4 Critical Care Case Study

1. Critical Care Case Study
NURS 451 – Clinical Management of Adult Health Nursing III

Purpose of Assignment
The purpose of this case study is to integrate knowledge from the humanities and sciences,
including nursing research and theory, to plan, provide, and evaluate holistic care provided to
a client selected during this clinical rotation.

Student Approach to Assignment
I chose to write this case study on this particular patient because this was the first patient I
had cared for that was not generally awake and alert. This patient came into the hospital
with a septic infection that progressed to an inability to adequately oxygenate himself and
renal failure. He had been on a ventilator for several weeks by the time I was with him and
had received a tracheostomy through which to be mechanically ventilated. This experience
was difficult for me as he did not respond on any level to anything except for pain.

Reason for Inclusion of this Assignment in the Portfolio
This assignment gave me a new outlook on patient care and an experience that I had yet to
have first hand. Caring for this patient was difficult for me for many reasons. The following
program objectives are highlighted in this case study:
Critical Thinking
Evaluates nursing care outcomes through the acquisition of data and the
questioning of inconsistencies
By assessing and reassessing this patient, I was able to quickly notice the changes our
interventions were causing. Also, rounds on this patient included a discussion as to his need
or contraindication of heparin as an anticoagulant related to his platelet and aggregation
counts. This patient was still on heparin but was being evaluated on the first day for heparin-
induced thrombocytopenia and on the second day, for disseminated intravascular coagulation.
Both of these were the discussions during interdisciplinary rounds.
Nursing Practice
Applies appropriate knowledge of major health problems to guide nursing
practice
By researching and understanding the pathophysiology going on with this patient, I was better
able to treat his multiple organ dysfunction syndrome by not only correcting the root cause of
the problem, but also by intervening with the associated signs and symptoms to lessen their
devastating effects on this patient’s health. We used his ABG values to determine appropriate
ventilation settings and to ensure that his body was being properly oxygenated.

2. Implements traditional nursing care practices as appropriate to provide
holistic health care to diverse populations across the lifespan
Throughout my time with this patient, I implemented such traditional practices as constant
monitoring, and treating his respiratory and renal failure by monitoring ABG levels and urine
outputs. I also tried to comfort his wife while she was present in his room.
Communication
Adapts communication method to patients with special needs
Communication with a patient who does not respond to speech or light touch is very difficult.
Patients need to know what is going on in their care and the belief is that hearing is the last
sense to go and the first to come back. I ensured that I spoke aloud everything that I would do
before it was done so that, if he could hear me, he would know what to expect.
Research
Evaluates research that focuses on the efficacy and effectiveness of
nursing interventions
I discussed an article in which subjective skin temperature of the foot is used as an accurate
measure of cardiac output. This article provided an additional way to ensure that this
patient’s extremities are being perfused. The thought is that is his heart can get enough
blood and oxygen to his feet, he should be getting enough to oxygenate his renal tissues as
well.
Professionalism
Differentiates between general, institutional, and specialty-specific
standards of practice to guide nursing care
I used the standards of practice of acute and critical care nursing (AACN) to look back on my
time with this patient to ensure that the standards for critical care nursing are met. For
example, standard one, assessment, was met by evaluating this patient for HIT and DIC based
on his labs; standard two, diagnosis, was met by determining that he was in fact suffering
from HIT; and standard four, planning, was met by determining that this patient needed to
have his heparin dose stopped.
Culture
Demonstrates sensitivity to personal and cultural definitions of health and
how these beliefs influence an individual’s reactions to the illness
experience and end-of-life
This patient’s wife visited for a couple of hours each day and spent her time in his room doing
puzzles and watching television. In my family, when someone is in the hospital there is
always someone there with that person. For example, the last time my grandmother was in
the hospital, her children took turns spending evenings and nights with her while my
grandfather spent the days there. Upon speaking to Mrs. F, I learned that they were not close
with much of their family so there was little support for her and that she spent time there
because she felt guilty when she did not. Also, she explained that she was too scared of his
illness and possible death to spend too much time in the hospital where it was reality.