Critical care nursing is a complicated and rewarding field in which to work. The patients are critically ill and require specialized care for the best outcomes. In this lesson, we’ll review some critical care patient scenarios and case studies.

What Is a Critically Ill Patient?

So you’re interested in becoming a critical care nurse. What types of patients might you be caring for? What is involved? Let’s begin with defining critically ill patients.

Critically ill patients need to be monitored often due to medical instability, and they typically depend on breathing tubes and require blood pressure stabilization medication. As such, they are cared for in a hospital’s intensive care unit (ICU). There are several different types of ICUs, including cardiac, trauma, medical, surgical, neurological, even pediatric and neonatal.

Let’s discuss some common scenarios for critically ill patients.

Cardiac Case Study

Scenario 1

You are caring for a 56 year old man in the ICU who was admitted for chest pain to rule out myocardial infarction (heart attack). He has a history of high cholesterol, hypertension (high blood pressure), and he smokes a pack of cigarettes a day. His heart rate and blood pressure are elevated.

What are your initial thoughts? He’s got several lifestyle and medical factors that put him at high risk for heart attack. As his care provider, there are several things that need to be accomplished. First of all, it’s important to complete an assessment. See if he’s currently having chest pain and have him describe it to you. Perform a 12-lead electrocardiogram (ECG) to assess the heart and see if anything is out of the ordinary.

He will need oxygen to help his heart muscle that is dying from potential blockage. Because his heart rate and blood pressure are elevated, he needs medications to bring those down to normal levels. Blood needs to be drawn to evaluate his cardiac enzymes, which will tell you if damage is actually occurring in the heart muscle.

The cardiologist, or heart doctor, needs to be notified of all of your findings to help form a plan. This patient will need a trip to the cardiac catheterization lab (cath lab) so the cardiologist can open up the blocked blood vessel in the heart to restore blood flow. This is a common scenario in the cardiac ICU and usually ends in a good patient outcome.

Neurological Case Study

Scenario 2

Your patient is a 28-year-old woman in the neuro (brain) ICU who was in a motor vehicle accident and sustained a head injury. She has no medical history. Her heart rate has dropped and her blood pressure is elevated.

What do you think is going on here? Injury to the brain can be tricky to care for, especially when trauma is involved. When there is injury to any part of the body, inflammation (swelling) occurs as part of the body’s normal response.

Unfortunately, with a head injury, there’s not much room for swelling other than the opening at the base of the skull, the foramen magnum. This is where the brainstem sits, which is responsible for regulating the heart rate, blood pressure, and breathing. When inflammation of the brain occurs, the brainstem is compromised and pushed through the foramen magnum (brainstem herniation), which affects the heart rate, blood pressure, and breathing. This patient has a decreased blood pressure and increased blood pressure, meaning the brainstem is compromised.

The healthcare provider should be notified immediately of these findings. She will need medication to decrease the swelling in the brain, computerized tomography (CT) of the head to see what’s happening in the brain, and perhaps surgery to drain fluid and decrease the pressure on the brainstem. This is a common scenario in the neuro ICU and unfortunately does not always end well.

Surgical Case Study

Scenario 3

You are caring for a 38-year-old woman in the surgical ICU who had surgery to remove the gallbladder two days ago. She has a history of high cholesterol and gallstones. She is complaining of abdominal pain and nausea.

Cases can be pretty straightforward in the surgical ICU. First things first, let’s perform an assessment. We know she’s got abdominal pain, which could be from the surgery. How about vital signs? Her heart rate is elevated, her blood pressure is low, and she has a fever of 101 F.

What do you think we need to look at to come to a possible conclusion? Labwork. She had a complete blood cell count (CBC) drawn this morning, which had an elevated white blood cell (WBC) count. Do you know what this indicates? Infection! The elevated WBCs and fever tell us she has some type of infection.

Because her heart rate is elevated and her blood pressure is low, there’s a good chance she’s septic. Sepsis is a bloodstream infection that spreads throughout the body and can lead to death if not treated quickly.

The healthcare provider should be notified of your findings. Blood cultures need to be drawn to identify the microorganism causing the infection. The patient will need IV fluids to bring her blood pressure back up and IV antibiotics to begin fighting the infection. This is a common scenario in any ICU and can have a good outcome.

Lesson Summary

Critically ill patients are those who are cared for in a hospital’s intensive care unit and need breathing tubes, blood pressure stabilization medication, and frequent monitoring. Caring for critically ill patients requires assessment, intervention, communication, and treatment. Some of the tools they might need are:

  • Electrocardiogram (ECG) to assess the heart and a cardiac catheterization lab (cath lab) for opening blocked blood vessels and restoring blood flow
  • Computerized tomography (CT) to assess the brain
  • Complete blood cell count (CBC) to check the immune system

We reviewed scenarios and case studies for common situations found in the different types of intensive care units (ICUs). We also discussed a cardiac patient with a possible heart attack who was treated with medications for blood pressure and intervention in the cath lab. Additionally, we covered a neurological patient with a head injury and potential brainstem herniation, who also was treated with medications for lowering pressure in the brain and surgery to relieve that pressure. Finally, we discussed a surgical patient with possible sepsis, also treated with medications to fight off infection.