Novel Coronavirus Disease (COVID-19)
Part III: Critical Care
UNFOLDING Reasoning
John Taylor, 68 years old
Primary Concept
Immunity/Gas Exchange/Perfusion
Interrelated Concepts (In order of emphasis)
Clinical judgment
Communication
Acid-base balance
Patient education
NCLEX Client Need Categories Covered in NCSBN Clinical Covered in
Case Study Judgment Model Case Study
Safe and Effective Care Environment Step 1: Recognize Cues
• Management of Care Step 2: Analyze Cues
• Safety and Infection Control Step 3: Prioritize Hypotheses
Health Promotion and Maintenance Step 4: Generate Solutions
Psychosocial Integrity Step 5: Take Action
Physiological Integrity Step 6: Evaluate Outcomes
• Basic Care and Comfort
• Pharmacological and Parenteral
Therapies
• Reduction of Risk Potential
• Physiological Adaptation
, Part III. Transfer to ICU
John is emergently transferred to ICU due to acute
respiratory failure. You receive the following SBAR
report in preparation to assume care:
Situation:
Name/age: John Taylor is a 68-year-old African-American male.
BRIEF summary of primary problem: He presented to the emergency department because he felt crummy;
complaining of a headache, runny nose, feeling more weak, “achy all over” and hot to the touch and sweaty the past
twodays. When he woke up this morning, he no longer felt hot but began to develop a persistent “nagging cough” that
continued to worsen throughout the day. He has difficulty “catching his breath” when he gets up to go the bathroom.
Transferred to MedSurg four hours ago and was clinically stable until he got up to use the bathroom and went into
acuterespiratory distress with increasing O2 needs and decreasing O2 sat.
Background:
Primary problem/diagnosis: positive for COVID-19
RELEVANT past medical history: hypertension and type II diabetes
Code Status: Full code
Assessment:
Most recent vital signs:
• P: 134 (reg)
• R: 32 slightly labored
• BP: 102/54 MAP: 70
• O2 sat: 90% non-rebreather facemask-100%
RELEVANT body system nursing assessment data:
Pale, diaphoretic, anxious, breath sounds diminished with scattered coarse crackles bilat. Use of accessory muscles,
unable to verbalize.
RELEVANT lab values: Pending lactate and ABG
How have you advanced the plan of care?
Initiated rapid response and increased 02 nonrebreather mask.
Patient response: O2 sat has increased slightly from 85% on oxymask 6 L to 90% on NRB. Respiratory rate remains
elevated at 34 and blood pressure has decreased to 102/54 Isar at the
INTERPRETATION of current clinical status (stable/unstable/worsening):
Dramatic decline-CRITICAL
Recommendation:
Suggestions to advance the plan of care:
Emergent transfer to ICU
Part III: Critical Care
UNFOLDING Reasoning
John Taylor, 68 years old
Primary Concept
Immunity/Gas Exchange/Perfusion
Interrelated Concepts (In order of emphasis)
Clinical judgment
Communication
Acid-base balance
Patient education
NCLEX Client Need Categories Covered in NCSBN Clinical Covered in
Case Study Judgment Model Case Study
Safe and Effective Care Environment Step 1: Recognize Cues
• Management of Care Step 2: Analyze Cues
• Safety and Infection Control Step 3: Prioritize Hypotheses
Health Promotion and Maintenance Step 4: Generate Solutions
Psychosocial Integrity Step 5: Take Action
Physiological Integrity Step 6: Evaluate Outcomes
• Basic Care and Comfort
• Pharmacological and Parenteral
Therapies
• Reduction of Risk Potential
• Physiological Adaptation
, Part III. Transfer to ICU
John is emergently transferred to ICU due to acute
respiratory failure. You receive the following SBAR
report in preparation to assume care:
Situation:
Name/age: John Taylor is a 68-year-old African-American male.
BRIEF summary of primary problem: He presented to the emergency department because he felt crummy;
complaining of a headache, runny nose, feeling more weak, “achy all over” and hot to the touch and sweaty the past
twodays. When he woke up this morning, he no longer felt hot but began to develop a persistent “nagging cough” that
continued to worsen throughout the day. He has difficulty “catching his breath” when he gets up to go the bathroom.
Transferred to MedSurg four hours ago and was clinically stable until he got up to use the bathroom and went into
acuterespiratory distress with increasing O2 needs and decreasing O2 sat.
Background:
Primary problem/diagnosis: positive for COVID-19
RELEVANT past medical history: hypertension and type II diabetes
Code Status: Full code
Assessment:
Most recent vital signs:
• P: 134 (reg)
• R: 32 slightly labored
• BP: 102/54 MAP: 70
• O2 sat: 90% non-rebreather facemask-100%
RELEVANT body system nursing assessment data:
Pale, diaphoretic, anxious, breath sounds diminished with scattered coarse crackles bilat. Use of accessory muscles,
unable to verbalize.
RELEVANT lab values: Pending lactate and ABG
How have you advanced the plan of care?
Initiated rapid response and increased 02 nonrebreather mask.
Patient response: O2 sat has increased slightly from 85% on oxymask 6 L to 90% on NRB. Respiratory rate remains
elevated at 34 and blood pressure has decreased to 102/54 Isar at the
INTERPRETATION of current clinical status (stable/unstable/worsening):
Dramatic decline-CRITICAL
Recommendation:
Suggestions to advance the plan of care:
Emergent transfer to ICU
