Question

Patient: Rashid Ahmed Diagnosis: Dehydration and hypokalemia Brief Summary: Rashid Ahmed is a 50-year-old Middle Eastern male who was admitted this morning to the medical unit with a diagnosis of dehydration and hypokalemia. He has been experiencing nausea, vomiting, and diarrhea for the past 48 hours after eating at a local restaurant three days ago. Medications: • Trimethoprim/Sulfamethoxazole 160/800 mg PO q12h • Potassium chloride (KCL) 40 mEq PO once • Ondansetron 4 mg IV push q6h prn for nausea • Lisinopril 5mg PO daily • Atorvastatin 10mg PO nightly Orders: • Vital signs every 4 hours and prn • Daily weights • Activity: Up ad lib with assistance x1 • Diet: Clear liquids, progress to regular as tolerated • IV: 1000 mL dextrose 5% in normal saline with 20 mEq KCL at 125 mL/hr • Intake and output, record every 8 hours SBAR Report: S: Mr. Rashid Ahmed is a 50-year-old Middle Eastern male who was admitted to our unit at 0600 this morning after being admitted to the ED at 0400 with a diagnosis of dehydration and hypokalemia. We are monitoring his fluid and electrolyte status closely. I have just received admission orders. B: Three days ago, he developed abdominal cramping, nausea, vomiting, and severe diarrhea 12 hours after eating lunch at a local restaurant. The symptoms have continued for the past 2 days, and food and fluid intake has been minimal to none since the symptoms began. Last night he nearly passed out while going to the bathroom around 0300. Mr. Ahmed was brought to the ED by his wife, and reported dizziness, weakness, and continued nausea. He received 4 mg ondansetron IV for nausea in the ED. Lab work was drawn and is available in the patient chart, and urine and stool samples have been sent to the lab. Mr. Ahmed’s only medical history includes hypertension and hyperlipidemia. A: Mr. Ahmed is drowsy but oriented x 3, appears ill, and is irritable. He reports having a headache, which he rates a 4 on a scale of 0–10, but he hasn't wanted anything for it. Admission weight was 73 kg (162 lb), which the patient reports to be about 4.5 kg (10 lb) less than usual. Vital signs were obtained on admission, including orthostatic blood pressure readings which were positive. Patient had drop in BP from 135/70 while lying down to 105/55 once he stood up. He reports dizziness. Heart rate is tachycardic and irregular. Patient also noted to have a 100.4 degree temperature. He has only taken a few ice chips since admission due to his nausea. The patient had one small liquid stool in the ER. He has not voided or experienced emesis since admission. An IV bolus has been completed and now D5NS IV fluids are running at 125 mL/hr. R: Mr. Ahmed has new IV orders that need to be initiated. You will need to start him on oral antibiotics and potassium when nausea resolves. Provide patient education on safety, his prescribed medications, and intake and output measurement.

Patient Outcomes: Include at least 2 outcomes for each diagnosis Specific to the patient diagnosis Contains the following 4 criteria: measurable, attainable, realistic, and timed All criteria present for patient’s expected outcome

Intervention/Implementation:     Include at least 3 nursing interventions for each patient outcome Includes interventions/ nursing actions directly relating to pt. outcomes Specific in action, frequency and contain rationale # of interventions is appropriate to help pt./ family meet their outcomes

Answer 1

patient outcomes:
Dehydration: 1, the patient demonstrates lifestyle changes to avoid dehydration.
Nursing intervention: check the patient weight to find fluid loss in the body.
evaluate dehydration by observing skin turgor.
encourage the patient to fluids intakes to avoid dehydration.
2, patient explains symptoms that need to consult the health care provider immediately.
nursing interventions: encourage patients to eat, small, frequent meals.
Advise patient to avoid outside foods and encourage fluids.   
evaluate dehydration by observing skin turgor and watch the patient dehydration symptoms.
educate the patient and family about the signs and symptoms of dehydration and potassium loss.
3, a patient showing the absence of orthostasis, normal heart rate, and behavior essential to correct the fluid deficit.
Nursing intervention: monitor the patient vital signs continuously.
encourage plenty of fluids.
educate the patient on how to get out of bed.
Hypokalemia:1, the patient's potassium level became normal.
nursing intervention: Replace the fluid volume with adequate electrolyte therapy.
administer potassium supplements and intravenous fluids with KCL replacement.
encourage patient to have a potassium-rich diet
2, patient present without the headache
Nursing intervention: monitor the patient headache level using a scale
provide pain medications to avoid symptoms.
encourage patient more fluids and avoid stress
3, patient signs and symptoms treated with electrolytes, and the patient regained muscle strength.
Nursing interventions: monitor the patient weight daily
   prevent diarrhea and vomiting with antidiarrheal medication
monitor the patient vital signs every 4hours