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Patient Characteristics The Synergy Model’s eight characteristics help nurses identify patient needs across the continuum of health to illness and are as follows: resiliency, vulnerability, stability, complexity, resource availability, participation in care, participation in decision making, and predictability. Understanding these characteristics as they change with the patient’s condition helps determine the competencies essential to deliver optimal care. John’s patient characteristics are outlined in the following table: Stability (decreasing) Hypothermia, hypotension, tachycardia, tachypnea, confusion Complexity (increasing) Two or more body systems entangled, systemic infection, respiratory compromise Predictability (uncertain) Instability and uncertainty in the patient’s life Resiliency (decreased) Very rapid decline with sepsis, unresponsive 30 minutes upon arrival to ICU Vulnerability (increased) Little if no financial reserve from loss of job and limited resources Participation in decision making and care (absent shortly after admission) Confusion and cognitive impairment from advanced sepsis. Sister was very emotional and apologetic. She was not “close” to the patient in general as she identified in the history Resource availability (decreased) Limited financial resources. No assistance possible from family Unknown available community resources. John was experiencing a decrease in stability and resiliency based on the sepsis, renal failure, respiratory failure, and rapid physical decline. His complexity and vulnerability as a patient was drastically increasing because of the disease process as well as the lack of resource availability. The predictability is not certain as well as his willingness to participate in care. The nursing characteristics and competencies of the Synergy Model will be addressed as it relates to patient outcomes. Understanding and applying the Synergy Model to John’s patient characteristics first requires knowledge of the pathophysiology and treatment modalities for ARF and sepsis. Pathophysiology of acute renal failure According to Kosinski (2009), acute renal failure is “a sudden decline in both glomerular and tubular function, resulting in the failure of the kidneys to excrete nitrogen and waste products with a corresponding failure to maintain fluid, electrolyte and acid-base balance” (p.4). ARF may be associated with decreased urinary output of less than 30 ml/h. Prerenal failure may not result in kidney damage with early identification and prompt treatment. The focus of this discussion will be on prerenal caused by the alteration in renal systemic vascular resistance ratio as a result of sepsis. The normal functions of the kidneys are to filter and excrete wastes and toxins by regulating fluids, electrolytes, and acid-base balance. The kidneys receive 20% to 25% of cardiac output and the amount of blood that flows through the renal arterioles depends on renal blood flow. Any alteration in the renal blood flow alters the glomelular filtration rate (GFR) (Broden, 2009). The chemical and humoral mediators released during sepsis contribute to a pro-inflammatory response and systemic vasodilation. The resulting decrease systemic pressure stimulates the sympathetic nervous system, leading to renal artery constriction and a decrease in both filtration and excretion. Systems Assessment Impairment of renal function affects multiple body systems, making the care needs of ARF complex and challenging. Ongoing comprehensive assessments are critical; the caregiver must be attentive to the signs and symptoms of renal disease as well as complications with other organs and systems. The complexity of ARF demonstrates the need for correlating patient characteristics and nursing competencies in the Synergy Model to obtain optimal outcomes. Renal The primary effect of ARF is a decrease in urinary output that leads to fluid retention and edema. Oliguria is the classic sign with an output of less than 400 ml in 24 hours. The decrease in filtration leads to BUN and creatinine build up in the blood as the kidney loses its ability to remove waste products. Other lab results that may be abnormal include metabolic acidosis, hyperkalemia, hyponatremia, hyperphosphatemia, hypocalcemia, and hypermagnesemia.
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