Critical Care Clinical Case Study NUR 451- Clinical Management of Adult Health Nursing III Purpose of Assignment The purpose of this case study is to intergrade knowledge from the humanities, science, including nursing research and theory, to plan, provide, and evaluate holistic care provided to a client selected during this clinical rotation. Student Approach to Assignment For this assignment, I chose a patient that required the use of an Intra-Aortic Balloon Pump. During my clinical rotations, I never took care of a patient that required the use of this mechanical assistive device. The patient was a 69-year-old male that was diagnosed with a NonSTEMI Myocardial Infraction. However, while receiving treatment in the Coronary Care Unit, it was discovered the patient was also suffering from Mitral Regurgitation. The patient was given an Intra-Aortic Balloon Pump to help stabilize his blood pressure and improve his peripheral perfusion. Because I was involved in the care of this patient, I was able to gain an insight into the world of critical care nursing, while having a unique experience with the Intra-Aortic Balloon Pump. Reason for Inclusion of the Assignment in the Portfolio This assignment is included in this portfolio to highlight the care I provided to a critically ill patient and to demonstrate my knowledge of working in an intensive care setting. Critical Thinking Uses nursing and other appropriate theories and models to guide professional practice. In this case study, I incorporated nursing theories to support the prioritization of my patient’s nursing diagnoses. I included Orem’s SelfCare Deficit nursing theory to help support the patient’s priority diagnosis of impaired gas exchange related to alveolar-capillary membrane changes. In Orem’s Self-Care Deficit theory, there is a sub concept called Universal Self-Care requisites. This sub concept is associated with the human body being capable of breathing effectively, in-taking water and food, and undergoing basic elimination processes. My patient had a self-care deficit in his inability to breathe effectively, which required the assistance of mechanical ventilation. This theory allowed me to prioritize my patient’s nursing diagnosis and guide my nursing care to improve his overall oxygenation. Uses decision making skills in making clinical or professional judgments In this paper, I discussed how vasopressors were used in this patient’s care. I mentioned that although the Physician can prescribe various vasopressors, such as Levophed, the nurse has the ability to titrate the drips in a certain range based upon the patient’s reactivity to the dosage of the medication. While taking care of the patient, the patient’s blood pressure was too low, so the nurse and I made the clinical decision to titrate the Levophed to help facilitate an acceptable blood pressure range. Nursing Practice Applies appropriate knowledge of major health problems to guide nursing practice In this paper, I discussed the patient’s medical diagnosis of hypoxemic respiratory failure. This medical condition required the use of mechanical ventilation. The patient being on mechanical ventilation helped guide the nursing practice of performing routine oral hygiene to prevent ventilatorassociated pneumonia, as well as routinely monitoring the patient’s ABGs and pH levels to determine an improvement in the patient’s oxygenation status. Performs therapeutic interventions that incorporates principles of quality management and proper safety techniques based upon assessment findings. In this paper, I discussed the therapeutic interventions of elevating the head of the bed. Because my patient was mechanically ventilated, it was important to elevate the head of the bed to promote better lung expansion and improve gas exchange. Elevating the head of the bed also prevents ventilator-associated pneumonia and aspiration. The benefits of elevating the head of the bed help promote quality management of care and safety of the patient. Establishes and/or utilizes outcome measures to evaluate the effectiveness of care In this paper, I included various outcome measures to help evaluate the effectiveness of my patient’s care. I included the patient’s outcome of the patient being able to maintain an optimal gas exchange, as evidenced by normal ABGs, an appropriate pH level between 7.35 and 7.45, and a decrease in pulmonary edema. Unfortunately, at the end of my clinical rotation, the patient was able to maintain a normal ABG and pH level, but he still remained intubated due to a significant amount of pulmonary edema. Communication Uses therapeutic communication within the nurse-patient relationship In this paper, I discussed that although the patient was mechanically ventilated and moderately sedated, the nurse and I still communicated with the patient. During the physical assessments, the nurse and I would ask the patient to wiggle his toes, squeeze our hands, and open his eyes upon commands. Adapts communication methods to patients with special needs I discussed how my patient was mechanically ventilated. Although the patient was mechanically ventilated, the nurse and I would still explain every procedure to the patient before we implemented them. During this time, the nurse and I would utilize the concept of therapeutic touch to let the patient know we are present in the room, or to let the patient know he did good during a procedure. Research Applies research-based knowledge from the arts, humanities, and sciences to complement nursing practice. In this paper, I included various research articles to support the nursing care and practice that was provided to my case study patient. For example, I included one research article that complemented the nursing practice of elevating the head of the bed in mechanically ventilated patients. The research study complemented this nursing practice by including the various benefits of elevating the head of the bed, such as decreasing ventilator associated pneumonia, aspiration, and promoting better lung expansion ((Lyerla, LeRoughe, Cooke, Turpin, &Wilson, 2010) Evaluates research that focuses on the efficacy and effectiveness of nursing interventions. In this paper, I included a research study that was conducted on improving the vasopressor titration skills and efficacy. The article centered on the idea that vasopressors administration can be a difficult skill for nurses to learn. The article suggested that simulation based learning may be a useful took for improving nurse’s self-efficacy. The study concluded that the SBL training illustrated a positive effect on self-efficacy and performance of vasopressor administration. The research study supported the nursing intervention of effectively initiating vasopressor therapy in order stabilize the patient’s blood pressure (Bockenstedt, Baker, Weant, & Mason, 2012). Leadership Articulates the values of the profession and the role of the nurse as a member of the interdisciplinary health care team. In this paper, I discussed the importance of the nurses maintaining the prescribed protocols of the Intra-Aortic Balloon Pump issued from the physicians. Under these protocols, it is the nurse’s responsibility to communicate with the physicians about any potential complications associated with the IABP. This collaborative communication with the physicians decreases the probability of fragmentation of care and promotes patient healing. Professionalism Differentiates between general, institutional, and specialty-specific standards of practice to guide nursing care. While taking care of this patient, I was able to follow the institutional policies, general care practices, and AACN Standards of Practice. The nurse and I performed physical assessments to the critically ill patient, implemented interventions by administered medications such as albuterol and atrovent, and made outcome evaluations to evaluate the effectiveness of care by evaluating the patient’s ABG and pH levels.