Enrolled Patient Study

The learning objective to be addressed in this essay is to be more adept at filling out a fluid balance chart and understand its importance. I intend to use the Driscoll (2007) reflective cycle as I find the root process of interrogating and assessing events the most helpful at being reflective. The fluid and electrolyte balance monitoring and management are essential and highly significant to nursing care as highlighted by Jevon and Ewens (2007). Patients suffering from a negative fluid balance is understood as suffering in dehydration according to the definition of dehydration by Jevon (2010) Some symptoms of dehydration, as described by Goertz (2006) include thirst, headaches, dry skin, weight loss, fatigue and pyrexia. From this point onward

On April 7th, 2016, a 36 year old male inpatient at Tattnall Optim Medical Center come to radiology department for a procedure that include two views of chest and five views of bilateral ribs. Human Immunodeficiency Virus (HIV) and decreased white blood cell (WBC) were included in the patient’s medical history. The patient also experiences a chest pain, cough, shortness of breath, and weakness. He mentions that he have a bilateral ribs pain. HIV infection is a disease that affect the body’s immune system by attacking and destroying T lymphocytes, making the affected person susceptible to numerous respiratory infection and malignant tumor (Crowley, 2007. p. 158).

Tracking student activities might be difficult for some clinical instructors make it because clinical instructors need the time to prepare and think about it. Clinical teachers have also responsibility to make appropriate tracking student activities so that nursing students have the opportunity to acquire the nursing knowledge and experience during clinical sites. When I checked and looked that whole three clinical assignment sheets, each one includes appropriate information, but also each one needs to add some information. According to O’Connor (2015), “clinical preparation forms include patient initials, age, gender, allergies, admitted Dx, secondary Dx, diet, activity, medications, actions, major nursing consideration, admitted lab tests, current lab tests, significance, pathophysiology, developmental task, psychosocial assessment, physical assessment, problem list, and my evaluation of this experience” (p. 212-213). The difficult thing for clinical teachers is they

Relating to the identified issues for Philip, as a nurse, it is very crucial and essential to take effectual nursing interventions to treat the current health concerns. So, before implementing any action, it is mandatory for a team and me to specify when and what intervention I want. In Philip’s case, it is necessary to target his low blood pressure at first place. If the blood pressure remains low, this could lead to other complications. Currently, it is important to administer bolus of fluid (e.g. 0.9% normal saline). I want to improve his haemodynamic state i.e. want his BP within normal limit and urine output back to normal over the next hour. In order to take action on established goals; as nursing professional, I will make sure that patient is comfortable and I will also repeat observations such BP, HR.

Interpretation of the fluid balance of hospitalized patients and prescription of intravenous fluids is one of the core clinical skills required for the practice of medicine in almost every specialty. Failure to follow the best practice guidelines can result in increased morbidity and mortality in cases of under prescription, over prescription or from prescribing the wrong type of fluids as highlighted in the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) report about the perioperative mortality 1999. [1] The report emphasized on the importance of fluid prescription and recommended that it should be considered as important as drug prescription.

From January 2001 to December 2014, a single surgeon (TPG) performed 3777 consecutive metal-on-metal HRA procedures, of which, 27% were women. Choosing December 2014 as our date range cut-off point ensured a minimum of 2 years of follow-up results for both study groups. Group 1 consisted of 357 cases in 309 females performed before 2008, prior to the establishment of the newly developed surgical interventions. Group 2 comprises 654 resurfacings in 556 females. Group 2 females were significantly older, at a mean of 54 years compared to 50 years (p30% uncovered, and in all patients who have had an acetabular complication on the opposite hip, or who have a DEXA scan T-score 30. We have also demonstrated that a slowed weight bearing protocol and alendronate can prevent EFF [26]. Over time we evolved to develop a comprehensive protocol which establishes three groups based on proven risk factors: Group A, femoral neck T-score >0 and BMI 30; and Group C, Femoral neck T-score< -1.5.

Nursing care of hyponatremia require understanding of the relationship between sodium and fluid balance and the role of vasopressin, recognition of a patient’s volume status, onset of the of sodium deficit, severity of signs and symptoms, and degree of the sodium deficit. Depending on the severity (acute vs chronic) of the condition and the selected treatments, serum sodium levels should be measured every 1- 2 hours during initial treatment and at least every 4 hours until symptoms resolve. Oral care is important as patients to have a dry mouth due to fluid restrictions. According to hyponatremia treatment guidelines chronic hyponatremia must be corrected to less than 10 to 12 mEq/L over 24 hours and less than 18 mEq/L over 48 hours in order

Make sure the patient drink at least 2.5 L of water and urinate yellow amber healthy looking urine at the end of the day

The defining characteristics of the nursing diagnosis were dyspnea, along with an abnormal breathing pattern (Ackley & Ladwig, 2014). In order to alleviate symptoms of heart failure, Osborne et al., (2014) suggests use of loop diuretics to facilitate the removal of excess fluids which often accumulates in the lungs (Osborne et al., 2014). Therefore, patient C.Z. was educated on the importance of taking her medications as prescribed; she was also encouraged to ingest less than 2 grams of sodium on a daily basis coupled with a fluid restriction of 1500 milliliters (mLs) per day. An additional goal for patient C.Z. during her hospital stay was to maintain O2 saturations greater than 92% on room air, complete ten repetitions of incentive spirometry every hour while she was awake, reaching a level of at least 1500 mLs; and finally, ambulation as tolerated no less than three times per day prior to her

Weighing of the patient daily at the same time with the same clothing and on the same scale preferably in the morning time after urination in order to monitor fluid overload level for 2-to-3 pounds gain in a day or five pounds in a week

Nearly 60% of the human body is water. The daily fluid intake required for an adult to consume should be about 2600ml. A healthy person’s average daily fluid output is anywhere between 2600 – 2900ml, balancing out the daily fluid intake. Our bodily fluids are consistently moving to help carry nutrients to the cells as well as it carries wastes away from the cells. Not everyone is able to balance the fluids in their body making them either retain more or lose more than the fluid required. When suspecting any fluid imbalance or seeing any changes, the client should seek for any medical help to their primary health care provider to evaluate the patient and begin any treatment initiation if needed. When trying to manage fluid balance in patients that are hypovolemic, Intravenous therapy (I.V) may be used to administer solutions and/or medications to help maintain fluid balance if needed.

This is a priority for this patient because of certain factors. Nursing diagnosis deals with humans response to bio-psycho-social stressors and or health problems that a nurse is licensed to treat. We have assessed that this is an actual problem as evidenced by signs and symptoms patient is presenting. By gathering our assessment we can tell that she lacking fluid intake based on the nurses objective assessment of dry mucous membranes and the subjective information provided from patient that she " has not had an appetite".

Upon completion of the data collection, 583 patients were assessed for inclusion into the study, 325 in the 2010 pre-implementation group and 258 in the 2013 post-implementation group. A total of 200 patients were randomized in each group (n=400); however, 69 (35%) and 63 (32%) were excluded from the 2010 group and 2013 group respectively. Sample demographics are described in Table 1.

the patient, fill the basin half full, wring out a compress until the water is not dripping, check

This is especially important on those patients admitted with low mortality risk DRGs. This is accomplished by identifying and preventing, potentially avoidable complications and adverse events. For example, patients admitted for syncope and collapse secondary to dehydration will more than likely be placed on IV Fluids. One goal would be to hydrate the patient and reevaluate them throughout their hospitalization for improvement. However, if the patient’s intake and output is not monitored closely, the patient can become volume overloaded and develop symptoms similar to those seen with Right Sided Heart Failure. Once that happens, the patient will require additional medications and additional hospital days because of provider error of not placing an order for the Nurses to monitor his/her volume status.