Western Mindanao State University

College of Nursing
Zamboanga City

Alternative Learning System

Related Learning Experience
EMERGENCY ROOM

Instructions:
Answer the provided questions comprehensively following the subsequent format.
A. Use the Times Roman Font Style
B. Utilize at least three (3) or more references
C. References should be 2015 and latest
D. Output should be submitted as posted in the Google Class Assignment in PDF Format
E. Use the templates as guides in accomplishing your output
F. You will be graded according to the Rubric given

https://www.123rf.com/photo_57911846_a-motion-blurred-photograph-of-a-senior-female-patient-on-stretcher-
or-gurney-being-pushed-at-speed-.html

SCENARIO: A Case of Medical Emergency in Diabetes Insipidus (Hypernatremia)

A 52 year old female was brought to the emergency room presenting with seizure. Seizure event lasted for less
than 60 seconds. Nurse Jose noted copious amount of secretions in the patient's mouth, patient looking slightly
pale, restless and lethargic with GCS of 11. The sister reports that the patient has been drinking large volume of
water for the past 2 days and complains of being dizzy when standing. Vitals as follows:

Vital Signs
1) Blood pressure (BP) : 85/60 mmHg
2) Heart rate (HR) : 130 beats/min
3) Respiratory rate (RR) : 33 breaths/min
4) Temperature : 36.50 C
5) Sp02 : 91%
6) Height : 154 cm
7) Weight : 58kg
8) GCS : 11

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The doctor ordered the following medications:
Medications:
1. Phenytoin, loading dose, 10mg/kg, IV, over 30 minutes, STAT
2. Chlorothiazide, 500mg, IV, STAT
3. Dextrose 5% Water solution, 500ml, IV, over 1 hour

History:
Weakness for the last 3 days. Complains of dizziness when standing and having severe thirst.

Lifestyle factors:

The patient habitually self-medicate. She claimed to have “UTI” due to pain in the abdominal area and
took the spare ofloxacin tabs she had from her previous consultation prescription.

Laboratory results:
Examinations Patient’s Result Normal Value Indication
URINE OSMOLALITY 300 mOsm/Kg
SERUM SODIUM 150 mmol/L

Procedure:
MRI SCAN : Shows brain shrinkage

Source: https://n.neurology.org/content/67/5/880

Case Study Questions:

Initial blood gas was ordered for the patient. Result shows the following:

BLOOD GAS
Parameters Result
Blood pH 7.5
pC02 35
p02 67
HC03 35
02 sat 88

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  Analyze the blood gas result. DETERMINE THE ACID-BASE ISSUE.
 Discuss briefly the CAUSE of the acid-base issue in relation to the case scenario.

Your Tasks:

1. Determine the need for the required laboratory and diagnostic examinations.
 Give the indications for the abnormal result/values
2. Illustrate the organ involved and label accordingly.
3. Discuss the normal function of the organ involved.
4. Explain the pathophysiology based on the diagnosis.
A. Create the pathologic pathway of the pathogenesis (the development of the disease and the chain
of events leading to the illness) contributing to the patient’s illness condition.
B. Synthesize the life-threatening pathway as a consequence of the patient’s refusal / non-
compliance with treatment
5. Answer case study questions.
6. Formulate 2 Nursing Care Plan of according to the case scenario. And this should be based on the
NANDA approved Nursing Diagnosis.
 Give 2 nursing problems (2 NCPs)
 PRIORITIZE the problems and cite your reference/s
7. Develop a Drug Study based on your patient’s medications.

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 EXAMPLE:

A. Pathogenesis of Appendicitis

Fecaliths / Appendicoliths Intraluminal Scarring Tumors Pathogens Other Disease

Obstruction of the Appendiceal Lumen

Bacterial Overgrowth

Inflammation

Subjective Cues: Objective Cues:

1. Periumbilical Pain 1. Localized tenderness
2. Anorexia, Nausea & Vomiting 2. Rebound tenderness
3. Persistent, Continuous Pain in the RLQ 3. Muscle guarding
localized at McBurney’s point 4. Flexed right leg
5. Low grade fever

Resolved through Surgery (Appendectomy)

B. Life-Threatening Pathway (Patient’s refusal / non-compliance with treatment)

 Signs & Symptoms of Over 48 hours

 Without Intervention

PERFORATION

Leak of Content into the Omentum and Surrounding Tissues

COMPLICATIONS

Small bowel obstruction Abscess Formation Peritonitis

Escalating diffuse abdominal pain with rapid development

of toxicity as evidenced by:
1. Dehydration
2. Signs of sepsis
 Oliguria
 Hypotension
 Acidosis
 High-grade fever Page 4 of 12
 2. Nursing Care Plan

NURSING PLANNING
ASSESSMENT IMPLEMENTATION EVALUATION
DIAGNOSIS OBJECTIVE OF CARE INTERVENTION RATIONALE
Deficient fluid Short Term Goal: Independent: The client has achieved
Subjective Cues: volume related to normal vital signs. Urine
 Drinking large extreme thirst as Blood pressure, respiratory rate, Assess vital signs such To evaluate BP went back to normal osmolality and sodium
volumes of water evidenced by and heart rate returns to normal. blood pressure, heart orthostatic blood (120/80 mmhg). RR-20, serum osmolality is in
and dizziness above normal rate and respiratory rate. pressure and 100 bpm. normal ranged. Urine
when standing sodium serum monitor invasive output and input is
up level secondary hemodynamic already stabilized.
 Weakness to diabetes Long term Goal: parameters as
insipidus indicated and to
Client will demonstrate determine degree
stabilized fluid volume at a of intravascular
functional level with balanced deficit and
intake and output. Moreover, replacement needs
resulting to normal sodium
serum level and free of
electrolyte imbalance.

Identify the client with Taking history is The client has diabetes
Objective Cues: current or newly essential to be alert insipidus.
 Above normal diagnosed condition for possibilities of
sodium serum commonly associated electrolyte
level (150 with electrolyte imbalances either
mmol/L) imbalances, such as caused by
 Low urine inability to eat and underlying
osmolality (300 deficiency in taking condition or
mOm/kg) fluids. actually causing
 Blood pressure client’s symptoms.
(BP) :

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 85/60 Intake may be
mmHg Obtain history of usual reduced/increased The client’s significant
 Heart rate pattern of fluid intake because of current other verbalized that
(HR):130beats/ and recent alterations physical or recently the client
min environmental experienced excessive
 Respiratory rate issues thirst and weakness with
(RR):33 dizziness when standing
breaths/min up. Had seizures upon
 Had seizures admission

Assess client’s risk. Very young and The client is 52 year old,
Note the age, and the extremely elderly female.
disease process that may individuals are
lead to electrolyte quickly affected by
imbalances a fluid volume
deficit and are least
able to
express need

Monitor 24-hour urine Urine output may Yellowish urine at 6 am,

output, noting the be clear or 2.5 liters/24 hours.
characteristics of the concentrated Voiding every hour.
urine. (especially
during the day)
because of reduced
renal perfusion.
Patient may void
large volume of
urine than usual.

Monitor urine The patient may Serum osmolality-143

osmolality and serum retain high serum mmol/l
osmolality. osmolality Urine osmolality- 500
accompanied by mOsm/kg
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 low urine
osmolality.

Review client’s to identify The client took ofloxacin

medications, including medications that as treatment for her UTI
prescription and over- can alter fluid and without any prescription.
the-counter drugs, electrolyte balance
herbals, and nutritional
supplements

Note change in usual These may be

mentation, behavior, and signs of impaired The client had no follow up
functional abilities cerebral function seizures after admission.
due to dehydration Weakness is evident.
and electrolyte
imbalances.

Collaboration:
Dehydration is
Collaborate with often categorized Client had hypernatremia
physician to identify or according to serum and diabetes insipidus
characterize the nature sodium
of fluid and electrolyte concentration.
imbalance More than one
cause may exist at
a given time

Fluid used for Hypotonic IV fluids are

Administer fluids and replacement administered to the patient
electrolytes as indicated depends on the (1)
type of
dehydration
present and (2)
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degree of deficit
determined by age,
weight, and type of
trauma or
condition causing
the fluid deficit.

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 Reference/s:
NURSING PLANNING
ASSESSMENT IMPLEMENTATION EVALUATION
DIAGNOSIS OBJECTIVE OF CARE INTERVENTION RATIONALE
Deficient Short term Goals: Independent: The client has readily
Subjective Cues: knowledge The client will participate in accepted the information
 Had been taking related to learning process and exhibit Ascertain level of Client may or may Client expresses previous given and increased her
ofloxacin to treat insufficient increased interest and assume knowledge, including not ask for perception of taking interest in learning about
UTI for the pain information as responsibility for own learning anticipatory needs. information or may unprescribed medication. medication. The client
in abdominal evidenced by by beginning to look express inaccurate asked for more questions
area. unprescribed information and ask question. perceptions of regarding the medication
 Habitually self self-medication health status and and demonstrated the
medicates. Long term Goal: needed behaviors understanding of her
to manage self- condition and disease
Client will demonstrate care process and its
Objective Cues: understanding of condition or appropriate treatment.
 Medication- disease process and its Determine client’s Client may not be The client is mentally and The client is ready to
induced diabetes appropriate treatment by ability and readiness and physically, emotionally capable to change her lifestyle of
insipidus performing necessary procedure barriers to learning. emotionally, or understand the information self-medication without
correctly and explain reasons for mentally capable at and is ready to listen prior visit to physician.
the action. Moreover, the client this time and may
will initiate changes of lifestyle need time to work
regarding the use of medication. through and
express emotions
before learning

Identify significant Providing Educating client’s

others or family appropriate significant other with
members requiring information to medication and treatment
information others can provide regimen
reinforcement for
learning, as

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 everyone will
understand what is
to be expected

Identify motivating Motivation may be The client’s motivating

factors for the individual negative or factor is positive.
positive. Provides
information that
can guide content
specific to client’s
situation and
motivations

Provide information Reducing the Provided basic medical

relevant only to the amount of advices such as seek
situation information at any physician if antibiotics will
one given time be planned to use.
helps to keep the
client focused and
prevents client
from feeling
overwhelmed

Identify information that Enhances Communicated and

needs to be remembered possibility that assessed the client’s
information will be knowledge after the
heard and dissemination of
understood information by
questioning.
State objectives clearly Understanding The client understood the
in learner’s terms to why the material is importance of seeking
meet learner’s important to the medical advice to experts
learner provides rather than doing it
motivation to learn independently

Provide written Reinforces Gave hand outs and written

information/guidelines learning process. points to help the client to
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and self-learning remember important
modules for client to keypoints in medication.
refer to as necessary

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References:
Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2008). Nursing diagnosis manual: Planning, individualizing, and documenting client care. Philadelphia, PA: F.A. Davis.
In Herdman, T. H., In Kamitsuru, S., & North American Nursing Diagnosis Association,. (2018). NANDA International, Inc. nursing diagnoses: Definitions & classification 2018-2020.
Swearingen, P. L. (2008). All-in-one care planning resource: medical-surgical, pediatric, maternity, & psychiatric nursing care plans. 2nd ed. St. Louis, MO: Mosby Elsevier.
Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2019). Nursing care plans: Guidelines for individualizing client care across the life span.

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