Case study: high acuity to long-term.

Abstract

High acuity nursing involves caring for clients who have potentially life-threatening conditions. This care is described as required, due to a disruption in one or more principal organ systems. How high acuity care is differentiated from acute or long term care may be dependent on the client's initial overall condition and/or predicted outcome. The client discussed has sustained a spinal cord injury at the C5 level. This presentation will demonstrate how clients may continually pass through high acuity care circumstances, acute care, to ultimately a long term care situation. Description of this client in a case study format may result in a learning experience for practitioners concerned with the physiological and the psychosocial aspects of their clients who require high acuity, acute and/or long term care. Car or motorcycle accidents account for at least half of all spinal cord injuries. Most are injuries involving cervical segments number 5 and 6. Cord damage can ascend or descend as much as three levels above or below the injury, due to edema or cord compression post trauma (Woll, 1986). Accidents with severe damage to the spinal cord at the C5 level can result in quadriplegia. Injuries of this magnitude can be either complete or incomplete. Complete injuries cause a "... loss of all conscious motor and/or sensory function below the level of injury" while incomplete injury spares some function, motor and/or sensory (Zejdlik, 1992, p.66). The purpose of this article is to present a client case study as a model for practitioners who practice in high acuity, acute, and long term situations. Two nursing theories (self-care deficit and adaptation) will be used as a framework for the case study. An assessment of the client's physical findings, including history, physical examination, and psychosocial status will be described. Nursing diagnoses and nursing interventions for two specific clinical problems will be presented. Recommendations for future research, nursing care and/or referrals will be outlined.