Revised Care Plan - Gastroenteritis

Allergies/Reaction: No known allergies Code Status: Full Isolation: None Religion: None “Chief Complaint”: Upon arrival at the ED the patient stated “I have been throwing up for the last 12 hours. Everything I try to eat or drink will not stay down”. Nurses notes stated that the patient was actively vomiting at this time. Nursing Note / Hand-off details: (What was reported during bedside shift report?) The patient has been placed on antiemetics to control n/v. He is currently being observed to detect for blood in emesis or stool. Past Medical History/Secondary Medical Diagnoses: Hypertension (September, 2008) Alcoholism (undiagnosed) Substance Abuse (undiagnosed) Past Surgical History: Cholecystectomy (February 2010) Current List of Medications: (medication, dosage, indication) Azulfidine (sulfasalazine): decreases inflammation of the intestinal mucousa Flagyl (metronidazole): prevent secondary infection Budesonide (corticosteroid): decrease inflammation Humira (adalimumab): inhibit cytokine tumor necrosis factor (TNF) o Prevents migration of leukocytes from bloodstream to inflamed tissue. Tylenol (acetaminophen): relief of abdominal pain. Zofran (ondansetron): relief of nausea Primary Medical Diagnosis: (w/description of pt presenting s/s) Gastroenteritis is an inflammation of the mucosa of the stomach and small intestine. Common symptoms include diarrhea, nausea, vomiting, fever, and abdominal cramping. Pathophysiology: Gastroenteritis develops due to inflammation of the small or large bowel, often caused by infection. As viruses and foreign bacteria invade the intestines they attach to the mucousa cell walls. This attachment naturally releases toxins into the bowels leading to a number of gastrointestinal issues. Signs and Symptoms: Toxin production results in secretory diarrhea with a large volume of watery diarrhea, or aggravated vomiting of partially digested food, characterized by excessive mucosal secretion due to adenylate cyclase induction resulting in impaired intestinal absorption. Prolonged malabsorption of foods and liquids leads to dehydration, which is recognized as the most common complication associated with gastroenteritis. ASSESSMENT FINDINGS Objective Findings: T: 101.2F HR: 96 T: 99.2 Glucose: 112 HR: 84 Neuro: LOC: full Alert/Oriented: x4 BP: 110 /66 RR: BP: 118/76 RR: 16 16 O2: 97 % via room air Glucose: 64 O2: 99 % via NC Pupils: PEARRLA GCS: 15 Speech: Clear and appropriate Pain/Location: Bilateral Lower Abdominal Quadrants Score: 6/10. Last Pain Med: 07/29/21 (0800) U Upper/Lower Muscle Strength: inadequate due to malnutrition Numbness/Tingling: patient denies Cardiac: BP: 112/68 (right arm) Apical Rate/Rhythm: 82bpm Heart Sounds: audible S1/S2 Monitor (Rhythm): Normal Sinus Rhythum Capillary Refill: < 2 sec Edema (Location/Grade): none Pulmonary: Resp Rate: 16 resp/min Rhythm: unlabored Breath Sounds (Bilateral): clear and equal Pulse oximetry: 99% on room air GI: N/V: yes (x 2 days) Bowel Sounds: hyperactive x4 quads Abdomen: Hard/Soft: rigid Flat/Round/Distended: normal Tenderness: positive for rebound tenderness in lower quads bilaterally Last BM: 07/28/21 (2100) Diarrhea: positive Ostomy: No Stoma: No Incontinence: No GU: Voiding: adequate Foley: none Urine: clear/yellow. Bladder Scan: N/A St Cath/Amt: none Condom Catheter: none Incontinence ____________ Output: 800mL Past 24 hr. I & O: +650 mL Skin: Color: pink/appropriate for ethnicity Temp(Skin): 101.2 F Core Body Temp: 101.2 F Moistness: diaphoretic Skin Score: 16 Pressure Ulcer: none Location _____________ Treatment ___________________________________ Wounds/Incisions: none Dressings: none Extremities: All extremities are intact. No lesions, lacerations, abrasions, or noticeable deformities found on any of the 4 extremities. Lines/Devices: 18-gauge IV normal saline in Right radial pulse Pain: (OLDSCARTS) Abdominal Pain (7/10) secondary to episodes of vomiting. Other: Diagnostics/Procedures: Sputum culture Electrolyte screening Stool sampling Common Lab Values: Results/Findings/Interpretations: Negative for any infectious viruses/bacteria Imbalanced nutrition secondary to extreme vomiting Negative for any blood in stool Disease Specific Lab Values: ___ Today’s Problem List: Reduce vomiting episodes and decrease abdominal pain. Regain proper electrolyte balance. LABORATORY FINDINGS WBC Admissio n Baseline (INITIAL) Lab 13.6 Recent followup Lab RBC 5.2 5.2 Hemoglobin 12.3 13.2 Hematocrit 40% 42% Platelets 200,000 200,000 Mean Corpuscular Volume (MCV) N/A N/A 11.1 Clinical Significance (Normal values, Low values, High values) White blood cells are the main defense against disease. A high WBC count is called leukocytosis. It can result from certain medicines (i.e. corticosteroids), infections, diseases such as lupus, rheumatoid arthritis, or allergy, leukemia, severe emotional or physical stress, tissue damage (such as from burns or a heart attack). An RBC count is a blood test that measures how many red blood cells (RBCs) you have. RBCs contain hemoglobin, which carries oxygen. How much oxygen your body tissues get depends on how many RBCs you have and how well they work. The RBC count is almost always part of a complete blood count (CBC) test. The test can help diagnose different kinds of anemia (low number of RBCs) and other conditions affecting red blood cells. Hemoglobin is a protein in red blood cells that carries oxygen. The hemoglobin test measures how much hemoglobin is in your blood. This test is conducted as part of a complete blood count (CBC) exam. A hematocrit test is a type of blood test. Your blood is made up of red blood cells, white blood cells, and platelets. These cells and platelets are suspended in a liquid called plasma. A hematocrit test measures how much of your blood is made up of red blood cells. Red blood cells contain a protein called hemoglobin that carries oxygen from your lungs to the rest of your body. Hematocrit levels that are too high or too low can indicate a blood disorder, dehydration, or other medical conditions. A platelet count is a lab test to measure how many platelets you have in your blood. Platelets are parts of the blood that helps the blood clot. They are smaller than red or white blood cells. This test is conducted as part of a complete blood count (CBC) exam. Mean Corpuscular Hemoglobin Conc. (MCHc) N/A N/A Neutrophils N/A N/A Lymphocytes N/a N/a Monocytes N/a N/a Eosinophils N/a N/a Basophils N/a N/a Sodium (Na+) 118 136 A sodium test checks how much sodium is in the blood. Sodium is both an electrolyte and mineral. It helps keep the water (the amount of fluid inside and outside the body's cells) and electrolyte balance of the body. Sodium is also important in how nerves and muscles work. Most of the sodium in the body (about 85%) is found in blood and lymph fluid. Sodium levels in the body are partly controlled by a hormone called aldosterone, which is made by the adrenal glands. Aldosterone levels tell the kidneys when to hold sodium in the body instead of passing it in the urine. Small amounts of sodium are also lost through the skin when you sweat. Low sodium levels have many causes, such as heart failure, malnutrition, or diarrhea. Potassium (K+) 3.0 3.9 A potassium test checks how much potassium is in the blood. Potassium is both an electrolyte and a mineral. It helps keep the water (the amount of fluid inside and outside the body's cells) and electrolyte balance of the body. Potassium is also important in how nerves and muscles work. Potassium levels often change with sodium levels. When sodium levels go up, potassium levels go down, and when sodium levels go down, potassium levels go up. Potassium levels are also affected by a hormone called aldosterone, which is made by the adrenal glands. A potassium level that is too high or too low can be serious. Abnormal potassium levels may cause symptoms such as muscle cramps or weakness, nausea, diarrhea, frequent urination, dehydration, low blood pressure, confusion, irritability, paralysis, and changes in heart rhythm. Chloride (Cl-) 94 102 A chloride test measures the level of chloride in your blood or urine. Chloride is one of the most important electrolytes in the blood. It helps keep the amount of fluid inside and outside of your cells in balance. It also helps maintain proper blood volume, blood pressure, and pH of your body fluids. Tests for sodium, potassium, and bicarbonate are usually done at the same time as a blood test for chloride. Most of the chloride in your body comes from the salt (sodium chloride) you eat. Chloride is absorbed by your intestines when you digest food. Extra chloride leaves your body in your urine. Carbon Dioxide 27 25 (CO2) Carbon dioxide (CO2) is a gaseous waste product from metabolism. The blood carries carbon dioxide to your lungs, where it is exhaled. More than 90% of it in your blood exists in the form of bicarbonate (HCO3). The rest of it is either dissolved carbon dioxide gas (CO2) or carbonic acid (H2CO3). Your kidneys and lungs balance the levels of carbon dioxide, bicarbonate, and carbonic acid in the blood. Anion Gap 5.2 6.2 Glucose Level 64 108 This test measures the level of bicarbonate in a sample of blood from a vein. Bicarbonate is a chemical that acts as a buffer. It keeps the pH of blood from becoming too acidic or too basic. Abnormal results may indicate that your body has an electrolyte imbalance, or that there is a problem removing carbon dioxide through your lungs. Too much CO2 in the blood can indicate a variety of conditions including lung disease, Cushing’s Syndrome, and kidney disorders. An anion gap blood test is a way to check the levels of acid in your blood. The test is based on the results of another blood test called an electrolyte panel. Electrolytes are electrically charge minerals that help control the balance of chemicals in your body called acids and bases. Some of these minerals have a positive electric charge. Others have a negative electric charge. A blood glucose test measures the amount of a type of sugar, called glucose, in your blood. Glucose comes from carbohydrate foods. It is the main source of energy used by the body. Insulin is a hormone that helps your body's cells use the glucose. Insulin is produced in the pancreas and released into the blood when the amount of glucose in the blood rises. Normally, your blood glucose levels increase slightly after you eat. This increase causes your pancreas to release insulin so that your blood glucose levels do not get too high. Blood glucose levels that remain high over time can damage your eyes, kidneys, nerves, and blood vessels Glucose Level N/a N/a (POC) Calcium (Ca+) 7.6 9.2 A test for calcium in the blood checks the calcium level in the body that is not stored in the bones. Calcium is the most common mineral in the body and one of the most important. The body needs it to build and fix bones and teeth, help nerves work, make muscles squeeze together, help blood clot, and help the heart to work. Almost all of the calcium in the body is stored in bone. Normally the level of calcium in the blood is carefully controlled. When blood calcium levels get low (hypocalcemia), the bones release calcium to bring it back to a good blood level. When blood calcium levels get high (hypercalcemia), the extra calcium is stored in the bones or passed out of the body in urine and stool. A blood calcium test may be done: To check for problems with the parathyroid glands or kidneys, certain types of cancers and bone problems, or inflammation of the pancreas (pancreatitis). To find a reason for an abnormal electrocardiogram (EKG) test. After a kidney transplant. To see if your symptoms may be caused by a very low calcium level in the blood. Such symptoms may include muscle cramps, spasms, and twitching and tingling in the fingers and around the mouth. To see if your symptoms may be caused by a very high calcium level in the blood. Such symptoms may include weakness, lack of energy, not wanting to eat, nausea and vomiting, constipation, urinating a lot, belly pain, or bone pain. BUN (Blood urea nitrogen) 14 12 A blood urea nitrogen (BUN) test measures the amount of nitrogen in your blood that comes from the waste product urea. Urea is made when protein is broken down in your body. Urea is made in the liver and passed out of your body in the urine. A BUN test is done to see how well your kidneys are working. If your kidneys are not able to remove urea from the blood normally, your BUN level rises. Heart failure, dehydration, or a diet high in protein can also make your BUN level higher. Liver disease or damage can lower your BUN level. Creatinine 0.9 0.8 Creatinine and creatinine clearance tests measure the level of the waste product creatinine in your blood and urine. These tests tell how well your kidneys are working. Another substance, creatine, is formed when food is changed into energy through a process called metabolism. Creatine is broken down into creatinine. Your kidneys take creatinine out of your blood and pass it out of your body in urine. If your kidneys are damaged and can't work as they should, the amount of creatinine in your urine goes down while its level in your blood goes up. The blood creatinine level shows how well your kidneys are working. A high level may mean your kidneys are not working as they should. The amount of creatinine in the blood depends partly on the amount of muscle tissue you have. Men generally have higher creatinine levels than women. GFR 122 116 Glomerular filtration rate (GFR) is a test used to check how well the kidneys are working. Specifically, it estimates how much blood passes through the glomeruli each minute. Glomeruli are the tiny filters in the kidneys that filter waste from the blood. Magnesium (Mg+ +) 1.5 1.8 A magnesium blood test measures the amount of magnesium in your blood. Magnesium is a type of electrolyte. Electrolytes are electrically charged minerals that are responsible for many important functions and processes in your body. Your body needs magnesium to help your muscles, nerves, and heart work properly. Magnesium also helps control blood pressure and blood sugar. Most of your body's magnesium is in your bones and cells. But a small amount is found in your blood. Magnesium levels in the blood that are too low or too high can be a sign of a serious health problem. A magnesium blood test is used to check to see if you have too little or too much magnesium in the blood. Having too little magnesium, known as hypomagnesemia or magnesium deficiency, is more common than having too much magnesium, which is known as hypermagnesemia. Phosphorous 2.7 3.4 A magnesium blood test measures the amount of magnesium in your blood. Magnesium is a type of electrolyte. Electrolytes are electrically charged minerals that are responsible for many important functions and processes in your body. Your body needs magnesium to help your muscles, nerves, and heart work properly. Magnesium also helps control blood pressure and blood sugar. Most of your body's magnesium is in your bones and cells. But a small amount is found in your blood. Magnesium levels in the blood that are too low or too high can be a sign of a serious health problem. A magnesium blood test is used to check to see if you have too little or too much magnesium in the blood. Having too little magnesium, known as hypomagnesemia or magnesium deficiency, is more common than having too much magnesium, which is known as hypermagnesemia. PT 11.2 11.5 (Prothrombin Time) INR 11.2 11.5 PTT 66 66 Prothrombin time (PT) is a blood test that measures the time it takes for the liquid portion (plasma) of your blood to clot. The most common reason to perform this test is to monitor your levels when you are taking a blood-thinning medicine called warfarin. You are likely taking this medicine to prevent blood clots. You may also need this test to find the cause of abnormal bleeding or bruising, check how well your liver is working, and look for signs of a blood clotting or bleeding disorder. Partial thromboplastin time (PTT) is a blood test that looks at how long it takes for blood to clot. It can help tell if you have a bleeding problem or if your blood does not clot properly. You may need this test if you have problems with bleeding or your blood does not clot properly. When you bleed, a series of actions involving many different proteins (clotting factors) take place in the body that help the blood clot. This is called the coagulation cascade. The PTT test looks at some of the proteins or factors involved in this process and measures their ability to help blood clot. Anti Xa N/a N/a D-Dimer N/a N/a 22 28 ALT AST (Aspartate aminotransferase) 16 22 Partial thromboplastin time (PTT) is a blood test that looks at how long it takes for blood to clot. It can help tell if you have a bleeding problem or if your blood does not clot properly. You may need this test if you have problems with bleeding or your blood does not clot properly. When you bleed, a series of actions involving many different proteins (clotting factors) take place in the body that help the blood clot. This is called the coagulation cascade. The PTT test looks at some of the proteins or factors involved in this process and measures their ability to help blood clot. An aspartate aminotransferase (AST) test measures the amount of this enzyme in the blood. AST is normally found in red blood cells, liver, heart, muscle tissue, pancreas, and kidneys. AST formerly was called serum glutamic oxaloacetic transaminase (SGOT). Low levels of AST are normally found in the blood. When body tissue or an organ such as the heart or liver is diseased or damaged, additional AST is released into the bloodstream. The amount of AST in the blood is directly related to the extent of the tissue damage. After severe damage, AST levels rise in 6 to 10 hours and remain high for about 4 days. An aspartate aminotransferase (AST) test is done to: Check for liver damage. Help identify liver disease, such as hepatitis. Liver disease may produce symptoms such as pain in the upper abdomen, nausea, vomiting, and sometimes jaundice. Check on the success of treatment for liver disease. Find out whether jaundice was caused by a blood disorder or liver disease. Keep track of the effects of medicines that can damage the liver. ALK LDH Bilirubin, total Bilirubin, direct Bilirubin, indirect Lactic Acid Ammonia HbA1C Total Protein 4.2 6.4 A total serum protein test measures the total amount of protein in the blood. It also measures the amounts of two major groups of proteins in the blood: albumin and globulin. Albumin is made mainly in the liver. It helps keep the blood from leaking out of blood vessels. Albumin also helps carry some medicines and other substances through the blood and is important for tissue growth and healing. Globulin is made up of different proteins called alpha, beta, and gamma types. Some globulins are made by the liver, while others are made by the immune system. Certain globulins bind with hemoglobin. Other globulins transport metals, such as iron, in the blood and help fight infection. Serum globulin can be separated into several subgroups by serum protein electrophoresis. Globulin is tested to: Determine your chances of developing an infection. See if you have a blood disease, such as multiple myeloma or macroglobulinemia. Albumin 2.7 3.4 Albumin is tested to: Check how well the liver and kidneys are working. Find out if your diet contains enough protein. Help determine the cause of swelling of the ankles (edema) or abdomen (ascites) or of fluid collection in the lungs that may cause shortness of breath (pulmonary edema). Amylase 94 52 Lipase 166 120 An amylase test measures the amount of amylase in your blood or urine. Amylase is an enzyme, or special protein, that helps you digest food. Most of your amylase is made in the pancreas and salivary glands. A small amount of amylase in your blood and urine is normal. A larger or smaller amount may mean that you have a disorder of the pancreas, an infection, alcoholism, or another medical condition. An amylase blood test is used to diagnose or monitor a problem with your pancreas, including pancreatitis, an inflammation of the pancreas. An amylase urine test may be ordered along with or after an amylase blood test. Urine amylase results can help diagnose pancreatic and salivary gland disorders. One or both types of tests may be used to help monitor amylase levels in people who are being treated for pancreatic or other disorders. Lipase is a type of protein made by your pancreas, an organ located near your stomach. Lipase helps your body digest fats. It's normal to have a small amount of lipase in your blood. But, a high level of lipase can mean you have pancreatitis, an inflammation of the pancreas, or another type of pancreas disease. Troponin T 0.025 0.025 Troponin I 0.025 0.025 CPK-MB 3.2% 3.2% A lipase test may be used to diagnose pancreatitis or another disease of the pancreas, find out if there is a blockage in your pancreas, and check for chronic diseases that affect the pancreas, including cystic fibrosis. A troponin test measures the levels of troponin T or troponin I proteins in the blood. These proteins are released when the heart muscle has been damaged, such as occurs with a heart attack. The more damage there is to the heart, the greater the amount of troponin T and I there will be in the blood. A troponin test measures the levels of troponin T or troponin I proteins in the blood. These proteins are released when the heart muscle has been damaged, such as occurs with a heart attack. The more damage there is to the heart, the greater the amount of troponin T and I there will be in the blood. CK levels were historically used in emergency room patients to test for myocardial infarction (now often replaced by troponin), rhabdomyolysis, muscular dystrophy, myositis, myocarditis, malignant hyperthermia, neuroleptic malignant syndrome Levels are determined specifically in patients with chest pain and cardinal features of chest pain Activity is estimated in the course of acute ischemic heart disease to diagnose acute myocardial infarction (AMI) and to estimate infarct size CK-MB activity is normal in 25 - 50% of patients with MI at time of admission rises some 4 - 6 hours after the onset of chest pain, peaks within 12 - 24 hours, and returns to baseline levels within 36 - 48 hours o These times may be shorted considerably by thrombolytic therapy CRP 1.2 BNP 68 1.2 C-reactive protein (CRP) is produced by the liver. The level of CRP rises when there is inflammation throughout the body. It is one of a group of proteins called acute phase reactants that go up in response to inflammation. The levels of acute phase reactants increase in response to certain inflammatory proteins called cytokines. These proteins are produced by white blood cells during inflammation, such as bronchitis. 68 Brain natriuretic peptide (BNP) test is a blood test that measures levels of a protein called BPN that is made by your heart and blood vessels. BNP levels are higher than normal when you have heart failure. BNP levels go up when the heart cannot pump the way it should. A result greater than 100 pg/mL is abnormal. The higher the number, the more likely heart failure is present and the more severe it is. Sometimes other conditions can cause high BNP levels. These include: Kidney failure Pulmonary embolism Pulmonary hypertension Severe infection (sepsis) Lung problems TSH N/a N/a Cholesterol HDL 46 50 LDL 68 74 Triglycerides 122 118 pH 7.28 7.36 PaCO2 36 36 P aO 2 82 88 S aO 2 97% 99% HCO3 20 ABGs Urinalysis Specimen type? color, clarity, pH, specific gravity, glucose, keytone, blood, protein, nitrate, leukocyte, urobilinogen, WBC, RBC, hyaline casts, 24 HDL helps remove cholesterol from your arteries. Cholesterol is a waxy, fat-like substance that's found in all the cells in your body. Your liver makes cholesterol, and it is also in some foods, such as meat and dairy products. Your body needs some cholesterol to work properly. But if you have too much cholesterol in your blood, you have a higher risk of coronary artery disease LDL is the main source of cholesterol buildup and blockage in the arteries. Triglycerides are a type of fat. They are the most common type of fat in your body. They come from foods, especially butter, oils, and other fats you eat. Having a high level of triglycerides can raise your risk of heart diseases, such as coronary artery disease. Blood gases are a measurement of how much oxygen and carbon dioxide are in your blood. They also determine the acidity (pH) of your blood. The test is used to evaluate respiratory diseases and conditions that affect the lungs. It helps determine the effectiveness of oxygen therapy. The test also provides information about the body's acid/base balance, which can reveal important clues about lung and kidney function and the body's general metabolic state. This is the physical and chemical processes in the body that convert or use energy. PaCO2 specifically evaluates how well carbon dioxide (CO2) moves from the lungs into the blood. PaO2 specifically evaluates the pressure of oxygen in the lungs. A low partial pressure of oxygen can indicate an infection of the lungs, or possible obstruction in the bronchioles. Oxygen saturation is a measurement of the percentage of hemoglobin saturated with oxygen. Oxygen saturation levels below 95% are considered low, and termed hypoxemia. Hypoxemia is a belownormal level of oxygen in your blood, specifically in the arteries. Hypoxemia is a sign of a problem related to breathing or circulation, and may result in various symptoms, such as shortness of breath. The bicarbonate content of serum or plasma is a significant indicator of electrolyte dispersion and anion deficit. Together with pH determination, bicarbonate measurements are used in the diagnosis and treatment of numerous potentially serious disorders associated with acid-base imbalance in the respiratory and metabolic systems. squamous epithelial, culture set up No blood found in vomit or diarrhea Cultures (urine, blood, sputum, body fluid, wound, CSF, etc..) Vanco Trough Drug Levels (UDS?) Negative COVID Negative Influenza A / B Blood Type Disease-specific labs not listed Patient Centered Problem List / Nursing Diagnoses: Nursing Dx: (NANDA) r/t (pathophysiology – NOT medical Dx) aeb (patient’s s/s) 1. Imbalanced nutrition (less than body requirements) related to vomiting and diarrhea (x2 days) as evidenced by poor nutritional lab values. 2. Deficient fluid volume related to active fluid loss (diarrhea and vomiting x2 days) as evidenced by poor electrolyte measurements. Specifically potassium, calcium, and sodium levels lower than normal range. Short-Term Goal (timed/measurable) 1. Patient will have an increased nutritional intake and will not excrete nutrients prior to full digestion. 2. Client will maintain fluid volumes as evidenced by good skin turgor, stable vital signs, capillary refill < 2sec, adequate urinary output, and moist mucous membranes. Interventions / Rationale (What nursing interventions are you doing to meet your goal??) 1. Weigh client daily and measure 24 hour intake and output. 2. Monitor vital signs. Assess patient for temperature elevation and orthostatic hypotension. 3. Palpate peripheral pulses. Measure skin turgor, capillary refill, and observe skin color. 4. Monitor labs as indicated by physician. 5. Provide tube feedings (with excessive prescribed potassium, calcium and sodium) electrolyte, and water via IV if necessary. 1. Although fluid intake and weight gain greater than output may not accurately reflect intravascular volume, these measurements provide useful data for comparison. 2. Tachycardia is present along with varying degrees of hypotension, depending on the degree of the fluid volume deficit. Fever increases metabolism and exacerbates fluid loss via sweating, urine, and vomiting. 3. Conditions that contribute to extracellular fluid deficit can result in inadequate organ perfusion to all areas and may cause circulatory collapse and shock. 4. Depending on amount, and frequency, of fluid loss metabolic and electrolyte (potassium, sodium, and calcium) imbalances may occur. 5. Enteral replacement can provide proteins and other needed elements in addition to meeting general fluid replacements when swallowing is not intact. 2. 1. Measure patient’s weight. 2. Monitor the client’s intake/output. 3. Provide perineal care following episodes of diarrhea. 4. Provide a prescribed diet according to nutritional needs. Diet must be administered in a fashion comfortable for the patient’s current state. 5. Provide parenteral fluids, as ordered by physician. 1. Measuring the patient’s weight upon admission allows the nursing team to accurately monitor the patient’s response to therapy. 2. Measure the amount of food and fluids the patient is able keep down. 3. Perineal care is indicated following discharge to prevent skin breakdown and possibility for infection. 4. Due to the patient’s inability to swallow (constant nausea) nutrients are delivered PPN in order to correct the patient’s poor nutritional state. 5. To ensure adequate fluid and electrolyte levels. Short-Term Goals Outcome: (Goal Met OR NOT Met? Why??) 1. Yes, the patient was able to keep down fluids and small amounts of food PO with the assistance of antiemetic medications. 2. Yes, the patient retained an appropriate fluid volume as evidenced by an increase in previously depleted electrolyte values. Long-Term Goal: The patient will remain properly nourished and will no longer experience episodes of diarrhea or vomiting