Critical Case Study Example

BUE ID: QMU ID:
Faculty of Nursing
Critical Care and Emergency Nursing Case Study
Module Name : Critical Care and Emergency Nursing.
Module Code: N2388.
Module Leader: Prof. Manal Ismail.
Hospital Name:
Date of Submission:
Word Count:
Page 1 of 5
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Outlines:
 Introduction to the Patient Status

 Pathophysiology
 Assessment of the patient
 Nursing management
 Ethical aspect
 Summary
 Appendices
o Assessment sheet
o Record
o Nursing care plan
 References
Page 2 of 5
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Introduction to the Patient Status
Mr. M is a 50-year-old male who presented to the emergency department (ED) at 10 a.m. with
complaints of abdominal pain, nausea, and vomiting since approximately 6 a.m. He states that the
nausea and vomiting have been pretty constant since it began after breakfast. The abdominal pain
in his lower abdomen is crampy with a pain score grading of 6/10 and sometimes is a little better
after he vomits but it quickly returns. He tried to take some antacid, but this didn’t stay down
either. He was transferred to the ICU with a diagnosis of diabetic ketoacidosis DKA. On arrival
to the unit, my assessment showed that he was fully conscious (if the patient was unconscious
write his GCS(. He has right subclavian CVC, an NGT, and a urinary catheter. The patient was
attached to a cardiac monitor and pulse oximeter in the ICU.
The past medical history of the patient includes hypertension (HTN) for 3 years, and type I
diabetes mellitus for 2 years. his mother has HTN, and high cholesterol, and his father has DM. As
regards the surgical history, the patient had right knee arthroplasty for 3 years. There were no
known drug allergies. Mr. M used to take Amlodipine 10 mg daily. He is married, lives with his
wife; has no children; No smoking history.
The medical orders for Mr. M to remain NPO (nil per oral)).
Regarding the pathophysiology of the patient's health problem. Three major physiological
changes exist in Diabetic Ketoacidosis ( DKA) Hyperglycemia, Metabolic acidosis, and Fluid &
electrolyte imbalances(USE in-text citation). (includes diagrams)
Hyperglycemia: It results from insulin deficiency and increased hepatic gluconeogenesis, (fat and
protein converted to glucose) and glycogenolysis, (breakdown of complex glycogen into simple
glucose) leading to hyperglycemia and reduced glucose utilization in peripheral tissue. Metabolic
acidosis occurs due to the accumulation of large quantities of ketone bodies. hyperglycemia
causes osmotic diuresis (water shifts from the intracellular to the extracellular space to dilute the
excess glucose) leading to dehydration and electrolyte loss then develops into a coma. finally,
insulin in the bloodstream normally controls ketones, but in the absence of insulin, ketones
accumulate in the blood leading to ketosis(explains why this is dangerous and requires critical
care observation)..
Page 3 of 5
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During my nursing assessment of the patient, it was found that the patient has
………………,……. , ………………… (Follow the assessment sheet of the patient and collect
the abnormalities found in each system in two paragraphs). (Appendix I: assessment sheet &
record)
The Laboratory studies and investigations of the patient include Labs: CBC – WBC: 10.4;
Hgb: 13.2; Hct: 40; plts – 480; Lactate: 5 mmol/L, Ca – 8.2; Mg1.8; Phos – 4.4; Urine: cloudy,
yellow; + protein; +Glucose; + ketones; Serum glucose 350 mg/Dl, Serum Osmolality – 300 and
his ABG: PH=7.27/ PaCO2=34/ HCO3=16(comment on whether these values are high/ low
or normal?)
Abdominal ultrasound & ECG were done as the doctor ordered because ……( indicate why
these are indicated)
As regards the current medication the doctor ordered to give the patient
 IV Fluids: 0.9% normal saline 1 L over the first hour. Once glucose is 200mg/dL
then change fluids to D5 0.45% and NaCl at 150 mL/hr.
 Potassium chloride 20-30 mEq/L to each bag of fluids to prevent hypokalemia.
why close monitoring and replacement of potassium is critical in the care of
patients with DKA?
 Insulin 11 units/hour IV. Once glucose reaches 200 mg/dL then glucose checks
move to every 2 hours. Explain why+citation
 Levofloxacin 500 mg po q day for 7-10 days.
 Zofran for nausea.
Nursing Management ((Appendix II: NURSING CARE PLAN)
- Write an introduction paragraph summarizing the nursing diagnosis of the patient with
priorities
- Give a clear description of two problems according to the priorities of the patient and discuss
the rationale for each intervention which have been made in the real situation
- Discusses the effects of the selected interventions on the designed expected outcomes, along
with the barriers (student self-limitations, hospital resources or policy restrictions, patient, and
family barriers) that made you not achieve the desired goal.
- Uses literature and evidence to support the discussion (in-text citation)
Page 4 of 5
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- Uses logically structured and coherently written with a clear development of ideas
-
Ethical and Cultural Considerations(ONE example only).

- Mr. M used to eat large amounts of potatoes and rice in his food. This contains a lot of
carbohydrates and starch that may contributed to his DKA. I discuss dietary
recommendations with Mr. M and, taking into account their cultural beliefs and practices.
(Link carbs in potatoes. explain in more depth here).
- Mr. M may have preferred to have his wife during his stay in the ICU. The NURSE should be
aware of his communication preferences and make every effort to accommodate them.
In caring for Mr. M, it is crucial to adhere to the following ethical principles: (in-text citation)
Summary
Using the main ideas identified in the case study. Discuss the patient's progress, reflect on the
care situation briefly, and provide recommendations for further actions that will enhance similar
care delivery processes.
N.B:
 Write a 2000-word case study, Use Time New Roman, font 12, Justified text
 Write the assignment in the form of paragraphs
 Follow case study guidelines and marking criteria for more details.
 You should write a complete references list (Harvard format)
 Appendices include the original clinical documentation (patient assessment sheet,
patient record, and nursing care plan (in the form of a table).
Page 5 of 5

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BUE ID: QMU ID:

Critical Care and Emergency Nursing Case Study

Module Name : Critical Care and Emergency Nursing.

Module Code: N2388.

Module Leader: Prof. Manal Ismail.

 Introduction to the Patient Status

Introduction to the Patient Status

Ethical and Cultural Considerations(ONE example only).

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