Complex Nursing - Case Study Example

ARDS is the primary diagnosis bringing with it many long term and short term problems that will are assessed throughout the paper. Nursing assessment begins with heart and lung status including the review of best in practice studies recently done to support decisions made, as well as determinations of care. This status includes the discussion of "copious green sputum" which has developed in this client and the most recent evidence based practice from research. Colon resection is discussed in its own right but also as part of the possible cause of ARDS.

There are assessment skills discussed related to this surgery and the possible outcomes including ARDS. Nursing skills related to this assessment are discussed. There are also discussions related to the neurological and sedated state of the client and what is included in that assessment as well as nursing plan for care. This client has skin integrity issues both related to the ARDS and to the fact that the patient is sedated and on a ventilator. There are very specific assessments discussed here as well as research of evidence based practice that is included to support this assessment and plan.

Medications and the assessment as well as practice needed as an integrated part of care is included in this discussion and last but not least, the psychosocial impact for this client is enormous. This client has a young family and a business that he must run. Mortality rates for ARDS related to colon resection are quite heavy. This is discussed as part of the nursing assessment in the sense of both short and long term impact.ICU Case Review In all cases the ICU nurse must begin the shift with a complete assessment of what the status of the client is.

The history of the last twenty four hours is presented in the transfer report from one nurse to the other. A full physical assessment is then done on the client from head to toe. In this case the assessment begins with the chest and lungs assuring appropriate ventilation and cardiac status for this patient. This assessment continues by assessing output affected by both cardiac and pulmonary status as well as abdomen with the consideration that this client is a recent surgical client with a colon resection.

Medications that the patient is receiving are assessed as well as the resultant sedation from at least one of those. Skin integrity is an important issue for this patient based on his ARDS diagnosis as well as ventilatory and sedation status. There are then ethical and psychosocial considerations for this client. All of these assessments will be discussed in this paper in combination with studies and evidence based practice research found to support them. The resultant nursing plan for the day will then be presented.

At 0700 this client is ventilated at SIMV 8, Tidal Volume 1000, and pressure support 10 cm.H2O. A 500ml bolus of Normal Saline has just been administered. Last vital signs recorded