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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 assignment was to integrate knowledge gained through the first four
semesters into a particular patient. This process gave feedback to the instructors and myself as to
the level of knowledge and care I was able to perform thus far in the nursing curriculum.
Student Approach to Assignment
The patient chosen for this case study was the first patient I cared for with serious injury.
Care of this patient required a complex knowledge of the systems of the body and how each
system relates to the function of the whole. This was the first time I was required to develop a
care map that related to system function rather to one another. This gave me a true understanding
of the proper order of nursing diagnoses. This patient was a 53 year old male who suffered an
acute myocardial infarction, mental dysfunction, and loss of consciousness requiring ventilator
support.
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 Karl Ludwig von Bertalanffys general and open
systems theory which focuses on the human being as a system made up of different layers
to include cells, organs, and blood. I also highlight the importance of social and
psychological health. This theory was in turn used a guide to better the entire person
through recovery rather than just the physical conditions. Mr. As nursing diagnosis
addressed these areas of concern as well.

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


Example: In this paper I discussed how I decided to use the patients sister to help
control the patients anxiety. The patient was pulling at his tubes and fighting the
ventilator weaning process. This increased his blood pressure as well as the heart rate.
When his sister was communicating with him he was calm and cooperative with the
weaning process.
Evaluates nursing care outcomes through the acquisition of data and the questioning of
inconsistencies.
Example: In order to be extubated Mr. A was expected to maintain his respirations,
total percentage of oxygen, and keep his FiO2 at certain levels. While dealing with

the anxiety of not being able to talk, seeing unfamiliar faces, and uncomfortable
tubing, he was not able to reach these levels. This prompted me to involve his sister in
the weaning process. Therapeutic communication outcome was evaluated and
determined to be more effective between the patient and his sister rather than between
him and nursing staff due to the inconsistent response from the patient.
Nursing Practice
Demonstrates an awareness of complementary modalities and their usefulness in
promoting health.
Example: I demonstrated awareness of complementary modalities and their
usefulness in promoting health by using distraction to diminish his agitation and
anxiety. Dealing with the anxiety with medications would have led him to rely more
on the ventilator and not progress through the weaning treatment to extubate. In his
case his Sister and I used therapeutic conversation for the distraction.

Applies appropriate knowledge of major health problems to guide nursing practice


Example: I discussed the seriousness of the patients major health problems; AMI,
respiratory failure, and mental dysfunction and how the different problems relate to
one another. Furthermore, Interventions were prioritized and given based on this
knowledge of his major health problems (AMI, respiratory failure)
Communication
Uses therapeutic communication within the nurse-patient relationship.
Example: Communication with the family stressed the importance of the cooperation
of the patient in his treatment process. The patients sister was a key role in
communication due to her ability to involve the patient in his care. The education was
communicated well with the combination of the sister and myself and eventually
helped foster the trust in the relationship.
Research
Differentiates between descriptive nursing literature and published reports of nursing
research.
Example: In this case study, I used the nursing literature review to specific teaching to
men about the signs or symptoms that may present letting the patient know that a
heart attack is possible. This published report was not descriptive on the research as it
did not give sample size, methods, or results of any particular research. However,
descriptive research was also used to understand the importance of different members
of the family and how, based on family structure, those members were more or less
significant to the patient. This research did include the key components of actual
research as stated above.
Evaluates research that focuses on the efficacy and effectiveness of nursing interventions.

Example: In this paper, I discussed the research finding that many nurses missed the
physiological signs of increased anxiety such as tachycardia, increased blood
pressure, and increased chest pain. I then applied that knowledge to physiologic
readings to determine the level of anxiety in order to better treat a patient that was not
able to communicate.

Culture
Articulates an understanding of how human behavior is affected by culture, race,
religion, gender, lifestyle and age.
Example: In the paper, I discussed how the patients gender and single status make
him more in need for thorough education, I also hit on the importance of his mother
and sister since he does not have a significant other.

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