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.

Answer

Patient Information and Health Assessments Complete patient demographics, health assessments, and interventions

Pharmacology: Complete & accurate description of current meds, including purpose for this patient, side effects, and all other data listed in chart

Pathophysiology: Includes “signs and symptoms”

Answer 1

patient information and Health assessment

name: Rashid Ahmed

Age/gender:50/male

province:middle eastern

guardian : wife

name of emergency contact:

cheif complaints

nausea,vomiting ,diarrhea for 2 days

medical diagnosis: dehydration &hypokalemia

past medical history

hyperlipidemia and hypertension

physical assessment

wt 73kg , Temperature 100.4degree BP 135/70 (lying) 105/55(standing),HR >100,urine output-nil

medication

Ondanstron 4mg IV

Getting IV fluids dNS 125ml/hr

present condition

drowsy,oriented but irritable having headache

Hypokalemia is a low level of potassium (K⁺) in the blood serum.Blood potassium < 3.5 meq/litre Symptoms may include feeling tired, leg cramps, weakness, and constipation.

signs and symptoms

The symptoms of hypokalemia are nonspecific and predominantly are related to muscular or cardiac function. Complaints may include the following:

• Weakness and fatigue (most common)

• Muscle cramps and pain (severe cases)

• Worsening diabetes control or polyuria

• Palpitations

• Psychological symptoms (eg, psychosis, delirium, hallucinations, depression)

Physical findings are often within the reference range. Abnormal findings may reflect the underlying disorder. Severe hypokalemia may manifest as bradycardia with cardiovascular collapse. Cardiac arrhythmias and acute respiratory failure from muscle paralysis are life-threatening complications that require immediate diagnosis.

The treatment of hypokalemia has 4 facets, as follows:

• Reduction of potassium losses

  • managing diarrhea and vomting.odansetron is a 5HT3 receptor antagonist helps in controlling vomiting

  • since this is a case of acute gastroenteritis due to food poisoning presenting with diarrhea.Ater stool examination and culture appropriate antibiotic initiated will control diarrhea.

• Replenishment of potassium stores

• by administering potassium supplements.IV fluids also relenish electrolytes lost

For orthostatic hypotension follow safety precautions

• Be careful on awakening Elevate the head of the bed (reducing nocturia) Drink two cups of cold water 30 minutes before arising Shift from supine to an erect position in gradual stages.