Critical Care 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 chosen due to the progression of his pathophysiology that led him into the ICU. During his hospital stay, the patient showed complications associated with sepsis. The patient was also a Navy sailor. I had the unique opportunity to report on the patient’s status to his Medical Officer from his ship, and listen in on him discussing the plan of care with the attending physician. This assignment was intended to explain this patient’s story, what it all meant, and what the nursing profession did (and could have done) for him. 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 decision-making skills in making clinical or professional judgments.  In this paper, I spend a great deal of time describing the patient’s nursing diagnoses and prioritizing them. In this process, I detail my thought pattern related to why the priorities are set in the way I describe them, which uses much critical thinking and clinical judgments to determine which areas are the priority for intervention. For instance, the patient was admitted to the ICU with a diagnosis of sepsis. An immediate reaction would be that his septic infection is the highest priority. For this patient, his priority was his impaired gas exchange – which was determined by his trend in lab values and assessment data as the root cause of many of his nursing diagnoses. Therefore, I could make a clinical judgment that his respiratory care took priority when needed, and getting the patient off of the ventilator would the first step in achieving wellness.  Nursing Practice.  Demonstrates an awareness of complementary modalities and their usefulness in promoting health.  I demonstrated awareness of complementary modalities and their usefulness in promoting health by making efforts to ensure the needs of the patient’s family were met. This sounds simple, but the patient’s parents had flown in from California, taking sick days from work, and had been in town for over a week already. With the

patient being sedated, his brief periods of consciousness were stressful and exciting for the family, and his parents were the patient’s primary support system. By ensuring their ability to be present and comfortable, I was helping the patient’s future spiritual/emotional wellness by strengthening him on the front that I could manage – the wellness of his support system. This patient in particular grew agitated and sometimes violent during sedation vacations and a notable different occurred when his parents were present during these times. Therefore, by increasing their comfort and feeling of welcome, I was empowering them to empower him.  Applies appropriate knowledge of major health problems to guide nursing practice  In this case study, I laid out the patient’s nursing diagnoses and prioritized them. I did this after analyzing each and the acute impact they have on the patient. In the case of this patient, his impaired gas exchanged was determined to be the highest priority. Using my knowledge of the respiratory system and treatment of it, I concluded that getting the patient off of the ventilator as soon as possible would benefit his care. Each day the patient spends on the ventilator increases his risk for VAP, dependency, and hinders his progress through the requirement of sedation. If he was off the ventilator, and breathing on his own, he would be removed from the sedation. This would allow him to move and circulate fluids, promote blood flow, cough up sputum, and many other actions that reduce his risks for many complications – like pressure ulcers.  Establishes and/or utilizes outcome measures to evaluate the effectiveness of care  In this case study, I utilized the outcome measures to determine how effective the care was. My goal for the patient to be off the ventilator was not met. However, he was trending in that direction. This was determined using his vital signs and lab values, particularly a respiratory rate of 18 (6 breaths over the ventilator) and his oxygen saturation rose to 89%. This showed that the treatments were working, but not to the pace that was described in my goals and outcome criteria (3 days).  Communication  Uses therapeutic communication within the nurse-patient relationship.  In this case study, communication with the patient was not possible due to his sedation – although I did talk frequently to the patient in the event that he could still hear me. However, I was able to establish a good relationship with the patient’s parents. I was able to gain their trust by describing that I am Navy, like their son, and continued the relationship by answering various questions. Of particular mention in the case study is a teaching session for the father about the use of Lasix in decreasing edema. His parents were particularly interested in this topic because, like most younger males with edema, his scrotum had taken the brunt of the increased fluid. I explained that this was not a unique finding to a sepsis patient, but the Lasix helps get rid of the excess fluid through increased urination. I also explained how the Lasix was

effectiveness, because after administration the patient would typically void 15002000mL of urine.  Produces clear, accurate, and relevant writing using correct grammar, spelling and punctuation  In this case study, I described my thoughts and actions in a clear manner, with several articles cited and listed correctly, and with all aspects of the paper in appropriate APA format.  Teaching  Provides relevant and sensitive health education information and counseling to patients, and families, in a variety of situations and settings  As described above, this was met when I instructed the patient’s father on the pathophysiology of Lasix and how it will benefit his son. He was particularly interested in this topic because, like most younger males with edema, his scrotum had taken the brunt of the increased fluid. I explained that this was not a unique finding to a sepsis patient, but the Lasix helps get rid of the excess fluid through increased urination. I also explained how the Lasix was effectiveness, because after administration the patient would typically void 1500-2000mL of urine.  Research  Applies research-based knowledge from the arts, humanities and sciences to complement nursing practice  In this case study, I used research articles to describe the importance of cleanliness and space in a patient’s room and the effectiveness of nurse-led care bundles.  Culture  Articulates an understanding of how human behavior is affected by culture, race, religion, gender, lifestyle and age.  My patient, being in the Navy, had access to a big support group. Almost constantly, a shipmate from his ship was present as well as his family. His family was actually an obstacle that had been overcome, since, being Navy, he was far from home. His parents were able to fly in and stay during his hospitalization.