Discuss how your understanding of the care requirements of the critically ill adult will influence your nursing practice in the future

Introduction to Critical Care Nursing (Adult)

Assessment Title:

You are required to write an essay based on a given case scenario.

 

Assessment Details:

The purpose of this assignment is for you to analyse a given patient scenario so that you can:

 

1)  Demonstrate an understanding of relevant underlying pathophysiology

2)  Explain the significance of observations and assessment findings as outlined within the scenario

3)  Offer rationale for the treatment strategies within the scenario

4)  Consider implications for your future nursing practice.

 

You will be given two patient scenarios at the start of the module and you choose which one you wish to use for the basis of this essay (only chose ONE). Within the scenario, key information about the patient’s diagnosis, assessment findings and current treatment will be given. Within your essay you need to:

 

1)  Consider the diagnosis/ condition and identify the physiological changes of that condition which would lead to admission to a critical care area.

2)  Explain the assessment findings in light of the physiological changes and discuss the significance of the findings i.e. what the assessment findings are telling you about the patient

3)  Discuss the current treatment that the patient is receiving, offering rationale for that treatment, with support from literature

4)  Discuss how your understanding of the care requirements of the critically ill adult will influence your nursing practice in the future

 

Your essay should be clearly presented. You will need to support your explanations and discussions with appropriate literature and theory which will need to be correctly referenced.

 

The word limit for essay is 2500 words.

Assessment scenario 1

A 65 year old man (90kg) has been admitted to the intensive care unit, from a medical ward, with left ventricular failure. On assessment you find, Airway He is alert and appears exhausted Breathing He is self-ventilating on 60% Venturi mask with SpO2 of 95%. His respiratory rate is 35 bpm, and his breaths are shallow. There is equal expansion of his lungs. He does not appear to have central cyanosis. On auscultation, he has air entry throughout with bilateral crackles in lung bases. He is using his accessory muscles. His arterial blood gases are: pH 7.30 pO2 9 kPa pCO2 3.5 kPa HCO3 16 mmol/l BE -7 Lactate 3.5. Circulation His observations on admission are: HR 130bpm, monitored in a sinus tachycardia. BP 100/40 mmHg with MAP 60 mmHg CVP 10mmHg Core temperature 36.5 °C His limbs feel cool and his capillary refill is 3 seconds. He has a urinary catheter insitu and there is 150mls in the bag (it has been 8 hours since the catheter has been inserted). He has a raised JVP. Cardiac output monitoring has been commenced and the following readings are obtained: SVRI 2400 dyne.s/lm5 /m2 CI 1.5l/min/m2 SV 40mls Disability Alert and orientated Blood sugars 12mmol.l Exposure Nil of note Management plan: • Commence non-invasive ventilation: CPAP 5cmH2O with FiO2 .6 (wean FiO2 as able) • Commence dobutamine 250mg/50ml to maintain MAP>65mHg • Commence insulin infusion • Administer 250ml bolus of crystalloid (against response in SV, CI and urine output) • Consider frusemide infusion