RashidAhmed sim,VERIFIED WITH CORRECT ANSWERS.

Documentation Assignments 1. Document your findings related to the focused assessment regarding Mr. Ahmed's fluid and electrolyte status. Mr. Ahmed was admitted to the medical unit with a diagnosis of dehydration and hypokalemia. Three days before, he developed abdominal cramping, nausea, vomiting, and servere diarrhea. Patients weight when he was admitted was 73 kg (162 lbs). Patient stated that weight is 4.5 kg (10 lbs) less than usual. Indicated that patient is not uptaking fluids. Patients labs also showed low serum potassium 2.9 mEq/L and low sodium 130 mEq/L levels. I started by assessing Mr. Ahmeds skin turgor. Noted tenting of the skin and skin was warm and dry which are signs of dehydration. Accessed the patient mucous membrances which were dry, which indicated that the patient was dehydrated. His neurological assessment concluded that he was alert and orientated x3. Patient had reduced muscle strength in his arms and legs with normal sensations to all extremities. Patients pupils are 7 mm and reactive to light bilaterally. Assessed Mr. Ahmeds vital signs. Assessed patients pedal and radial pulse, noted as irregular and tachycardic at a rate of 120 beats per minute. Patient had a orthostatic blood pressure. BP was102/73. Ascultaed patients heart, heard irregular heartbeats and the heart rate was fast. Indication of sinus tachycardia. Temperature of 101 F, SpO2 was 94%, and respiration was 29 breaths per minute. Chest was symmetric and breath sounds were clear and equal bilaterally. Patient had diarrhea for the past 2-3 days and bowel sounds were hyperactive. Capillary refill time was about 4 seconds. Patient had a urinary output of 70mL of dark amber urine, sign of urinary retention that is indicated with dehydration. Patients labs showed his postassium levels were low at 2.9 mEq/L, while normal range is 3.6-5 mEq/L and his sodium levels were low at 130 mEq/L, while normal range is 135-145 mEq/L. Patient stated he is weak and dizzy, but alert and orientated x3. Patient claimed to have headache and stomach cramps and rated the pain a 4 out of 10. Mr. Ahmed stated he did not need anything for the pain. Assessed his IV site had no redness, swelling, infiltration, bledding or drainage. The dressing was dry and intact. Normal saline was running at 150 mL/hr, used for extracellular fluid replacement, in this case it was to treat the patients dehydration. Patient was given 2 tablets of potassium chloride 40 mEq to increase his potassium and to maintain potassium level. I also administered 1000 mL dextrose 5% in normal saline with 20 mEq KCL at 125 mL/ hr. 2. Recognize and report clinical manifestations of hypokalemia and hyponatremia. During hypokalemia and hyponatremia all systems get affected, the cardiovascular, gastrointestinal, genitourinary, musculoskeletal, and neurologic sysem. Hypokalemia is when bloods postassium levels are too low. Deficient serum postassium levels are considered less then 3.5 mEg/L. Normal postassium levels are 3.6 to 5 mEg/L. Clinical manifestions of hypokalemia include muscle weakness and fatigue, digestive problems, nausea, vomiting, diarrhea, cardiac arrhythmasia, tachycardia, irregular sinus rhythm, neurological decline, confusion, speech changes. Hypokalemia can lead to paralysis and loss of respiratory functions. Therefore, monitoring SpO2 levels, respiratory rate, and overall muscle strength are important if someone had hypokalemia. Elevated serum pH can occur, so monitoring pH levels by tesing the arterial blood gas analysis (AGB’s). Signs that Mr. Ahmed had manifestions of hypokalemia was that he was experiencing nausea, he was drowsy, but was alert and orientated x3. The patients heart rate and pulse were irregular and there was indication of sinus tachycardia. His serum postassium levels were low at 2.9 mEq/L. Hyponatremia is low serum levels of sodium. Normal blood sodium level is between 135-145 mEq/L. Clinical manifestions of hyponatremia include nausea, vomiting, headache, confusion, muscle weakness, seizures, coma, neurologic damage, abdominal cramps, tachycardia, oliguria, and cyanosis. Signs that Mr. Ahmed had manifestions of hyponatremia was he was nausea, his muscle strength was reduced, headache, and abdominal cramps. Patients serum sodium was low at 130 mEq/L. 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. I asked if the patient had any pain. Patient had a headache and stomach cramps. He rated this pain level at 4 out of 10 and he did not want anything for the pain. Patient had abdominal cramping, nausea, vomiting, and servere diarrhea for 2-3 days. Pateint was given IV push every 6 hr PRN of Ondansetron 4 mg to prevent nausea and vomiting. Patient stated he was thirsty, but he could not keep anything down. He was given ice chips to help with his thirst. Patients bowel sounds were hyperactive. Asked the patient if he has any allergies and he replied no. Patient stated he was weak and dizzy. Assessed the patients neurological assessment, it concluded that he was alert and orientated x3. Patient had reduced muscle strength in his arms and legs with normal sensations to all extremities. Patients pupils are 7 mm and reactive to light bilaterally.Assessed Mr. Ahmeds skin turgor. Noted tenting of the skin and skin was warm and dry which are signs of dehydration. Accessed the patient mucous membranes which were dry, which indicated patient was dehydrated. Then I removed my gloves and performed hand hygiene and donned a pair of clean gloves. Patients chest was symmetric with respiratory rate of 29 breaths per minute. Ascultated patients lungs. Breath sounds were clear and equal bilaterally. Ascultated patients heart, heard irregular heartbeats and the heart rate was fast. Assessed patients pedal and radial pulse, noted as irregular and tachycardic at a rate of 120 beats per minute. BP showed that the patient was hypotensive at 102/73. Temperature of 101 F and SpO2 was 94%. Assessed capillary refill, refill time was about 4 seconds. Patient had a urinary output of 70mL of dark amber urine, sign of urinary retention that is indicated with dehydration. Removed gloves and performed hand hygiene and donned a clean pair of gloves. I assessed the patients IV site. There was no redness, swelling, infiltration, bleeding, or drainage. The dressing was dry and intact. Patient was receiving normal saline of 1000 mL at 150 mL/ hr. This solution is isotonic which is used for electrolyte fluid replenishment. I compared the medication label with the MAR and the order before administering medication to the patient. 1 tablet dose of trimethoprim/sulfamethoxazole 160/800 mg was given orally. I compared the medication label with the MAR and the order and administered 2 tablets dose of potassium chloride 20 mEq orally. I compared the medication label with the MAR and the order and started a 1000 mL infusion of dextrose 5% in normal saline with 20 mEq KCL at 125 mL/hr. I proceeded to educate Mr. Ahmed about his medications. I explained the signs and symptoms of taking antibiotic that he may have nausea, vomiting, bloating, and to contact his provider if the symtoms progress. Informing when and how much dosage of the medication he should be taking per day. Explained that he is getting electrolytes via IV for replenishment of electrolytes and fluids and to treat his hypokalemia and hyponatremia. Educated patient on intake and output, dehydration, and his diet. Informed the patient that he should start drinking about 6-8 glasses of water daily. Lastly, I educated the patient about safely, activities, and fall risk due to his orthostatic postural tachycardia. Patient verbailized understanding by responding okay. 4. Document all patient teaching regarding care, medications, and safety issues provided to Mr. Ahmed, and his response to the education. I educated Mr. Ahmad about his medications. Informed the patient that he will be started on a Trimethoprism/Sulfamethoxazole 160/800 mg which is a oral antibiotic. I explained to the patient that he will take the antibiotic 1 tablet orally twice daily. I explained the signs and symptoms of taking antibiotics may include nausea, vomiting, bloating, and to contact his provider if the symtoms progress. I informed the patient that he will be getting potassium chloride 40 mEq and to take this medication orally once a day. He will be taking 2 doses of this medication because one dose only contains 20 mEq and his order is to take 40mEq. 1000 mL infusion of dextrose 5% in normal saline with 20 mEq KCL at 125 mL/hr. I explained that he is getting these electrolytes via IV for replenishment of electrolytes and fluids to treat his hypokalemia and hyponatremia. Mr. Ahmed was responsive and understood how to properly take his medications. I then educated the patient on intake and output, dehydration, and his diet. Patient responded that he did not know what intake and output contained. I informed that monitoring the intake helps with ensuring the patient has a proper intake of fluids and obtaining the proper nutrients. As well, monitoring the output helps determine wheather there is an adequate output of urine and normal defecation. The intake and output monitors the patients response to treatment. Informed the patient that he should start drinking about 6-8 glasses of water after his nausea subsides. Informed the patient that he should follow his regular diet and it would be benefitcal to eat foods that are rich in potassium. For example, fruits like bananas and leafy grean vegetables. Lastly, I educated the patient about safely, activities, and fall risk due to his orthostatic postural tachycardia and he stated that he gets dizzy. I explained the importance that when he wants to get out of bed, he should call for help so that there is a nurse present to assist him. Also, when he is getting up from his bed, he should get up slowly, as rising too fast may cause the patient to get light headed and fall. Educated the patient that he may experience a change in level of consciousness due to his hypokalemia and hyponatremia. Patient verbailized understanding by responding okay and was receptive of the information