NURS 1067 Week 9
Dehydration
Definition: Dehydration = Fluid volume deficit
Excessive loss of water from body tissues
Accompanied by a disturbance of body electrolytes
Occurs when fluid output > fluid intake
Also refers to hypovolemia
Causes of Dehydration
Primary Causes:
Lack of fluid intake (due to nausea or inability to access fluids)
Excessive fluid loss due to:
Vomiting
Diarrhea
GI suctioning
Excessive sweating
Additional factors:
Burns
Hemorrhage
Dementia
Medications (e.g., diuretics)
Developmental Considerations
Young children and elderly individuals are particularly vulnerable to dehydration.
Introduction to Fluid Balance
Semester 1: Introduction to fluid balances and basic nursing assessments.
Semesters 2 and 3: Revisit concepts and develop deeper understanding of fluid and electrolyte imbalances.
Regulation of Fluid Balance
Complex physiological mechanisms include:
Hypothalamic regulation
Pituitary regulation
Adrenal cortical regulation
Renal regulation
Cardiac regulation
Gastrointestinal regulation
Insensible water loss (not typically measurable)
Fluid Balance Statistics
Normal Fluid Balance for Adults: 2500 mL total daily input/output:
Intake:
Fluids: 1200 mL
Solids: 1000 mL
Water from oxidation: 300 mL
Output:
Insensible loss (skin & lungs): 900 mL
Urine: 1500 mL
Feces: 100 mL
Fluid Balance Definition
Fluid Balance = Intake - Output
**Possible Outcomes: **
Positive fluid balance (+): Intake > Output
Neutral fluid balance: Intake = Output
Negative fluid balance (-): Intake < Output
Practical Calculations: Intake & Output
Example Case: Mr. Heinz’ fluid intake/output record and calculations on a 12-hour shift:
Tasks:
Calculate total intake and output.
Determine if fluid balance is positive or negative.
Sample Calculation Question
Scenario: A patient’s fluid intake and output over 12 hours:
Intake: 500 mL juice + 200 mL tea
Output: 800 mL urine + 300 mL rectal enema (retained)
Fluid Balance Calculation: Evaluate result from options:
-200mL, +200mL, -500mL, +500mL
Signs and Symptoms of Dehydration
Nursing Assessments:
Weight
Mucous membranes
Ins/Outs (Intake & Output)
Urine characteristics
Level of consciousness (LOC)
Skin condition
Cardiovascular changes
Respiratory changes
Vital Signs Observation
Monitor parameters:
Heart Rate
Blood Pressure
Respiratory Rate
Temperature
O2 Saturations
Severity of Symptoms
Mild Dehydration:
Dry mucous membranes
Increased thirst
Concentrated urine
Moderate Dehydration:
Sunken eyes
Loss of skin turgor
Dry oral mucous membranes
Decreased urine output
Vital sign changes
Severe Dehydration / Shock:
Rapid, thready pulse
Cyanosis
Cold extremities
Rapid respiratory rate
Lethargy or coma
Nursing Diagnoses Related to Dehydration
Deficient fluid volume
Risk of deficient fluid volume
Hypovolemic shock (covered in Semester 3)
Nursing Interventions for Dehydration
Offer oral fluids frequently.
Educate on reducing output (e.g., avoid caffeine, alcohol).
Provide frequent mouth and skin care.
Monitor:
Daily weights
Heart Rate, Blood Pressure, Temperature
Skin turgor, mucous membranes
Labs (blood, urine)
Intake and output Q8H or more frequently if needed.
Medical Management of Dehydration
IV Fluids:
Amount and electrolyte content determined by physician.
Treating Causes:
Anti-emetic therapy for vomiting, anti-diarrheal agents for diarrhea.
Medication for food-related nausea (anti-emetic).
Common Gastrointestinal Issues
Overview of GI System Anatomy
Components include:
Salivary glands (parotid, submandibular, sublingual)
Pharynx, esophagus, stomach, intestines (small, large)
Liver, pancreas, gallbladder, rectum and anus.
Nausea and Vomiting (N+V)
Definitions:
Nausea: Discomfort in epigastrium with an urge to vomit.
Vomiting: Forceful expulsion of partially digested food and secretions from the upper GI tract.
Often closely related and treated as a cohesive issue.
Causes of Nausea and Vomiting
Symptoms of:
GI diseases (e.g., Crohn's, colitis, IBS)
Other medical conditions (psychological, neurological, kidney, liver diseases)
Infections (Norovirus, food poisoning)
Medications (such as chemotherapy)
Anesthesia.
Clinical Manifestations
Nausea: Subjective complaint; may include anorexia.
Vomiting Warning Signs:
Nausea, increased salivation, sweating, abdominal discomfort.
Prolonged Vomiting Risks:
Dehydration (loss of water/electrolytes)
Metabolic alkalosis or acidosis due to gastric and bile contents respectively.
Nursing Assessment for Nausea and Vomiting
Evaluate:
History of GI disorders and relevant symptoms.
Consider psychological and systemic factors (pregnancy, infections, etc.).
Determine underlying causes via thorough assessments of:
Timing, frequency, amount, and precipitating factors of N+V.
Contents of Emesis Assessment
Check contents for indications:
Partially digested food
Bile or fecal odor
Coffee grounds appearance
Bright red blood.
Nursing Diagnoses Related to Nausea/Vomiting
Nausea: Related to environmental stimuli, unpleasant tastes, or sights.
Dehydration: Related to insufficient intake due to prolonged vomiting.
Nutritional Deficiencies: Due to insufficient dietary intake from symptoms.
Safety Issues: Related to risks of aspiration during episodes.
Expected Patient Outcomes for N+V
Report minimal to no nausea.
No signs of dehydration or weight loss.
Achieve neutral fluid balance.
Nursing Interventions for N+V
Continuous monitoring and assessment of:
Signs of dehydration
Lab values
Remove triggers of nausea.
Maintain hygiene and comfort measures.
Encourage fluids and nutrition when tolerated.
Medical Management of Nausea/Vomiting
Administer IV fluids for dehydration.
Use antiemetic medications appropriate for underlying causes:
Examples:
Dimenhydrinate (Gravol) for nausea/vomiting/dizziness.
Ondansetron (Zofran) for chemotherapy-induced nausea.
Prochlorperazine (Stemetil) for short-term N&V management.
Constipation
Definition of Constipation
Characterized by:
Decreased frequency of bowel movements
Hard and difficult-to-pass stools
Retention of feces in rectum.
Can be a combination of these factors.
Causes of Constipation
Primary Causes:
Non-ambulatory state
Dehydration
Low-fiber diet
Medications (e.g., opioids)
Ignoring urge to defecate
Chronic laxative use.
Secondary Causes:
Metabolic (neurological, muscular disorders), endocrine disorders, and colon diseases (IBS, diverticulitis).
Clinical Manifestations of Constipation
Symptoms include:
Discomfort, abdominal pain
Abdominal distention
Straining (Valsalva maneuver)
Hard and dry stools
Anorexia, nausea, potential bleeding.
Complications Related to Constipation
Potential conditions:
Fecal impaction
Hemorrhoids
Megacolon
Valsalva maneuver-related cardiac issues.
Nursing Assessment for Constipation
Key evaluations:
Health history (bowel movement patterns, previous bowel diseases, medication use)
Physical assessments, clinical manifestations.
Expected Patient Outcomes for Constipation
Maintain a regular elimination pattern within two days.
Adequate hydration and fiber intake initiated immediately.
Client learns to prevent constipation.
Nursing Interventions for Constipation
Patient education includes:
Bowel training and not ignoring urges.
Diet and fluid education.
Promote ambulation and avoid laxative overuse.
Medical Management for Constipation
If needed, pharmaceutical agents are available and categorized:
Bulk-forming (Metamucil): Requires fluids to increase fecal bulk.
Fecal softeners (Docusate sodium): Lubricates and softens stools.
Saline and osmotic (Lactulose): Causes fluid retention in bowel.
Stimulants (Dulcolax): Increase peristalsis.
Nutritional Management for Constipation
Increase fiber intake, especially soluble fiber (e.g., from vegetables, grains).
Ensure adequate hydration (approximately 2-3L/day) if not contraindicated.
Promote regular eating patterns.
Diarrhea
Definition of Diarrhea
Characterized by frequent passage of loose, watery stools.
May be acute or chronic (lasting >2 weeks).
Represents a symptom rather than a standalone disease.
Causes of Diarrhea
Mechanisms:
Decreased fluid absorption due to mucosal damage/malabsorption.
Increased secretion by the bowel due to infections, medication (e.g., laxatives), foods (e.g., sugar).
Motility disturbances (e.g., IBS).
Clinical Manifestations of Diarrhea
Symptoms may include:
Watery, explosive stools
Abdominal cramping and pain
Perianal discomfort
Accompanying fever, nausea, vomiting, and weight loss (in chronic cases).
Complications Related to Diarrhea
Potential issues:
Dehydration (especially in the young and elderly)
Electrolyte imbalance (notably decreased potassium)
Weight loss and malnutrition
Bacteremia if infection enters bloodstream.
Diagnostic Approaches for Diarrhea
Evaluate underlying cause through:
Blood tests (CBC, electrolytes)
Stool examinations (routine, specialized tests)
Endoscopy or barium enema if necessary.
Nursing Assessment for Diarrhea
Key evaluations include:
Health history (duration, frequency, medication use)
Completion of a thorough physical assessment.
Expected Patient Outcomes for Diarrhea
Maintain or achieve normalized bowel movements.
Prevent skin breakdown and dehydration.
Return to baseline body weight.
Nursing Interventions for Diarrhea
Regular monitoring for dehydration and electrolyte balance.
Ensure hygiene practices, promoting skin integrity.
Provide medications, IV fluids as required.
Medical Management for Diarrhea
Focuses on symptom control and addressing underlying causes:
Administering antibiotics or anti-inflammatory agents if indicated.
Avoidance of certain medications (e.g., over-the-counter anti-diarrheal agents in specific situations).
Nutritional Management for Diarrhea
Adjust based on underlying cause:
Generally avoid high-sugar foods, spicy foods, and other personal triggers.