NRS-460 Benchmark - Case Study: Timothy Smith –
Hospice/Palliative Care
Directions: Based on the information given in the case study, formulate a conclusion based
on your evaluation and complete the Critical Thinking assignment as instructed below.
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. The purpose of this assignment is to navigate
patient needs associated with cognitive and physical decline while demonstrating effective
communication and compassionate care.
PART I: Health History and Medical Information
Evaluate the health history and medical information for Timothy Smith, presented below.
Upon discharge from the hospital, Mr. Smith had a successful recovery with home health
and outpatient therapy. At the end of his home health journey, Timothy was mobile with
a walker and his cognitive abilities had significantly improved. He continued his physical
and cognitive therapies to better his mobility on the left leg and address his ongoing
PTSD and depression.
After 5 years of successful physical and cognitive therapy, Mr. Smith began to see a
decline in his activities of daily living (ADL) and began refusing to attend checkups. At
this time, his mother was his primary care giver. She has been diagnosed with terminal
cancer.
Mr. Smith's decline continued to progress. His mother, who was his primary support,
passed away, and he does not have a secondary support. He has been dragging his left leg
due to decreased mobility, which has led to the development of an infected friction
wound on the left foot. After no-showing three appointments with the psychiatrist, Mr.
Smith showed up looking disheveled, had a positive drug screen, and seemed to be
dealing with his cognition issues outside of the medical field. Due to the accident and
decrease in cognition, he isn't able to comprehend his health needs. Due to immobility
and progressive leg weakness, the provider ordered a vascular study of bilateral lower
extremities. The study identified thrombus in the left popliteal vein. The patient reports
shortness of breath despite no fever, which led to a chest x-ray being completed, showing
no noticeable changes.
Laboratory Tests and Vitals:
1. Neurocognitive test - Montreal Cognitive Assessment (MoCA)
2. Vascular study showed a thrombus in the left popliteal vein.
3. Patient is experiencing shortness of breath despite clear chest x-ray.
© 2024. Grand Canyon University. All Rights Reserved.
, 4. SpO2: 84% on room air
PART II: Critical Thinking Activity
Use the findings from your evaluation to complete the following:
Clinical Assessment and Interventions
Answer the following questions based on Mr. Smith's presentation and history.
Discuss the conditions that could be Mr. Smith’s shortness of breath, even though his chest
causing Mr. Smith's shortness of X-ray looks normal, is concerning because it suggests
breath given his clear chest x-ray. something may be happening that isn’t yet showing up
Your response should be a on imaging. What’s especially worrisome is the blood
minimum of 150 words. clot recently found in his left popliteal vein. Given that
clot, we must consider the possibility that a pulmonary
embolism could be developing. Small or early PE
events may not immediately appear on a chest X-ray,
yet they can significantly impair oxygenation,
explaining his SpO₂ of 84% on room air. Additionally,
his immobility and progressive weakness after breaking
a long bone increase his risk for thrombus migration
(Vyas et al., 2024). Another potential contributor is
deconditioning resulting from long-term reduced
mobility, which can weaken respiratory muscles and
reduce overall lung capacity. Anxiety associated with
PTSD, depression, and cognitive decline may also
manifest as dyspnea, especially under stress. Chronic
opioid or illicit drug use, suggested by the positive drug
screen, may depress respiratory drive. Finally,
underlying clot burden, early infection not yet
radiographically apparent, or worsening cardiovascular
function could contribute to his symptoms. These
possibilities require urgent evaluation to prevent rapid
deterioration.
Identify possible interventions that Immediate interventions should begin with oxygen
would be needed to address Mr. therapy, initiated as soon as hypoxemia is identified.
Smith's shortness of breath. Include Supplemental oxygen via nasal cannula or face mask
the timeframe for each intervention should be provided within the first minutes of
in your discussion. Your response assessment to raise his SpO₂ above 92%. The second
should be a minimum of 150 words. intervention, which should occur within the first hour,
is a STAT CT pulmonary angiogram to evaluate for a
pulmonary embolism, given the known popliteal
thrombus and new respiratory compromise (American
Lung Association, 2020). Concurrently, the patient
Hospice/Palliative Care
Directions: Based on the information given in the case study, formulate a conclusion based
on your evaluation and complete the Critical Thinking assignment as instructed below.
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. The purpose of this assignment is to navigate
patient needs associated with cognitive and physical decline while demonstrating effective
communication and compassionate care.
PART I: Health History and Medical Information
Evaluate the health history and medical information for Timothy Smith, presented below.
Upon discharge from the hospital, Mr. Smith had a successful recovery with home health
and outpatient therapy. At the end of his home health journey, Timothy was mobile with
a walker and his cognitive abilities had significantly improved. He continued his physical
and cognitive therapies to better his mobility on the left leg and address his ongoing
PTSD and depression.
After 5 years of successful physical and cognitive therapy, Mr. Smith began to see a
decline in his activities of daily living (ADL) and began refusing to attend checkups. At
this time, his mother was his primary care giver. She has been diagnosed with terminal
cancer.
Mr. Smith's decline continued to progress. His mother, who was his primary support,
passed away, and he does not have a secondary support. He has been dragging his left leg
due to decreased mobility, which has led to the development of an infected friction
wound on the left foot. After no-showing three appointments with the psychiatrist, Mr.
Smith showed up looking disheveled, had a positive drug screen, and seemed to be
dealing with his cognition issues outside of the medical field. Due to the accident and
decrease in cognition, he isn't able to comprehend his health needs. Due to immobility
and progressive leg weakness, the provider ordered a vascular study of bilateral lower
extremities. The study identified thrombus in the left popliteal vein. The patient reports
shortness of breath despite no fever, which led to a chest x-ray being completed, showing
no noticeable changes.
Laboratory Tests and Vitals:
1. Neurocognitive test - Montreal Cognitive Assessment (MoCA)
2. Vascular study showed a thrombus in the left popliteal vein.
3. Patient is experiencing shortness of breath despite clear chest x-ray.
© 2024. Grand Canyon University. All Rights Reserved.
, 4. SpO2: 84% on room air
PART II: Critical Thinking Activity
Use the findings from your evaluation to complete the following:
Clinical Assessment and Interventions
Answer the following questions based on Mr. Smith's presentation and history.
Discuss the conditions that could be Mr. Smith’s shortness of breath, even though his chest
causing Mr. Smith's shortness of X-ray looks normal, is concerning because it suggests
breath given his clear chest x-ray. something may be happening that isn’t yet showing up
Your response should be a on imaging. What’s especially worrisome is the blood
minimum of 150 words. clot recently found in his left popliteal vein. Given that
clot, we must consider the possibility that a pulmonary
embolism could be developing. Small or early PE
events may not immediately appear on a chest X-ray,
yet they can significantly impair oxygenation,
explaining his SpO₂ of 84% on room air. Additionally,
his immobility and progressive weakness after breaking
a long bone increase his risk for thrombus migration
(Vyas et al., 2024). Another potential contributor is
deconditioning resulting from long-term reduced
mobility, which can weaken respiratory muscles and
reduce overall lung capacity. Anxiety associated with
PTSD, depression, and cognitive decline may also
manifest as dyspnea, especially under stress. Chronic
opioid or illicit drug use, suggested by the positive drug
screen, may depress respiratory drive. Finally,
underlying clot burden, early infection not yet
radiographically apparent, or worsening cardiovascular
function could contribute to his symptoms. These
possibilities require urgent evaluation to prevent rapid
deterioration.
Identify possible interventions that Immediate interventions should begin with oxygen
would be needed to address Mr. therapy, initiated as soon as hypoxemia is identified.
Smith's shortness of breath. Include Supplemental oxygen via nasal cannula or face mask
the timeframe for each intervention should be provided within the first minutes of
in your discussion. Your response assessment to raise his SpO₂ above 92%. The second
should be a minimum of 150 words. intervention, which should occur within the first hour,
is a STAT CT pulmonary angiogram to evaluate for a
pulmonary embolism, given the known popliteal
thrombus and new respiratory compromise (American
Lung Association, 2020). Concurrently, the patient
