NRS-460 Benchmark – Case Study: Timothy Smith – Intensive Care Unit (ICU)
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.
The purpose of this assignment is to evaluate patient data to navigate decision-making in ambiguous situations, assist the patient and family in managing complex care needs, and perform effectively in an interdisciplinary team.
PART I: Health History and Medical Information
Evaluate the health history and medical information for John Doe, presented below.
After his discharge from the ED, John was transferred to the Intensive Care Unit (ICU) for specialized care and monitoring where you took over as his nurse. Upon arrival to the ICU, John was identified as Timothy Smith. He arrives intubated on a ventilator and requires continuous assessment for his TBI, multiple fractures, and underlying psychological conditions. Specialty providers are considering the risks vs. benefits of a hematoma evacuation. Upon entry to the ICU, Mr. Smith has been diagnosed with:
1. Severe Traumatic Brain Injury with a GCS score of 6, managed with an external ventricular drain (EVD)
2. Respiratory instability managed with a ventilator
3. Femur fracture with open reduction and internal fixation (ORIF)
4. Hairline fracture of 3 left ribs
Laboratory Tests, Results, and Vitals:
1. EVD – Intracranial Pressure (ICP) – 12
2. Echocardiogram (EKG): Sinus Tachycardia Rate 128
3. Arterial Blood Gas (ABG):
a. PaCO2 Level – 51 mmHg,
b. HCO3 Level – 30 mEq/L
c. pH 7.39
d. PaO2 79 mmHg
e. SaO2 98% on ventilator
4. Respiratory Rate: mechanical ventilation rate 14 with no spontaneous respirations
5. CBC –
a. White Blood Cells: 12.9
b. Hemoglobin: 13.6
c. Hematocrit: 38.7
d. Platelet Count: 310,000
6. CMP:
a. Potassium 4.5 mEq/L
b. Sodium 135 mEq/L
c. Bilirubin: 2.1 mg/dL
7. GCS 8 after placement of EVD and drainage of 10ml of sanguineous fluid from drain.
a. Deficit for only opening eyes to pain (2)
b. Verbal response is incomprehensible sounds (2)
c. Motor score of (4) withdraw from pain
PART II: Critical Thinking Activity
Use the findings from your evaluation to complete the following:
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Power of
Attorney
Upon
arrival in the ICU, you discover Mr. Smith does not have a power of attorney.
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Discuss
how you would determine who would make decisions on his behalf. Your response
should be a minimum of 150 words.
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How can
you utilize the chaplain to assist in locating the family? Your response
should be a minimum of 150 words.
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Quality
vs. Quantity of Life
Health
care professionals often have to have difficult conversations with patients
and families in the intensive care unit (ICU) regarding prognosis and outcomes.
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What
resources are available to have difficult discussion with Timothy’s family on
quality versus quantity of life? Your response should be a minimum of 150
words.
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Given Mr.
Smith’s assessment findings, discuss his quality of life should he receive
hematoma evacuation surgery. Your response should be a minimum of 150 words.
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Ethical
Considerations
Ethical
considerations are an important part of nursing care but become especially vital
when dealing with trauma patients considering the potential of poor
prognosis.
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Discuss
the ethical considerations of palliative care, possible outcomes, and
limitations with Mr. Smith’s condition taking into account his assessment
findings. Your response should be a minimum of 200 words.
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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.
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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.
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Economic
Issues
BSN-prepared
nurses have an understanding of system-based practice including implications
of financial and economic considerations related to providing care.
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Due to the
multi-system injuries Mr. Smith incurred, discuss the economic issues that
the individual and family may encounter. Consider his ability to work,
housing needs, supplemental income, temporary disability, insurance, and
medical expenses. Your response should be a minimum of 200 words.
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Collaboration
What is
the purpose of collaborating with the following when providing care for Mr. Smith?
Explain the role of each team member’s competency and how they contribute to
Mr. Smith’s care.
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Occupational
Therapists
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Physical
Therapists
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Respiratory
Therapists
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Speech
Therapists
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Dieticians
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Physiatrists
(Doctor of Rehabilitative Medicine)
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Wound Care
Nurse
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Neuropsychologists
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Select two
team members and discuss their competencies (skill set) as applicable to Mr.
Smith’s care. Your response should be a minimum of 150 words.
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Interdisciplinary
Team
Interdisciplinary
team collaboration is vital to the successful management of patients with
complex conditions.
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Part I: Team
Dynamics
Explain
what principles can be applied to facilitate effective team dynamics in a way
that: (1) ensures that the role of each individual/team member is defined by
his/her scope of practice; and (2) ensures that the delegation of work to
team members based on roles and competencies is assigned without confusion
for the team or patient. Your response should be a minimum of 200 words.
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Part II:
Interprofessional Communication
1. Discuss
the importance of each member of the interdisciplinary team communicating
their information in a professional, accurate, and timely manner when
treating Mr. Smith. Your response should be a minimum of 150 words.
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2. How
does the presence of diversity, equity, and inclusion impact the dynamics of
team-based communications? Your response should be a minimum of 150 words.
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ICU
Psychosis/Delirium
There are
specific considerations that nurses should be aware of when taking care of
patients in the ICU.
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Explain
ICU psychosis/delirium. Your response should be a minimum of 100 words.
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What
interventions can nurses implement to prevent ICU psychosis/delirium from
happening? Your response should be a minimum of 150 words.
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Based on
Mr. Smith’s current assessment findings, discuss his risk of developing ICU
psychosis/delirium. Your response should be a minimum of 150 words.
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References
(Please include working hyperlinks.)
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