Lily was a 65 year old lady with stage 5 chronic renal failure, she had recently started hemodialysis treatment three times a week as an inpatient and had responded well to the treatment. During dialysis treatment on the morning of the first day, Lily's observations showed that she was: tachycardic, hypotensive, tachypnea, had an oxygen saturation level of 88%, and was becoming confused and drowsy. It became apparent that Lily had become hypovolemic. The hypovolemic shock observed in this patient was of a particularly critical nature due to the fact that the dialysis treatment had rapidly taken her through the first two phases of shock with very rapid failure of her compensatory mechanisms (Tait, 2012). It was also much more difficult to identify early signs of hypovolemic shock, as some signs and symptoms could have been attributed to renal failure (Macintosh and Moore, 2011; Murphy and Byrne, 2009). expected for this patient will last two days. This time period focuses not only on the initial stage of the patient's deterioration, but will also cover the subsequent 36-hour treatment period in which the patient was stable but still at risk of worsening. By covering this time period, this case study will have the opportunity to not only examine the psychosocial aspects of the care provided, but also to examine the clinical settings in which the care was provided (acute/high dependency unit ) and how this may have affected the care provided. In relation to Corbin and Strauss' (1991) Trajectory model, Lily was in the crisis stage of the eight-stage model, this stage occurs when a potentially life-threatening situation occurs. This model is an interesting factor to consider in relation to the ps...... middle of paper ......Royal College of Physicians. 2012. National Early Warning Score (NEWS). London: Royal College of Physicians. Ryan, H., Cadman, C. and Hann, L. 2004. Establishing standards for the assessment of ward patients at risk of worsening. British journal of nursing, 13 (20), pp. 1186-1190. Samuelson, K. A. 2011. Pleasant and unpleasant memories of intensive care in mechanically ventilated adult patients: results of 250 interviews. Critical and Critical Care Nursing, 27 (2), pp. 76-84. Schulman, C.S., & Staul, L. 2010. Standards for the Frequency of Measurement and Documentation of Vital Signs and Physical Assessments. Intensive Care Nurse, 30 (3), pp. 74-76.Tait, D. 2012. Acute and critical care in adult nursing. Los Angeles: SAGE/Learning Matters.World Health Organization. 2006. World Health Report 2006 – Working together for health. Geneva: World Health Organization.