DehydrationDehydration

DehydrationDehydration

essential to body function and health. Water essential to body function and health. Water content decreases from birth to old age; in content decreases from birth to old age; in neonates, approximately 75% of the body neonates, approximately 75% of the body weight is water content; by adulthood, the weight is water content; by adulthood, the percentage has decreased to approximately percentage has decreased to approximately 60%; in the elderly, only about 55% of the 60%; in the elderly, only about 55% of the body weight is water content. The sharpest body weight is water content. The sharpest decline in fluid volume occurs within the decline in fluid volume occurs within the first 10 years of life.first 10 years of life.

DehydrationDehydration

DehydrationDehydration—— excessive loss of fluid excessive loss of fluid from the bodyfrom the body—— occurs when the loss occurs when the loss of fluid exceeds the fluid intake.of fluid exceeds the fluid intake.

CausesCauses

Excessive fluid loss, reduced fluid Excessive fluid loss, reduced fluid intake, third-space fluid shift, or a intake, third-space fluid shift, or a combination of these factors can combination of these factors can cause fluid volume losses cause fluid volume losses

Other causes of fluid loss Other causes of fluid loss includeinclude::

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 diabetes mellitus with polyuria or diabetes

insipidusinsipidus fistulasfistulas excessive use of laxativesexcessive use of laxatives aggressive diuretic therapyaggressive diuretic therapy FeverFever excessive fluid removal with hemodialysis or excessive fluid removal with hemodialysis or

peritoneal dialysis therapy peritoneal dialysis therapy

Possible causes of reduced Possible causes of reduced fluid intake includefluid intake 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.

The pathophysiology of The pathophysiology of dehydrationdehydration

The pathophysiology of dehydration involves The pathophysiology of dehydration involves a number of mechanisms. The loss of body a number of mechanisms. The loss of body fluids causes an increase in blood solute fluids causes an increase in blood solute concentration that increases osmolality. concentration that increases osmolality.

Serum sodium levels rise. In an attempt to Serum sodium levels rise. In an attempt to regain fluid balance between intracellular regain fluid balance between intracellular and extracellular spaces, water molecules and extracellular spaces, water molecules shift out of the cells into the concentrated shift out of the cells into the concentrated blood blood

The pathophysiology of The pathophysiology of dehydrationdehydration

. This process, combined with increased . This process, combined with increased water intake and increased water water intake and increased water retention in the kidneys, usually retention in the kidneys, usually restores fluid balance. But without restores fluid balance. But without sufficient water in the extracellular sufficient water in the extracellular space, fluid continues to shift out of the space, fluid continues to shift out of the cells into the extracellular space, cells into the extracellular space, causing the cells to shrink and causing the cells to shrink and impairing cellular function impairing cellular function

ComplicationsComplications

Complications include hypotension, Complications include hypotension, risk of falls related to hypotension, risk of falls related to hypotension, and decreased cardiac output and and decreased cardiac output and perfusion to tissues and organs. perfusion to tissues and organs. Severe dehydration can progress to Severe dehydration can progress to hypovolemic shock hypovolemic shock

Other complications include renal Other complications include renal failure from decreased renal failure from decreased renal perfusion and, without intervention, perfusion and, without intervention, death death

What happens in What happens in hypovolemic shockhypovolemic shock

In hypovolemic shock, vascular fluid In hypovolemic shock, vascular fluid volume loss causes extreme tissue volume loss causes extreme tissue hypoperfusion hypoperfusion

Internal fluid losses can result from Internal fluid losses can result from hemorrhage or third-space fluid hemorrhage or third-space fluid shifting shifting

External fluid loss can result from External fluid loss can result from severe bleeding or from severe severe bleeding or from severe diarrhea, diuresis, or vomiting diarrhea, diuresis, or vomiting

Inadequate vascular volume leads to Inadequate vascular volume leads to decreased venous return and cardiac decreased venous return and cardiac output output

The resulting drop in arterial blood The resulting drop in arterial blood pressure activates the bodypressure activates the body’’s s compensatory mechanisms in an attempt compensatory mechanisms in an attempt to increase vascular volume to increase vascular volume

If compensation is unsuccessful, If compensation is unsuccessful, decompensation and death may occur.decompensation and death may occur.

AssessmentAssessment An assessment may reveal numerous An assessment may reveal numerous

symptoms affecting many body systems symptoms affecting many body systems 1- orthostatic hypotension due to increased 1- orthostatic hypotension due to increased

systemic vascular resistance and decreased systemic vascular resistance and decreased cardiac output cardiac output

2- . Tachycardia induced by the sympathetic 2- . Tachycardia induced by the sympathetic nervous system to increase cardiac output nervous system to increase cardiac output

3- . Physical findings may include flattened 3- . Physical findings may include flattened neck veins related to decreased circulating neck veins related to decreased circulating fluid volumefluid volume

4- sunken eyeballs related to decreased 4- sunken eyeballs related to decreased total fluid volume with consequent total fluid volume with consequent dehydration of connective tissue and dehydration of connective tissue and aqueous humor aqueous humor

5- Urine will be dark amber in color 5- Urine will be dark amber in color and decreased in volume and decreased in volume

6- diminished skin turgor due to 6- diminished skin turgor due to decreased fluid in the dermal layer decreased fluid in the dermal layer

7- The patient may also exhibit 7- The patient may also exhibit weakness , irritability weakness , irritability

Diagnostic testsDiagnostic tests

HematocritHematocrit is elevated. is elevated. Serum osmolalitySerum osmolality is elevated (greater than is elevated (greater than

300 mOsm/kg; in patients with diabetes 300 mOsm/kg; in patients with diabetes insipidus, osmolality ranges from 50 to insipidus, osmolality ranges from 50 to 200 mOsm/kg).200 mOsm/kg).

Serum sodium levelSerum sodium level is elevated (greater is elevated (greater than 145 mEq/L).than 145 mEq/L).

Urine specific gravityUrine specific gravity is greater than 1.030 is greater than 1.030 (in patients with diabetes insipidus, (in patients with diabetes insipidus, specific gravity is usually less than 1.005).specific gravity is usually less than 1.005).

TreatmentTreatment

The patient with severe dehydration will The patient with severe dehydration will require I.V. fluid replacement. I.V. fluids require I.V. fluid replacement. I.V. fluids should be hypotonic, low-sodium solutions, should be hypotonic, low-sodium solutions, such as dextrose 5% in water such as dextrose 5% in water

Avoid rapid administration of the I.V. Avoid rapid administration of the I.V. solutions, because this will cause fluid to solutions, because this will cause fluid to move from the veins into the cells and result move from the veins into the cells and result in edema. Fluids should be administered in edema. Fluids should be administered gradually, over a period of 48 hours.gradually, over a period of 48 hours.

ALERTALERT

Rapid administration of I.V. Rapid administration of I.V. solution can cause edema, which solution can cause edema, which in turn may progress to cerebral in turn may progress to cerebral edema, a potentially fatal edema, a potentially fatal complicationcomplication

nursing diagnosesnursing diagnoses

Deficient fluid volume related to Deficient fluid volume related to inadequate fluid intake and active fluid inadequate fluid intake and active fluid lossloss

Decreased cardiac output related to Decreased cardiac output related to decreased fluid volumedecreased fluid volume

Impaired oral mucous membranes related Impaired oral mucous membranes related to dehydrationto dehydration

Risk for injury related to dizziness or Risk for injury related to dizziness or hypotensionhypotension

Nursing interventionsNursing interventions

1- Obtain a patient history to determine the cause 1- Obtain a patient history to determine the cause of the fluid imbalance.of the fluid imbalance.

2- Insert a urinary catheter, as ordered for 2- Insert a urinary catheter, as ordered for accurate monitoring of fluid output.accurate monitoring of fluid output.

3- Encourage the patient to increase oral intake of 3- Encourage the patient to increase oral intake of fluidfluid

4- Provide oral fluids of the patient4- Provide oral fluids of the patient ’’s preference, s preference, and place within easy reach.and place within easy reach.

5- Assist the patient if he5- Assist the patient if he’’s unable to feed himself s unable to feed himself or hold a cup.or hold a cup.

6- Avoid acidic juices if the patient has impaired 6- Avoid acidic juices if the patient has impaired oral membrane integrity oral membrane integrity

Nursing interventionsNursing interventions

7- Provide I.V. fluid replacement if the patient can7- Provide I.V. fluid replacement if the patient can ’’t orally t orally consume adequate amounts of fluid.consume 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 11- Institute safety precautions if the patient is experiencing orthostatic hypotension, dizziness, or alterations in mental statusorthostatic hypotension, 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), Review medications that can contribute to fluid loss (diuretics),

and obtain an order to discontinue or adjust doseand obtain an order to discontinue or adjust dose

MonitoringMonitoring

1- Assess and record weight at the 1- Assess and record weight at the same time each day.same 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 3- Assess and record daily intake of fluid intake and output.fluid intake and output.

4- Monitor color and amount of urine 4- Monitor color and amount of urine output output

5- Monitor serum electrolytes and 5- Monitor serum electrolytes and urine osmolality.urine osmolality.

6- Monitor active losses of fluid from 6- Monitor active losses of fluid from drainage, suctioning, vomiting, or drainage, suctioning, vomiting, or bleeding.bleeding.

7- Assess and record changes in 7- Assess and record changes in mental status or neurologic functions mental status or neurologic functions

Closely monitor very young patients and Closely monitor very young patients and elderly patients for dehydration, because elderly patients for dehydration, because individuals in these groups are susceptible to individuals in these groups are susceptible to fluid loss due to inability to communicate fluid loss due to inability to communicate thirst or obtain fluid without assistance thirst or obtain fluid without assistance

Inaccurate assessment of output related to Inaccurate assessment of output related to absorbent products such as diapers also absorbent products such as diapers also places these patients at risk. Fluid loss may places these patients at risk. Fluid loss may also occur in these populations due to also occur in these populations due to diarrhea or vomiting, or due to perspiration diarrhea or vomiting, or due to perspiration caused by fever caused by fever

Patient teachingPatient teaching

1- Describe and provide information on causes of 1- Describe and provide information on causes of fluid loss or decreased oral intake of fluid.fluid loss or decreased oral intake of fluid.

2- Provide information on the care plan and the 2- Provide information on the care plan and the importance of maintaining proper nutrition and importance of maintaining proper nutrition and fluid intake.fluid intake.

3- Refer the patient to home care services if 3- Refer the patient to home care services if continued monitoring or I.V. fluid administration is continued monitoring or I.V. fluid administration is required.required.

4- Discuss signs and symptoms of dehydration, 4- Discuss signs and symptoms of dehydration, and instruct the patient and his family to and instruct the patient and his family to immediately report this information to their immediately report this information to their health care provider health care provider

Patient teachingPatient teaching

5- Teach the patient and his family 5- Teach the patient and his family how to monitor daily intake and how to monitor daily intake and output and weight.output and weight.

6- Provide information on 6- Provide information on medications and dietary supplements medications and dietary supplements that can cause diuresis and lead to that can cause diuresis and lead to dehydration.dehydration.

Prepared by ; Jaber AlnamiPrepared by ; Jaber Alnami

ER staff Nurse(Sabya General ER staff Nurse(Sabya General Hospital)Hospital)

Thank YouThank You

I wish you enjoy with my topicI wish you enjoy with my topic