Question

1) When obtaining a nursing history from a patient starting on a newly prescribed diuretic, what information would be priority? What questions should be asked?

2) What are some of the causes of dehydration? What are the signs and symptoms to monitor for? Explain the purpose of fluid and electrolyte replacement?

Answer 1

1) When obtaining a nursing history from a patient starting on a newly prescribed diuretic, what information would be priority? What questions should be asked?

• Assess the patient urinmary elimination pattern. Ask for the urine colour. In fact, urine color is one of the best indicators of a person’s hydration level – clear urine means you are well hydrated and darker urine means you are dehydrated.
• Monitor BP.

  Re-check blood pressure, renal function and electrolytes within 4-6 weeks of commencing therapy.

  If blood pressure is not adequately controlled by a low dose of thiazide, an additional antihypertensive agent should be considered rather than increasing the dose.

• Assess the side effects such as rashes. Discontinue furosemide at first sign of rash; may be life-threatening.

2) What are some of the causes of dehydration? What are the signs and symptoms to monitor for? Explain the purpose of fluid and electrolyte replacement?

Causes

• The basic causes of dehydration are not taking in enough water, losing too much water, or a combior nation of both.
• Sometimes, it is not possible to consume enough fluids thats may leads to dehydration.
• Diarrhea – the most common cause of dehydration and related deaths. The large intestine absorbs water from food matter, and diarrhea prevents this from happening. The body excretes too much water, leading to dehydration.
• Vomiting – leads to a loss of fluids and makes it difficult to replace water by drinking it.
• Sweating – the body’s cooling mechanism releases a significant amount of water. Hot and humid weather and vigorous physical activity can further increase fluid loss from sweating. Similarly, a fever can cause an increase in sweating and may dehydrate the patient, especially if there is also diarrhea and vomiting.
• Diabetes – high blood sugar levels cause increased urination and fluid loss. Frequent urination – usually caused by uncontrolled diabetes, but also can be due to alcohol and medications such as diuretics, antihistamines, blood pressure medications, and antipsychotics.
• Burns – blood vessels can become damaged, causing fluid to leak into the surrounding tissues.
• Most occurrences of dehydration can be easily reversed by increasing fluid intake, but severe cases of dehydration require immediate medical attention.

Symptoms

The first symptoms of dehydration include thirst, darker urine, and decreased urine production.

urine color is one of the best indicators of a person’s hydration level – clear urine means you are well hydrated and darker urine means you are dehydrated.

As the condition progresses to moderate dehydration, symptoms include:

• dry mouth
• lethargy
• weakness in muscles
• headache
• dizziness

Severe dehydration

• lack of sweating
• sunken eyes
• shriveled and dry skin
• low blood pressure
• increased heart rate
• fever
• delirium
• unconsciousness

Symptoms in children

• in babies – a sunken fontanel (soft spot on the top of the head)
• dry tongue and mouth
• irritable
• no tears when crying
• sunken cheeks and/or eyes
• no wet diaper for 3 or more hours

Fluid replacement

• Dehydration must be treated by replenishing the fluid level in the body. This can be done by consuming clear fluids such as water, clear broths, frozen water or ice pops, or sports drinks (such as Gatorade).
• Some dehydration patients, however, will require intravenous fluids in order to rehydrate. People who are dehydrated should avoid drinks containing caffeine such as coffee, tea, and sodas..
• Prevention is really the most important treatment for dehydration. Consuming plenty of fluids and foods that have high water content (such as fruits and vegetables) should be enough for most people to prevent dehydration.
• People should be cautious about doing activities during extreme heat or the hottest part of the day, and anyone who is exercising should make replenishing fluids a priority.
• Since the elderly and very young are most at risk of being dehydrated, special attention should be given to them to make sure they are receiving enough fluids.