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 0â€“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 Ahmedâ€™s case make you feel?Talk about what went well in the scenario.Reflecting on Rashid Ahmedâ€™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 Ahmedâ€™s fluid imbalance.Cause of fluid deficitAssessment FindingsCause of assessment changes
Vomiting and Diarrhea
What potential problems could arise if the identified fluid and electrolyte imbalances are not corrected?
Identify the rationale for weighing Rashid Ahmed at the same time each day wearing the same clothing.
Discuss the rationale for infusion of 0.9% normal saline.
Identify potential patient safety issues
What other interprofessional team members should be involved in Rashid Ahmedâ€™s care?
Describe how you would apply the knowledge and skills that you obtained in Rashid Ahmedâ€™s case to an actual patient care situation.