Name: Abegail P.

Mier
BSN3-C

Assessment/Cues Nursing Diagnosis Planning Nursing Rationale Evaluation

Intervention
Objective/Cuse Risk for Imbalanced Long-term Goal:  Assess and  Regular monitoring of vital signs  Evaluate the patient's
Fluid Volume related Monitor Vital helps in identifying any fluctuations understanding of
 Vital signs: Blood to the removal of  Patient will Signs or abnormalities in blood pressure, dietary restrictions and
pressure stable, excess fluid during maintain fluid heart rate, and temperature, which their ability to adhere
heart rate within dialysis. balance to the prescribed diet.
can indicate changes in fluid
normal range. within normal  Monitor  Monitor vital signs
limits.
volume. and electrolyte levels
Electrolyte
 Skin is pale and  Dialysis may result in electrolyte to ensure stability and
Levels
cool to touch. Short-term imbalances. Regular monitoring of improvement.
Objectives: electrolyte levels helps in early  Assess the patient for
 Edema is present detection and appropriate any signs of
in the lower  Patient will intervention to prevent dehydration or fluid
extremities. demonstrate  Educate Patient overload.
complications such as muscle
understanding on Dietary Evaluate the
Restrictions cramps and weakness. 
 Lab results of dietary  Dietary restrictions, particularly in effectiveness of
indicate restrictions sodium and potassium intake, are interventions in
electrolyte within the preventing
crucial post-dialysis to prevent fluid
imbalances. next 24 hours. complications such as
 Patient will  Encourage
retention and electrolyte muscle cramps and
exhibit no Fluid imbalances. Patient education weakness.
signs of Monitoring and enhances compliance and self-care.
dehydration Intake  Helping the patient keep track of
within 48 daily fluid intake assists in
hours. maintaining a balance between
hydration and preventing excess
 Assist with fluid accumulation.
Ambulation  Encouraging movement helps
and Position prevent venous stasis and reduces
Changes the risk of fluid accumulation in the
extremities. It also aids in the
prevention of muscle cramps.
Name: Abegail P. Mier
BSN3-C

Generic Classification Mechanism of Indication Contraindication Adverse Effect Nursing Responsibilities

name Action
Generic Alkalinizing Sodium Sodium Hypersensitivity: Metabolic Alkalosis:  Assess Patient's Acid-Base Balance:
Name: agent bicarbonate works bicarbonate is Patients with a Excessive use of Regularly monitor the patient's acid-
Sodium as an alkalinizing used to correct known sodium bicarbonate base balance, including blood pH and
Bicarbonate agent by metabolic hypersensitivity to can lead to metabolic bicarbonate levels, to evaluate the
increasing the pH acidosis, a sodium bicarbonate alkalosis, causing effectiveness of sodium bicarbonate
Brand Name: of body fluids. It condition should not receive symptoms such as therapy.
Citrocarbonate acts as a buffer, characterized this medication. nausea, vomiting,  Monitor Vital Signs: Watch for signs
neutralizing excess by a decrease in Metabolic or muscle twitching, of fluid overload, such as increased
Route: PO acid in the body. the body's pH and hand tremors. blood pressure, edema, and respiratory
Bicarbonate ions due to the Respiratory distress.
combine with accumulation of Alkalosis: Sodium Fluid Retention:  Administer Medication as Prescribed:
hydrogen ions to acids. bicarbonate is Sodium bicarbonate Follow the prescribed dosage and
form water and contraindicated in may lead to fluid administration schedule carefully.
carbon dioxide, conditions where retention, especially Intravenous administration should be
promoting the the body already in patients with heart done slowly to avoid adverse
excretion of has an excess of failure or renal reactions.
hydrogen ions in bicarbonate or is in impairment.  Educate the Patient: Provide patient
the urine. a state of lkalosis. education regarding the importance of
adhering to the prescribed dosage and
any dietary restrictions to help
maintain acid-base balance.
 Monitor for Signs of Adverse Effects:
Be vigilant for symptoms of metabolic
alkalosis, such as changes in mental
status, muscle weakness, and
respiratory changes.
 Evaluate Renal Function: Assess renal
function regularly, especially in
patients with pre-existing renal
conditions, as sodium bicarbonate is
excreted by the kidneys.