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 a 76-year-old, African American male that
eventually required below-the-knee amputation. This was my first patient that I provided care for
before and after a major operation. He required amputation because of a chronic venous stasis
ulcer that had become gangrenous. Providing care for this patient was an incredible learning
experience. When I approached the case study assignment, I focused on two nursing diagnoses I
identified.
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.
The following program objectives are highlighted:
Critical Thinking
Uses decision-making skills in making clinical or professional judgments
Example: My 76-year-old patient was severely ill and required admission to the
intensive care unit. He had up to six intravenous medication drips infusing at one
time. By providing care, and writing a case study, I was able to reflect upon nursing
action and care provided. When so many medications are being delivered
simultaneously, it is crucially important for the nurse to understand the mechanism of
action of the different drugs. The patient was hypotensive with a blood pressure of
76/44. The nurse I was shadowing was scanning medications and preparing to give
them to him via his oral gastric tube. I noticed that he was on Metoprolol (Lopressor),
a beta-blocker. I was afraid to offend my nurse, but I stood up as a patient advocate
and told her that I think we should hold this medication as he was already
hypotensive. I used critical thinking, leadership and decision-making skills to provide
quality patient care.
Engages in creative problem solving
Example: In this paper, we were asked to explore alternative interventions which may
aid in our patient care. One of my identified nursing diagnoses was impaired gas
exchange. To improve gas exchange, I suggested chest physiotherapy as an alternative

intervention which was not currently being implemented. The 76-year-old patient was
bed-ridden and on mechanical ventilation. By beginning chest physiotherapy, the
health care team may improve gas exchange by loosening secretions which could
later be suctioned.
Evaluates nursing care outcomes through the acquisition of data and the questioning of
inconsistencies
Example: To reiterate, one of my patients identified nursing diagnosis was impaired
gas exchange. One contributing factor to my patients nursing diagnosis was his blood
pressure. In this paper, I discussed how I advocated for my patient when the nurse
was passing medications. One of his medications was Metoprolol (Lopressor). The
nurse intended to crush this medication and administer it to the patient through his
oral gastric tube. This action was an inconsistency to effective nursing care because
the patient had a blood pressure of 74/44 and a heart rate of 49 beats per minute.
Metoprolol should have been contraindicated and the nurse held the medication after I
pointed the rationales out.
Nursing Practice
Implements traditional nursing care practices as appropriate to provide holistic health
care to diverse populations across the life span
Example: Part of traditional nursing care is the use of pulse oximetry. Pulse oximetry
measures the oxygen saturation of the patient. In this case study, I discussed how
pulse oximetry measurements can differentiate between diverse populations across
the life span. My patient, as a 76-year-old African American, may have a 3% to 5%
decrease in oxygen saturation simply due to the darker coloration of his nail bed.
Demonstrates an awareness of complementary modalities and their usefulness in
promoting health
Example: I discussed complementary modalities in regards to patient care and their
usefulness in promoting health and healing by reflecting on the importance of a social
support system. A research study I included in this case study identified a social
support system as one of the greatest variables in amputation recovery. The authors
identified social support as a fundamental part of rehabilitation.
Establishes and/or utilizes outcome measures to evaluate the effectiveness of care
Example: To reiterate, one of my patients identified nursing diagnosis was impaired
gas exchange. As part of the nursing process, I identified an outcome; extubation two
weeks post amputation. To determine a patients readiness to be extubated, a nurse
assesses and evaluates weaning trials and sedation vacations. I explored this diagnosis
and outcome and discussed possible obstacles.
Communication
Uses therapeutic communication within the nurse-patient relationship

Example: In this case study, I discussed the communication techniques I utilized in

the critical care setting. This patient had heavy familial involvement; however, the
patients son was the patients healthcare proxy. He wished all information be
provided to him and he would disseminate the information to his family. As a nurse,
you must abide by the patients and familys wishes. I discussed how this dynamic
effected my bedside patient care.

Research
Applies research-based knowledge from nursing as the basis for culturally sensitive
practice
Example: In this paper, one of the nursing research articles I utilized described the
effects of social support systems on amputation patients. The research article
discussed the perception of various cultures on social support systems. By reviewing
this article, I was able to recommend heavy involvement to the patients African
American family. I was able to apply research-based knowledge from nursing to
provide culturally sensitive practice.
Evaluates research that focuses on the efficacy and effectiveness of nursing interventions
Example: In this paper, I discussed the research finding of a nurse-driven sepsis
screening in the emergency department. The 76-year-old initially presented to the
emergency department with symptoms of the flu. He was discharged with Tamiflu.
However, if the emergency department had implemented a nurse-driven sepsis
screening, the patient could have been admitted directly to the intensive care unit
rather than being sent home for a few days. Therefore, by implementing current
research into current practice we may be able to improve patient outcomes by
recognizing septic patients earlier.
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 paper, I discussed the moment where I realized by patient was
hypotensive, possibly as a result of sepsis, and did not need Lopressor. As a student, I
took accountability for the quality of care given to my patient.
Professionalism
Demonstrates accountability for ones own professional practice
Example: In this paper, I discuss the step-by-step approach for my professional
practice in the intensive care unit. I support interventions with evidence and research.
Once given responsibility of a patient, I strive to follow all physician orders and
recommended interventions.

 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 patient had a large family and the cultural
considerations that relate to this dynamic. The patients son gave specific instructions
to relay all patient-sensitive information directly to him. His behavior was dictated by
his culture, lifestyle and age. During our patient care, we abided by his request and
redirected any patient-sensitive questions towards the patients son.

Considers the impact of research outcomes and, the effects of health and social policies,
on persons from diverse backgrounds
Example: In this paper, I discussed the research outcomes of the perception in
adjustment of lower-limb amputees. I related the research to my patient who had
recently experienced a lower-limb amputation. Of the 20 patients interviewed in the
exploratory study, all patients shared similar beliefs on the effects of a social support
system; it was necessary.