Dehydration

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Dehydration

  1. 1. DehydrationDehydration
  2. 2. DehydrationDehydration  essential to body function and health. Wateressential to body function and health. Water content decreases from birth to old age; incontent decreases from birth to old age; in neonates, approximately 75% of the body weightneonates, approximately 75% of the body weight is water content; by adulthood, the percentageis water content; by adulthood, the percentage has decreased to approximately 60%; in thehas decreased to approximately 60%; in the elderly, only about 55% of the body weight iselderly, only about 55% of the body weight is water content. The sharpest decline in fluidwater content. The sharpest decline in fluid volume occurs within the first 10 years of life.volume occurs within the first 10 years of life.
  3. 3. DehydrationDehydration  DehydrationDehydration—— excessive loss of fluid fromexcessive loss of fluid from the bodythe body—— occurs when the loss of fluidoccurs when the loss of fluid exceeds the fluid intake.exceeds the fluid intake.
  4. 4. CausesCauses  Excessive fluid loss, reduced fluid intake,Excessive fluid loss, reduced fluid intake, third-space fluid shift, or a combination ofthird-space fluid shift, or a combination of these factors can cause fluid volumethese factors can cause fluid volume losseslosses
  5. 5. Other causes of fluid loss includeOther causes of fluid loss include::  hemorrhagehemorrhage  excessive perspirationexcessive perspiration  acute renal failure with polyuriaacute renal failure with polyuria  abdominal surgeryabdominal surgery  vomiting or diarrheavomiting or diarrhea  nasogastric drainagenasogastric drainage  excessive GI suctioningexcessive GI suctioning  diabetes mellitus with polyuria or diabetes insipidusdiabetes mellitus with polyuria or diabetes insipidus  fistulasfistulas  excessive use of laxativesexcessive use of laxatives  aggressive diuretic therapyaggressive diuretic therapy  FeverFever  excessive fluid removal with hemodialysis or peritonealexcessive fluid removal with hemodialysis or peritoneal dialysis therapydialysis therapy
  6. 6. Possible causes of reduced fluidPossible causes of reduced fluid intake includeintake include::  dysphagiadysphagia  comacoma  environmental conditions preventing fluid intakeenvironmental conditions preventing fluid intake  psychiatric illness.psychiatric illness.  Fluid shifts may be related to:Fluid shifts may be related to:  initial phase of a burninitial phase of a burn  acute intestinal obstructionsacute intestinal obstructions  acute peritonitisacute peritonitis  pancreatitispancreatitis  crushing injuriescrushing injuries  pleural effusionpleural effusion  ascitesascites  accumulation of blood around a hip fracture.accumulation of blood around a hip fracture.
  7. 7. The pathophysiology of dehydrationThe pathophysiology of dehydration  The pathophysiology of dehydration involves aThe pathophysiology of dehydration involves a number of mechanisms. The loss of body fluidsnumber of mechanisms. The loss of body fluids causes an increase in blood solutecauses an increase in blood solute concentration that increases osmolality.concentration that increases osmolality.  Serum sodium levels rise. In an attempt toSerum sodium levels rise. In an attempt to regain fluid balance between intracellular andregain fluid balance between intracellular and extracellular spaces, water molecules shift out ofextracellular spaces, water molecules shift out of the cells into the concentrated bloodthe cells into the concentrated blood
  8. 8. The pathophysiology of dehydrationThe pathophysiology of dehydration  . This process, combined with increased. This process, combined with increased water intake and increased water retentionwater intake and increased water retention in the kidneys, usually restores fluidin the kidneys, usually restores fluid balance. But without sufficient water in thebalance. But without sufficient water in the extracellular space, fluid continues to shiftextracellular space, fluid continues to shift out of the cells into the extracellular space,out of the cells into the extracellular space, causing the cells to shrink and impairingcausing the cells to shrink and impairing cellular functioncellular function
  9. 9. ComplicationsComplications Complications include hypotension, risk ofComplications include hypotension, risk of falls related to hypotension, andfalls related to hypotension, and decreased cardiac output and perfusion todecreased cardiac output and perfusion to tissues and organs. Severe dehydrationtissues and organs. Severe dehydration can progress to hypovolemic shockcan progress to hypovolemic shock
  10. 10.  Other complications include renal failureOther complications include renal failure from decreased renal perfusion and,from decreased renal perfusion and, without intervention, deathwithout intervention, death
  11. 11. What happens in hypovolemicWhat happens in hypovolemic shockshock  In hypovolemic shock, vascular fluidIn hypovolemic shock, vascular fluid volume loss causes extreme tissuevolume loss causes extreme tissue hypoperfusionhypoperfusion  Internal fluid losses can result fromInternal fluid losses can result from hemorrhage or third-space fluid shiftinghemorrhage or third-space fluid shifting  External fluid loss can result from severeExternal fluid loss can result from severe bleeding or from severe diarrhea, diuresis,bleeding or from severe diarrhea, diuresis, or vomitingor vomiting
  12. 12.  Inadequate vascular volume leads to decreasedInadequate vascular volume leads to decreased venous return and cardiac outputvenous return and cardiac output  The resulting drop in arterial blood pressureThe resulting drop in arterial blood pressure activates the bodyactivates the body’’s compensatory mechanismss compensatory mechanisms in an attempt to increase vascular volumein an attempt to increase vascular volume  If compensation is unsuccessful,If compensation is unsuccessful, decompensation and death may occur.decompensation and death may occur.
  13. 13. AssessmentAssessment  An assessment may reveal numerous symptomsAn assessment may reveal numerous symptoms affecting many body systemsaffecting many body systems  1- orthostatic hypotension due to increased1- orthostatic hypotension due to increased systemic vascular resistance and decreasedsystemic vascular resistance and decreased cardiac outputcardiac output  2- . Tachycardia induced by the sympathetic2- . Tachycardia induced by the sympathetic nervous system to increase cardiac outputnervous system to increase cardiac output  3- . Physical findings may include flattened neck3- . Physical findings may include flattened neck veins related to decreased circulating fluidveins related to decreased circulating fluid volumevolume  4- sunken eyeballs related to decreased total4- sunken eyeballs related to decreased total fluid volume with consequent dehydration offluid volume with consequent dehydration of connective tissue and aqueous humorconnective tissue and aqueous humor
  14. 14.  5- Urine will be dark amber in color and5- Urine will be dark amber in color and decreased in volumedecreased in volume  6- diminished skin turgor due to6- diminished skin turgor due to decreased fluid in the dermal layerdecreased fluid in the dermal layer  7- The patient may also exhibit weakness ,7- The patient may also exhibit weakness , irritabilityirritability
  15. 15. Diagnostic testsDiagnostic tests  HematocritHematocrit is elevated.is elevated.  Serum osmolalitySerum osmolality is elevated (greater than 300is elevated (greater than 300 mOsm/kg; in patients with diabetes insipidus,mOsm/kg; in patients with diabetes insipidus, osmolality ranges from 50 to 200 mOsm/kg).osmolality ranges from 50 to 200 mOsm/kg).  Serum sodium levelSerum sodium level is elevated (greater thanis elevated (greater than 145 mEq/L).145 mEq/L).  Urine specific gravityUrine specific gravity is greater than 1.030 (inis greater than 1.030 (in patients with diabetes insipidus, specific gravitypatients with diabetes insipidus, specific gravity is usually less than 1.005).is usually less than 1.005).
  16. 16. TreatmentTreatment  The patient with severe dehydration will requireThe patient with severe dehydration will require I.V. fluid replacement. I.V. fluids should beI.V. fluid replacement. I.V. fluids should be hypotonic, low-sodium solutions, such ashypotonic, low-sodium solutions, such as dextrose 5% in waterdextrose 5% in water  Avoid rapid administration of the I.V. solutions,Avoid rapid administration of the I.V. solutions, because this will cause fluid to move from thebecause this will cause fluid to move from the veins into the cells and result in edema. Fluidsveins into the cells and result in edema. Fluids should be administered gradually, over a periodshould be administered gradually, over a period of 48 hours.of 48 hours.
  17. 17. ALERTALERT  Rapid administration of I.V. solutionRapid administration of I.V. solution can cause edema, which in turncan cause edema, which in turn may progress to cerebral edema, amay progress to cerebral edema, a potentially fatal complicationpotentially fatal complication
  18. 18. nursing diagnosesnursing diagnoses  Deficient fluid volume related to inadequate fluidDeficient fluid volume related to inadequate fluid intake and active fluid lossintake and active fluid loss  Decreased cardiac output related to decreasedDecreased cardiac output related to decreased fluid volumefluid volume  Impaired oral mucous membranes related toImpaired oral mucous membranes related to dehydrationdehydration  Risk for injury related to dizziness orRisk for injury related to dizziness or hypotensionhypotension
  19. 19. Nursing interventionsNursing interventions  1- Obtain a patient history to determine the cause of the1- Obtain a patient history to determine the cause of the fluid imbalance.fluid imbalance.  2- Insert a urinary catheter, as ordered for accurate2- Insert a urinary catheter, as ordered for accurate monitoring of fluid output.monitoring of fluid output.  3- Encourage the patient to increase oral intake of fluid3- Encourage the patient to increase oral intake of fluid  4- Provide oral fluids of the patient4- Provide oral fluids of the patient’’s preference, ands preference, and place within easy reach.place within easy reach.  5- Assist the patient if he5- Assist the patient if he’’s unable to feed himself ors unable to feed himself or hold a cup.hold a cup.  6- Avoid acidic juices if the patient has impaired oral6- Avoid acidic juices if the patient has impaired oral membrane integritymembrane integrity
  20. 20. Nursing interventionsNursing interventions  7- Provide I.V. fluid replacement if the patient can7- Provide I.V. fluid replacement if the patient can’’t orally consumet orally consume adequate amounts of fluid.adequate amounts of fluid.  8- Provide meticulous oral care and assess mucous membranes.8- Provide meticulous oral care and assess mucous membranes.  9- Provide meticulous skin care and lubrication.9- Provide meticulous skin care and lubrication.  10- Turn and reposition if the patient is immobile.10- Turn and reposition if the patient is immobile.   11- Institute safety precautions if the patient is experiencing orthostatic11- Institute safety precautions if the patient is experiencing orthostatic hypotension, dizziness, or alterations in mental statushypotension, dizziness, or alterations in mental status  12- Administer an antidiarrheal or antiemetic, if appropriate.12- Administer an antidiarrheal or antiemetic, if appropriate. Review medications that can contribute to fluid loss (diuretics), and obtainReview medications that can contribute to fluid loss (diuretics), and obtain an order to discontinue or adjust dosean order to discontinue or adjust dose
  21. 21. MonitoringMonitoring  1- Assess and record weight at the same1- Assess and record weight at the same time each day.time each day.  2- Monitor vital signs for fever,2- Monitor vital signs for fever, hypotension, and tachycardia.hypotension, and tachycardia.  3- Assess and record daily intake of fluid3- Assess and record daily intake of fluid intake and output.intake and output.  4- Monitor color and amount of urine4- Monitor color and amount of urine outputoutput
  22. 22.  5- Monitor serum electrolytes and urine5- Monitor serum electrolytes and urine osmolality.osmolality.  6- Monitor active losses of fluid from6- Monitor active losses of fluid from drainage, suctioning, vomiting, ordrainage, suctioning, vomiting, or bleeding.bleeding.  7- Assess and record changes in mental7- Assess and record changes in mental status or neurologic functionsstatus or neurologic functions
  23. 23.  Closely monitor very young patients and elderlyClosely monitor very young patients and elderly patients for dehydration, because individuals inpatients for dehydration, because individuals in these groups are susceptible to fluid loss due tothese groups are susceptible to fluid loss due to inability to communicate thirst or obtain fluidinability to communicate thirst or obtain fluid without assistancewithout assistance  Inaccurate assessment of output related toInaccurate assessment of output related to absorbent products such as diapers also placesabsorbent products such as diapers also places these patients at risk. Fluid loss may also occurthese patients at risk. Fluid loss may also occur in these populations due to diarrhea or vomiting,in these populations due to diarrhea or vomiting, or due to perspiration caused by feveror due to perspiration caused by fever
  24. 24. Patient teachingPatient teaching  1- Describe and provide information on causes of fluid1- Describe and provide information on causes of fluid loss or decreased oral intake of fluid.loss or decreased oral intake of fluid.  2- Provide information on the care plan and the2- Provide information on the care plan and the importance of maintaining proper nutrition and fluidimportance of maintaining proper nutrition and fluid intake.intake.  3- Refer the patient to home care services if continued3- Refer the patient to home care services if continued monitoring or I.V. fluid administration is required.monitoring or I.V. fluid administration is required.  4- Discuss signs and symptoms of dehydration, and4- Discuss signs and symptoms of dehydration, and instruct the patient and his family to immediately reportinstruct the patient and his family to immediately report this information to their health care providerthis information to their health care provider
  25. 25. Patient teachingPatient teaching  5- Teach the patient and his family how to5- Teach the patient and his family how to monitor daily intake and output andmonitor daily intake and output and weight.weight.  6- Provide information on medications and6- Provide information on medications and dietary supplements that can causedietary supplements that can cause diuresis and lead to dehydration.diuresis and lead to dehydration.
  26. 26. Prepared by ; Jaber AlnamiPrepared by ; Jaber Alnami ER staff Nurse(Sabya GeneralER staff Nurse(Sabya General Hospital)Hospital)  Thank YouThank You

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