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Assessment Diagnosis Planning Intervention Rationale Evaluation

Subjective: Electrolyte imbalance At the end of 8 hours of  Review of blood  Goal not met so sad
nursing interventions the chemistry specially the
“Nanghihina ako.” patient: serum potassium and
serum sodium
Objective:  Will be free of  Monitor heart rate and  Tachycardia, bradycardia
complications resulting rhythm by palpation and and other dysrhytmias
 PR: 120 bpm from electrolyte auscultation are associated with
imbalance potassium and sodium
 Hydroxyurea imbalance
medication  Will be able to identify  Assess rate and depth of  Certain electrolyte
interventions to prevent respirations and ease of imbalances, such as
 Furosemide or reduce the effect of respiratory effort hypokalemia, can cause
medication electrolyte imbalance or exacerbate respiratory
insufficiency
 (+) Edema upper  Assess fluid intake and  These parameters are
and lower output variable, depending on
extremities the fluid status, and are
indicators of therapy
K: needs and effectiveness

Na:  Encourage frequent rest  General muscle


periods; assist with daily weakness decreases
activities, as indicated activity tolerance