Critical Care Nursing: Synergy for Optimal Outcomes
Roberta Kaplow and Sonya R. Hardin
Synergy Aspects of the Case Studies
Chapter 22: Select Respiratory Disorders, Airway Adjuncts, and Noninvasive
Ventilation
Case 1
Resiliency
This patient is highly resilient given his age of 23 years and of being in apparent good
health prior to the accident.
Vulnerability
This patient is highly vulnerable for infection, because of presence of a ventricular drain,
pleural chest tube, and ventilator and will require long-term rehabilitation.
Stability
This patient is moderately stable with an oxygen saturation of 100% and EtCO2 of 23.
His heart rate ranges from 96 to 110 beats per minute; blood pressure ranges from 110/75
to 140/95, even with sedation. His last arterial blood gas results indicate he is being
hyperventilated.
Complexity
This patient is highly complex having sustained a closed head injury, left-sided rib
fractures with pulmonary contusion, flail chest and hemo/pneumothorax. There were no
intra-abdominal injuries, but he did sustain a left femur fracture. His drug screen was
positive for cocaine, marijuana, and alcohol.
Resource Availability
Given the information presented in the case, his resource availability is unknown. Almost
100% of persons with severe head injury will be permanently disabled and will not return
to their premorbid level of function. The estimated cost to inpatient care is more than $25
billion annually in the US (see www.emedicine.com/med/topic2820.htm).
Participation in care
This patient has a low level of participation in care given his closed head injury, sedation,
and ventilated status.
Participation in decision making
This patient has a low level of participation in decision making given his closed head
injury, sedation, and ventilated status.
Predictability
This patient is highly unpredictable given his closed head injury and numerous medical
interventions (e.g., IV sedation, chest tubes, ventilator, ventricular drain, and drug
screen).
Case Study 2
Resiliency
This patient has a low level of resiliency given his past medical history of multiple
admissions to the hospital with acute exacerbations of COPD, including two extended
courses of intubation and mechanical ventilation.
Vulnerability
This patient is highly vulnerable for exacerbation of his COPD and ultimately a respiratory
arrest given his arterial blood gas results of: pH 7.24, pCO2 70, pO2 51, SaO2 79%, HCO3 32.
Stability
This patient is highly unstable given his drowsy but easily arousable state, respirations of
36 breaths per minute, and mild distress.
Complexity
This patient is moderately complex. He is presenting with an exacerbation of COPD.
Resource Availability
This patient has moderate resource availability. He lives in the community with his wife.
Participation in care
This patient has low level of participation of care given his drowsy state and difficulty
with breathing.
Participation in decision making
This patient has moderate level of participation in decision making. In his current state,
he is not capable of making decisions regarding his care. However, he has discussed his
wishes with his wife regarding ventilation.
Predictability
This patient is moderately predictable. He has a high potential for decompensating and
requiring life extending therapy.