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
© 2024. Grand Canyon University. All Rights Reserved.
, 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 Based on current assessment findings, Mr. Smith is not
yet safe or appropriate for discharge home. Although he
1. Evaluate Mr. Smith's readiness
was independent prior to the accident, he now requires 2
for discharge based on the
L/min nasal cannula oxygen, is oxygenating at only
information provided in the case
94%, and continues to demonstrate splinting and
study. Based on your findings,
hypoventilation, which places him at ongoing risk for
evaluate health goals for this
atelectasis and impaired ventilation. In addition, his
patient. Discuss how you would
ORIF sites and abrasions still require active wound care
modify the plan of care. Your
and dressing changes, and his persistent 6/10 lower-
response should be a minimum of
extremity pain remains inadequately controlled for safe
200 words.
ambulation, participation in ADLs, or independent
mobility at home. He also continues to rely on enteral
tube feeds, and discharge should not occur until he is
able to tolerate safe oral intake and demonstrate
adequate nutritional status. Psychosocial factors—
including a history of PTSD, depression, nicotine and
recreational drug use, as well as the psychological
impact of the recent trauma—further heighten his
vulnerability to poor self-management and reduced
adherence if discharged prematurely. Literature supports
that physical stability and symptom control contribute
2
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
© 2024. Grand Canyon University. All Rights Reserved.
, 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 Based on current assessment findings, Mr. Smith is not
yet safe or appropriate for discharge home. Although he
1. Evaluate Mr. Smith's readiness
was independent prior to the accident, he now requires 2
for discharge based on the
L/min nasal cannula oxygen, is oxygenating at only
information provided in the case
94%, and continues to demonstrate splinting and
study. Based on your findings,
hypoventilation, which places him at ongoing risk for
evaluate health goals for this
atelectasis and impaired ventilation. In addition, his
patient. Discuss how you would
ORIF sites and abrasions still require active wound care
modify the plan of care. Your
and dressing changes, and his persistent 6/10 lower-
response should be a minimum of
extremity pain remains inadequately controlled for safe
200 words.
ambulation, participation in ADLs, or independent
mobility at home. He also continues to rely on enteral
tube feeds, and discharge should not occur until he is
able to tolerate safe oral intake and demonstrate
adequate nutritional status. Psychosocial factors—
including a history of PTSD, depression, nicotine and
recreational drug use, as well as the psychological
impact of the recent trauma—further heighten his
vulnerability to poor self-management and reduced
adherence if discharged prematurely. Literature supports
that physical stability and symptom control contribute
2
