Critical Care (Adult Health II) Clinical 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

The patient chosen for this case study was a patient I cared for on the cardiac/telemetry
unit at Bon Secours De Paul Medical Center. He was a 92-year-old African American male with
a history of hypertension, hyperlipidemia, anemia, type 2 diabetes, atrial flutter, coronary artery
disease, obstructive sleep apnea, and systolic heart failure with diastolic dysfunction and an
ejection fraction of 45-50%. He was admitted to the emergency department with complaints of
weight gain, shortness of breath, and edema; and the admitting medical diagnosis was acute
respiratory failure and acute on chronic systolic heart failure.

Reason for Inclusion of the Assignment in the Portfolio

This assignment is included in the portfolio because it highlights the care that I gave to a
complex patient and demonstrates integration of a wide variety of end of program behaviors.
Critical Thinking
Uses nursing and other appropriate theories and models to guide professional practice.
Example: In this case study, I used Virginia Hendersons nursing need theory to
prioritize the nursing diagnoses relevant to care for my patient. This theory
emphasizes basic human needs as the central focus of nursing practice and
importance of increasing the patients independence so progress after hospitalization
is not delayed. Furthermore, in the case with my patient, the two major organs of
heart and lungs require adequate functioning for survival so by using this theory the
two nursing diagnosis of decreased cardiac output and impaired gas exchange were
top two priorities to increase the patients independence after hospitalization.

Uses decision-making skills in making clinical or professional judgments.

Example: In this paper, I used decision-making skills in making clinical judgments
whenever administering the alpha adrenergic blocker and beta blocker Carvedilol
(Coreg) to my patient to improve cardiac output. It was necessary to assess the
patients blood pressure and heart rate before administering this medication to be sure
these vitals were in safe parameters. By using this decision-making process, will
prevent the fall of blood pressure and heart rate to dangerous levels.
 Evaluates nursing care outcomes through the acquisition of data and the questioning of
inconsistencies.
Example: In this case study, I have written a section in which I evaluated the nursing
care through acquisition of data in order to evaluate if the care for this patient is
effective or needs further intervention. For example, regarding the nursing diagnosis
excess fluid volume. There was an order for strict I&Os and sodium intake, this
intervention was evaluated as effective as evidenced by a net loss of 4,080 mL
equaling about 4 kg. This was important to monitor weight gain and loss as well
because it goes hand and hand with monitoring worsening signs of heart failure.

Nursing Practice
Applies appropriate knowledge of major health problems to guide nursing practice.
Example: In this paper, it was vital to understand and apply appropriate knowledge of
the major health problem of health failure in order to guide nursing practice. I had to
apply this knowledge of heart failure in order to formulate the nursing diagnosis of
decreased cardiac output, impaired gas exchange, ineffective tissue perfusion, and
excess fluid volume. After the assessment was completed and diagnosis were made, I
then could plan outcomes and implement interventions for my nursing practice.

Implements traditional nursing care practices as appropriate to provide holistic health

care to diverse populations across the life span.
Example: Some examples of traditional nursing care discussed in this case study
included administering medications, edema management, education, nutritional
support, and managing fatigue. It was discussed considering my patients old age and
the fact that 50% of heart failure patients die within 5 years, that a chaplain consult
would be beneficial for my patient. This is an example of providing holistic health
care because we considered the spiritual and religious aspect for this patient.

Establishes and/or utilizes outcome measures to evaluate the effectiveness of care

Example: In this case study, I performed the interventions of restricting fluids to 1500
mL per day and salt intake to less than 2 grams to aid in edema management and
improve fluid balance for my patient. In my outcome measure I stated the patient will
lose 2 kg within 2 days by limiting the fluids, sodium, and through Lasix. After
evaluation, in fact he lost 4,080 mL=4 kg, so it was noted that the care was met and
effective.
 Communication
Uses therapeutic communication within the nurse-patient relationship.
Example: In this case study, it was necessary to form a rapport with the patient and
have a therapeutic communication between the nurse and patient because end-of-life
considerations were discussed which caused the patient to express his fear of dying. It
required myself to have this therapeutic relationship with the patient to be empathic
and effectively listen to concerns to help alleviate anxiety the patient was
experiencing.

Produces clear, accurate, and relevant writing using correct grammar, spelling and
punctuation.
Example: Throughout, this case study it was necessary to produce clear, accurate,
and relevant writing to integrate the knowledge from the humanities and sciences,
including nursing research and theory to formulate a case study about a patient I
cared for in my adult health clinical.

Research
Differentiates between descriptive nursing literature and published reports of nursing
research.
Example: In this case study, I used the nursing literature review to support the
practice of using fluid management strategies in heart failure patients. I also used
several published reports of nursing research to discuss the care for patients in
respiratory failure and how specialist nurses improve outcomes in heart failure.

Evaluates research that focuses on the efficacy and effectiveness of nursing interventions.
Example: In this paper, I discussed a research article from the American Association
of Critical-Care Nurses (AACN) Journal in regards to fluid management strategies in
heart failure. This research supports the intervention of restricting fluids to at least
1,500 mL per day in order to effectively manage edema and heart failure.

Leadership
Delegates and supervises the nursing care given by others while retaining the
accountability for the quality of care given to the patient.
Example: In this case study, I discussed how I was able to delegate the task of
measuring the output of my patient to the nursing care partner. This enabled my nurse
and I to document and effectively implement the strict input and output intervention
while still retaining the accountability for the quality of care given to my patient.
 Professionalism
Differentiates between general, institutional, and specialty-specific standards of practice
to guide nursing care.
Example: Nursing care provided by the registered nurse and I were guided by the
AACN Standards of Professional Practice. We appropriately utilized resource by
offering chaplain service; we ensured quality of care by providing medications to
adequately control edema management and other medications such as blood pressure
medications like Coreg; ensured strict I&Os; we also lived up to the nursing ethics by
advocating for the client and familys meeting with the attending physician to discuss
an advance directive plan.

Understands the effect of legal and regulatory processes on nursing practice and health
care delivery, as well as limits to ones own scope of practice.
Example: Within the care for this patient, I discussed different medications given to
the patient. Some were IV push medication, which was outside my scope of practice
as a student nurse. Therefore, I observed the RN give lasix to the patient IV push.

Culture
Articulates an understanding of how human behavior is affected by culture, race,
religion, gender, lifestyle and age.
Example: In the cultural consideration portion of this paper, I considered the research
statistics from the CDC that states African Americans are more likely to have heart
failure than any other races and also are more likely to present with symptoms at an
earlier age. Studies have shown that African Americans often have less access to
healthcare and are less likely to visit a doctor and get routine screenings. While
having a discussion with my patient he stated that in his younger years he did not get
routine screenings and also has had high blood pressure and cholesterol for over 30
years. It is important for health care providers to consider this when providing care.
By considering my patients race, gender, lifestyle, and age in this paper, allowed me
to articulate an understanding of how human behavior is affected by these factors.

Demonstrates sensitivity to personal and cultural definitions of health, and how these
beliefs influence an individuals reactions to the illness experience and end of life.
Example: In this paper, I talked about the discussion of end of life care with my
patient. He originally discussed his feelings of fear of death but after meeting with
the chaplain and discussing his religion, he stated he had less fear of dying but
still was not ready. It is important to be sensitive to personal beliefs of health
because it allows us as nurses to be culturally sensitive.

Teaching
Provides teaching to patients and/or professionals about health care procedures and
technologies in preparation for and following nursing or medical interventions.
 Example: In this paper, I discussed interventions provided to patient about his health
which included teaching for discharge instructions. The teaching included to take his
mediations as directed once discharged, keep a daily weight log, exercise, and
maintain a cardiac diet with low sodium diet to support his cardiovascular system
health. In addition, educating the patient on the different types of foods that should be
eaten and avoid to benefit for their cardiovascular system such as avoiding alcohol,
food with high saturated fat and cholesterol, and avoiding foods with high salt intake.