Critical Care Medical Case Study

A 45 year old male was admitted to ICU following an exploratory laparotomy which showed a ruptured appendix and peritonitis. The procedure began as a laparoscopic cholecystectomy but the initial finding was pus throughout the peritoneal cavity and a normal gallbladder. An open exploratory laparotomy where a ruptured appendix was discovered which was removed and a washout was performed. The patient had a two day history of abdominal pain prior to his admission through A&E. He had no previous medical or surgical history. The patient smoked 20/day and drank alcohol at the weekends. Once admitted to ICU, he was intubated and ventilated on bilevel ventilation and sedated with propofol and fentanyl. In theatre he received two

The American Association of Critical Care Nurses (AACN) developed a model that explicates the bedside nurse practice. The goal of this model was to explain what skills or competencies were brought to the overall patient care by nurses when meeting the needs of the patient and their families (Hardin, 2013; McEwen, 2014b). The Synergy Model for Patient Care is a middle range nursing theory.

Every year, up to 249,000 BSIs occur within hospitals in the US. Apparently, 32.2% of these BSIs do occur in the ICUs (Chopra, Krein, Olmsted, Safdar & Saint, 2013)The apparent bias in prevalence of BSIs within the ICUs is associated with the increased utilization of the CVCs within these units since they deal with a majority of critical care situations.

Healthcare in the United States is changing which has given rise to new hurdles that must be overcome. One of the issues that we are currently facing in many tertiary facilities is the need for set criteria involving intensive care unit admissions and discharges. Throughout the country the total number of intensive care unit (ICU) beds are on the rise, but the current supply still outnumbers the demand (Cognet & Coyer, 2014). The cost of staying in an ICU is continuing to increase with technology, and there are limitations that insurance companies and the government have set forth to the number of days a patient can reside there dependent upon his diagnosis and condition. Intensive care units will continue to undergo strain due to high census, and decisions to discharge patients will be effected (Wagner, Gabler, Ratcliffe, Brown, Strom, & Halpern, 2013). Typically, the decision to have a patient occupy an ICU bed is based upon whether or not they are sick enough to be there or if they are well enough to be discharged to a progressive care unit (PCU) or medical surgical unit (Meyer, 2003). A progressive care unit is a step down from an ICU, but has stricter criteria for admission than a medical surgical unit based upon the patients medical status. Not all facilities offer a PCU, but the need for this level of care is continuing to rise with the number of ICU admissions increasing. Standardized guidelines for patient placement in

One of the primary issues the Healthgrades report identified was the impact and direct costs involved with patient complications and mortality. Healthgrades focuses on making the hospitals accountable and transparent into their clinical performance thereby providing care that is of higher quality, save lives and decrease costs (Healthgrades, 2013). Everyone who works in an acute care setting hears the term “increased length of stay” and according to Healthgrades complications account for 31% to 68% of the total variation in direct hospital costs. In fact, increased length of stay has the biggest impact on direct cost to the hospital

Please note that it is our responsibly as the therapist to check the orders in the EPIC and review our patients charts for accuracy. We must deliver and abide by our physicians orders.

The organization I will reviewing is the Neonatal Intensive Care Unit (NICU), a sub-department within the Maternal Child Department at Salinas Valley Memorial Hospital. The Salinas Valley Memorial Hospital (SVMH) is a public district hospital in Salinas, California. With 269 hospital beds and 2,132 employees (Salinas Valley Memorial Heathcare Systems, 2016). The district is located in the highly populated Monterey County. Three other hospitals serve this area, one being a county hospital the two other smaller private hospitals. The population SVMH serves is Hispanic by majority, with varied socioeconomic status. Customers are mixed payers with a large percentage of its customers being Medical/ Medicare, but is experiencing, as most healthcare

The American Journal of Critical Care is a bi-monthly, peer-reviewed journal focused on improving the care of critically ill patients and their families. The authors provide resources in the form of research studies, case reports, reports on new techniques, clinical/basic science reviews, guest editorials and clinical studies. The editors strongly encourage works focused on collaborative practice and research targeted at health professionals caring for critical care populations.

Gélinas, C., Arbour, C., Michaud, C., Robar, L., & Côté, J. (2013). Patients and ICU nurses'

The need for critical care providers is increasing, especially with an aging American population. Patients in acute care settings receive 18 to 23 million days of critical care yearly at an estimated cost of nearly 1% of the gross domestic product (Health Research Services Administration [HRSA], 2006). There will be a need of 4,300 MD intensivists by 2020, but only an estimate of over 2000 are expected to be available to practice in the United States (Krell, 2008). This disparity can be reduced with the use of advanced practice registered nurses (APRNs) that are specifically trained in this specialty. APRNs are in position to provide quality care, address health system issues, and reduce health care costs while improving access. Unfortunately,

The United States of America has around 5,534 registered hospitals. Out of the 5,534 hospitals, only about 250 of them include level one trauma centers and certain states do not occupy a level one hospital. Major problems develop from the low number of trauma centers, especially when the role of overworked and shortage of staff comes into the picture. According to studies, “Intensive Care Unit (ICU) patients cared for by hospitals with below-target RN staffing levels had a 2% to 7% increase in mortality” (“Nursing”). Continuing along, patients mortality rate when not in the ICU, increases 12%.

The purpose of this assignment is to identify and evaluate the effectiveness of nursing care to a patient in the Paediatric Intensive Care Unit (PICU). The assignment presents a case study on a patient who suffered an out-of-hospital cardiac arrest, and includes the reason for admission, diagnosis, interventions, management and progress. Due to the many nursing interventions involved in the case study and the word constraints of the assignment, four primary interventions will be focused on, being neuroprotective cares, suctioning, pain and sedation, and family centred care. Furthermore, supporting evidence will be provided and discussed on the impact the care had on both patient and their family, as well as external resources. Lastly,

The three hospitals that were identified acute care hospital, long-term care hospital, and teaching hospitals. Acute care is a medical treatment at a hospital which is short-term care. Acute care is where a patient is evaluated for a brief but serious episode of illness such as trauma, disease, and recovery for surgery. Acute hospitals are normally provided in a hospital by multiple personnel using medical supplies, equipment, and pharmaceuticals. An acute care hospital is known as a short-term hospital with medical staff and the necessary personnel to help provide with diagnosis, and treatment and care of a wide range acute circumstances. In the acute hospitals, most incidents are reported to the Reporting and Learning System. Long-term care

It has been a foreseeable goal of healthcare organizations to solve integration and interoperability problems across systems with disparate EMRs since the introduction of health information exchanges, with the emphasis on improving clinical outcomes and containing costs. The Vermont HIE did just that in 2015 when they successfully interfaced all 14 Vermont hospitals to their HIE through the initiatives of the Vermont Information Technology Leaders or VITL (Raths, 2016). VITL was able to accomplish this by developing a clinical data warehouse that allowed them to create data marts for Accountable Care Organizations or ACOs. Realizing head on that for ACOs to integrate processes and improve care coordination, VITL stressed the need for data

The patient is an 88-year-old female who fell while walking at home in the assisted living facility where she lives and sustained a fracture of the right wrist. She was evaluated in the ED by her physical therapy they felt that she was very unstable. She need moderate assist for all activities and they were really unable to walk her, therefore she is admitted. She is known to have coronary artery disease, CVA, Parkinson's disease, increased lipids, and chronic atrial fibrillation. The patient is admitted inpatient and despite intensive inpatient therapies she was requiring tremendous amount of assistance and I believe she required acute inpatient hospitalization because she was an unsafe discharge. She will require follow-up in a subacute