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: MEDICATIONS GIVEN/TAKEN

• 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.

1.) Fill Out Table

Medication

Dose, Route & Frequency

Classification

Purpose / Mechanism of Action

Significant Side Effects / Adverse Reactions

Nursing Implications

Answer 1

Medication	Dose, Route & Frequency	Classification	Mechanism of action/ purpose	Significant side effects/ Adverse reactions	Nursing implication
Trimethoprim	160mg,orally, twice daily twelve hour interval	Sulphonamides broad spectrum antibiotic	Inhibits dihydrofolate reductase enzyme and tetrahydrofolic acid is not formed	Steven Johnson Syndrome Urticaria Hypersensitivity reaction	-watch for signs of hemolysis,pallor periodic check of blood counts
Sulfamethoxazole	800mg,orally,twelve hour interval	Sulphonamide group of antibiotic	Inhibits synthesis of dihydrofolic acid by bacteria by competing with para amino benzoic acid	Steven johnson syndrome Hypersensitivity reaction electrolyte imbalance	Watch for signs of pallor, jaundice
Potassium chloride	40mEq, orally, once daily	Electrolyte	increase blood potassium level	arrythmia,bleeding, vomiting	observe for arrythmia
Ondansetron	4mg, intravenously,once every 6 hours	Anti emetic	selective serotonin 5HT3 receptor antagonist	blurred vision, low heart rate,	avoid this dug in patients with family history of prolonged QT Syndrome
Lisinopril	5mg, orally, once daily	anti hypertensive class of drug, ACE Inhibitor	Angiotensin converting enzyme inhibitor	dizziness,headache, allergic reaction, interact with potassium increasing agent	look for any arrythmia
Atorvastatin	10 mg, orally, once daily	cholesterol lowering drug	HMGCoA Reductase enzyme inhibition	chest pain, tiredness,dark colored urine,	observe for any side effect