NRS-460 Benchmark Case Study: Timothy Smith - Intensive Care Unit

NRS-460 Benchmark Case Study: Timothy Smith – Intensive Care Unit

The purpose of this assignment is to evaluate patient data to navigate decision-making in ambiguous situations, assist the patient and family in managing complex care needs, and perform effectively in an interdisciplinary team.

PART I: Health History and Medical Information

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Evaluate the health history and medical information for John Doe, presented below.

After his discharge from the ED, John was transferred to the Intensive Care Unit (ICU) for specialized care and monitoring, where you took over as his nurse. Upon arrival in the ICU, John was identified as Timothy Smith. He arrives intubated on a ventilator and requires continuous assessment for his TBI, multiple fractures, and underlying psychological conditions. Specialty providers are considering the risks vs. benefits of a hematoma evacuation. Upon entry to the ICU, Mr. Smith has been diagnosed with:

Severe Traumatic Brain Injury with a GCS score of 6, managed with an external ventricular drain (EVD)
Respiratory instability managed with a ventilator
Femur fracture with open reduction and internal fixation (ORIF)
Hairline fracture of 3 left ribs

Laboratory Tests, Results, and Vitals:

EVD – Intracranial Pressure (ICP) – 12
Echocardiogram (EKG): Sinus Tachycardia Rate 128
Arterial Blood Gas (ABG):
1. PaCO2 Level – 51 mmHg,
2. HCO3 Level – 30 mEq/L
3. pH 7.39
4. PaO2 79 mmHg
5. SaO2 98% on ventilator
Respiratory Rate: mechanical ventilation rate 14 with no spontaneous respirations
CBC –
1. White Blood Cells: 12.9
2. Hemoglobin: 13.6
3. Hematocrit: 38.7
4. Platelet Count: 310,000
CMP:
1. Potassium 4.5 mEq/L
2. Sodium 135 mEq/L
3. Bilirubin: 2.1 mg/dL
GCS 8 after placement of EVD and drainage of 10 ml of sanguineous fluid from the drain.
1. Deficit for only opening eyes to pain (2)
2. Verbal response is incomprehensible sounds (2)
3. Motor score of (4) withdraw from pain

PART II: Critical Thinking Activity

Use the findings from your evaluation to complete the following:

Power of Attorney Upon arrival in the ICU, you discover Mr. Smith does not have a power of attorney.
Discuss how you would determine who would make decisions on his behalf. Your response should be a minimum of 150 words.	In the absence of an appointed power of attorney (POA), decision-making for Timothy Smith—who is presently intubated, non-verbal, and has a Glasgow Coma Scale (GCS) score of 8—must adhere to a legal and ethical hierarchy. As a nurse, I would promptly tell the healthcare provider and case manager to commence a formal capacity assessment, verifying that Mr. Smith is unable to make informed decisions. Subsequently, we shall adhere to the legal next-of-kin hierarchy established by the state, which often commences with a legal spouse, followed by adult offspring, parents, and, subsequently, siblings. Attempts will be undertaken to reach any accessible family members via the hospital registration system or emergency contact details supplied during his emergency department admission. In the absence of a family willing to serve as a surrogate, the hospital ethics committee may designate a legal guardian or suggest the engagement of an ethical consultant or a court-appointed conservator (Martin et al., 2023). Meticulously recording all communication initiatives and decisions is essential for transparency and legal adherence.
How can you utilize the chaplain to assist in locating the family? Your response should be a minimum of 150 words.	The hospital chaplain may serve as an essential resource in identifying Timothy Smith’s family, particularly in urgent and high-pressure ICU circumstances. Chaplains are educated in crisis management, communication, and emotional support, frequently acting as intermediaries between healthcare teams and families. I would coordinate with the chaplain to collect any accessible patient belongings, identification, or personal objects that may include contact information, such as a mobile phone, wallet, or address book. The chaplain may collaborate with hospital social workers and registration personnel to identify emergency contacts recorded in the electronic health record or emergency department intake forms. Chaplains may also employ community resources, religious ties, or prior admissions to identify familial or spiritual links. Their empathetic approach may be effective in engaging reluctant or alienated family members. In the absence of known relatives, chaplains may offer spiritual support to the patient while the interdisciplinary team investigates legal options for surrogate decision-making (Martin et al., 2023).
Quality vs. Quantity of Life Health care professionals often have to have difficult conversations with patients and families in the intensive care unit (ICU) regarding prognosis and outcomes.
What resources are available to have a difficult discussion with Timothy’s family on the quality versus quantity of life? Your response should be a minimum of 150 words.	Engaging in a dialogue about the quality versus quantity of life with Timothy Smith’s family necessitates a nuanced, multidisciplinary strategy bolstered by suitable resources. A vital resource is the hospital’s palliative care team, comprising physicians, nurses, social workers, and chaplains adept at conducting goals-of-care discussions. This team can deliver clear and empathetic communication regarding prognosis, treatment alternatives, and probable results, assisting the family in comprehending the equilibrium between life-extending measures and quality of life. Clinical ethics advisors may assist in navigating ethically complicated issues, particularly when there are divergent attitudes and opinions regarding life-sustaining treatment among family members or between family and doctors (Martin et al., 2023). Social professionals are crucial in tackling emotional and practical difficulties, guaranteeing that families receive the requisite psychological care. Nurses, via their ongoing patient interactions, can champion the patient’s dignity and comfort while addressing the family’s inquiries and concerns. This team advocates for collaborative decision-making focused on the patient’s optimal interests and values.
Given Mr. Smith’s assessment findings, discuss his quality of life should he receive hematoma evacuation surgery. Your response should be a minimum of 150 words.	Considering Mr. Smith’s significant traumatic brain injury (TBI), a Glasgow Coma Scale (GCS) score of 8, and absence of spontaneous respirations, his prognosis remains uncertain despite the hematoma evacuation operation. Surgical intervention may alleviate intracranial pressure and avert additional neurological decline, but the degree of irreversible brain damage incurred may considerably restrict his possibility for recovery (Domensino et al., 2023). Following surgery, he may encounter prolonged reliance on a ventilator, physical disabilities, cognitive deficits, and an inability to execute fundamental everyday duties. His numerous fractures exacerbate his therapy requirements and healing duration. The quality of life is likely contingent upon the extent of neurologic function restored; certain patients persist in a minimally cognizant or vegetative condition after surgical intervention. Surgery may prolong life, but it may not restore significant functionality. Consequently, the healthcare staff must collaborate closely with the family to ensure that decisions are consistent with Mr. Smith’s values, possible outcomes, and the advantages and disadvantages of extended life support.
Ethical Considerations Ethical considerations are an important part of nursing care, but become especially vital when dealing with trauma patients, considering the potential of a poor prognosis.
Discuss the ethical considerations of palliative care, possible outcomes, and limitations with Mr. Smith’s condition, taking into account his assessment findings. Your response should be a minimum of 200 words.	Palliative treatment for Mr. Smith’s condition presents numerous ethical dilemmas, particularly because of his severe traumatic brain injury (TBI), low Glasgow Coma Scale (GCS) score, and need for mechanical ventilation. The fundamental ethical concepts encompass autonomy, beneficence, nonmaleficence, and justice (Martin et al., 2023). Given Mr. Smith’s absence of decision-making capability and the unavailability of an advance directive or power of attorney, honoring autonomy becomes intricate. The healthcare team must prioritize his best interests, frequently necessitating surrogate decision-makers who are informed by Mr. Smith’s presumed preferences had he been capable of articulating them. Beneficence and nonmaleficence must be meticulously equilibrated. Ongoing aggressive interventions, such as hematoma evacuation, may prolong life but could also lead to extended pain, reduced quality of life, or a chronic vegetative state (Martin et al., 2023). Palliative care emphasizes alleviating pain, mitigating misery, and providing emotional and spiritual support to patients and their families. When complete recovery is improbable, transitioning objectives from curative to palliative care may offer a more ethically justifiable and compassionate approach. Nonetheless, the constraints of palliative care encompass possible familial discord, emotional turmoil, and ambiguity in prognosis. These decisions necessitate clear, empathetic communication, interdisciplinary collaboration, and maybe ethics advice to assist the family and guarantee ethically appropriate, patient-centered treatment.
Psychosocial and Spiritual Considerations Providing holistic nursing care for patients with complex conditions requires that the nurse take 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.	Despite Mr. Smith’s incapacity to communicate owing to intubation and diminished consciousness, the nurse is instrumental in fulfilling his psychological and spiritual needs through comprehensive, empathetic care. Initially, fostering a tranquil and courteous atmosphere by addressing him as though he were aware upholds his dignity and existence (Domensino et al., 2023). Nurses can prompt family members to converse with Mr. Smith or play familiar music to foster comfort and connection, potentially yielding psychosocial advantages despite his diminished level of awareness. The nurse can commence chaplaincy services to provide prayers, religious ceremonies, or a calming presence, customized to any known or presumed spiritual background. In the absence of documented spiritual preferences, non-denominational support can promote tranquility and emotional stability for both the patient and their family. Incorporating culturally sensitive practices—such as touch, lighting, or personal artifacts—can enhance spiritual well-being (Kanmani et al., 2022). The nurse’s compassionate presence preserves Mr. Smith’s dignity throughout this pivotal phase of care.
Economic Issues BSN-prepared nurses have an understanding of system-based practice, including implications of financial and economic considerations related to providing care.
Due to the multi-system injuries Mr. Smith incurred, discuss the economic issues that the individual and family may encounter. Consider his ability to work, housing needs, supplemental income, temporary disability, insurance, and medical expenses. Your response should be a minimum of 200 words.	Mr. Smith’s extensive injuries, comprising severe traumatic brain damage, respiratory failure, and many fractures, pose considerable financial difficulties for him and his family. Given a GCS of 8 and the absence of spontaneous respirations, his likelihood of returning to work shortly, if ever, is minimal (Kanmani et al., 2022). The loss of salary will impose immediate financial pressure, particularly if he is the principal breadwinner. The family may need to seek temporary or permanent disability benefits, which can take time for processing and may not completely compensate for missed wages. Should Mr. Smith survive, he may necessitate prolonged rehabilitation, in-home assistance, or admission to a skilled nursing facility—all of which entail significant expenses. Housing adaptations, including wheelchair accessibility and home medical equipment, may be required, imposing further financial strain (Domensino et al., 2023). The family may incur out-of-pocket costs for drugs, therapies, and travel for medical visits, contingent upon the degree of insurance coverage. If Mr. Smith has adequate insurance or becomes uninsured, medical expenses may become burdensome. Families frequently have challenging decisions, such as taking unpaid leave from employment to offer care or downsizing residences to finance continuous treatment (Kanmani et al., 2022). The prompt engagement of a social worker or financial counselor is crucial for assisting the family in examining insurance alternatives, governmental aid, and community resources.
Collaboration What is the purpose of collaborating with the following when providing care for Mr. Smith? Explain the role of each team member’s competency and how they contribute to Mr. Smith’s care.
Occupational Therapists	OTs focus on helping Mr. Smith regain independence in daily activities such as grooming, dressing, and feeding. They assess his functional abilities and introduce adaptive equipment or techniques for long-term care planning.
Physical Therapists	PTs assist with mobility and strength restoration, especially important following his femur fracture and prolonged bed rest. They work on muscle reconditioning, coordination, and fall prevention.
Respiratory Therapists	RTs manage ventilator settings and monitor Mr. Smith’s respiratory status. They are crucial in weaning him off mechanical ventilation and preventing complications like pneumonia.
Speech Therapists	Once Mr. Smith is extubated, SLPs will assess his ability to swallow safely and evaluate cognitive-linguistic deficits caused by TBI.
Dieticians	They ensure Mr. Smith receives adequate nutrition, either through enteral feeding or orally, tailoring plans to support healing and prevent malnutrition.
Physiatrists (Doctor of Rehabilitative Medicine)	These rehabilitation physicians coordinate Mr. Smith’s recovery plan, addressing musculoskeletal, neurological, and cognitive challenges through an integrated approach.
Wound Care Nurse	They manage any surgical sites, pressure injuries, or skin integrity issues, mainly due to immobility.
Neuropsychologists	They assess cognitive function and mental health following brain injury, guiding strategies for emotional and behavioral support during rehabilitation (Castro & Franco, 2023).
Select two team members and discuss their competencies (skill set) as applicable to Mr. Smith’s care. Your response should be a minimum of 150 words.	A Physical Therapist (PT) is essential to Mr. Smith’s rehabilitation following his femur fracture, rib fractures, and immobility resulting from traumatic brain injury (TBI). Physical therapists are educated to evaluate strength, range of motion, balance, and mobility (Castro & Franco, 2023). In Mr. Smith’s situation, tailored rehabilitation regimens will be devised to avert muscle atrophy, enhance circulation, and mitigate the danger of deep vein thrombosis and pressure ulcers. As he stabilizes, physical therapists will aid with bed mobility, transfers, and ultimately weight-bearing activities to facilitate ambulation. Their objectives are to improve functional autonomy and diminish long-term physical impairment. A neuropsychologist specializes in evaluating and addressing the cognitive, emotional, and behavioral consequences of brain injury. Considering Mr. Smith’s GCS of 8 and indications of substantial brain injury, the neuropsychologist will assist in assessing his memory, attention, language, and executive function (Castro & Franco, 2023). This informs prognosis and directs therapeutic approaches. Moreover, they facilitate emotional well-being, assist the family in comprehending behavioral alterations, and aid in long-term strategies for cognitive rehabilitation and community reintegration.
Interdisciplinary Team Interdisciplinary team collaboration is vital to the successful management of patients with complex conditions.
Part I: Team Dynamics Explain what principles can be applied to facilitate effective team dynamics in a way that: (1) ensures that his/her scope of practice defines the role of each individual/team member; and (2) ensures that the delegation of work to team members based on roles and competencies is assigned without confusion for the team or patient. Your response should be a minimum of 200 words.	Enhancing effective team dynamics in the management of a complicated patient like Mr. Smith necessitates the implementation of essential principles, including clearly delineated responsibilities, transparent communication, collaborative leadership, and reciprocal respect. To guarantee that each team member functions within their designated scope of practice, it is imperative to delineate roles at the commencement of care through organized interdisciplinary meetings or care rounds (Castro & Franco, 2023). Every provider—nurse, physician, therapist, or specialist—must comprehensively comprehend their responsibilities, tasks, and constraints as dictated by licensure and institutional policies. Effective delegation is facilitated by comprehending each professional’s competencies, education, and therapeutic strengths. The nurse should refrain from delegating drug administration to unlicensed personnel, but may assign activities such as mobility support to a physical therapy aide (Castro & Franco, 2023). This mitigates role ambiguity and improves patient safety. Standardized communication instruments such as SBAR (Situation-Background-Assessment-Recommendation) facilitate consistent information flow, especially during handoffs and transitions in care. The utilization of electronic health records (EHRs) facilitates the dissemination of information among team members, ensuring alignment on treatment objectives (Castro & Franco, 2023). Leadership ought to foster a non-hierarchical, collaborative framework wherein all perspectives are acknowledged and contributions are esteemed. When every team member comprehends their responsibilities and values the contributions of others, care coordination becomes seamless, efficient, and centered on the patient.
Part II: Interprofessional Communication 1. Discuss the importance of each member of the interdisciplinary team communicating their information in a professional, accurate, and timely manner when treating Mr. Smith. Your response should be a minimum of 150 words.	Efficient communication among interdisciplinary team members is essential for guaranteeing safe, coordinated, and high-quality treatment for Mr. Smith. Due to his intricate condition—comprising severe traumatic brain injury, respiratory failure, and orthopedic trauma—prompt and precise information sharing can significantly affect outcomes (Kanmani et al., 2022). Every team member provides particular expertise that must be amalgamated into a unified treatment strategy. The respiratory therapist must swiftly convey alterations in ventilator settings or oxygenation status to the ICU nurse and physician. Likewise, physical therapists are required to inform the team about mobility advancements or issues that could influence rehabilitation strategies. Professional communication cultivates mutual respect and trust among team members, thereby enhancing collaboration and minimizing errors. Employing structured tools such as SBAR (Situation-Background-Assessment-Recommendation) standardizes communication and mitigates the risk of overlooking crucial information (Kanmani et al., 2022). Consistent interdisciplinary rounds, documentation in the electronic health record, and direct verbal updates facilitate real-time modifications to the care plan. Ultimately, consistent and courteous communication guarantees that Mr. Smith receives thorough, patient-centered care adapted to his changing health.
2. How does the presence of diversity, equity, and inclusion impact the dynamics of team-based communications? Your response should be a minimum of 150 words.	Diversity, equity, and inclusion (DEI) profoundly affect team communication dynamics by promoting a collaborative, courteous, and culturally adept atmosphere. A diverse healthcare team comprises personnel with distinct backgrounds, experiences, and viewpoints, enhancing clinical decision-making and augmenting problem-solving capabilities. When team members perceive inclusion and value, they are more inclined to contribute openly and confidently, hence improving overall team performance and cohesion (Castro & Franco, 2023). Equity guarantees that all individuals—irrespective of their function, ethnicity, gender, or background—possess an equal opportunity to express concerns, convey insights, and engage in decision-making (Martin et al., 2023). This fosters psychological safety, an essential element of good communication. Inclusion guarantees that minority voices are acknowledged and valued, hence diminishing the likelihood of marginalization or communication failures (Castro & Franco, 2023). When attending to patients such as Mr. Smith, who may originate from diverse cultural or social backgrounds, DEI principles assist the team in being attuned to the patient’s values and preferences. Ultimately, a culture that fosters DEI enhances communication, reduces bias, and results in more equitable, patient-centered outcomes.
ICU Psychosis/Delirium There are specific considerations that nurses should be aware of when taking care of patients in the ICU.
Explain ICU psychosis/delirium. Your response should be a minimum of 100 words.	ICU psychosis, or ICU delirium, is a sudden and variable impairment of awareness, attention, cognition, and perception frequently observed in critically ill patients. It is marked by confusion, disorientation, hallucinations, agitation, and disrupted sleep-wake patterns. ICU delirium may manifest as hyperactive, hypoactive, or mixed types and is frequently underdiagnosed, particularly in non-verbal or sedated patients (Xu et al., 2025). Risk factors encompass mechanical ventilation, extended ICU admissions, sleep deprivation, infections, metabolic disturbances, and the administration of sedatives or opioids. ICU delirium correlates with prolonged hospitalizations, elevated death rates, and persistent cognitive deterioration, rendering early detection and prevention crucial for enhancing patient outcomes.
What interventions can nurses implement to prevent ICU psychosis/delirium from happening? Your response should be a minimum of 150 words.	Nurses are crucial in mitigating ICU psychosis/delirium via proactive, evidence-based strategies. Initially, regular reorientation—by informing the patient of the date, time, location, and treatment purpose—mitigates confusion. Facilitating regular sleep-wake cycles through the reduction of nocturnal disruptions, the darkening of lights throughout the evening, and the limitation of daytime naps aids in the management of circadian rhythms (Castro & Franco, 2023). Early mobilization, including passive range-of-motion exercises or sitting upright in bed, has demonstrated a reduction in the incidence of delirium. Nurses should promote family contact when suitable, since familiar voices and presence can alleviate anxiety and confusion. Restricting the administration of sedatives and opioids, when feasible, and conducting regular sedation interruptions facilitate neurological evaluations and mitigate medication-induced delirium. The consistent application of delirium assessment instruments, such as the CAM-ICU (Confusion Assessment Method for the ICU), facilitates early identification (Xu et al., 2025). Additional therapies involve providing hearing aids or spectacles for people with sensory impairments and managing pain, hypoxia, and infection, which are prevalent drivers of delirium. This comprehensive approach can markedly enhance patient outcomes and the quality of service.
Based on Mr. Smith’s current assessment findings, discuss his risk of developing ICU psychosis/delirium. Your response should be a minimum of 150 words.	Mr. Smith is at elevated risk for ICU psychosis/delirium owing to several predisposing variables inherent in his current condition. He has a significant traumatic brain injury (TBI) with a Glasgow Coma Scale (GCS) score of 8, indicating compromised cognitive function (Martin et al., 2023). He is intubated and receiving mechanical ventilation, exhibiting no spontaneous respirations, so heightening the risk associated with sedation, immobility, and absence of environmental awareness. The ICU environment—marked by incessant noise, illumination, and continual disruptions—can disturb circadian cycles, leading to sleep deprivation and sensory overload. Furthermore, his increased white blood cell count (12.9) and raised bilirubin level (2.1 mg/dL) may suggest infection or hepatic impairment, both recognized factors contributing to delirium. The administration of drugs like sedatives, analgesics, and maybe people with paralysis increases their risk (Xu et al., 2025). Due to restricted movement, absence of verbal communication, and a modified neurological condition, Mr. Smith is at risk of developing hypoactive delirium, which is more challenging to identify yet equally perilous. Timely identification, ongoing assessment utilizing instruments such as CAM-ICU, and proactive measures will be essential in reducing his risk and enhancing both immediate and prolonged outcomes.
References (Please include working hyperlinks.) Castro, I. M. C., & Franco, M. C. A. (2023). Palliative care: a multidisciplinary approach to people with traumatic brain injury. Research Square (Research Square). https://doi.org/10.21203/rs.3.rs-3712371/v1 Domensino, A., Tas, J., Donners, B., Kooyman, J., Van Der Horst, I. C., Haeren, R., Ariës, M. J., & Van Heugten, C. (2023). Long-Term Follow-Up of Critically Ill Patients with Traumatic Brain Injury: From Intensive Care Parameters to Patient and Caregiver-Reported Outcomes. Journal of Neurotrauma, 41(1–2), 123–134. https://doi.org/10.1089/neu.2022.0474 Kanmani, T. R., Raju, B., Srikanth Pallerla, M., P., J., A., & Makkar, S. (2022). Exploring Psychosocial Concerns and Needs of Ventilator and Nonventilator Caregivers in the Emergency and Trauma Care Setting. Journal of Health and Allied Sciences NU, 13(02), 212–221. https://doi.org/10.1055/s-0042-1750182 Martin, M., Kendall, S., & Uveges, M. K. (2023). Traumatic brain injury, dysphagia, and the ethics of oral intake. AACN Advanced Critical Care, 34(3), 255–262. https://doi.org/10.4037/aacnacc2023789 Xu, M., McGonigle, T. W., Liu, J., Dittus, R. S., Heckers, S., Pandharipande, P. P., Williams-Roberson, S., Patel, M. B., Ely, E. W., & Wilson, J. E. (2025). Dimensions of psychosis in delirious and catatonic trauma critically ill patients. Biomarkers in Neuropsychiatry, 100128. https://doi.org/10.1016/j.bionps.2025.100128

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Assessment Description

Use the “Case Study: Timothy Smith – ICU” template to complete the assignment.

This case study has indirect care experience requirements. The “NRS-460 – Case Studies: Indirect Care Experience Hours” form, found in the Topic 1 Resources, will be used to document the indirect care experience hours completed in the case study. As progress is made on the case study, update this form indicating the date(s) each section is completed. This form will be submitted in Topic 5.

You are required to cite a minimum of three sources to complete this assignment. Sources must be published within the past 5 years and appropriate for the assignment criteria and relevant to nursing practice.

While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting guidelines, which can be found in the APA Style Guide, located in the Student Success Center. This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to LopesWrite. A link to the LopesWrite technical support articles is located in Class Resources if you need assistance.