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 assignment was the only case in this rotation, apart from the
emergency department, where the patient was conscious. The patient was an 88 year-old male
admitted to the ICU after going into septic shock from a urinary infection that was contracted
after surgery for a stent placement in his right ureter. The septic shock led him into acute
respiratory distress and eventual acute respiratory failure. In caring for this patient and viewing
the entire clinical picture through this assignment, I learned how quickly a patient can deteriorate
and why knowledge and critical thinking in nursing is vital for reversing the deterioration of
patients.
Reason for Inclusion of the Assignment in the Portfolio
This assignment is significant to the portfolio because it demonstrates how I use the core
competencies of nursing in the care of a critical patient. The following objectives are covered
within this assignment:
! Critical Thinking
" Uses nursing and other appropriate theories and models to guide professional practice.
# Example: In this assignment, I utilized Virginia Hendersons Nature of Nursing
theory to support the priority nursing diagnosis; the theory states that the central focus
of nursing is emphasis of fundamental human needs. The nursing care was directed at
maintaining the patients airway and getting the patient off mechanical ventilation,
leading to patient independence, which is the basis of this theory.
" Uses decision-making skills in making clinical or professional judgments.
# Example: In this case study, I mention how the patient has a background in medicine.
I used my professional judgment with regards to the patients anxiety stemming from
inability to communicate his thoughts and not to a lack of any cognitive
understanding of his condition. With this interpretation of the situation, I spoke to the
patient as a medical professional versus using laymans terms.
" Evaluates nursing care outcomes through the acquisition of data and the questioning of
inconsistencies.
# Example: In this case study, I discussed the expected outcomes for the patient and
how each was evaluated with assessment, such as maintaining the airway as
evidenced by adequate secretions. This was evaluated with assessment of lung sounds

and ability of the patient to independently maintain oxygenation after extubation,

indicating a successful outcome.
! Nursing Practice
" Applies appropriate knowledge of major health problems to guide nursing practice.
# Example: This assignment applies the knowledge of major health problems, identified
as medical diagnoses, that the nursing care revolved around. The pathophysiology of
sepsis leading to the patients identified condition of acute respiratory failure is
thoroughly described.
" Performs therapeutic interventions that incorporate principles of quality management
and proper safety techniques based upon assessment findings.
# Example: In this case study, the patients anxiety to his condition is discussed as a
nursing priority. Interventions were implemented to promote reduced stress, improve
comfort and achieve stabile vital signs. This case study explains the measures taken to
reduce the patients anxiety, such as speaking to his good ear, enunciating words for
him to read lips, writing on paper for him to read, and providing oral care to reduce
dry mouth. These interventions were implemented for the safety of the patient to
ensure an adequate airway by reducing his noted anxiety.
" Implements traditional nursing care practices as appropriate to provide holistic health
care to diverse populations across the life span.
# Example: This case study discusses the traditional nursing practices performed during
care of the patient, such as assessments, medication administration, repositioning, and
reducing stress by allowing family at bedside during care.
" Establishes and/or utilizes outcome measures to evaluate the effectiveness of care.
# Example: In this case study, I discussed the goal of extubation for the patient and
what measures would need to be met before this was possible. The nursing and
medical staff used the measurable outcomes, which were: clear breath sounds;
respiratory rate and rhythm within normal limits; and ability to cough, to evaluate the
readiness for removal endotracheal tube, indicating effective care was provided. The
tube was removed successfully and all outcome measures were met.
! Communication
" Adapts communication methods to patients with special needs.
# Example: In this assignment, I mentioned how communication was a barrier due to
the patients inability to reciprocate conversation. I discussed how alternatives forms
of communication were used to promote patient understanding, such as speaking to
the patients ear with the hearing aide, asking simple questions slowly for him to read
lips, and writing simple messages on paper for the patient to respond with shaking
and nodding of his head.

! Research
" Differentiates between descriptive nursing literature and published reports of nursing
research.
# Example: In this assignment, nursing research is utilized to support the nursing
interventions that were implemented in the care of the patient. This assignment also
used descriptive research to gain insight into nurses knowledge and attitudes in the
practice of oral care interventions implemented.