The purpose of this paper is to analyze a specific case study in this Troy University School of Nursing student’s clinical experience with the application of the Synergy Model. Both patient characteristics exhibited and nursing characteristics necessary for optimal care and synergy to occur in this specific case study will be discussed.
This particular case study involves a 29 year old obstetric patient who presented to the labor and delivery unit at 33 weeks gestation with complaints of abdominal pain for the past three days that had become more severe and absence of fetal movement noted since the previous evening. Her obstetric history revealed she has one living child and has had one previous miscarriage at ten weeks gestation. Ultrasound revealed no fetal cardiac activity upon arrival.
Despite having undergone a previous cesarean section with her first child, physicians collaborated with each other and with the patient, and decision was made to induce labor chemically and attempt a vaginal birth after cesarean (VBAC). When no cervical change had begun and the patient began bleeding moderately, the decision for a cesarean section was necessary.
Upon arrival to the postpartum unit, the patient’s physician instructed to observe the patient carefully for she had increased potential for developing disseminated intravascular coagulation (DIC), “a life-threatening secondary complication of a number of varied disease states” (Plaut, 2011, p. 24). DIC “typically overwhelms compensatory anticoagulation mechanisms resulting in depletion of factors and laboratory derangement” (Plaut, 2011, p. 26). The patient’s hemoglobin and hematocrit had dropped from 14gm/dL and 38% to 10gm/dL and 26%, respectively. No significant difference was noted in platelet count before and after surgery; however, the platelets were low at 90,000. Assessment revealed a boggy uterus, which the physician reported was the result of the presence of a hematoma. Additionally, there was heavy lochia rubra, and the abdominal dressing was completely saturated. The site was cleaned, and a pressure dressing was applied. Intravenous (IV) fluids were bolusing; however, when blood pressure was only obtainable manually and revealed that her blood pressure was 74/34, the decision was made to send the patient to the intensive care unit (ICU). There, coagulation studies revealed an elevated PT, PTT, D-dimer, and a decreased fibrinogen count. She received a peripherally inserted central catheter (PICC), a transfusion of two units of packed red blood cells (PRBCs), as well as cryoprecipitate therapy during her treatment in the ICU.
The Synergy Model defines eight patient characteristics that nurses must understand in order to facilitate optimal clinical outcomes. All eight patient characteristics will be discussed as they relate to this particular case study.
Resiliency describes a patient’s ability to return to base-line level of functioning...