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.