Nursing Care Plan

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CASE STUDY
IN
NCM-103
(CARE OF CLIENTS WITH PROBLEMS IN OXYGENATION, FLUID
AND ELECTROLYTE BALANCE, NUTRITION AND METABOLISM
AND ENDOCRINE)

Submitted to :
Mr. Darren N. Constantino
Submitted by :
Olive Keithy Ascaño

CASE STUDY 1

1.
a.The possible fluid and electrolyte imbalances that the 78-year-old woman may experience are hyponatremia, hypokalemia and hyperkalemia because of nausea and vomiting that are common in these imbalances. b.The following interventions are appropriate to decrease the patient’s problem : •Assess for the factors that may lead to excess or deficit of a specific electrolyte or fluid •Monitor intake and output of the patient

Teach patient and family about the type, cause, and treatments for electrolyte imbalance, as appropriate. •Provide diet appropriate for patient's electrolyte imbalance (e.g., potassium-rich, low-sodium, and low-carbohydrate foods) •Administer IV fluids as indicated

2.

a.Data that are most relevant to the case and situation of the patient include weight gain of 12 ibs, blood pressure of 150/88 mm Hg and bilateral ankle edema. The possible cause of the the patient’s symptoms include underlying causes like kidney diseases, renal ischemia or heart failure, obesity or being overweight, old age, varicosities and tight clothing. b.These are the nursing priorities in the management of the patient’s bilateral ankle edema : •Administer diuretics

Limit fluid intake
Restrict foods rich in sodium
Elevate the patient’s legs without causing pressure
Use compression socks or hosiery to help poor circulation in the legs

CASE STUDY 2
1.
a.The type of acid-base imbalance that would be most likely to develop is Respiratory Alkalosis. b.The causes of Respiratory Alkalosis are head injury, stroke or brain hemorrhage that results to hyperventilation or breathing so fast that he depletes a majority of the carbon dioxide in his system causing an acid-base imbalance. Respiratory alkalosis causes the level of carbon dioxide to drop and the pH to rise creating this imbalance. c.Some interventions that can help this patient include:

Provide safety/seizure precautions, e.g., bed in low position, padded side rails, frequent observation •Encourage patient to breathe slowly and deeply. Speak in a low, calm tone of voice and provide safe environment •Provide sedation/pain medication, as indicated

2.
a.The patient has metabolic acidosis.
b.
Assess the clinical symptoms, health history and lab results. Identify the underlying cause to intervene properly •When there is severe acidosis (pH < 7.1), sodium bicarbonate is necessary to bring the pH level to a safe level •Correct the sodium and water deficits

c.The cause of Mrs. R.L’s metabolic acidosis is her renal failure, because the kidneys are not removing enough acid from the body.

CASE STUDY 3
1.Assess and monitor for maturation on the newly placed arteriovenous fistula. During the maturation process, look, listen and feel the AVF at every dialysis treatment. Begin assessing the AVF by placing a tourniquet gently placed just below the axilla area. There should be no prominent collateral veins, there is a strong thrill at the arterial anastomosis, and the presence of bruit. 2.Acute kidney failure occurs suddenly and is marked by a sudden decline in kidney function while chronic kidney failure is a progressive or continuous deterioration of kidney function. Nursing care/ priorities for acute kidney failure include following a special diet to keep your kidneys from working too hard, limiting sodium, potassium, and phosphorus and a need for dialysis. For chronic kidney failure include treatment of underlying causes such as diabetes and high blood pressure, diet modification, exercise and avoiding alcohol or cigarettes. 3.UTIs are caused by bacteria, most often by the bacteria that are found inside the intestines and sometimes on the skin around the...
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