Patient Goals: How will you know they are met? After performing the interventions, the goals will be evaluated and that is how it will be determined if the interventions are met or need modification. 1.The patient’s fluid output will be within normal range (400 to 2000ml) and the input will be within normal range (1200-1500 ml) in the next 1 to 12 hours. 2.The patient will have a systolic blood pressure of 120 mm Hg and a diastolic blood pressure of 80 mm Hg and a pulse within 60 bpm to 100 bpm in the next 24 hours. 3.The patient will verbalize a personal plan for preventing and recognizing fluid volume deficit by the end of the shift. 4. The patient will show signs of improved mental status (alert and oriented X4 person, place, time …show more content…
Rationale with reference and citations for each Nursing Implementation & Patient Response to Intervention State whether appropriate or not. 1. The patient’s vital signs, including the blood pressure and the heart rate will be monitored and documented. 1. According to Gulanick and Myers, a reduction in circulating blood volume can cause hypotension and tachycardia. The change in heart rate is a compensatory mechanism to maintain cardiac output. Usually, the pulse is weak and may be irregular if an electrolyte imbalance occurs. Hypotension is evident in …show more content…
L) 1. This intervention is appropriate for my patient because his blood pressure was 100/68 mm Hg, and the heart rate was 122 bpm. The normal blood pressure is 120/80 mm Hg, and the normal heart rate is 60 to 100 bpm. As a result, my patient is hypotensive and tachycardic. It is important to keep the blood pressure at 120/80 mm Hg and the heart rate within normal limits (60 bpm to 100 bpm). My patient’s blood pressure and heart rate were monitored and documented. The trends showed improvement at the end of the shift he had a blood pressure of 118/ 78 mm Hg. At the beginning of the shift his blood pressure was 100/68 mm