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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 client chosen for this case study was the only client in which I was able to provide
care to from the point of admission into the Intensive Care Unit (ICU) through my second day on
the unit. The client was a 72 year-old female admitted from the Emergency Department for
diabetic ketoacidosis (DKA) and sepsis. Her significant psychiatric background and recent
history of repeated hospitalizations allowed me to gain insight on the psychosocial concerns that
healthcare providers are faced with in the acute care setting. The focus of this case study was the
stabilization of her acute state that resulted from her psychiatric condition.
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 client
with complex acute and chronic conditions and demonstrates the integration of a wide variety of
end of program competencies.
Critical Thinking
Uses nursing and other appropriate theories and models to guide professional practice.
Example: In this case study, I used Betty Neumans Systems Model to support the
nursing interventions used and recommended in the care of the client. According to
this theory, physiological, psychological, sociocultural, developmental or spiritual
stressors can affect an individual at any point in the lifespan. This theory focuses on
addressing the client holistically and expresses that any stressor in one area can have
an effect in the others. Utilizing this theory, nursing care was guided by the focus on
the psychological stressors that existed for this client to return her to a state of
optimal well-being.
Uses decision-making skills in making clinical or professional judgments.
Example: While ensuring a safe environment is imperative for all patients in every
nursing setting, this paper addressed the implementation of additional safety measures
as her acute state of confusion and risk for injury were heightened. My decisionmaking skills were put to the test when the padded lap belt that was meant to keep her
in a safe position in bed posed as an increased safety hazard as she repeatedly
wriggled herself down the bed until the band was almost around her neck. To ensure
her safety, I reported this finding to the nurse and did not leave the bedside. When I
had to leave the bedside, I enlisted the nurse or care partner in supervising her. I also

engaged the client in conversation to soothe her agitation to keep her from wriggling
down in bed.
Evaluates nursing care outcomes through the acquisition of data and the questioning of
inconsistencies.
Example: In this paper, I discussed the clients history of over five suicide attempts
over the last seven months and the subsequent admissions into the Behavioral Health
Unit (BHU). Each attempt was done through the injection of insulin, prescribed to
manage her Diabetes Mellitus (DM). I questioned the lack of intervention by home
health services or social services to evaluate the clients ability to provide self-care
and addressed the recommendation of such services to ensure the clients safety and
well-being after discharge.
Nursing Practice
Implements traditional nursing care practices as appropriate to provide holistic health
care to diverse populations across the lifespan.
Example: In this case study, I discussed traditional nursing care practices that
included medication administration, measuring blood glucose levels hourly and
assessing restraint application hourly.
Research
Differentiates between descriptive nursing literature and published reports of nursing
research.
Example: In this case study, I referenced a descriptive nursing article that defined
sepsis and its pathophysiology, outlined early care bundles and hemodynamic
monitoring and interventions that are to be implemented while in the intensive care
unit. This paper also references a nursing research article in which the authors divided
300 intensive care patients into two randomized control groups to evaluate the
effectiveness of glucose monitoring with a computerized system compared to paper
charting. Lastly, this paper discussed the findings from a cross sectional and
descriptive-correlational study in which 243 family members were surveyed to
determine their mental health status and degree of burden that they have faced when
acting as a caregiver for their family member that suffer from mental disorders.
Evaluates research that focuses on the efficacy and effectiveness of nursing interventions.
Example: In this paper, I discussed the research finding that individuals that provide
care for their family members with mental health disorders are at a higher risk of
developing anxiety and depression as a result of the higher level of burden they
experience after assuming care of their loved one. I addressed the importance of
nursing care that addresses their needs and concerns, providing education about their
increased mental health risks and involving them in every aspect of the plan of care.
Leadership

Articulates the values of the profession and the role of the nurse as member of the
interdisciplinary health care team.
Example: As this paper discussed the repeated hospitalizations for uncontrolled blood
glucose levels, I addressed the role that the nurse plays in educating the family about
the signs and symptoms hypoglycemia and hyperglycemia. I also addressed the role
that the nurse plays as a member of the interdisciplinary health care team in
implementing the sepsis bundle in a timely manner.
Professionalism
Differentiates between general, institutional, and specialty-specific standards of practice
to guide nursing care.
Example: Nursing care that was provided by the registered nurse and myself was
guided by the general and institutional standards of practice through providing safe
environment, adhering to restraint protocol regarding the use of the lap band and
utilization of the bed alarm. The collaboration of the health care team in
implementing the sepsis bundle was addressed and adheres to the AACNs standards
of practice.
Culture
Articulates an understanding of how human behavior is affected by culture, race,
religion, gender, lifestyle and age.
Example: This case study addressed the clients age and recent change in her lifestyle
(recent move to the area, husband having moved into an assisted living facility and
son being able to provide intermittent care) that possibly contribute to her psychiatric
history and repeated attempts of suicide. I related these cultural considerations to her
inability to provide self-care and provided recommendations for home nursing care
that could address these concerns more efficiently than the acute setting has provided
in the past.