Assignment

eport 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.

 

 

Opening QuestionsHow did the simulated experience of Rashid Ahmed’s case make you feel?Talk about what went well in the scenario.Reflecting on Rashid Ahmed’s case, were there any actions you would do differently if you were to repeat this scenario? If so, how would your patient care change?Scenario Analysis Questions*PCC    What priority problem(s) did you identify for Rashid Ahmed? What information led to identification of the priority problems?PCC    Complete the following table related to the causes and assessment findings specific to Rashid Ahmed’s fluid imbalance.Cause of fluid deficitAssessment FindingsCause of assessment changes

Vomiting and Diarrhea

PCC

    What potential problems could arise if the identified fluid and electrolyte imbalances are not corrected?

EBP

    Identify the rationale for weighing Rashid Ahmed at the same time each day wearing the same clothing.

EBP

    Discuss the rationale for infusion of 0.9% normal saline.

S

    Identify potential patient safety issues

T&C

    What other interprofessional team members should be involved in Rashid Ahmed’s care?

Concluding Questions

Describe how you would apply the knowledge and skills that you obtained in Rashid Ahmed’s case to an actual patient care situation.

 

 

 

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Assignment

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.

 

Please answer this questions

  • 1. Document your findings related to the focused assessment regarding Mr. Ahmed’s fluid and electrolyte status.
  • 2. Recognize and report clinical manifestations of hypokalemia and hyponatremia.
  • 3. Referring to your feedback log, document all nursing care provided, including management of fluid balance with IV therapy, and Mr. Ahmed’s response to this care.
  • 4. Document all patient teaching regarding care, medications, and safety issues provided to Mr. Ahmed, and his response to the education.

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Assignment

Situation: Mr. Russell is a 55-year-old Native American male who was admitted with a stroke with mild left hemiplegia yesterday afternoon. He had a head CT and received thrombolytic therapy in the ED. He is nothing by mouth except for medications until the speech therapist has completed a bedside evaluation, which is scheduled for later this morning. He is scheduled for physical therapy later today.

Background: Mr. Russell has a history of hypertension, coronary artery disease, and diabetes mellitus type 2. He has smoked over a pack of cigarettes per day for the past 35 years and does not exercise.

Assessment: We have already checked his blood glucose level this morning. His vital signs have been stable and he slept well last night. He was able to get up to go to the bathroom with the use of a walker. His neurological checks are stable and he continues to have mild left hemiplegia. His hand grasps are almost equal but a little weaker on the left side. His pupils are equal and react to light. Swallow reflex is intact. He is oriented x3. I have already done a Morse Fall Risk assessment with a total high risk score of 60.

Recommendation: You should do a vital signs assessment, perform a neurological assessment, and talk about safety with Mr. Russell. You should also provide patient education on risk and prevention of aspiration. His morning medications are up and should be administered.

 

 

Please answering this questions.

Opening QuestionsHow did the simulated experience of Vernon Russell’s case make you feel?Talk about what went well in the scenario.Reflecting on Vernon Russell’s case, were there any actions you would do differently if you were to repeat this scenario? 

If so, how would your patient care change?Scenario Analysis Questions*S    What priority problem(s) did you identify for Vernon Russell?S/EBP    Correlate the abnormal coagulation studies results to Vernon Russell’s current treatment that has been initiated thus far.EBP/I    What resources are available to the interprofessional health care team to guide the care of Vernon Russell and/or any stroke patient?PCC/S    Discuss the rationale for Vernon Russell being placed on NPO status?PCC/S    How did you respond to Vernon Russell’s question related to why he needs someone to help him walk, and what is your rationale for your response?PCC    Utilizing Vernon Russell’s health history, identify factors that predisposed him to having a stroke.T&C    Discuss why the referral for speech therapy is important in Vernon Russell’s care.Concluding QuestionsDescribe how you would apply the knowledge and skills that you acquired in Vernon Russell’s case to an actual patient care situation.

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