Western Mindanao State University

College of Nursing
Zamboanga City

Alternative Learning System

Related Learning Experience
Nursing Care Plan

PLANNING
NURSING
ASSESSMENT OBJECTIVE IMPLEMENTATION EVALUATION
DIAGNOSIS INTERVENTION RATIONALE
OF CARE
Subjective Cues: Altered electrolyte 1. Monitor the patient’s signs 1. Hypokalemia can be life 1. Regularly check on the patient for - The patient obtained sufficient
balance related to - After 48 hrs of nursing and symptoms for any adverse threatening. Careful assessment the next 48 hours and inform the serum potassium because of the
-patient has been complaining active fluid loss intervention, the patient changes and sudden for its early presence is needed doctor for sudden changes. treatment and because the
of abdominal pain and seen leading to will be able to maintain complications. especially for high risk patients. patient was willing to listen to
vomiting since 10:00 PM last Hypokalemia serum potassium levels the advice given by the doctor
night within normal range and nurse involved.
2. Paralytic ileus commonly
-diarrhea follows gastric losses through 2. Regularly check on the patient for
2. Observe for absence or vomiting, gastric suction, or the next 48 hours and inform the
changes in bowel sounds. protracted diarrhea. doctor for sudden changes.
Objective Cues:

-patient looks slightly pale with 3. Provides an opportunity for

cold clammy skin. the patient to prevent a 3. Impart knowledge on how to make
3. Discuss preventable causes recurrence. healthier decisions such a foods to
-has severely dry mouth and of the condition such as eat and avoid and proper medication.
poor skin turgor nutritional choices and the
proper use of laxatives.
-further observed that the 4. Potassium may be replaced 4. Advice the patient in eating more
patient is unable to move her 4. Encourage high potassium and level maintained through foods like oranges, bananas,
limbs voluntarily and diet. the diet when the client is tomatoes, coffee, red meat, and dried
spontaneously allowed oral food and fluids. fruits which are rich in potassium.

-her right arm appeared to be

twitching 5. Ensures controlled delivery
of medication to prevent bolus 5. Regularly check on the patient for
-has a slightly altered LOC with effect and reduce associated the next 48 hours and inform the
GCS of 13. 5. Monitor rate of IV discomfort such as burning doctor for sudden changes
potassium administration sensation at IV site.
using micro drop set or
infusion pump.

This study source was downloaded by 100000792113510 from CourseHero.com on 11-09-2022 22:50:49 GMT -06:00
 Reference/s:
 10 Fluid And Electrolyte Imbalances Nursing Care Plans. (2017, April 25). Nurseslabs. https://nurseslabs.com/fluid-electrolyte-imbalances-nursing-care-plans/2/
 Hypokalemia Nursing Care Plan. (2021). Scribd. https://www.scribd.com/document/278680359/Hypokalemia-Nursing-Care-Plan
 Hyperkalemia & Hypokalemia Nursing Care Plans Diagnosis and Interventions. (2021, January 5). NurseStudy.net; NurseStudy.net. https://nursestudy.net/hyperkalemia-hypokalemia-nursing-care-plans/

This study source was downloaded by 100000792113510 from CourseHero.com on 11-09-2022 22:50:49 GMT -06:00
Powered by TCPDF (www.tcpdf.org)