Case Presentation

Female Ward
I. Introduction:
A mental disorder, also called a mental illness or psychiatric disorder, is
a mental or behavioral pattern or anomaly that causes either suffering or an impaired ability to
function in ordinary life (disability), and which is not developmentally or socially normative. Mental
disorders are generally defined by a combination of how a person feels, acts, thinks or perceives.
This may be associated with particular regions or functions of the brain or rest of the nervous
system, often in a social context. Mental disorder is one aspect of mental health.

The study of a patient with Incarcerated Inguinal Hernia has been chosen by this group for its
significance and connection to us third year level students who are studying Medical Surgical
Nursing. The study of its occurrence, medical and nursing management along with the
responsibilities, causation and possible complications, advantage and disadvantage would provide
better understanding on how our responsibilities as soon-to-be nurses should be, by gaining
knowledge, skills and learning through hands-on experiences, observation through the use of critical
thinking skills and patient centered interaction and assessments.

II. Purpose/ Objective:
Learning Goal Student Centered Client Centered
Skills To be able to perform the
nursing skills learned in school
into real life situation such as
1. Providing safety and
maintaining privacy
2. Giving medications
following the rights of
medication
administration
3. Giving holistic care and
other necessary nursing
interventions needed for
the patient.
To be able to perform
1. Independent nursing skills
such as providing comfort ,
maintaining privacy,
monitoring, and keeping the
safety of the patient .
2. Dependent nursing actions
such as giving due
medications.
Knowledge To be able to familiarize self
about the disorder: Mental
and Behavioral Disorder
secondary to Brain Disease
To be able to identify the
different signs and symptoms
of the disease.
To educate patient regarding
his condition, hence be able to
provide awareness regarding
the management of the
disease.
Attitude To be able to develop an
optimistic outlook towards
providing holistic care of
patient.
To be able to act
professionally with the
To be able to give the patient
the holistic care needed
throughout the duty hours.
supervision of our clinical
instructor.

To be able to provide support
during the treatment process.



III. Biography :
Name: Patient G
Age: 39 years old
Sex: Female
Birthdate: July 6, 1974
Birthplace: Lubao Pampanga
Marital Status: Single
Address: #337 Purok II A San Rafael Baruya Lubao, Pampanga
Occupation: None
Religion: Roman Catholic
Room: Female Ward I
Date and time of Admission: December 13, 2013; 4:25pm
Admitting Diagnosis: Mental Retardation with Psychosis in Relapse/Manageable
Final Diagnosis: Mental and Behavioral Disorder secondary to Brain Disease

IV. Chief Complaint:
Impaired sleep for 3 nights as verbalized by her sister.

V. History of Present Illness:
Patient G had several confinements at Mariveles Mental Hospital, she was
discharged last June 2013 and had follow-up at the OPD. She was last seen at the OPD
on the 1
st
week of December. 3 days prior to consultation, she had poor sleep and then
2 days prior to consultation, she asked her sister to bring her in MMH but requested for
her to wait until she finds money. Yesterday, she started singing aloud with unstable
mood.

VI. Past Medical History:
Patient G was confined in a district hospital in their town

VII. Past Surgical History:
Unknown.

VIII. Allergies/ Medications:
He has no allergies to any foods and medications given to her upon hospitalization.
The following are the medications given upon hospitalization as ordered by the Physician:
Haloperidol 5mg OD
Carbamazepine 200mg OD
Chlorpromazine 200 mg HS
Diphenhydramine 50mg HS/PRN

IX. Smoking, Alcohol, Substance Abuse :
She is not a smoker, not an alcoholic and not a substance abuse person as stated by
the patient.

X. Social/ Work History:
She has not engaged in any social/work history due to her illness since 5 years old.

XI. Family History:
According to her sister, her mother has several confinements at NCMH due to
nervous breakdown and her auntie is also a patient at MMH.

XII. Review Of System:

Anatomy of the Nervous System
If you think of the brain as a central computer that controls all bodily functions, then the nervous system
is like a network that relays messages back and forth from the brain to different parts of the body. It
does this via the spinal cord, which runs from the brain down through the back and contains threadlike
nerves that branch out to every organ and body part.
When a message comes into the brain from anywhere in the body, the brain tells the body how to react.
For example, if you accidentally touch a hot stove, the nerves in your skin shoot a message of pain to
your brain. The brain then sends a message back telling the muscles in your hand to pull away. Luckily,
this neurological relay race takes a lot less time than it just took to read about it.
Considering everything it does, the human brain is incredibly compact, weighing just 3 pounds. Its many
folds and grooves, though, provide it with the additional surface area necessary for storing all of the
body's important information.
The spinal cord, on the other hand, is a long bundle of nerve tissue about 18 inches long and inch
thick. It extends from the lower part of the brain down through spine. Along the way, various nerves
branch out to the entire body. These make up the peripheral nervous system.
Both the brain and the spinal cord are protected by bone: the brain by the bones of the skull, and the
spinal cord by a set of ring-shaped bones called vertebrae. They're both cushioned by layers of
membranes called meninges as well as a special fluid called cerebrospinal fluid. This fluid helps protect
the nerve tissue, keep it healthy, and remove waste products.




At the most basic level, the function of the nervous system is to send signals from one cell to others, or
from one part of the body to others. There are multiple ways that a cell can send signals to other cells.
One is by releasing chemicals called hormones into the internal circulation, so that they can diffuse to
distant sites. In contrast to this "broadcast" mode of signaling, the nervous system provides "point-to-
point" signalsneurons project their axons to specific target areas and make synaptic connections with
specific target cells.Thus, neural signaling is capable of a much higher level of specificity than hormonal
signaling. It is also much faster: the fastest nerve signals travel at speeds that exceed 100 meters per
second.
At a more integrative level, the primary function of the nervous system is to control the body.It does this
by extracting information from the environment using sensory receptors, sending signals that encode
this information into the central nervous system, processing the information to determine an
appropriate response, and sending output signals to muscles or glands to activate the response. The
evolution of a complex nervous system has made it possible for various animal species to have advanced
perception abilities such as vision, complex social interactions, rapid coordination of organ systems, and
integrated processing of concurrent signals. In humans, the sophistication of the nervous system makes
it possible to have language, abstract representation of concepts, transmission of culture, and many
other features of human society that would not ex Neurotransmitters are the chemicals which allow the
transmission of signals from one neuron to the next across synapses. They are also found at the axon
endings of motor neurons, where they stimulate the muscle fibers. And they and their close relatives are
produced by some glands such as the pituitary and the adrenal glands. In this chapter, we will review
some of the most significant neurotransmitters.

Acetylcholine
Acetylcholine was the first neurotransmitter to be discovered. It was isolated in 1921 by a German
biologist named Otto Loewi, who would later win the Nobel Prize for his work. Acetylcholine has many
functions: It is responsible for much of the stimulation of muscles, including the muscles of the gastro-
intestinal system. It is also found in sensory neurons and in the autonomic nervous system, and has a
part in scheduling REM (dream) sleep.
The plant poisons curare and hemlock cause paralysis by blocking the acetylcholine receptor sites of
muscle cells. The well-known poison botulin works by preventing the vesicles in the axon ending from
releasing acetylcholine, causing paralysis. The botulin derivative botox is used by many people to
temporarily eliminate wrinkles - a sad commentary on our times, I would say. On a more serious note,
there is a link between acetylcholine and Alzheimer's disease: There is something on the order of a 90%
loss of acetylcholine in the brains of people suffering from Alzheimer's, which is a major cause of
senility.
Norepinephrine
In 1946, a Swedish biologist by the name of Ulf von Euler discovered norepinephrine (formerly called
noradrenalin). He also won a Nobel Prize. Norepinephrine is strongly associated with bringing our
nervous systems into "high alert." It is prevalent in the sympathetic nervous system, and it increases our
heart rate and our blood pressure. Our adrenal glands release it into the blood stream, along with its
close relative epinephrine (aka adrenalin). It is also important for forming memories.
Stress tends to deplete our store of adrenalin, while exercise tends to increase it. Amphetamines
("speed") work by causing the release of norepinephrine, as well as other neurotransmitters called
dopamine and seratonin..
Dopamine
Another relative of norepinephrine and epinephrine is dopamine, discovered to be a neurotransmitter in
the 1950s by another Swede, Arvid Carlsson. It is an inhibitory neurotransmitter, meaning that when it
finds its way to its receptor sites, it blocks the tendency of that neuron to fire. Dopamine is strongly
associated with reward mechanisms in the brain. Drugs like cocaine, opium, heroin, and alcohol
increase the levels of dopamine, as does nicotine. If it feels good, dopamine neurons are probably
involved!
The severe mental illness schizophrenia has been shown to involve excessive amounts of dopamine in
the frontal lobes, and drugs that block dopamine are used to help schizophrenics. On the other hand,
too little dopamine in the motor areas of the brain are responsible for Parkinson's disease, which
involves uncontrollable muscle tremors. It was the same Arvid Carlsson mentioned above who figured
out that the precursor to dopamine (called L-dopa) could eleviate some of the symptoms of Parkinson's.
He was awarded the Nobel Prize in 2000.
Recently, it has been noted that low dopamine may related not only to the unsociability of
schizophrenics, but also to social anxiety. On the other hand, dopamine has been found to have
relatively little to do with the pleasures of eating. That seems to involve chemicals such as endorphin
(see below).
GABA
In 1950, Eugene Roberts and J. Awapara discovered GABA (gamma aminobutyric acid), which is also
usually an inhibitory neurotransmitter. GABA acts like a brake to the excitatory neurotransmitters that
lead to anxiety. People with too little GABA tend to suffer from anxiety disorders, and drugs like Valium
work by enhancing the effects of GABA. Lots of other drugs influence GABA receptors, including alcohol
and barbituates. If GABA is lacking in certain parts of the brain, epilepsy results.
Glutamate
Glutamate is an excitatory relative of GABA. It is the most common neurotransmitter in the central
nervous system - as much as half of all neurons in the brain - and is especially important in regards to
memory. Curiously, glutamate is actually toxic to neurons, and an excess will kill them. Sometimes
brain damage or a stroke will lead to an excess and end with many more brain cells dying than from the
original trauma. ALS, more commonly known as Lou Gehrig's disease, results from excessive glutamate
production. Many believe it may also be responsible for quite a variety of diseases of the nervous
system, and are looking for ways to minimize its effects
Glutamate was discovered by Kikunae Ikeda of Tokay Imperial Univ. in 1907, while looking for the flavor
common to things like cheese, meat, and mushrooms. He was able to extract an acid from seaweed -
glutamate. He went on to invent the well known seasoning MSG - monosodium glutamate. It took
decades for Peter Usherwood to identify glutamate as a neurotransmitter (in locusts) in 1994.
Serotonin
Serotonin is an inhibitory neurotransmitter that has been found to be intimately involved in emotion
and mood. Too little serotonin has been shown to lead to depression, problems with anger control,
obsessive-compulsive disorder, and suicide. Too little also leads to an increased appetite for
carbohydrates (starchy foods) and trouble sleeping, which are also associated with depression and other
emotional disorders. It has also been tied to migraines, irritable bowel syndrome, and fibromyalgia.
Vittorio Erspamer first discovered what we now call seratonin in the 1930s. It was found in blood serum
in 1948 by Irvine Page, who named it serotonin (from serum-tonic). Another researcher in Pages lab -
Maurice Rapport - proved that it was an amine (a group of chemicals that include the
neurotransmitters). John Welsh found that it was a neurotransmitter in molluscs in 1954, and Betty
Twarog (also at Page's lab) found it in vertebrates in 1952. All this gives you a sense of the cooperative
nature of most of scientific discovery!
Prozac and other recent drugs help people with depression by preventing the neurons from
"vacuuming" up excess seratonin, so that there is more left floating around in the synapses. It is
interesting that a little warm milk before bedtime also increases the levels of seratonin. As mom may
have told you, it helps you to sleep. Serotonin is a derivative of tryptophan, which is found in milk. The
"warm" part is just for comfort!
On the other hand, serotonin also plays a role in perception. Hallucinogens such as LSD, mescaline,
psilocybin, and ecstasy work by attaching to seratonin receptor sites and thereby blocking transmissions
in perceptual pathways.
Endorphin
In 1973, Solomon Snyder and Candace Pert of Johns Hopkins discovered endorphin. Endorphin is short
for "endogenous morphine." It is structurally very similar to the opioids (opium, morphine, heroin, etc.)
and has similar functions: Inhibitory, it is involved in pain reduction and pleasure, and the opioid drugs
work by attaching to endorphin's receptor sites. It is also the neurotransmitter that allows bears and
other animals to hibernate. Consider: Heroin slows heart-rate, respiration, and metabolism in general -
exactly what you would need to hibernate. Of course, sometimes heroin slows it all down to nothing:
Permanent hibernation.
ist without the human brain.























GASTROINTESTINAL SYSTEM















































XIII. Psychopathology

Non-Modifiable Factors
- Age (5 months)
- Gender (Female)
-Genetic Factors

Modifiable Factors
- Environment
- Poor Hygiene
- Malnutrition
Streptococcus
Pneumoniae
Nasopharyngeal Implantation
Enters the blood From wounds
Invades the CNS
Inflammation of meninges
Infection
Brain Parynchema
Pia Mater
Arachnoid & Subarachnoid space
Increase in one component of the brain

Increased ICP
Bacterial Meningitis
- Fever
- Irritability
- Poor
Sucking
Reflex

- Bulging Anterior
Fontanels
- Vomiting
- Increased ICP
- Altered Level of
Consciousness


If Treated:

- Early Diagnosis &
Prompt Treatment
- Antibiotics
- Antipyretics
- Analgesics
- Corticosteroids /
Anti-inflammatory
agents
- Anti-emetics
- Avoid cooling too
much
- Place in a quiet &
dark environment
If Not Treated
Seizures
Thrombophlebitis of veins and
venous sinuses
Congestion and infarction
of surrounding tissue

Adhesion Formation
Cranial nerve palsies

Visual or auditory impairment

Sepsis

Coma
Death
Poor Prognosis
Delayed
Treatment

Memory
Impairment
Profound learning
disabilities
Early
Treatment
Good
Prognosis
XIV. Mental Status Examination
Seen this adult female wearing lavender colored blouse and denim pants.
Behaved, irrelevant with her responses.
Claimed that she was with her Ate and stated the name of her nephew.
Claimed that she is single.
She was quite unsure with her mothers name Marlyn daw and volunteered hindi
ako sasaktan ni mama and later said magpapahinga na ako.

XV. Physical Examination :
PHYSICAL ASSESSMENT
I. Vital Signs
Temperature
Pulse Rate
Respiratory Rate
Blood Pressure
Actual Findings
37.1 degree celsius
74 beats per minute
22 cycles per minute
120/90 mmHg
II. Level of Consciousness Conscious and Coherent

III. BODY PARTS NORMAL FINDINGS ACTUAL FINDINGS Explanation
A. GENERAL
APPEARANCE
With normal weight,
afebrile,
proportionality and
symmetry
The body parts are
proportional to each
other.
Normal Findings
B. SKIN The color depends on
race, ethnic
background,
complexion, sun
exposure, and
pigmentation
tendencies.
With brown skin
complexion, no
pigmentations noted.

Lesion due to wound
from scratching

The patients skin is
normal.



She has scabies infection.
C. HAIR Grows well, properly
tied, no hair loss, with
proper hair
distribution
With proper hair
distribution.

With scar on her left
parietal area.
Normal findings


Someone poke her with a
sharp thing on her head.
D. NAILS Clean and pink in
appearance.
Clean in appearance. Normal Findings
E. SKULL AND
HEAD
Normal cephalic,
symmetrical facial
structure, absence of
tenderness over the
maxillary sinuses.
With symmetrical
facial structure and no
tenderness.

Scar on the left side of
her face.
Normal Findings



Unknown
F. EYES Normal vision of
20/20
Normal vision of
20/20
Normal Findings
G. EARS Hears clearly Can hear clearly Normal Findings
H. NOSE AND
SINUSES
Straight Nasal septum,
no discharge present,
With straight nasal
septum, no discharge
Normal Findings
airway is patent,
mucous membranes
are pink, no swelling.
present, airway is
patent, mucous
membranes are pink,
no swelling.
I. MOUTH Lips are moist and
pink, no masses, gums
are pink and smooth,
The tongue is midline
and without any
hoarseness of voice.
Lips are moist and
pink, no masses.
The tongue is midline
and no hoarseness of
voice

Normal findings





J. NECK With normal range of
motion, can turn the
head against force of
the hand, no swelling.
With normal range of
motion, no swelling
noted and can turn his
neck left and right.
Normal findings
K. THORAX AND
LUNGS
There is no
tenderness, chest
movement should be
symmetric and
without lag or
impairment. With
normal lung sounds
There is no
tenderness, chest
movement should be
symmetric and
without lag or
impairment. With
normal lung sounds).
Normal Findings
L. HEART No palpitations,
normal PR should be
60- 100 in adult
No palpitations.
Pulse rate within
normal rate (84 beats
per minute)
Normal findings
M. BREAST AND
AXILLA
Absence of pain,
lumps, discharge, or
any surgery.
No pain, lump,
discharge seen.
Normal findings
N. UPPER
EXTREMETIES
Extremities should be
symmetrical and the
skin is warm without
any fracture.
No fracture
proportional
Normal findings
O. LOWER
EXTREMRTIES
Hair covers the legs,
the venous pattern is
normally visible, both
legs are symmetrical
and without any
swelling.
No swelling, fracture,
and symmetrical


Normal findings




P. GROSS MOTOR
FUNCTIONS
Gross motor skills
involve the large
muscles of the body
that enable such
functions as sitting
upright, lifting, and
throwing a ball.
Can hold large objects


Normal Findings
Q. FINE MOTOR
TEST
Fine motor skills
involve the small
Can write and grasp
small objects
Normal Findings
muscles of the body
that enable such
functions as writing,
grasping small objects,
and fastening
clothing.
R. SENSORY
FUNCTION
With normal senses.
Can see clearly, can
hear accurately, no
altered taste, can
smell normally.
Can hear clearly, no
alteration in taste and
smell.

S. ABDOMEN The contour of the
abdomen is usually
flat and rounded; the
skin surface is smooth,
and even with
homogenous color
and good skin turgor.
Uniform in color and
no presence of
tenderness.

Normal Findings


XV. Diagnostic and Laboratory Test:

Hematology Result NORMAL VALUES ANALYSIS / INTERPRETATION
01/25/12 Normal Findings
Hemoglobin 122 M- 130-180g/L
F- 120-160g/L
Normal Findings
Hematocrit 0.39 M- 0.40-0.54
F- 0.37-0.47
Normal Findings
WBC 6.7 5-10x10
9
/L Normal Findings
Segmenters 0.57 0.45-0.65 Normal Findings
Lymphocytes 0.28 0.20-0.35 Normal Findings
BT 2 mins,32 sec 2-5 minutes Normal Findings
CT 5mins,20 sec 5-15 minutes Normal Findings
Urinalysis Yellowish clear
No pus cells
present
No RBC present
Yellowish clear
No pus cells
present
No RBC present

Normal Findings
Hematology Hematocrit:
0.37-0.47
Hemoglobin:
120-150

Hematocrit:
0.40
Hemoglobin:
130

Normal Findings


XVI. Course in the Ward:


COURSE IN THE WARD
May 14, 2014

Haloperidol 5mg OD
Carbamazepine 200mg OD
Chlorpromazine 200 mg HS
Diphenhydramine 50mg HS/PRN
Morning care done.
Exercise therapy, play therapy, family tree, song therapy, and bibliography
(proverbs) done.

May 15, 2014

Haloperidol 5mg OD
Carbamazepine 200mg OD
Chlorpromazine 200 mg HS
Diphenhydramine 50mg HS/PRN
Morning care done.
Dance therapy, music and art therapy, and bibliography (riddle) done.

May 16, 2014

Haloperidol 5mg OD
Carbamazepine 200mg OD
Chlorpromazine 200 mg HS
Diphenhydramine 50mg HS/PRN
Morning care done.
Phototherapy done.



XVII. Psychopharmacology

PHARMACOLOGIC TREATMENT
Date Generic/ Trade
name
Dosage/
Frequency
/ Route
Classification Indication Contraindic
ation
Side
Effects
Nursing
Responsi
bility
7-14-
13
Omeprazole
(Mefracid)

20mg 1tab
OD PO
Belongs to the
class of proton
pump inhibitor
It is used in
the
treatment
of
Duodenal
ulcer,
Gastric
ulcer, reflux
oesophagiti
s,
Indigestion
and
It is
contraindic
ated in
persons
with
hypersensiti
vity to the
drug,
neonates
and during
lactation.
Possible
side
effects:
breathing
difficulty,
nausea,
fever,
weakness,
and
diarrhea.
Instruct
the
patient
to take
the
medicati
on using
the rights
of
medicati
on
administr
stomach
discomfort
ation
such as
right
time,
right
dose,
right
route.
6-21-
13
Metoclopramide 10mg/2ml
TID
It belongs to a
group of
medicines
called
dopaminergic
blockers.
Metoclopra
mide is
used short-
term to
treat
heartburn
caused by
gastroesop
hageal
reflux.
It is also
used to
treat slow
gastric
emptying in
people with
diabetes
(also called
diabetic
gastropares
is), which
can cause
nausea,
vomiting,
heartburn,
loss of
appetite,
and a
feeling of
fullness
after meals.
Metoclopra
mide is
contraindic
ated
in pheochro
mocytoma.
Patients
who
take antipsy
chotics are
recommend
ed not to
take
metoclopra
mide.

Possible
Side
effects:
drowsines
s,
excessive
tiredness,
weakness,
headache,
dizziness,
diarrhea,
nausea
and
vomiting.
akathisia,
and focal
dystonia
.
Instruct
the
patient
to take
the
medicati
on using
the rights
of
medicati
on
administr
ation
such as
right
time,
right
dose,
right
route.
7-14-
13
Cefuroxime

500mg 1tab
TID PO
Cefuroxime is a
semisynthetic
cephalosporin
antibiotic(2
nd

generation),
chemically
similar to
For
respiratory
tract
infections,
meningitis,
gonorrhea,
surgical
Hypersensit
ivity to
cephalospor
ins.

Possible
side
effects:
Large
doses can
cause
cerebral
Instruct
the
patient
to take
the
medicati
on using
penicillin

prophylaxis
and for
susceptible
infections
irritation
and
convulsio
ns;
nausea,
vomiting,
diarrhea,
GI
disturbanc
es;
erythema
multiform
e,
epidermal
necrolysis.
the rights
of
medicati
on
administr
ation
such as
right
time,
right
dose,
right
route.

XVIII. Nursing Care Plan

Assessment Nsg. Dx Scientific
Explanation
Planning Intervention Rationale Evaluation
Subjective:

As
verbalized
by the
patient


Objective:
Poor
skin
turgor
Dry skin
Dry lips

Deficient
fluid
volume
related to
impaired
water
absorption
as
manifeste
d by poor
skin turgor
After 8
hours of
nursing
interventio
n the
patient will
show
improveme
nt on the
objective
assessment

Goal:
Independent:
Monitor
vital signs

Assess
color and
amount of
urine

Monitor
temperatu
re


Collaborative:
Administer
parenteral
fluids as
ordered by
the
physician
Fast drip
of IVF as
ordered by
the
physician

To evaluate
patients
current
status










To aid in
dehydratio
n




To aid in
dehydratio
n


After 8 hours
of nursing
interventions
, the patient
was able to
meet the
goal as
evidence of
improved
objective
cues

Assessment Nsg. Dx Scientific
Explanation
Planning Intervention Rationale Evaluation
Subjective:

As
verbalized
by the
patient


Objective:
Poor
skin
turgor
Dry skin
Dry lips

Deficient
fluid
volume
related to
impaired
water
absorption
as
manifeste
d by poor
skin turgor
After 8
hours of
nursing
interventio
n the
patient will
show
improveme
nt on the
objective
assessment

Goal:
Independent:
Monitor
vital signs

Assess
color and
amount of
urine

Monitor
temperatu
re


Collaborative:
Administer
parenteral
fluids as
ordered by
the
physician
Fast drip
of IVF as
ordered by
the
physician

To evaluate
patients
current
status










To aid in
dehydratio
n




To aid in
dehydratio
n


After 8 hours
of nursing
interventions
, the patient
was able to
meet the
goal as
evidence of
improved
objective
cues



Assessment Nsg. Dx Scientific
Explanation
Planning Intervention Rationale Evaluation
Subjective:

As
verbalized
by the
patient


Objective:
Poor
skin
turgor
Dry skin
Dry lips
Deficient
fluid
volume
related to
impaired
water
absorption
as
manifeste
d by poor
skin turgor
After 8
hours of
nursing
interventio
n the
patient will
show
improveme
nt on the
objective
assessment

Goal:
Independent:
Monitor
vital signs

Assess
color and
amount of
urine

Monitor
temperatu
re



To evaluate
patients
current
status










After 8 hours
of nursing
interventions
, the patient
was able to
meet the
goal as
evidence of
improved
objective
cues
Collaborative:
Administer
parenteral
fluids as
ordered by
the
physician
Fast drip
of IVF as
ordered by
the
physician

To aid in
dehydratio
n




To aid in
dehydratio
n