NRS-460 Benchmark – Case Study: Timothy Smith – Intensive Care Unit (ICU)
The purpose of this assignment is to evaluate patient data to navigate decision-making in ambiguous situations, assist the patient
NRS-460 Benchmark – Case Study: Timothy Smith – Intensive Care Unit (ICU)
Directions: Read the case study below. Evaluate the information and formulate a conclusion based on your evaluation. Complete the critical thinking table and submit the completed template to the assignment dropbox.
The purpose of this assignment is to evaluate patient data to navigate decision-making in ambiguous situations, assist the patient and family in managing complex care needs, and perform effectively in an interdisciplinary team.
PART I: Health History and Medical Information
Evaluate the health history and medical information for John Doe, presented below.
After his discharge from the ED, John was transferred to the Intensive Care Unit (ICU) for specialized care and monitoring where you took over as his nurse. Upon arrival to the ICU, John was identified as Timothy Smith. He arrives intubated on a ventilator and requires continuous assessment for his TBI, multiple fractures, and underlying psychological conditions. Specialty providers are considering the risks vs. benefits of a hematoma evacuation. Upon entry to the ICU, Mr. Smith has been diagnosed with:
- Severe Traumatic Brain Injury with a GCS score of 6, managed with an external ventricular drain (EVD)
- Respiratory instability managed with a ventilator
- Femur fracture with open reduction and internal fixation (ORIF)
- Hairline fracture of 3 left ribs
Laboratory Tests, Results, and Vitals:
- EVD – Intracranial Pressure (ICP) – 12
- Echocardiogram (EKG): Sinus Tachycardia Rate 128
- Arterial Blood Gas (ABG):
- PaCO2 Level – 51 mmHg,
- HCO3 Level – 30 mEq/L
- pH 7.39
- PaO2 79 mmHg
- SaO2 98% on ventilator
- Respiratory Rate: mechanical ventilation rate 14 with no spontaneous respirations
- CBC –
- White Blood Cells: 12.9
- Hemoglobin: 13.6
- Hematocrit: 38.7
- Platelet Count: 310,000
- CMP:
- Potassium 4.5 mEq/L
- Sodium 135 mEq/L
- Bilirubin: 2.1 mg/dL
- GCS 8 after placement of EVD and drainage of 10ml of sanguineous fluid from drain.
- Deficit for only opening eyes to pain (2)
- Verbal response is incomprehensible sounds (2)
- Motor score of (4) withdraw from pain
Expert Answer and Explanation
PART II: Critical Thinking Activity
Use the findings from your evaluation to complete the following:
Use the findings from your evaluation to complete the following:
Power of Attorney
Upon arrival in the ICU, you discover Mr. Smith does not have a power of attorney. |
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Discuss how you would determine who would make decisions on his behalf. Your response should be a minimum of 150 words. | Normally, managing a clinical case in which a patient exhibits symptoms like those seen with Mr. Smith requires that a provider seek consent from an individual legally mandated to make decisions on his behalf. This is particularly crucial when making decisions concerning the use of invasive clinical procedure. Considering Mr. Smith’s health status including his complex health needs, the power of attorney would be necessary to help make decisions on matters related to his rehabilitation.
Given that the power of attorney is absent, the first step is to determine the individual that is legally authorized to make decisions on matters related to his health. Hierarchically, the potential decision-makers include the spouse, his children that are above 18 years, his parents, siblings and then relatives (Levi et al., 2024). In the event that none of these family members is available, an alternative option would be engaging the court to appoint a guardian to make decisions or hasten decision-making. |
How can you utilize the chaplain to assist in locating the family? Your response should be a minimum of 150 words. | Chaplaincy provides emotional and spiritual support that Mr. Smith needs to cope with the stress tied to his physical health issues. The chaplaincy particularly provides comforting and reassuring words. However, the chaplain’s role goes beyond offering words of encouragement considering that they provide support when it comes to locating the patient’s kin. Chaplain’s assistance in this case takes various forms including applying their experience in community outreach to reach out to individuals that have strong social connections in the community.
These individuals range from religious leaders to community leaders. They may also take advantage of the networks they have established to engage people involved in delivery of social services, with information about Mr. Smith’s family members. The chaplain may comfort the patient, addressing the stressors that could be exacerbating the patient’s health issues. This may help stabilize the patient, improving their consciousness. Accordingly, the patient can be in a position to provide pertinent information about their kin. |
Quality vs. Quantity of Life
Health care professionals often have to have difficult conversations with patients and families in the intensive care unit (ICU) regarding prognosis and outcomes. |
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What resources are available to have difficult discussion with Timothy’s family on quality versus quantity of life? Your response should be a minimum of 150 words. | Having complicated discussions with the family of Mrs. Smith, particularly those that involve determining balance between the quantity and quality of life necessitates the reliance on a wide range of resources. Part of these resources includes case managers and other professionals, and their role involves sharing pertinent insights that help navigate the intricate conversations (De Luca et al., 2022).
Additional resources are ethics committees, which offer counsel and share knowledge that is helpful in confronting difficult ethical issues tied to decision-making. Addressing concern related to challenging conversations demands that the parties involved in this discussion effectively communicate. Maintaining clarity in how one communicates and emphasizing with the patient are some of the crucial considerations when engaging in these kinds of discussions. In addition to these considerations, individuals involved in the conversations should support whatever they share with the patient with evidence, which essentially helps them to better understand the shared idea. Visually presented information on brochures can be accompanied with verbally communicated information to improve understanding. |
Given Mr. Smith’s assessment findings, discuss his quality of life should he receive hematoma evacuation surgery. Your response should be a minimum of 150 words. | Given that further brain injury may result with the buildup of intracranial pressure, performing hematoma evacuation is necessary to minimize the risk of this injury, which could potentially impair the functioning of Mr. Smith’s neurological system. Reducing the intracranial pressure by administering the procedure helps stabilize the brain, enhancing Mr. Smith’s cognition.
While the patient can benefit from this intervention, they face the risk of experiencing impaired neurological functioning, which could hamper his ability to maintain normal motor functioning. With improperly done hematoma evacuation procedure, Mr. Smith is likely to develop infection, prolonging the duration of hospital stay. The patient relies on respiratory support, and shows decline in level of consciousness. It is crucial that these factors be considered following the surgical interventions or when the patient is transitioning to the stage of long-term rehabilitation. The rehabilitation may focus on supporting the patient to regain the ability to maintain the required levels of physical and cognitive functioning. |
Ethical Considerations
Ethical considerations are an important part of nursing care but become especially vital when dealing with trauma patients considering the potential of poor prognosis. |
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Discuss the ethical considerations of palliative care, possible outcomes, and limitations with Mr. Smith’s condition taking into account his assessment findings. Your response should be a minimum of 200 words. | Addressing Mr. Smith’s health needs demands paying attention to the fundamental ethical considerations including autonomy which emphasizes respecting the patient’s right to make decisions on matters pertaining to their health. It also extends to the patient’s family especially if the patient is mentally incapacitated, and is unable to make decisions about their own health.
The other consideration involves using an intervention with zero harm to the patient, which is consistent with the ethical principle of beneficence. Guided by this principle, a provider evaluates potential interventions, and opts for the most safe and effective intervention. Prioritizing palliative care as an intervention would be necessary if Mr. Smith has slim chances of recovering. With this approach to care, the provider prioritizes an intervention that alleviates pain, and stress, optimizing the quality of the patient’s life (Ramathuba & Ndou, 2020). Additionally, administering this kind of care results to the increase in the level of patient satisfaction in the sense that it aligns with his clinical case. However, ignoring the curative aspect of treatment by purely focusing on addressing distress and pain raises concerns. It specifically leaves the family members struggling with guilt especially when they have to decide to have their sick kin receive palliative care and not curative care. |
Psychosocial and Spiritual Considerations
Providing holistic nursing care for patients with complex conditions requires that the nurse takes into account the patient’s psychosocial and spiritual needs. |
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Given the patient’s current situation, discuss ways in which the nurse can take into account and address the patient’s psychosocial and spiritual needs. Your response should be a minimum of 150 words. | Part of the intervention for the holistic care approach involves considering and addressing a patient’s psychosocial and spiritual needs. To meet these aspects of the patient’s needs, the provider develops a health plan with information on how to address these needs. For instance, they may incorporate into the plan prayer sessions. The other option is to involve a religious leader into his care to provide spiritual support.
Involving Mr. Smith’s family during his journey of recovery can help him access the social support that he needs during this journey. This kind of support reduces loneliness including the distress linked to the feeling of being alone as one struggles with the disease. Encouraging Mr. Smith to openly share his thoughts and concerns is crucial in meeting his psychosocial needs. By sharing details about his social needs, the patient can receive help such as connecting him with appropriate resources. These forms of support foster spiritual healing, translating to improved health outcomes. |
Economic Issues
BSN-prepared nurses have an understanding of system-based practice including implications of financial and economic considerations related to providing care. |
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Due to the multi-system injuries Mr. Smith incurred, discuss the economic issues that the individual and family may encounter. Consider his ability to work, housing needs, supplemental income, temporary disability, insurance, and medical expenses. Your response should be a minimum of 200 words. | The injuries that Mr. Smith sustained including the care that he is currently receiving would pose a significant financial burden for him and his family considering that they will have to spend money on drugs, follow-up appointments, surgical interventions and hospitalization. Accordingly, the accumulation of these expenses, they are likely to struggle financially.
With the prolonged duration of hospitalization which is possible given the severity of his health status, Mr. Smith will lose his livelihood because he will no longer be able work (Clarke et al., 2021). With the patient as the primary provider in his household, the loss of income will compromise the family’s financial freedom. Analysis of Mr. Smith’s health status reveals that he will need to undergo sustained rehabilitation. With additional expenses, the family risk facing financial distress especially if the insurer does not cover the rehabilitation services. Even if the family manages to successfully finance Mr. Smith’s rehabilitation program, it will need to make changes to make necessary modifications to their home to support Mr. Smith’s mobility. These new modifications come with extra financial burden. For Mr. Smith’s family, the idea of seeing him struggle with his condition can be a source of distress, impairing their concentration at work. This may result to reduced productivity at work. |
Collaboration
What is the purpose of collaborating with the following when providing care for Mr. Smith? Explain the role of each team member’s competency and how they contribute to Mr. Smith’s care. |
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Occupational Therapists | They assist the patient to adapt to their environments, and to develop the ability to perform activities of daily living. |
Physical Therapists | They employ physiotherapy techniques like manual therapy to help the patient attain mobility. |
Respiratory Therapists | Responsible of managing mechanical ventilators during respiratory therapy. |
Speech Therapists | Works with the patient to address speech limitations linked to impaired brain functioning. |
Dieticians | Provides the patient with nutritional information like the types of foods that improve healing. |
Physiatrists (Doctor of Rehabilitative Medicine) | Responsible of coordinating broad patient rehabilitation care plan. |
Wound Care Nurse | Are involved in managing wounds to minimize the risk of infection and enhance healing of the wound. |
Neuropsychologists | Evaluate the patient’s emotional and cognitive health, and providing the necessary support to help the patient regain normal functional health status in these two areas. |
Select two team members and discuss their competencies (skill set) as applicable to Mr. Smith’s care. Your response should be a minimum of 150 words. | Neurologist: Ability to diagnose and manage neurological disorders.
Respiratory therapists: Have to demonstrate that they are able to administer oxygen, analyze breath, and administer medications. |
Interdisciplinary Team
Interdisciplinary team collaboration is vital to the successful management of patients with complex conditions. |
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Part I: Team Dynamics
Explain what principles can be applied to facilitate effective team dynamics in a way that: (1) ensures that the role of each individual/team member is defined by his/her scope of practice; and (2) ensures that the delegation of work to team members based on roles and competencies is assigned without confusion for the team or patient. Your response should be a minimum of 200 words. |
Facilitation of the team dynamics, which essentially influence attainment of team objectives, requires consideration of the definition of roles, reciprocated respect and open communication. The principle, definition of roles, is crucial in this case in the sense that it lets every member of the team to understand the limits of their duties, or the scope of the tasks they are required to perform. Having everyone perform the tasks they are delegated is likely to translate to improved team performance. This also minimizes wastage of resources due to the duplication of services.
For the team to thrive, each member has to abide by the principle of mutual respect, ensuring that they acknowledge the perspectives of colleagues. Guided by this principle, every person in the team contributes knowing that their views matter in conversations centered on optimizing the quality of care delivered (Reiter-Palmon, Kennel, & Allen, 2021). By respecting each other, team members minimize the risk of conflicts which are known to prolong decision-making. With open communication, everyone is presented with information related to the goals and milestones. This increases awareness of the mistakes made, compelling team members to put in more efforts. Combined with the other two principles, the adoption of this principle to inform team dynamics is likely to translate to improved care outcomes. |
Part II: Interprofessional Communication
1. Discuss the importance of each member of the interdisciplinary team communicating their information in a professional, accurate, and timely manner when treating Mr. Smith. Your response should be a minimum of 150 words. |
Communicating in real-time and in a professional manner ensures that the patient continually receives the right care. Inefficient communication is associated with undesirable outcomes like the inconsistency in delivery of services, increased incidences of error, and inefficiency. Utilizing some of the frameworks that guide communication translates to accuracy and clarity in how one conveys information.
An example is the SBAR framework which provides a structured model of informing communication. Guided by this framework, the leader of the team has to consistently and regularly update their colleagues, ensuring that everyone is constantly aware of the intervention objectives. This is necessary for a successful collaboration. With this kind of communication, still, it is possible to win the buy-in of other members of the team, which ensures that the team moves in a common direction as it addresses the patient’s needs (Anderson, Lavelle, & Reedy, 2021). With shared knowledge of expectations and goals, the team spends less time making decisions which is not the case when the expectations fail to align. |
2. How does the presence of diversity, equity, and inclusion impact the dynamics of team-based communications? Your response should be a minimum of 150 words. | Realization of enhanced team dynamics requires consideration of the diversity, equity and inclusion. For the team formed to address Mr. Smith’s needs, embracing diversity is crucial because it presents members with the opportunity to interact with people with divergent perspectives on how to meet these needs. This is because people from diverse backgrounds come with unique experiences, and their viewpoints can help with identifying potent interventions or creative ways of resolving difficult clinical problems (Mullin et al., 2021).
As a principle, equity emphasizes fair treatment of every member of the team. In team dynamics context, this principle compels the leader to ensure that they fairly distribute resources to team members, and delegate tasks based on one’s expertise, and in a fair manner. Applying this principle in team dynamics ensures that everyone has equal chance of participating in preparation and implementation of the intervention plan. Inclusion pertains to incorporating the divergent opinions into the decision-making process. |
ICU Psychosis/Delirium
There are specific considerations that nurses should be aware of when taking care of patients in the ICU. |
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Explain ICU psychosis/delirium. Your response should be a minimum of 100 words. | The ICU delirium or ICU psychosis denotes a condition in which a person exhibits symptoms of agitation, decline in consciousness and disorientation, seen in ICU patients or patients with terminal illnesses. The disorder is attributed to various factors including the use of sedatives, metabolic impairment, disturbance in sleep patterns, and impaired sensory ability.
Factors that directly interfere with sleep quality, and which cause long hours of wakefulness are equally the known causes of the disorder. In addition to the aforementioned symptoms, manifestations like restlessness and drowsiness are common with ICU psychosis. However, the condition is associated with other manifestations that are included in the existing diagnosis guidelines. |
What interventions can nurses implement to prevent ICU psychosis/delirium from happening? Your response should be a minimum of 150 words. | A nursing practitioner has various options in terms of the interventions they can choose to minimize the patient’s risk of ICU psychosis or delirium. One of these interventions is ensuring that Mr. Smith maintains the required quality of sleep, which necessitates minimizing destructions like noise that may interfere with his sleep.
Reducing the screen time including the use of smartphone during bedtime should be stressed especially when educating the patient about the relationship between the quality of sleep and the risk of psychosis. It is equally important to recommend avoidance of the unnecessary sedative drugs because excessive and prolonged use of these drugs substantially increases the risk of psychosis due to their mechanisms of actions in which they alter certain aspects of the neurotransmission processes. If a patient is on sedatives on the ground of medical reasons, it is imperative that the use of these sedatives be monitored so that prompt actions can be taken in case of serious side effects that may lead to psychosis. |
Based on Mr. Smith’s current assessment findings, discuss his risk of developing ICU psychosis/delirium. Your response should be a minimum of 150 words. | The chances of Mr. Smith developing ICU delirium/psychosis are high given his health complications. The TBI condition, which disrupts the neurotransmission or signal transmission processes. It also disrupts the cerebral blood flow, predisposing Mr. Smith to the risk of developing delirium, a condition characterized by loss of consciousness, aggression and confusion.
Mr. Smith’s reliance on the mechanical ventilation is a potential source of distress, which if left unmanaged can significantly limit the functioning of the brain considering that stress is one of the factors that hasten the development of psychosis. This stress may also stem from the clinical conditions linked to being treated in a stressful setting, in which the patient constantly interacts with providers. However, the choice of the medication used to enhance breathing may interfere with the brain’s message processing mechanisms, increasing the risk of psychosis. These are factors that a provider should consider when working with Mr. Smith. |
References
Anderson, J. E., Lavelle, M., & Reedy, G. (2021). Understanding Adaptive Teamwork In Health Care: Progress and Future Directions. Journal Of Health Services Research & Policy, 26(3), 208–214. Https://Doi.Org/10.1177/1355819620978436. Clarke, L., Anderson, M., Anderson, R., Klausen, M. B., Forman, R., Kerns, J., Rabe, A., Kristensen, S. R., Theodorakis, P., Valderas, J., Kluge, H., & Mossialos, E. (2021). Economic Aspects of Delivering Primary Care Services: An Evidence Synthesis to Inform Policy and Research Priorities. The Milbank quarterly, 99(4), 974–1023. https://doi.org/10.1111/1468-0009.12536. De Luca, E., Cosentino, C., Cedretto, S., Maviglia, A. L., Bucci, J., Dotto, J., Artioli, G., & Bonacaro, A. (2022). Multidisciplinary Team Perceptions of The Case/Care Managers’ Role Implementation: A Qualitative Study. Acta Bio-Medica : Atenei Parmensis, 93(3), E2022259. Https://Doi.Org/10.23750/Abm.V93i3.13371. Levi, B. H., Dimmock, A. E., Van Scoy, L. J., Smith, T., Kunzler, B., Foy, A. J., Badzek, L., & Green, M. J. (2024). What Counts as a Surrogate Decision?. The American Journal of Hospice & Palliative Care, 41(2), 125–132. https://doi.org/10.1177/10499091231168976. Mullin, A. E., Coe, I. R., Gooden, E. A., Tunde-Byass, M., & Wiley, R. E. (2021). Inclusion, Diversity, Equity, and Accessibility: From Organizational Responsibility to Leadership Competency. Healthcare Management Forum, 34(6), 311–315. Https://Doi.Org/10.1177/08404704211038232. Ramathuba, D. U., & Ndou, H. (2020). Ethical Conflicts Experienced By Intensive Care Unit Health Professionals In a Regional Hospital, Limpopo Province, South Africa. Health SA = SA Gesondheid, 25, 1183. Https://Doi.Org/10.4102/Hsag.V25i0.1183. Reiter-Palmon, R., Kennel, V., & Allen, J. A. (2021). Teams in Small Organizations: Conceptual, Methodological, and Practical Considerations. Frontiers in psychology, 12, 530291. https://doi.org/10.3389/fpsyg.2021.530291. |
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Navigating Patient Data and Decision-Making in Ambiguous ICU Situations
Healthcare professionals often face complex scenarios where patient data must be carefully evaluated to guide decision-making—especially in high-stakes environments like the Intensive Care Unit (ICU). Whether assisting families in understanding treatment options or managing ambiguous clinical situations, nurses and medical practitioners need structured approaches to ensure optimal patient outcomes.
This article explores key strategies for interpreting patient data, improving clinical reasoning, and enhancing communication in critical care settings.
Understanding Case Study Assignments for Patient Data Evaluation
Many nursing and medical programs use case studies—such as the Timothy Smith ICU case—to help students develop critical thinking skills. These assignments typically require:
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Analyzing patient histories and lab results
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Navigating ethical dilemmas in care plans
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Communicating effectively with families
Resources like Studocu, Course Hero, and CliffsNotes provide real-world examples of how to approach such assignments systematically.
Clinical Reasoning and Decision-Making in Nursing
Effective ICU decision-making relies on structured frameworks, including:
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Data Interpretation – Assessing vitals, lab reports, and imaging.
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Risk-Benefit Analysis – Weighing treatment options under uncertainty.
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Interdisciplinary Collaboration – Consulting with doctors, social workers, and ethicists.
The NCBI Clinical Reasoning Guide offers evidence-based methodologies for refining these skills.
Nursing Assessment Techniques
A thorough patient assessment is the foundation of care. Key components include:
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Physiological Evaluation (e.g., Glasgow Coma Scale, hemodynamic monitoring).
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Psychological and Social Needs – Addressing anxiety, family dynamics, and cultural considerations.
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Spiritual Care – Respecting patient beliefs in end-of-life decisions.
For protocols, refer to the StatPearls Nursing Assessment Guide.
Therapeutic Communication in Critical Care
Families in ICU settings often experience distress. Techniques like:
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Active Listening – Validating concerns without interruption.
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Teach-Back Method – Ensuring comprehension of medical information.
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Nonverbal Reassurance – Eye contact, calm tone, and empathetic gestures.
can reduce anxiety. Explore 17 Therapeutic Communication Techniques for deeper insights.
Key Takeaways
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Case studies train professionals to handle ambiguity.
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Clinical reasoning must balance data, ethics, and teamwork.
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Patient assessments require holistic approaches.
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Communication builds trust with families during crises.
By mastering these areas, healthcare teams can navigate ICU challenges with confidence.