Question

what piece of data drives the plan of care of a patient with dehydration?

Answer 1

Fluid volume deficit or we say hypovolemia is a state or condition where the fluid output exceeds the fluid intake . It occurs when the body loses both water and electrolytes from the extracellular surface in similar proportion , the common sources of fluid is to be loss are the gastrointestinal tract , polyuria and increased perspiration , Risk factors for dehydration are as follows ;- vomiting , diarrhea , GI suctioning , sweating , decreased intake , nausea , vomiting , inability to gain access to fluids , adrenal insufficiency , hemorrhage , coma , osmotic diuresis , burns , ascites , liver dysfunction, third spcae fluid shifts.

Appropriate management is required to prevent potentially life threatening hypovolemic shock condition, The goal of management are to treat the undrlying disorder and return the extracellular fluid compartment to normal , so that to restore the fluid volume and to correct any electrolyte imbalances.

GOALS AND OUTCOMES

Here are some examples of goals and outcomes for fluid volume deficit are as given below;-

• patient demonstrates lifestyle changestoavoid progression of dehydration
• patient verbalizes awareness of causative factors and behaviours essential to correct fluid deficit .
• patient explains  the measures so that can be taken to treat or prevent fluid volume loss.
• patient describes symptoms that indicates the need to be consulted with the health care provider

NURSING ASSESSMENT

NURSING RATIONALE

Monitor and document vital signs especially BP and HR . Assess the skin turgocity and oral mucous membranes for sign of dehydration . Monitoring the BP for orthostatic changes . as well as monitir HR for orthostatic changes , Assess alteration in mentation or the sensorium Assess color and amount of urine . report th eurin eoutput if it lesss than 30ml/hr for 2 c onsecutive hours monitor the fluid staus in relation to dietary intake ,

decrease in circulatoring blood volume can cause hypotension . and tachycardia . usually the pulse is weak and may also find the irregular if electrolyte imbalnce . sign of dehydration are detected by skin . Skin turgor should be assessed over the sternum or on inner thigh A common manifestation of fluid loss is postural hypotension . it is manifested by a 20mmHg drop in systolic Bp and a 10 mmHg drop in diastolic Bp . Alteration in sensorium may be caused by abnormally high or low glucose , electrolyte abnormalities , acidosis , cerebral perfusion , hypoxia, A normal urine color output is above the 30ml/hr . and concentrated urine denotes fluid deficit , Most fluid come sinto the body through drinking ,water in food and water formed by oxidationof foods .

MANAGEMENT

NURSING INTERVENTION

NURSING RATIONALES

urge the patient to drink prescribed amount of fluid , thatis to be drink more and more water as you can If patient can tolerate oral fluid , prefer oral fluid the,provide fluid and straw at bedside within easy reach .provide fresh water with the straw emphasize the importance of oral hygiene . plan a daily activities . provide comfortable environment by covering patient with light sheets. insert IV catheter to have IV access .

oral fluid replacement is indicated for mild fluid deficit , also enhanced to take sports drinks , juices that can facilitate the fluid replacement oral hydrating solutions ( e.g - rehydrate ) can be considered to be needed   Most elderly patients may have reduced sense of thirst and may require continuin remenders to drink . fluid defict can cause dry , sticky mouth / give attention to the mouth care and promotes intereast in drinking fluids planning conserves patient's energy. drop the situation where the patient can experience overheatinh to prevent further fluid loss, parenteral fluid replacement is indicated to prevent or treat hypovolemic complications .