Critical Care Nursing: A Case Study

What happened in this clinical incident?

What happened in this clinical incident?

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In accordance to the given study, the patient A is reported to have been suffering from problems of shortness of breath. The patient is 81 years old. She is reported to her general physician about her problems and presented that she is having fine creps at the base of her lungs. She is also facing elevated jugular venous pressure in both of her lungs. An oral Lasix was commenced on the patient after her symptoms were reported to the physician.

The next day to this, the patient reported herself at the local hospital where she again reported the similar problems which she did to the GP. The oral Lasix failed to work on the patient and she showed signs of dizziness. A visiting medical officer was called in to conduct check up on the patient. On assessment it was seen that arterial fibrillation rate of the patient was 120/ min. The patient was seen to be tachycardic according to her measured vitals. She was fatigued and refused to take her meals as seen on the next day. According to the nursing reports, the skin of the patient had turned pale. She also suffered from nausea along with severe back pain because of which she lacked mobility. An x-ray of the abdomen along with the pathology was asked for the patient, which showed that the white cell count was quite high. Therefore urinary tract infection was diagnosed and the patient was given medications accordingly. In the later stages the diagnosis revealed that the patient has been suffering for severe diarrhoea because of which there was a need for removing dehydration in the patient. As a result the patient was inserted with a large bore IV cannula. The lack of recovery suggested the need for referral transfer. The next day after this, while being assessed by the air evacuation team, the death of the patient occurred. The primary cause of the death was reported to be septicaemia.

Q2. What activities did the nurse or midwife need to complete in the immediate situation?

In cases of critical situations especially in the critical care units, the nurses are required to maintain certain codes and conducts which helps to promote an optimal nursing care for the patients, thus ensuring patient safety. Of the several standards of nursing practise, the practise that are required to be maintained in such conditions which need immediate attention involves critical thinking carried out then nurses. Additionally the nurses or the midwives are required to promote a therapeutic and professional relationship with the patient. The nursing practise should also take care to ensure the implementation of provision of a safe practice along with appropriate and responsive quality of care (Acebedo-Urdiales, Medina-Noya & Ferré-Grau, 2014).

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What activities did the nurse or midwife need to complete in the immediate situation?

It is the duty of the nurses involved in acute care units to imply the critical thinking process in order to properly the available evidences for the given case. The practise or the activities that the nurse will carry out should be developed based on the earlier experiences or knowledge, actions, feelings and beliefs (Chang, 2015). Cultural competence should be a significant part of the evidence based practices and according to this the decisions should be taken by the nurses regarding the performed activities. Documentation is another important factor that needs to be considered in cases which require immediate attention. Maintenance of accurate and comprehensive documents regarding the given care or the activities conducted is required for proper evaluation of the condition of the patient (Australian Commission on Safety and Quality in Health Care, 2012).

Nursing care plan development and implementation is an important part of the activities that needs to be carried out by the nurses present in such critical situations. It is the duty of the involved nurses or the midwives to develop a nursing care plan that is in relation to the obtained evidences from the reports of the patient. Use of collaborative practises and its implementation in the nursing plan involves several aspects like contingencies, options priorities along with the goals, actions, outcomes and timeframes are agreed with the relevant condition of health of the persons (Butcher et al., 2018). The nursing plan can be modifies in accordance to the patient condition. In order to facilitate the agreed outcomes, modification of the documents and the evaluation is also carried out in the nursing plan. In such situations it is also the duty of the nurse to negotiate on the planning on how the practise will be evaluated and how the time frame for evaluation will be managed. The resources available for the coordinates needs to be implemented effectively in the planned actions.  

Q3. What professional behaviours may have made a difference in this situation?

The given case study showed that the nurses who were involved in providing care to the patient lacked to maintain proper codes of conduct in their nursing practise. Maintenance of the standards of the nursing care would have made a difference in the situation given. In the given scenario, the nurses lacked the provision of a safe and responsive quality nursing practise. The case showed that when the time when the RN should have focused on the health of patient A, at that time the RN was busy in ordering medicine for another patient. They even forgot to ask about the status of the patient A. in order to prevent such situations where the lack of responsibility on the part of the nurse would take a toll on the life of the patient, the standards of nursing practise should be implemented (Doenges, Moorhouse & Murr, 2014). According to the standards, the nurses should provide a timely direction along with an efficient supervision in order to ensure that the delegated practice towards the patient is safe and correct. In order to make a difference to the prevailing situation, it was required to effectively identify and report the prevailing potential risk factors and the actual risks that is associated with the system issues of the patient. The nursing practise should have been developed based on the identified risk factors (Giger, 2016).

What professional behaviors may have made a difference in this situation?

 Maintenance capacity is a major part of nursing practise which requires to be observed by the nurses during providing of care to the patients. The responds that are made by the nurse professionals should be done in a timely manner. There is also a need for the nurses to try to provide education to the patient. This will help to make sure and enhance the information of the patient regarding their prevailing disorder (International Council of Nurses, 2018). In cases which need immediate care, the nurses are required to maintain a lifelong learning approach in order to continue to enhance the patient’s control over health. In such situations it is also very important for the nurses to be accountable of any activity they conduct in addition to taking responsibilities of the decisions, actions or behaviours (Nursing and Midwifery Board of Australia – Home, 2018).

Q4. What do you learn from this case study about your own preparedness for professional practice?

From the insights that I gained from this case study, it helped me to understand the importance of professional behaviour in the nursing practise. In addition to this, I also understood the importance of the involvement of the standards of nursing practise while caring for the patients. I also understood the importance and the need to implement proper nursing care plans especially in the case of acute or critical patients. The insights obtained from the case study also helped to realise how much is being responsible in our requited, as just a small mistake can take a toll on the lives of the patients.

Reference List

Acebedo-Urdiales, M. S., Medina-Noya, J. L., & Ferré-Grau, C. (2014). Practical knowledge of experienced nurses in critical care: a qualitative study of their narratives. BMC medical education, 14(1), 173.

Australian Commission on Safety and Quality in Health Care. (2012). National safety and quality health service standards. Australian Commission on Safety and Quality in Health Care.

Butcher, H. K., Bulechek, G. M., Dochterman, J. M. M., & Wagner, C. (2018). Nursing Interventions classification (NIC)-E-Book. Elsevier Health Sciences.

Chang, E. (2015). Transitions in nursing: Preparing for professional practice. Elsevier Health Sciences.

Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2014). Nursing care plans: guidelines for individualizing client care across the life span. FA Davis.

Giger, J. N. (2016). Transcultural Nursing-E-Book: Assessment and Intervention. Elsevier Health Sciences.

Hockenberry, M. J., & Wilson, D. (2014). Wong’s nursing care of infants and children-E-book. Elsevier Health Sciences.

International Council of Nurses. (2018). Retrieved from

Khandelwal, N., Kross, E. K., Engelberg, R. A., Coe, N. B., Long, A. C., & Curtis, J. R. (2015). Estimating the effect of palliative care interventions and advance care planning on ICU utilization: a systematic review. Critical care medicine, 43(5), 1102.

Nursing and Midwifery Board of Australia – Home. (2018). Retrieved from