NRS-460 Benchmark – Case Study: Timothy Smith –
Medical Surgical Unit
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.
It is necessary for an RN-BSN-prepared nurse to demonstrate an enhanced understanding of the
complex management of disease, the clinical manifestations and associated treatment protocols,
and how they impact patients across the life span.
PART I: Health History and Medical Information
Evaluate the health history and medical information for Timothy Smith, presented below.
Upon arrival to the medical-surgical unit, you are assigned as Mr. Smith's primary care
nurse. It has been reported that the patient started confusing his days and nights and
becoming restless. Once his family was identified in the Intensive Care Unit (ICU), his
mother was an active visitor and helped with care decisions. She notified his care team
that Timothy was an active military service member with a history of post-traumatic
stress disorder (PTSD) and depression, which have led to smoking and recreational drug
use. Two days prior to arrival to the med-surg unit, Mr. Smith was extubated from the
ventilator and has been weaned down to a 2L nasal cannula. Three days prior his EVD
was removed. The focus has been shifted to strengthening him to walk and healing
abrasions from the accident. Tube feeding was continued from the ICU while awaiting
clearance to begin swallowing on his own. Dressing changes are ordered from the open
reduction internal fixation (ORIF) and for any third-degree abrasions from the accident.
1. Oxygen – 2L Nasal Cannula, FaO2: 21-24%; Hypoventilation (splinting, coughing, deep
breathing)
2. Physical therapy
3. Respiratory therapy
4. Hairline fracture of 3 left ribs
5. Wound care for ORIF and abrasions
6. Psychosocial needs (PTSD, depression, ICU psychosis)
7. Pain control
Laboratory Tests, Results, and Vitals:
1. Skin assessments
2. Protein level
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3. Follow-up x-rays of ribs show healing and no punctures, tube feeding catheter tip located
in the upper stomach
4. GCS: 14 (deficit for confusion at times)
5. Respiratory rate – 16
6. SpO2 94%
7. Blood pressure – 118/68
8. A psychiatric nurse practitioner has begun visiting and noticed he is showing signs of
depression and is struggling to cope with the accident.
9. CT scan of the head
10. Pain assessment score of 6 out of 10, with the patient reporting his leg is the worst source
of pain, also experiencing pain with deep breaths, and mild headache
PART II: Critical Thinking Activity
Use the findings from your evaluation to complete the following:
Plan of Care
When assuming care of this patient, you were told that the plan for Mr. Smith is to be
discharged home tomorrow. This was not the plan when you took care of Mr. Smith yesterday.
Part 1: Evaluate Outcomes of Care
1. Evaluate Mr. Smith's readiness
for discharge based on the
information provided in the case
study. Based on your findings,
evaluate health goals for this
patient. Discuss how you would
modify the plan of care. Your
response should be a minimum of
200 words.
2. Based on your assessment, how
would you recommend modifying
the plan of care to meet Mr. Smith's
needs? Your response should be a
minimum of 150 words.
Part 2: Protocol
What protocol would you use to
implement your recommendations
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for Mr. Smith's updated plan of
care? Your response should be a
minimum of 200 words.
Recovery and Response to Treatment
Consider Mr. Smith's history of PTSD and depression.
Discuss the impact his PTSD and depression
history might have on his recovery and
response to treatment. Your response should
be a minimum of 150 words.
Complications
Consider Mr. Smith's history of PTSD and depression in addressing the following questions.
Discuss the overall complications
that may affect Mr. Smith's
motivation, compliance, and
psychological well-being. Your
response should be a minimum of
150 words.
Put together an interdisciplinary
team to support all areas of his
recovery, including mental health
support. Provide rationale for your
response by referencing his
assessment findings. Your response
should be a minimum of 150 words.
Smoking and Drug Use
Consider Mr. Smith's history of smoking and recreational drug use.
History of Smoking
How might his history of smoking
impact healing of the bones? Your
response should be a minimum of
150 words.
Cessation of Smoking
1. Discuss how you would integrate
smoking cessation and
rehabilitation experts into Mr.
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Smith's recovery team. Your
response should be a minimum of
150 words.
2. How might Mr. Smith's past
usage of recreational drugs impact
his pain management? Your
response should be a minimum of
150 words.
Balancing
Discuss how the nurse would
balance promoting smoking
cessation for Mr. Smith while
respecting his self-determination in
his health care decisions. Your
response should be a minimum of
150 words.
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.
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.
Care Planning and Insurance
Nurses have to have an awareness of the socioeconomic impact of care delivery, especially
when planning care for patients with complex needs.
Who would you need to involve if
you discover that the patient is
uninsured? Your response should
be a minimum of 150 words.
How would this impact the
socioeconomic aspect of Mr.
Smith's care planning moving
forward? Your response should be
a minimum of 150 words.