NSG-320 Adult Health Nursing I

Assignment 4: Level 2 Adult Medical–Surgical Care Plan and Clinical Evaluation Reflection

1. Assessment Overview

Unit/Program: Pre-Licensure BSN
Course: NSG-320 Adult Health Nursing I
Assessment Type: Individual Level 2 adult med–surg care plan plus brief clinical reflection (theory–clinical linked task)
Placement: Mid-course (after initial adult health units such as endocrine, cardiovascular, and respiratory)
Length: 4–5 page written care plan (approximately 1,200–1,500 words) plus a 300-word clinical reflection
Weighting: 15–20% of course grade; often linked to clinical performance expectations

The assignment advances your application of the nursing process by requiring a Level 2 adult health care plan with a stronger focus on pathophysiology, complications, and evaluation of outcomes in a complex medical–surgical scenario.

2. Clinical Scenario Context

You will develop an evidence-based, client-centred care plan for an adult hospitalized with an acute medical–surgical condition commonly emphasized in NSG-320 (for example, postoperative hip fracture, decompensated heart failure, uncontrolled diabetes with hypertriglyceridemia).

• Your instructor may assign a specific case (for example, hip fracture exemplar) or allow you to select a de-identified client from your NSG-320 clinical experience, consistent with course policy.
• The care plan must reflect Level 2 expectations, meaning more complex analysis of risks, complications, and interprofessional management than in earlier fundamentals courses.
• Client information should include medical diagnosis, key assessment findings, treatments, and psychosocial context sufficient to support your nursing diagnoses and priorities.

3. Task Description

3.1 Written Level 2 Care Plan (4–5 pages)

Using the NSG-320 care plan guidelines and exemplars as a model, construct a detailed care plan organized around the nursing process.

i. Concise Client Overview

• Summarize the client’s age, key medical diagnoses (for example, postoperative hip fracture, type 2 diabetes, hypertension, hypertriglyceridemia), relevant history, and current reason for hospitalization.
• Include the most pertinent assessment findings: vital signs, pain, mobility status, psychosocial concerns, and any invasive devices or major therapies.

ii. Problem List and Potential Complications

• List actual problems and “risk for” complications that are important in Level 2 adult health, such as impaired mobility, ineffective tissue perfusion, risk for pressure injury, risk for thromboembolism, or risk for acute decompensation.
• Briefly explain why each risk or complication is clinically significant for this client’s condition.

iii. Priority Nursing Diagnoses (NANDA-I)

• Select two actual nursing diagnoses as the focus of the care plan and clearly identify one priority diagnosis; you may include one additional “risk for” diagnosis but do not use a risk diagnosis as the primary priority.
• Write each diagnosis in full NANDA format: diagnostic label, related-to etiology, and as-evidenced-by supporting assessment data, consistent with program expectations.

iv. Goals, Expected Outcomes, and Complication Monitoring

• For each actual diagnosis, write two SMART goals, one focused on symptom or function improvement and one focused on prevention or early identification of complications.
• Specify what improvement, deterioration, or no change would look like by the end of your shift, and how you will recognize it.

v. Nursing and Interprofessional Interventions with Rationales

• Identify at least three nursing interventions per diagnosis (independent, dependent, or collaborative), along with at least one interprofessional action (for example, physical therapy consult, dietitian referral, diabetes educator).
• For each intervention, provide a brief evidence-based rationale that draws on pathophysiology and current guidelines.
• Incorporate both acute care actions (for example, monitoring for cardiopulmonary deterioration, managing pain, assisting with mobility) and patient and family education (for example, medication adherence, lifestyle modifications).

vi. Evaluation of Outcomes

• Describe how you would evaluate whether the client is progressing as expected by the end of your shift. Specify which objective and subjective findings signal improvement, worsening, or no change.
• Explain how you would evaluate whether your teaching was effective, including what you would ask, observe, or verify with the client or family.

The care plan should demonstrate safe use of the nursing process at an intermediate level, moving beyond task lists to integrated reasoning about risks, complications, and quality outcomes.

3.2 Clinical Evaluation Reflection (approximately 300 words)

Write a short reflection that connects your care plan to your actual or simulated clinical experience.

i. Identify one aspect of your care that went as planned and contributed to progress toward a goal (for example, effective pain management that enabled early mobilization).

ii. Identify one aspect that did not go as expected or that you would change in future (for example, underestimating the time needed for diabetes education or smoking cessation counselling).

iii. Explain what this experience taught you about prioritizing care, monitoring for complications, and collaborating with the healthcare team in adult health nursing.

4. Assignment Requirements and Formatting

• Length: 4–5 double-spaced pages for the care plan plus approximately 300 words for the reflection; title page and reference list not included in the page count.
• Structure: Use clear headings and subheadings that align with the nursing process, including Client Overview, Problem List, Nursing Diagnoses, Goals and Outcomes, Interventions and Rationales, and Evaluation, followed by Clinical Reflection.
• Sources: Include at least three current peer-reviewed sources (2018–2026) and your adult health or fundamentals text to support rationales.
• Style: Follow the program’s required academic style (APA or Harvard) consistently for in-text citations and references.
• Confidentiality: De-identify all client information and comply with institutional privacy and documentation policies.

5. Marking Criteria / Scoring Rubric (Summarized)

Total: 100 marks.

5.1 Level 2 Care Plan (80 marks)

i. Clinical Data, Problem Identification, and Complications (20 marks)

• High Distinction (18–20): Client summary is concise yet comprehensive; problem list and potential complications are clearly derived from assessment data and pathophysiology.
• Pass (11–15): Key data present but some links between findings, problems, and complications are implicit rather than explicit.
• Fail (0–10): Important data and risks are missing or poorly connected.

ii. Nursing Diagnoses and Prioritization (15 marks)

• High Distinction (14–15): Diagnoses are correctly phrased, well supported by evidence in the assessment, and prioritization is justified using safety and Maslow or similar frameworks.
• Pass (8–11): Diagnoses generally accurate with minor errors; rationale for priority somewhat limited.
• Fail (0–7): Diagnoses incomplete, incorrect, or not prioritised logically.

iii. Goals and Outcome Criteria (15 marks)

• High Distinction (14–15): SMART goals are specific, measurable, and carefully linked to both symptom control and complication prevention.
• Pass (8–11): Goals mostly specific but with some vague measures or time frames.
• Fail (0–7): Goals broad, unmeasurable, or poorly aligned with diagnoses.

iv. Interventions, Rationales, and Interprofessional Collaboration (20 marks)

• High Distinction (18–20): Interventions are detailed, realistic, and show strong integration of pathophysiology, pharmacology, and quality and safety concepts; rationales are concise and evidence-based, and interprofessional roles are clearly outlined.
• Pass (12–16): Interventions appropriate but rationales more descriptive than analytical; collaboration described briefly.
• Fail (0–11): Interventions generic or incomplete; rationales missing or not evidence-based.

v. Evaluation and Clinical Reasoning (10 marks)

• High Distinction (9–10): Evaluation plan uses specific clinical indicators to judge progress and clearly explains how care would be adjusted if expected outcomes are not met.
• Pass (5–7): Evaluation criteria general or partially specified.
• Fail (0–4): Evaluation superficial or absent.

vi. Writing Quality and Referencing (10 marks)

• High Distinction (9–10): Writing is clear, organized, and professional with accurate referencing and minimal errors.
• Pass (5–7): Mostly clear with some issues in language or citation.
• Fail (0–4): Frequent errors or inconsistent referencing impede clarity.

5.2 Clinical Reflection (20 marks)

i. Insight into Care Prioritisation and Outcomes (10 marks)

• High Distinction (9–10): Reflection provides specific examples of effective and less effective actions and thoughtfully considers their impact on client progress.
• Pass (6–8): Describes experiences but with limited analysis.
• Fail (0–5): Narrative remains descriptive with little insight into learning.

ii. Integration of Theory, Evidence, and Teamwork (10 marks)

• High Distinction (9–10): Connects experiences to adult health content, evidence, and interprofessional practice, identifying specific strategies for improvement in future care.
• Pass (6–8): General references to theory and teamwork without detailed integration.
• Fail (0–5): Minimal or no linkage to theory or evidence.

6.

A 68-year-old man admitted with decompensated heart failure and poorly controlled type 2 diabetes required close monitoring for fluid overload, cardiopulmonary deterioration, and worsening glycaemic control. The priority nursing diagnosis of “Decreased cardiac output related to impaired myocardial contractility as evidenced by dyspnoea on exertion, peripheral oedema, and reduced activity tolerance” guided my focus on daily weights, lung sounds, fluid balance, and response to diuretic therapy. Education about diet, medication adherence, and smoking cessation was integrated into routine care so that the client could link symptom changes to his own self-management after discharge (Savarese and Lund, 2019).

Learning Resources / References

1. Lewis, S.L. et al. (2023) Medical-surgical nursing: Assessment and management of clinical problems. 12th edn. St. Louis: Elsevier.
2. Ignatavicius, D.D., Workman, M.L. and Rebar, C.R. (2021) Medical-surgical nursing: Concepts for interprofessional collaborative care. 10th edn. St. Louis: Elsevier.
3. Savarese, G. and Lund, L.H. (2019) ‘Global public health burden of heart failure’, Heart Failure Clinics, 15(3), pp. 289–297. Available at: https://doi.org/10.1016/j.hfc.2019.02.004.
4. American Diabetes Association (2022) ‘Standards of medical care in diabetes—2022’, Diabetes Care, 45(Suppl 1), pp. S1–S264. Available at: https://doi.org/10.2337/dc22-SINT.
5. National Institute for Health and Care Excellence (NICE) (2018) Chronic heart failure in adults: Diagnosis and management. NICE guideline NG106. Available at: https://www.nice.org.uk/guidance/ng106.