This case study describes the care of a patient who came into the hospital with sepsis and progressed to acute respiratory and renal failure requiring mechanical ventilation and a tracheostomy. The patient did not respond to any external stimuli except pain. Through researching the patient's conditions and monitoring lab values, the student was able to understand the pathophysiology and appropriately treat the patient's multiple organ dysfunction syndrome. The experience provided an opportunity for the student to learn how to communicate with and provide comfort to patients with limited response abilities.

1. Critical Care Case Study<br />NURS 451 – Clinical Management of Adult Health Nursing III<br />Purpose of Assignment<br />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.<br />Student Approach to Assignment<br />I chose to write this case study on this particular patient because this was the first patient I had cared for that was not generally awake and alert. This patient came into the hospital with a septic infection that progressed to an inability to adequately oxygenate himself and renal failure. He had been on a ventilator for several weeks by the time I was with him and had received a tracheostomy through which to be mechanically ventilated. This experience was difficult for me as he did not respond on any level to anything except for pain. <br />Reason for Inclusion of this Assignment in the Portfolio<br />This assignment gave me a new outlook on patient care and an experience that I had yet to have first hand. Caring for this patient was difficult for me for many reasons. The following program objectives are highlighted in this case study:<br />Critical Thinking<br />Evaluates nursing care outcomes through the acquisition of data and the questioning of inconsistencies<br />By assessing and reassessing this patient, I was able to quickly notice the changes our interventions were causing. Also, rounds on this patient included a discussion as to his need or contraindication of heparin as an anticoagulant related to his platelet and aggregation counts. This patient was still on heparin but was being evaluated on the first day for heparin-induced thrombocytopenia and on the second day, for disseminated intravascular coagulation. Both of these were the discussions during interdisciplinary rounds. <br />Nursing Practice<br />Applies appropriate knowledge of major health problems to guide nursing practice<br />By researching and understanding the pathophysiology going on with this patient, I was better able to treat his multiple organ dysfunction syndrome by not only correcting the root cause of the problem, but also by intervening with the associated signs and symptoms to lessen their devastating effects on this patient’s health. We used his ABG values to determine appropriate ventilation settings and to ensure that his body was being properly oxygenated. <br />Implements traditional nursing care practices as appropriate to provide holistic health care to diverse populations across the lifespan<br />Throughout my time with this patient, I implemented such traditional practices as constant monitoring, and treating his respiratory and renal failure by monitoring ABG levels and urine outputs. I also tried to comfort his wife while she was present in his room. <br />Communication<br />Adapts communication method to patients with special needs<br />Communication with a patient who does not respond to speech or light touch is very difficult. Patients need to know what is going on in their care and the belief is that hearing is the last sense to go and the first to come back. I ensured that I spoke aloud everything that I would do before it was done so that, if he could hear me, he would know what to expect. <br />Research<br />Evaluates research that focuses on the efficacy and effectiveness of nursing interventions<br />I discussed an article in which subjective skin temperature of the foot is used as an accurate measure of cardiac output. This article provided an additional way to ensure that this patient’s extremities are being perfused. The thought is that is his heart can get enough blood and oxygen to his feet, he should be getting enough to oxygenate his renal tissues as well. <br />Professionalism<br />Differentiates between general, institutional, and specialty-specific standards of practice to guide nursing care<br />I used the standards of practice of acute and critical care nursing (AACN) to look back on my time with this patient to ensure that the standards for critical care nursing are met. For example, standard one, assessment, was met by evaluating this patient for HIT and DIC based on his labs; standard two, diagnosis, was met by determining that he was in fact suffering from HIT; and standard four, planning, was met by determining that this patient needed to have his heparin dose stopped. <br />Culture<br />Demonstrates sensitivity to personal and cultural definitions of health and how these beliefs influence an individual’s reactions to the illness experience and end-of-life<br />This patient’s wife visited for a couple of hours each day and spent her time in his room doing puzzles and watching television. In my family, when someone is in the hospital there is always someone there with that person. For example, the last time my grandmother was in the hospital, her children took turns spending evenings and nights with her while my grandfather spent the days there. Upon speaking to Mrs. F, I learned that they were not close with much of their family so there was little support for her and that she spent time there because she felt guilty when she did not. Also, she explained that she was too scared of his illness and possible death to spend too much time in the hospital where it was reality.<br />