NSG 122 Unit 1 nursing process walkthrough example

Five Stages, One Argument: The Nursing Process Applied to an 84-Year-Old Man Admitted Dry and Weak After Three Days of Vomiting and Diarrhea

Student Name

Department of Nursing, Herzing University

NSG 122: Nursing Fundamental Concepts

Instructor Name

January 14, 2026

Five Stages, One Argument: The Nursing Process Applied to an 84-Year-Old Man Admitted Dry and Weak After Three Days of Vomiting and Diarrhea

Assessment

He is a composite: 84, retired from thirty years as a school custodian, living on his own in a ground-level apartment, walking with a four-wheeled walker. He was admitted to a medical floor after three days of vomiting and loose stools; the vomiting stopped yesterday, and he had two loose stools this morning.

What he said (subjective data): "I haven't been able to keep anything down, so I stopped drinking." "I feel wobbly when I stand up." "My mouth feels like cotton." "I'm so tired."

What was observed and measured (objective data): lying blood pressure 124/70, heart rate 88; standing blood pressure 102/62, heart rate 108, with dizziness after one minute. Temperature 37.2 °C. Weight 64.1 kg; his clinic weight two months ago was 67.0 kg. Tongue dry with a furrowed surface. Urine output 180 mL in the eight hours since admission, dark amber. Serum sodium 146 mmol/L and blood urea nitrogen 38 mg/dL, both above the laboratory's reference ranges. Alert and oriented, but slower to answer than his daughter says is usual. Needed one person's help to stand from the bed.

The two kinds of data are kept apart because they carry different weight. His statements tell us what he experiences; the measurements show what can be checked and repeated. Some commonly taught bedside signs, such as skin turgor, are unreliable in older adults: a systematic review found that very few single signs or tests could identify water-loss dehydration in people over 65 (Hooper et al., 2015). Here the weight loss, the standing blood pressure, the urine output, and the laboratory values carry the assessment, and skin turgor was not used.

Diagnosis: The Problem Statement

Deficient fluid volume related to active fluid loss through vomiting and diarrhea and reduced oral intake, as evidenced by weight loss of 2.9 kg, a fall in systolic blood pressure of 22 mm Hg on standing with a rise in heart rate, dry tongue, urine output of 180 mL over 8 hours, and raised serum sodium and urea nitrogen.

The statement follows the format and wording used in the course's classification text (Herdman et al., 2024). Every piece of evidence named in it appears in the assessment above. His dizziness on standing also supports a second problem, risk for falls, which is addressed in the mobility plan later in the course and noted here only so the first goal is not written in isolation.

Planning: Goals

Short-term goal: by the end of the second day of admission, the patient will have a urine output of at least 30 mL per hour averaged over each eight-hour shift, and a standing systolic blood pressure within 10 mm Hg of his lying pressure.

Longer-term goal: by discharge, expected on the fourth day, he will drink at least 1,500 mL a day without prompting for two consecutive days, and his weight will be within 1 kg of his clinic weight of 67.0 kg.

Each goal is about the patient, not the nurse, and each has a number and a date, so a reader can tell whether it was met.

Implementation: Nursing Actions

Measure and record all intake and output, including each loose stool, every shift. Weigh him daily at 0600, before he eats, using one scale and similar clothing each time. Measure lying and standing blood pressure and heart rate every eight hours, standing him with one person assisting and the walker in front of him. Offer 150 to 200 mL of a drink he chooses every hour while awake, keeping a filled cup within reach of his stronger right hand. Monitor the intravenous fluids ordered by the provider and report output below 30 mL per hour for two consecutive hours. Report the morning sodium and urea nitrogen results to the provider. Teach him and his daughter why fluids matter and how to spot the return of dizziness or dark urine.

Each action is something a nurse carries out, not an order to be written. The fluid volumes, intravenous rate, and laboratory frequency are set by the provider's orders; the nursing actions deliver, measure, and report.

Evaluation

Evaluation returns to the goals as written. By the end of day two, his output averaged 42 mL per hour on the day shift and 35 mL per hour overnight: met. His standing systolic pressure was 114 against a lying pressure of 122, a difference of 8 mm Hg: met. By the morning of day four he had drunk 1,600 mL and 1,550 mL on the previous two days, the second day without prompting from staff: partly met, since the first day needed three prompts. His weight was 66.4 kg, within 1 kg of his clinic weight: met. The fluid problem is resolved; the drinking habit is not yet secure, so his discharge teaching focuses on a daily drinking routine.

The patient is constructed for this assignment, and the problem statement wording follows the classification cited. General principles of the nursing process follow the course fundamentals text (Potter et al., 2023).

References

Herdman, T. H., Kamitsuru, S., & Takáo Lopes, C. (Eds.). (2024). NANDA International nursing diagnoses: Definitions and classification, 2024-2026 (13th ed.). Thieme.

Hooper, L., Abdelhamid, A., Attreed, N. J., Campbell, W. W., Channell, A. M., Chassagne, P., Culp, K. R., Fletcher, S. J., Fortes, M. B., Fuller, N., Gaspar, P. M., Gilbert, D. J., Heathcote, A. C., Kafri, M. W., Kajii, F., Lindner, G., Mack, G. W., Mentes, J. C., Merlani, P., ... Hunter, P. (2015). Clinical symptoms, signs and tests for identification of impending and current water-loss dehydration in older people. Cochrane Database of Systematic Reviews, Article CD009647. https://doi.org/10.1002/14651858.CD009647.pub2

Potter, P. A., Perry, A. G., Stockert, P. A., & Hall, A. M. (2023). Fundamentals of nursing (11th ed.). Elsevier.