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    Kyla Mae Zabala
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    Dolores, a 35-year-old woman, was experiencing weakness and inability to tolerate fluids due to nausea and vomiting. She was diagnosed with fluid volume deficiency due to hypertonic dehydration, as indicated by elevated serum sodium, increased urine specific gravity, and inability to react to thirst. The nursing care plan included monitoring vital signs, administering IV fluids and electrolytes under supervision, and collaborating with other departments to check urine and stool. The short-term goal was for Dolores to show improvement in strength and ability to respond to thirst within 48 hours. The long-term goal was for her to return to her baseline health with no further signs of dehydration after a week of observation.

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    Dolores, a 35-year-old woman, was experiencing weakness and inability to tolerate fluids due to nausea and vomiting. She was diagnosed with fluid volume deficiency due to hypertonic dehydration, as indicated by elevated serum sodium, increased urine specific gravity, and inability to react to thirst. The nursing care plan included monitoring vital signs, administering IV fluids and electrolytes under supervision, and collaborating with other departments to check urine and stool. The short-term goal was for Dolores to show improvement in strength and ability to respond to thirst within 48 hours. The long-term goal was for her to return to her baseline health with no further signs of dehydration after a week of observation.

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    4 views2 pages

    NCP-Drug-Study K

    Uploaded by

    Kyla Mae Zabala
    Dolores, a 35-year-old woman, was experiencing weakness and inability to tolerate fluids due to nausea and vomiting. She was diagnosed with fluid volume deficiency due to hypertonic dehydration, as indicated by elevated serum sodium, increased urine specific gravity, and inability to react to thirst. The nursing care plan included monitoring vital signs, administering IV fluids and electrolytes under supervision, and collaborating with other departments to check urine and stool. The short-term goal was for Dolores to show improvement in strength and ability to respond to thirst within 48 hours. The long-term goal was for her to return to her baseline health with no further signs of dehydration after a week of observation.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    of 2

    NURSING CARE PLAN

    Assessment Nursing Diagnosis Planning Intervention Rationale Evaluation

    Fluid Volume Short-term Goal: Independent: • To check and After a week of


    Subjective: observe the careful
    Deficiency is After 48 hrs of • Monitor the vital patient condition. observation, the
    • 35y/o Female associated intervention and signs from time to And to know if patient was able
    • Weakness with monitoring, Dolores time check if there’ the patient is to regain her
    • Unable to tolerate hypertonic should show s no more back to her usual energy
    fluid intake because dehydration improvement in her complication previous state. levels and
    of nausea & as indicated strength, • Make an accurate • Medtech team tolerate fluids
    vomiting. particularly in her intake and output can help without any signs
    by: elevated
    ability to respond to records examine the of dehydration.
    serum sodium and satisfy her patient’s urine She is now free
    levels, thirst. Additionally, Dependent: and stool. from any
    Objective: increased her serum sodium • We need to potential risks of
    • Elevated serum urine specific and urine specific • Give a IV fluids replace the lost dehydration.
    sodium:155 meq/l gravity, and gravity levels and electrolytes fluid volume due
    • High blood incapacity to should return to If prescribed by to nausea by
    pressure react to thirst their normal ranges. your physician. providing her
    (hypertension) reflex . with fluids under
    130/90 Collaborative: supervision.
    • Elevated urine Long-term Goal:
    specific gravity: After a week of • Collaborate to
    1.0357 close observation, medtech
    Dolores should be department to
    able to return to her check urine and
    baseline health and stool of the patient
    he should be able
    to return to her
    usual state with no
    further signs of
    dehydration.
    Situation: Dolores Wellbeing, a 35 yr old sales lady, reports weakness, and flu-like symptoms for 3-4 days. Although thirsty,
    she is unable to tolerate fluids because of nausea and vomiting, and she has liquid stools 2-4 times per day.

    Physical Exam
    Ht: 5’3
    Wt: 166lbs
    Temp: 38.6
    PR: 86BPM
    RR: 24CPM
    BP: 130/90
    Diagnostic Data
    Urine specific gravity: 1.0357
    Serum Sodium: 155meq/ L
    CXR: negative

    Formulate a Nursing Care Plan based on this situation. Give rationale to every interventions. You can use NANDA as your
    guide in formulating.

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