Case Study: Timothy Smith – Medical Surgical Unit

NRS-460 Benchmark – Case Study: Timothy Smith – Medical Surgical Unit

Directions: Read the case study below. Evaluate the information and formulate a conclusion based on your evaluation. Complete the critical thinking table and submit the completed template to the assignment dropbox.

It is necessary for an RN-BSN-prepared nurse to demonstrate an enhanced understanding of the complex management of disease, the clinical manifestations and associated treatment protocols, and how they impact patients across the life span.

PART I: Health History and Medical Information

Evaluate the health history and medical information for Timothy Smith, presented below.

Upon arrival to the medical-surgical unit, you are assigned as Mr. Smith’s primary care nurse. It has been reported that the patient started confusing his days and nights and becoming restless. Once his family was identified in the Intensive Care Unit (ICU), his mother was an active visitor and helped with care decisions. She notified his care team that Timothy was an active military service member with a history of post-traumatic stress disorder (PTSD) and depression, which have led to smoking and recreational drug use. Two days prior to arrival to the med-surg unit, Mr. Smith was extubated from the ventilator and has been weaned down to a 2L nasal cannula. Three days prior his EVD was removed. The focus has been shifted to strengthening him to walk and healing abrasions from the accident. Tube feeding was continued from the ICU while awaiting clearance to begin swallowing on his own. Dressing changes are ordered from the open reduction internal fixation (ORIF) and for any third-degree abrasions from the accident.

1. Oxygen – 2L Nasal Cannula, FaO2: 21-24%; Hypoventilation (splinting, coughing, deep breathing)
2. Physical therapy
3. Respiratory therapy
4. Hairline fracture of 3 left ribs
5. Wound care for ORIF and abrasions
6. Psychosocial needs (PTSD, depression, ICU psychosis)
7. Pain control

Laboratory Tests, Results, and Vitals:

1. Skin assessments
2. Protein level
3. Follow-up x-rays of ribs show healing and no punctures, tube feeding catheter tip located in the upper stomach
4. GCS: 14 (deficit for confusion at times)
5. Respiratory rate – 16
6. SpO2 94%
7. Blood pressure – 118/68
8. A psychiatric nurse practitioner has begun visiting and noticed he is showing signs of depression and is struggling to cope with the accident.
9. CT scan of the head
10. Pain assessment score of 6 out of 10, with the patient reporting his leg is the worst source of pain, also experiencing pain with deep breaths, and mild headache

 

PART II: Critical Thinking Activity

Use the findings from your evaluation to complete the following:

Plan of Care When assuming care of this patient, you were told that the plan for Mr. Smith is to be discharged home tomorrow. This was not the plan when you took care of Mr. Smith yesterday.
Part 1: Evaluate Outcomes of Care 1. Evaluate Mr. Smith’s readiness for discharge based on the information provided in the case study. Based on your findings, evaluate health goals for this patient. Discuss how you would modify the plan of care. Your response should be a minimum of 200 words.
2. Based on your assessment, how would you recommend modifying the plan of care to meet Mr. Smith’s needs? Your response should be a minimum of 150 words.
Part 2: Protocol What protocol would you use to implement your recommendations for Mr. Smith’s updated plan of care? Your response should be a minimum of 200 words.
Recovery and Response to Treatment Consider Mr. Smith’s history of PTSD and depression.
Discuss the impact his PTSD and depression history might have on his recovery and response to treatment. Your response should be a minimum of 150 words.
Complications Consider Mr. Smith’s history of PTSD and depression in addressing the following questions.
Discuss the overall complications that may affect Mr. Smith’s motivation, compliance, and psychological well-being. Your response should be a minimum of 150 words.
Put together an interdisciplinary team to support all areas of his recovery, including mental health support. Provide rationale for your response by referencing his assessment findings. Your response should be a minimum of 150 words.
Smoking and Drug Use Consider Mr. Smith’s history of smoking and recreational drug use.
History of Smoking How might his history of smoking impact healing of the bones? Your response should be a minimum of 150 words.
Cessation of Smoking 1. Discuss how you would integrate smoking cessation and rehabilitation experts into Mr. Smith’s recovery team. Your response should be a minimum of 150 words.
2. How might Mr. Smith’s past usage of recreational drugs impact his pain management? Your response should be a minimum of 150 words.
Balancing Discuss how the nurse would balance promoting smoking cessation for Mr. Smith while respecting his self-determination in his health care decisions. Your response should be a minimum of 150 words.
Psychosocial and Spiritual Considerations Providing holistic nursing care for patients with complex conditions requires that the nurse takes into account the patient’s psychosocial and spiritual needs.
Given the patient’s current situation, discuss ways in which the nurse can take into account and address the patient’s psychosocial and spiritual needs. Your response should be a minimum of 150 words.
Care Planning and Insurance Nurses have to have an awareness of the socioeconomic impact of care delivery, especially when planning care for patients with complex needs.
Who would you need to involve if you discover that the patient is uninsured? Your response should be a minimum of 150 words.
How would this impact the socioeconomic aspect of Mr. Smith’s care planning moving forward? Your response should be a minimum of 150 words.
References (Please include working hyperlinks)

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