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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