Critical Care Case Study

NURS 451- Clinical Management of Adult Health Nursing III

Purpose of Assignment
The purpose of this case study it 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
This assignment, through research and clinical care, allowed me to gain an in-depth
understanding of the critically ill patient. Furthermore, it assessed my critical thinking
skills as I worked to incorporate the components of nursing process to guide my care. The
patient in this case study was a 62-year-old female admitted to the emergency department
with acute respiratory failure after experiencing aspiration pneumonia during a cruise
ship with her husband and daughter. Upon her arrival to the ED department she was
intubated as vitals reflected respiratory depression. As her condition worsened, she was
transferred to the intensive care unit. The case study focused on acute respiratory failure
and common complications that are associated with respiratory failure; this includes
acute respiratory distress syndrome, metabolic acidosis, and multiple organ distress
syndrome. I chose this patient for my case study because it provided an insight to how the
damage of one organ leads to the damage of another, a common theme of most critically
ill patients. Additionally, her complex case required the use of the nursing process as well
as critical thinking skills; this allowed me to provide holistic and patient centered care.
This case study reflects the use of the nursing process components that I used including
assessment, diagnosis, expected outcomes, nursing interventions, outcomes and
evaluation

Reason for Inclusion of this Assignment in the Portfolio

This assignment was added in my nursing portfolio because I believe it contributed to my
understanding of the critically ill patient in an acute care setting. Clinical care of the
patient induced my critical thinking while researching the pathology helped me gain a
better understanding of respiratory failure. Furthermore, I believed that this case was
unique in providing the conflict of family dynamic changes that occur during illness.

v Critical Thinking
Evaluates nursing care outcomes through the acquisition of data and the
questioning of inconsistencies.
The structure of this case study was conducted using the nursing process. I
was able to explore the expected outcomes based on patient presentation and
was able to implement interventions to reach the outcomes. In addition, I
evaluated the effectiveness of interventions and made changes based on

findings. One of the desired outcomes for this patient was to avoid
complications such as infection during hospital stay. Upon evaluation of
interventions, the patient still displayed an elevated white blood cell count.
Factors that elevate WBC such as multiple lines, Foley, and increased stress
level were recognized and incorporated to the plan of care.
Uses nursing and other appropriate theories and models to guide professional
practice

Betty Neumans system model guided the nursing care provided. This
theory focuses on the use of nursing preventions and interventions in
response to environmental stressors. Neumans theory suggests that nurses
should work to protect and maintain patients optimal health by
maintaining maximum level of function. Neumans theory was
implemented as the nurse and I prevented further stress invasion by
treating the patients pain, monitoring electrolytes and preventing
infections. Florence Nightingales environmental theory was also used.
Nightingales theory which suggests that nursing is an act of utilizing the
environment of the patient to assist him in his recovery was seen as we
consistently altered the environment by altering factors affecting health.
This included cleanliness, which was done by providing oral care, and
making sure the room was clean.
Uses decision-making skills in making clinical or professional judgments

Once the patient was extubated, she immediately wanted to start drinking
fluids. We informed the patient that we had to do a bed side swallow test.
After conducting the test two times, we agreed that she failed the test and had
to wait until she is able to pass the test if she wanted any fluids; the physician
ordered her to be on a regular diet once her swallow test was passed.

v Nursing Practice
Demonstrates an awareness of complementary modalities and their usefulness in
promoting health.
I demonstrated the use of complementary modalities by interventions
created for the nursing diagnosis of compromised family coping. Because
the patients family seemed hopeless I intervened by providing hope
instillation; this was done to better promote a better perspective of the
future. I did this by encouraging the family when progress was being
made. Hope instillation can also be done by encouraging the use of

therapeutic touch, when appropriate, to demonstrate care and

understanding.
Implements traditional nursing care practices as appropriate to provide holistic
health care to diverse populations across the life span
Traditional nursing care interventions were implemented in the care of
this patient. This was done as the nurse and I took care of a sixty five
year old woman from Australia. We made sure to adequate oral care,
give medications at the prescribed time, provide incontinence care, and
give comfort measures for both the patient and family. When the
daughter and husband discovered that drugs were responsible for the
patients admission, they asked the nurse to inform the patient that they
were aware and to handle it in a manner to maintain the patients
dignity. This was respected and granted as the nurse made sure to tell the
patient at the appropriate time while providing empathy to listen to her
side of the story.
v Communication
Accesses and utilizes data and information from a wide range of sources to
enhance patient and professional communication
.
A variety of information based on evidence based practice was utilized to
enhance patient care. Many studies have shown that rotation and prone
therapy can maximize the V/Q (Ventilation and perfusion) mismatch.
Evidence based data by a research article reflected that 70-80% of
patients demonstrated an improvement in oxygenation and respiratory
mechanics post rotation therapy (Urdan, Stacey & Lough, 2014) .We
utilized this information by providing rotation therapy. Turning the
patient will rotate lung zones and provide more room for gas exchange.
Improvements were seen in the patients oxygenation during rotation
therapy. I was able to inform the patient about why this was being done. I
also utilized research ------v Research
Evaluates research that focuses on the efficacy and effectiveness of nursing interventions
Many practices, that have been shown to provide efficiency, were
implemented. The patient had the head of bed elevated, a commonly used
practice in the clinical setting. Specifically for this patient, it is important
that the head of bed is elevated to prevent aspiration, thus preventing
further damage to the pulmonary system. Interventions were also guided

by evidence based practice. To prevent the cascade of sepsis, we removed

all of the patients invasive lines and put her on a line holiday. This
intervention is an evidence-based practice based on the study, Early
Detection and Treatment of Severe Sepsis in the Emergency Department:
Identifying Barriers to Implementation of a Protocol-based Approach.
Differentiates between descriptive nursing literature and published reports of nursing
research.

I used a published nursing research that demonstrated the effectiveness of

prone and rotation therapy and its correlation on ventilation and perfusion.
I applied this evidence based practice because data demonstrated its
effectiveness and it provided the patient more room for gas exchange,
essentially guiding the patient to their best optimal health. Discriptive
nursing research was also used as we implemented findings from a study
that discussed the blood gas readings of ICU patients on ventilators. The
study was conducted using observational methods and provided
information on how to better interpret blood gas readings.
v Leadership
Articulates the values of the profession and the role of the nurse as member of the
interdisciplinary care team

The nurse recognized that the oxygen saturation was decreasing and
notified both the physician and the respiratory team. They were able to
recognize the PEEP needing to be increased on the ventilator in addition
to increasing the fi02. The nurses role as a member of the
interdisciplinary team demonstrates the effectiveness in providing
consistent care. Additionally, the nurse and I made sure that we
advocated for our patient and provided optimal care.
v Professionalism
Demonstrates accountability for ones own professional practice
During the care of this patient, the nurse allowed me to perform many

tasks such as medication administration and suctioning independently

while she observed. This gave me the opportunity to learn as a nursing
student and essentially allow me to become accountable for my patients
care. This allowed me to ensure that I applied my nursing knowledge to
give this patient quality care.
v Culture
Articulates an understanding of how human behavior is affected by culture, race,
religion, gender, lifestyle, and age.

Keeping the patients dignity and respect was very important to the
husband and daughter. When we discovered that her respiratory
depression was caused by an overdose, the husband and daughter told us
to make sure that we informed the patient in a respectful manner. The
family asked the nurse if she can have that conversation without them
present. The nurse respected and understood their wishes.