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    PUCAN, Julienne BSN III-D - NCP - HYPO&HYPERCHLOREMIA

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    Julienne Pucan
    This document contains a nursing care plan for a patient diagnosed with hypochloremia. The nursing diagnosis is fluid volume deficit related to low chloride levels as evidenced by dehydration, vomiting, weakness, fast breathing, and low blood pressure. The nursing goal is for the patient to regain hydration and strength and avoid further vomiting within 8 hours. Interventions include monitoring fluid intake and output, vital signs, electrolytes, and educating the patient on preventing dehydration. After 8 hours, the patient was able to explain treatment measures and demonstrated hydration, absence of symptoms, regained strength, and improved blood pressure.

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    PUCAN, Julienne BSN III-D - NCP - HYPO&HYPERCHLOREMIA

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    Julienne Pucan
    63 views2 pages
    This document contains a nursing care plan for a patient diagnosed with hypochloremia. The nursing diagnosis is fluid volume deficit related to low chloride levels as evidenced by dehydration, vomiting, weakness, fast breathing, and low blood pressure. The nursing goal is for the patient to regain hydration and strength and avoid further vomiting within 8 hours. Interventions include monitoring fluid intake and output, vital signs, electrolytes, and educating the patient on preventing dehydration. After 8 hours, the patient was able to explain treatment measures and demonstrated hydration, absence of symptoms, regained strength, and improved blood pressure.

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    PUCAN, Julienne BSN III-D_NCP_HYPO&HYPERCHLOREMIA

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    This document contains a nursing care plan for a patient diagnosed with hypochloremia. The nursing diagnosis is fluid volume deficit related to low chloride levels as evidenced by dehydration, vomiting, weakness, fast breathing, and low blood pressure. The nursing goal is for the patient to regain hydration and strength and avoid further vomiting within 8 hours. Interventions include monitoring fluid intake and output, vital signs, electrolytes, and educating the patient on preventing dehydration. After 8 hours, the patient was able to explain treatment measures and demonstrated hydration, absence of symptoms, regained strength, and improved blood pressure.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    63 views2 pages

    PUCAN, Julienne BSN III-D - NCP - HYPO&HYPERCHLOREMIA

    Uploaded by

    Julienne Pucan
    This document contains a nursing care plan for a patient diagnosed with hypochloremia. The nursing diagnosis is fluid volume deficit related to low chloride levels as evidenced by dehydration, vomiting, weakness, fast breathing, and low blood pressure. The nursing goal is for the patient to regain hydration and strength and avoid further vomiting within 8 hours. Interventions include monitoring fluid intake and output, vital signs, electrolytes, and educating the patient on preventing dehydration. After 8 hours, the patient was able to explain treatment measures and demonstrated hydration, absence of symptoms, regained strength, and improved blood pressure.

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    MARIANO MARCOS STATE UNIVERSITY

    College of Health Sciences

    JULIENNE PUCAN BSN III-D


    NCP FOR HYPOCHLOREMIA
    Nursing Diagnosis: Fluid volume deficit related to low chloride level as evidenced by
    dehydration, prolonged vomiting, weakness, tachypnea and blood pressure of 90/60 mmHg
    Nursing Inference: Chloride is an electrolyte that helps move fluid in and out of the cells. It
    works with other electrolytes, such as sodium and potassium, to help balance acids and
    bases in the body. If chloride levels drop, you becomes sick and dehydrated. In addition,
    hypochloremia occurs when there's a low level of chloride in the body. It can be caused
    by fluid loss through nausea or prolonged vomiting involving a loss of chloride in excess of
    sodium or by existing conditions, diseases, or medications.

    Nursing Goal: After 8 hours of nursing interventions, the patient will be able to explain
    measures that can be taken to treat or prevent fluid volume loss, demonstrates hydration,
    absence of vomiting and tachypnea, regain strength and blood pressure of 110/70 mmHg.

    Nursing Intervention

    Intervention Rationale
    Monitor urine output. Measure or estimate Fluid replacement needs are based on
    fluid losses from all sources such as gastric the correction of current deficits and
    losses ongoing losses
    Monitor vital signs and intake and output To determine patient’s status and the
    effectiveness of treatment
    Review nutritional issues (e.g., intake of Imbalances in these areas are associated
    sodium, chloride, potassium, and protein) with fluid imbalances
    Monitor laboratory studies as indicated Depending on the degree of fluid loss,
    differing electrolyte and metabolic
    imbalances may be present and require
    correction
    Ascertain client’s beverage preferences and To promote hydration
    encourage foods with high fluid content
    such as watermelon
    Encourage patient to avoid food that cause To prevent further dehydration
    dehydration such as coffee and tea
    Enumerate interventions to prevent or A patient needs to understand the value of
    minimize future episodes of dehydration drinking extra fluid to prevent fluid deficits
    Educate patient about possible causes and Enough knowledge aids the patient in
    effects of fluid loss or decreased fluid intake taking part in their plan of care
    Emphasize the relevance of maintaining Increasing the patient’s knowledge level
    proper nutrition and hydration will assist in preventing and managing the
    problem
    Teach family members how to monitor An accurate measure of fluid intake and
    output in the home. Instruct them to output is an important indicator of a
    MARIANO MARCOS STATE UNIVERSITY
    College of Health Sciences
    monitor both intake and output patient’s fluid status
    Refer to dietician as needed To  develop dietary plan and identify foods
    to be included or omitted
    Administer medication such as diuretics Help you replenish fluids and electrolytes
    that you lose when taking diuretics, thus
    helping you avoid dehydration

    Nursing Evaluation
    After 8 hours of nursing interventions, the patient were able to explain measures that can
    be taken to treat or prevent fluid volume loss, demonstrated hydration, absence of vomiting
    and tachypnea, regained strength and blood pressure of 110/70 mmHg

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