Question

Location: Medical Unit 0730

Report from night shift nurse:

Situation: 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.

Background: 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.

Assessment: 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. Heart rate is tachycardic and irregular. 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 normal saline is running at 150 mL/hr.

Recommendation: 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.

At least 1 Problem (highest priority)

At least 3 interventions directly related to that problem

At least 3 short term and 3 long term goal.

Expected outcome.

Answer 1

Answer : The highest priority should be the management of hypokalemia and dehydration, which leads to cardiac arrythmias ,hypovolemic shock and otherproblems . Interventions : 1) Monitor vital signs and rhythm for arrhythmias ,hypotension ,tachycardia and low spo2 . 2) Strict intake and output chart : Patient has severe dehydration so it may affect kidneys and reduce urine output 3)   Administer medications including antibiotics to prevent the condition. Short term goal : 1) subsiding nausea ,loose stools and vomiting . 2) resolved dehydration 3) maintained electrolyte imbalance and arrhythmias . Long term goals : 1) Avoid unhealthy food habits . 2) If any food poisonous occur , consult the doctor immediately. 3) Drink plenty of fluids to avoid dehydration. Expected outcome : 1) dehydration managed by iv fluids 2) vomiting and nausea reduced by antiemetics 3) managed hypokalemia and weakness by potassium supplements .4) prevent infection by antibiotics .