Laura Katherine Castano Barragan

Journal 5

Date: 7/28/2020

Professor El Kholy, Amira

I-Human, change in mental status and hypotension, 64%

I started the scenario in I-Human with E, B, 82-year-old female admitted to the unit for

change in mental status and hypotension. My score for the case was 64%. The patient had a hx of

osteoporosis, arthritis, late stage Alzheimer’s disease, hearing loss, incontinent of bladder and

bowel and 4 adult children. She lived in a long-term facility where mechanical lift was always

used for transfer to chair. Baseline vital signs where: BP: 90/62, HR: 108, RR: 20, Temp: 98.8,

spo2: 98%, Pain: 0/10/. High risk for falls and for Braden scale. The patient was full code and

had no allergies. During the visit relevant assessment included A/O x 1 to person, mini-mental

12/30, eyes sunken, lips dry and crackled, skin tented in clavicle, strength 2/5 in lower

extremities, 3/5 in upper extremities, elevated: Specific gravity (1.038), Na (147), Hematocrit,

BUN. IV in left arm, 125 ml per hour of normal saline being administered. VS: BP: 104/68,

RR: 16, HR: 104 +2, temp 98.8, spo2 98% on room air, pain: 0/10. Patient wears glasses, no

dentures. I recommended to provide oral care, monitor lab results, BP and HR, continue to

administer fluids per hour, social worker arrange discharge. Plan for future control of adequate

intake of food and fluid was necessary because that was what caused the dehydration.
 I was able to identify the signs and symptoms of dehydration and the importance of

managing the fluid deficit to solve them. I didn’t adequately classify all the problems in the

corresponding category. For example, I classified hypotension as fluid and electrolyte problem

because fluid deficiency was the cause, but the expert classification was perfusion. Hypotension

was what was causing diminished pulses. My strength in this scenario was the management of

the s/s and the identification of those related to dehydration. My weakness was to not ask all the

questions necessary even with the patient confusion. The patient was confused and disoriented,

so almost all the questions were answered by “I don’t know, I am a little forgetful”. Because of

the answers that I was receiving in regards to health history, I focused only in asking about the

present status to give the patient as much comfort as possible. By doing that I missed an answer

that she did give to her eating habits “I am not a big eater”. In general, I think I assessed the

patient well and kept in mind the recommendation made by HCP regarding fluid replacement

and diet.