiencies after menopause, reduced mobility, malnutirition, altered quality of bone
material with age and reduction in collagen cross link is also responsible for causing the osteoporosis
and to enhance risk of NOF.
14. Mrs Bishop must have a surgical repair of her fracture; this means some care will be referred to other
health carers. Explain and discuss the following three (3) health care professionals’ roles, within the
multidisciplinary team in regards to Heather’s care and management whilst in hospital.
 Orthopaedic Surgeon
 Physiotherapist
 Radiologist
 Orthopaedic surgeon:
Orthopaedic surgeon is responsible for the treatment and diagnosis of the bones, hips, joints, ligaments and
tendons. The surgeon will provide treatmet of hip and neck bone fracture of Mrs Bishop.
 Physiotherapist:
Due to fractures Mrs Bishop may need assistance to support the movement. Physiotherapist will help her to
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recover from the fecture and to continue her mobility issues.
 Radiologist:
The radiologists interprets the medical images like x rays, MRI and CT scan so that bone defects and other
injuries can be detected. Radiologists can help to detect the injuries of Mrs Bishop.
15. A functional deficit is a sign or a symptom associated with an illness in a body system or a variation
from normal. These functional deficits can also be identified as potential risk factors when performing
an intervention. Using the correct medical terminology identify two (2) main functional deficits in
Heather’s body systems necessitating nursing care and or monitoring.
1. Mrs Bishop has hearing issues and it can influence physiotherapy sessions. For example the inability to
hear the instruction of therapist can increase the fall risk and mobility risk of the patient.
2. Due to osteoporosis the bone strength of individual reduces and thus it may take time to recover from
the fracture. In addition the fall and fracture risk may continue to remain one of the critical functional
deficit.
16. You assess Heather’s reported pain level and note that it is a 9/10 and she is not due for medication.
This is an abnormal result and potentially a very serious issue. Consider your scope of practice as an
EN and within organisational requirements. Identify the reporting hierarchy that you would follow in
order to ensure that this information is relayed swiftly and action taken.
The severe pain faced by Mrs Bishop must be immediately informed to the responsible authorities so that
quick actions can be taken. As an enrolled nurse after taking this fact into account the information must be
first conveyed to registered nurse. The RN will evaluate the possible cause and remedies for the pain and will
provide the medcations for the pain management. RN can also consult the issue with clinical nurses for taking
effective interventions or the care strategies.
17. Mrs Bishop is ordered a high dose of a strong pain killing medication to be given orally. Consider your
basic pharmacology and pharmacokinetics in Mrs Bishop’s situation. List three (3) factors specific to
Mrs Bishop that may affect therapeutic levels.
1. Due to osteoporosis pain in bones and pain relief medications has been quite frequent to Mrs Bishop.
Thus the dosage and frequency of taking specific pain relief medications can affect the therapeutic
levels of the drug.
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2. The age factor is another factor which influences the therapeutic levels. For instance some
pain killer druges may be highly toxic in relation to age.
3. The interaction of pain relief medications with osteoporosis medications or the particular food
intake can also lower the therapeutic levels which is not safe for the patient.
End of section two
Case Study 3
Case study 3 – Mrs Jane Trenton (questions 18-25 refer to this scenario)
Mrs Jane Trenton is an 85 year old woman who has just returned to the residential care facility from a ten
(10) day hospital stay for dehydration caused by gastroenteritis (vomiting and diarrhoea).
You review her chart and find the following:
Medical History:
 Weight 65 Kg
 Height 150 cm
 Age 85 yrs. old
 Urinary incontinence
Social History:
 Partner in care also in facility (different area, dementia ward)
 Five (5) children in different states
 Enjoys social activities at the facility
On admission you perform a full integumentary assessment and vital signs as per organisational policy. Her
vital signs are;
 BP 110/80mmHg, P 65bpm, R 20bpm, T 36.5oC
 Urinalysis pH- 5, SG- 1010, Glucose- Neg, Ketone- Neg, Protein- Neg, Leukocytes- Neg, Blood
(RBC’s)- Neg
On inspection of Jane’s skin you find an area of erythema (dark red in colour) that does not blanch (go
white) when gently pressed. The area, over her left hip is raised but the skin remains intact. This appears to
be a pressure injury. Jane appears to be in some pain as you move her and gently touch the red area. Mrs
Trenton is not usually independently mobile and requires assistance for transfers and a wheelchair to move
around in. When in bed she needs to be frequently turned to prevent pressure injuries.
In consultation with the RN you dress the area to prevent further pressure and Jane’s care plan
documentation is adjusted to reflect 2nd hourly turns. You ensure that Jane has a clean, dry continence pad
on before settling her into her chair.
18. The following are considered normal values for urinalysis:
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 pH 4.6- 8, SG-1.015- 1.030, Glucose- Neg, Ketone- Neg, Protein- Neg, Bilirubin- Neg, Nitrites- Neg,
Leukocytes- Neg, Blood (RBC’s)- 2-3HPF (Clarke et al, 2016)
Identify which of Mrs Trenton’s urinalysis results are considered a variation of normal and a potential
risk for poor skin integrity.
The specific gravity is recorded lower then the normal range. The lower value of SG is associated with
the diarrhea and urinay bladder issue. The dehydration and improper water flow in the body also
influences the skin integration. In addition to this the red blood cell can also influence the skin health.
19. The skin is the largest organ in the body and has a surface area of 1.5 -2m2 in an adult. Identify four (4)
functions of the integumentary system.
 Integumentary system provides protection to underlying body tissues of the skin and also protect
infection from infectious organisms.
 The system also regulate the temperature of the bodyand thus is important for temperature homeostasis.
 Natural metabolic wasta material is also eliminated from the body through skin fat and water is also
stored by integumentary system.
 Production of vitamin D which is one of the essenital vitamin for the healthy living.
20. When functioning normally the skin comprises of three layers, the epidermis, dermis and
subcutaneous tissue. Mrs Trenton has a pressure injury that threatens to progress into her dermal
layer. Identify four (4) structures found in the dermis.
1. Nerve endings and hair follicles
2. Blood capillaries and Lymph vessels
3. Sweat and oil glands
4. Connective tissues particularly elastin and collagen
21. Pressure injuries can be caused by different factors. In Jane’s case the cause was likely to be pressure
from decreased mobility whilst in hospital. Identify two (2) other potential risk factors for Jane that
could be responsible for her pressure injury.
 The urine continence is also one of the potential risk factor which causes skin disintegration due to
moisture and frequent urination. Mrs Trenton is also required to use continence pads which increases the
risk of pressure injury.
 Due to higher age Mrs Trenton is not able to walk and move freely. As a result of this she has to use
wheelchair. Prolong sitting on wheelchair and continuous rest on bed without much physical activity is
significant reason of pressure injury development.
22. Mrs Trenton is 85 years old. As people age their bodies change and normal function can be
19th January 2017 Page 11

compromised. Explain the degenerative changes that occur to the skin as a result of ageing.
Due to aging number of cell layers and pigment contianing cells in epidermis are decreased. THus skin
becomes pale, translucent and thin with the age. In sun exposed regions of the skin pigmented spots
such as lentigos and age spots may also appear. THe skin elasticity and strenght is also reduced due to
age associated changes in connective tissues of skin. Along with these changes dermis blood vessels
becomes more fragile whcih cause bleeding under skin and bleeding. The decline in oil production by
sebaceous glands make skin dry and increases itchiness. The thinning of subcutaneous fat layer
enhances the skin injury risk and irregular temperature regulation. Among older people rough patches
and skin tages are also quite common.
23. In order for wounds to heal certain conditions need to be met both locally and systemically. Identify two
(2) local and two (2) systemic conditions that would delay wound healing.
Local
1. The mechanical factor can cause delay in the wound healing process. The sitting and resting position
can impose mechanical stress on the wound.
2. The reduced sensation is also one of the factor to delay the healing process. For example the
continuous use fo continency pads is necessary for Mrs Trenton thus she may not sense the rashes or
pain the region. This can increase the severity of the wounds and healing process may need
additional time.
Systemic
1. Age is one of the critical factor which influences the healing and regenerative capabilities of the skin.
Thus with increasing age wounds may take longer time to heal.
2. Mrs Trenton has recovered from the gastroenteritis and thus she is required to follow a controlled
diet. The inadequate nutritional intake can also slower the wound healing process because food
such as carbohydrate rich food can encourage the healing process.
24. Mrs Trenton is ordered medication to help with pain (such as paracetomol), to be given orally.
Consider your basic pharmacology and pharmacokinetics in Mrs Trenton’s situation. List three (3)
factors specific to Mrs Trenton that may affect the therapeutic dose being reached.
In the case of Mrs Trenton following factors may influence the therapeutic dose of the medications:
 Specific pain relief medications can enhance the frequency of urination and thus urine incontination must
be taken into account for the therapeutic dose.
 The pressure ulcer and age factor has made skin of Mrs Trenton highly sensitive. Thus some drugs may
also cause drug reactions or the skin allergies. The adverse reactions of medications on the skin sensitivity
of Mrs Trenton is also potential factor of therapeutic level.
 Some pain killer medication may again trigger the gastroenteritis (diarrhea) and thus the medication and
its interaction with the other medicines is vital factor in influencing therapeutic levels.
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25. Identify the condition that Mrs Trenton has that is considered iatrogenic (a direct impact of healthcare
intervention) in this case.
Mrs Trenton is 85 years old and thus due to several age and history of urine incontinency several iatrogenic
impacts are observed. For example due to age factor she used to take bed rest and needs wheelchair support.
However this intervention increases the issues related to skin integration. In addition due to dehydration when
she was admitted to hospital for 10 days then it increased her resting and lead to increasing pressure injury.
For the management of urine continency Mrs Trenton also uses continency pads. The regular and frequent use
of such pads increases redness, rashes and other skin problems. In additio to this the medications can also
show higher toxicity due to age related factors which is also anohter iatrogenic factor to cause skin reactions
and gastoenteritis issues.
END OF CASE STUDIES
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