Answer

Rob Fran Case Study

One of the primary responsibilities of registered nurses in the hospital settings is the delivery of hands-on care to patients via the assessment of the patient’s conditions, planning, and implementation of care, and the provision of patient education. Additionally, according to LeMone et al. (2014), registered nurses are tasked with the management of intravenous lines and the observation and monitoring of patients’ conditions. In the case of Rob Fran, dehydration has resulted in acute kidney injury. Although he has been transferred to the medical ward because of increased urine output, a need arises for the registered nurse to measure and maintain fluid balance. This paper provides a discussion of the nursing assessments that a registered nurse can do on Fran, how nursing care can be planned and implemented and the nature of patient education which should be offered to the patient.

Nursing Assessment

Fluid Assessment

Fluid assessment on Mr. Fran will entail the evaluation of his hydration status and the measurement of fluid balance which will result in actions being taken to ensure optimal hydration. The fluid assessment will aim to measure the balance of the input and output of fluids in his body which will allow for the proper functioning the metabolic processes. Notably, one of the issues that Mr. Fran faced when he was being admitted in the hospital was acute kidney injury resulting from dehydration. As such, the fluid assessment will be vital in evaluating the fluid balance as the presence of inadequate fluid or excessive fluid can adversely affect the renal function and cardiac functions (Prowle, Kirwan, & Bellomo, 2014). In the case of Mr. Fran, I would conduct the fluid assessment via capillary refill time and renal output and input. In specific, I will hold Mr. Fran’s hand at heart level and press on the pad of his middle finger for five seconds. I will then release the pressure and measure the time in seconds until the return of the normal body color. In the renal output and input, I will assess the volume of water he takes against the urine including its color and odor.

Cardiovascular Assessment

A cardiovascular examination will be vital for Mr. Fran is ensuring a healthy heart. Although the cardiovascular examination did show any abnormal pulse rates and rhythms nor were there any abnormalities detected in heart auscultation, his hypertensive condition will require a regular review of the heart. The primary goal of cardiovascular assessment will be to measure the heart sounds (auscultation) and pulse rate. Notably, according to Ostermann and Joannidis (2016), chronic kidney disease is one of the markers of cardiovascular risks. As such, there is a probability that Mr. Fran’s heart health is affected. Assessing his cardiovascular will seek to establish whether it has been affected by acute kidney injury. The assessment will be done via listening to the heart sound with a stethoscope. Additionally, the basic heart sound auscultation will be performed in the chest rates of the aortic, pulmonic, tricuspid, and mitral (Jin et al., 2017). Afterward, I will conduct a patient interview for any pain the chest which could be a manifestation of ischemia.

Urinalysis

Conducting urinalysis on Mr. Fran will have the primary goal of screening for diabetes especially the insulin levels as well as any kidney disorders and injuries, liver problems, and urinary tract infections. Notably, Mr. Fran’s specific gravity is 1.030 which means that he is experiencing mild dehydration. According to Schley et al. (2015), dehydration of more than 1.010 can lead to the formation of kidney stones and urinary tract infections which can result in renal damage. As such, a urinalysis will be vital to examine kidney health. Moreover, a urinalysis will be used to measure the electrolyte balance (Ostermann & Joannidis, 2016). I will collect of Mr. Fran’s urine, observe the urine color and odor, and then use the test stripes to establish any revealing findings from the urinalysis test.

Plan and Implement Nursing Care

In the nursing problem of imbalanced fluid intake, the following are the nursing actions/interventions which I would implement to manage the problem in Mr. Fran:

Regularly Offer of Fluids

To ensure that Mr. Fran does not continue to suffer from hydration, the regular provision of fluids such as water will be vital. Proper fluid intake today makes patients stay hydrated and thus avoid some of the issues/concerns such as renal failure, and imbalances in the potassium and sodium electrolytes (Ostermann et al., 2015).

Regularly Replenish and Refresh of Fluid Supplies

One of the probable causes of Mr. Fran failing to have a proper fluid balance is the absence of fluid supplies such as fruits juices, sports drinks, and even milk. As such, regularly replenishing him with fluid supplies will provide him with an opportunity to choose from among the many provided depending on his taste and preference (Vanmassenhove et al., 2017).

Use of Beverage Carts

The use of a beverage cart will provide Mr. Fran with a wide variety of fluid choices from which he can choose which one he will favor. Studies have demonstrated that the use of beverage carts results in a significant increase in fluid in each of the body compartments as well as the increased urine output (Ostermann et al., 2015).

Identify Anorexia

It will be vital to identify any instances of anorexia as it can lead to the patient limiting the amount of food and fluid that he takes. Anorexia monitoring can prevent hydration and protect the heart through a balance of fluid intake in the body (Wilson, 2014).

Provide Ice-Blocks and Other Fluid-Rich Foods

Mr. Fran might not be comfortable with taking water because he is feeling nauseated. As such, providing ice blocks which are fluid rich can ensure that he has an alternative source of fluid (Carrero et al., 2016). Ice blocks have been found to result in increased hydration and thus better renal health.

Use Visual Reminders

The fact that Mr. Fran may not be a fan of fluid intake can be cured via the use of reminders to drink such as posters. Today, according to Vanmassenhove et al. (2017), using posters reminds and convinces the patient about the importance of fluid intake and thus increases their consumption of fluids.

Assess Both Presence and Location of Edema

The dynamic interactions of blood hydrostatic and osmotic pressures, as well as interstitial fluid hydrostatic, may lead to a shift in body fluid from one compartment to the next. Prowle, Kirwan, and Bellomo (2014) state that assessing and finding edema will signify a need to minimize the fluid intake.

Monitor Fluid Intake and Output

I will monitor the amount of fluid taken by Mr. Fran (in millimeters) and the urine output to establish whether vast amounts of fluid are being retained in the body. Fluid intake and output monitoring will prevent the absorption of excess fluids and thus attain a balance in fluids and electrolytes (Wilson, 2014).

Weigh Mr. Fran Daily

I will have to weight Mr. Fran daily and compare the weight with the 24-hour intake and of fluids and renal output. Comparing the weight against the input and output will provide a reflection of intravascular volume and thus lead to a decrease or increase in fluid intake (Clark et al., 2016).

Monitor Vital Signs and Central Venous Pressure

Some of the vitals signs such as temperature elevation of orthostatic hypotension will be monitored every day as they will tell the degree of fluid deficit. Wilson (2014) argues that any presence of fever will increase metabolism and thus exacerbate the loss of fluids and increase dehydration.

Monitor Blood Pressure

Any sudden or marked elevation of blood pressure, restlessness, frothy sputum, and basilar crackles will be monitored especially because other fluid supplements will be used in general fluid replacement. Low blood pressure could be a demonstration of the presence of dehydration which would then call for increased fluid intake (Prowle, Kirwan, & Bellomo, 2014).

Ascertain Mr. Fran’s Beverage Preferences

After establishing the beverage that Mr. Fran prefers, a 24-hour schedule for fluid intake will be set up, and the client will be required to take foods with high fluid concentration. Such an action will not only relive thirst but also augment any parental replacement (Wilson, 2014).

Evaluate Mr. Fran’s Ability to Manage Own Hydration

Some of the impediments which might hinder the ability of Mr. Fran to hydrate include impaired gag and swallow reflexes, oral discomfort, and nausea. As such, establishing these factors can lead to appropriate actions being taken to increase or replace the fluids orally (Ostermann et al., 2015).

Provide Safety Precautions

The dehydration of Mr. Fran and the fact that he collapsed at work requires safety precautions such as the use of side rails, positioning the bed in a low situation, frequent observations, and any soft restraints. According to Greer et al. (2016), safety precautions will be protective measures against any injury to the client due to any altered thought processes arising from decreased cerebral perfusion.

Administer IV Solutions

I would give Mr. Fran colloids or isotonic solutions depending on whether he requires increased fluid or decreased one in the body. Notably, Prowle, Kirwan, & Bellomo (2014) argue that colloids such as Hespan and Dextran will correct any deficit in plasma protein concentration. However, isotonic solutions will be used if a need will be found for circulatory improvement. However, it may also result in increased renal clearance.

Monitor Mr. Fran for Complications

One of the issues which will arise during the nursing care is that Mr. Fran will be a risk of the relapse of some symptoms such as confusion and even fainting. As such, according to Murugan et al. (2016), monitoring any complications will be vital for the nurse. In specific, close surveillance of the patient will prevent any complications being an unnoticed and reduce the likelihood of adverse events.

Task 3: Patient Education

Mr. Fran will require education on acute kidney injury as well as maintenance of renal function and discharge. I will ensure that he learns about the definition of severe kidney injury, causes of the injury, symptoms, and when to call a doctor or a nurse. In this case, will educate Mr. Fran that the signs that he has such as vomiting, acting confused, and seizures are some of the symptoms of kidney failure (Ostermann et al., 2015). Additionally, I will endeavor to explain to him the actions that he should take to ensure that his renal function improves. One of those will be taking a lot of water and ensuring that he is hydrated in most of the times. Additionally, I will make him understand the need for change in diet as well as the medications which will be provided to him.

To help Mr. Fran maintain and improve his renal function after discharge, I will include management strategies such as drinking fluids as necessary and keeping a record of everything that he eats and drinks. Additionally, I will educate him on the importance of measuring the amount of urine each day, weighing himself, and keeping a record of the daily weights (Greer et al., 2016). Moreover, I will ensure that Mr. Fran learns how to take her temperature every day as well as blood pressure and keep records of the same. Mr. Fran will also be informed about the importance of maintaining good personal hygiene, taking the medications as directed, and the need for frequent blood and urine tests to monitor the kidney function. I will educate him that he should call the doctor right away if he encounters signs of bladder infection such as frequent urination, burning, and pain, as well as bleeding.

The information I have provided in the paragraph above will be vital in ensuring that Mr. Fran understands the condition he is in and how he can improve his renal functions and thus ensure a quick recovery. Educating him on the activities and actions that he should take will ensure that he does not exacerbate the situation by worsening the acute kidney injury (Sawhney, Marks, & Black, 2016). Additionally, the management strategies will be vital in making sure that he continues to monitor the condition even after discharge (LeMone et al., 2014). Moreover, educating him about the vital signs that should make him call a doctor will be critical so that an alarm will be raised in advance and any issues addressed. Patient education will be a fundamental aspect in this case for the patient to continue with the care actions and interventions after discharge.