How does dehydration occur?
Dehydration occurs when the fluid intake of the body is not sufficient to meet the fluid needs of the body.
What is the goal of treatment for dehydration? (3)
The goal of treatment is to
1: restore fluid volume
2: replace electrolytes as needed
3: eliminate the cause of the fluid volume deficit
What are the types of fluid volume deficits? (3)
Isotonic dehydration
Hypertonic dehydration
Hypotonic dehyration
What is isotonic dehydration?
Water and dissolved electrolytes are lost in equal proportions.
Also known as hypovolemia.
Most common type of dehydration.
What are the results of isotonic dehydration on the body?
Isotonic dehydration results in decreased circulating blood volume and inadequate tissue perfusion.
What is hypertonic dehydration?
Water loss exceeds electrolyte loss.
What occurs in the body during hypertonic dehydration? (Where do the fluids shift, what is the effect?)
Fluid moves from the intracellular compartment into the plasma and interstitial fluid spaces, causing cellular dehydration and shrinkage.
What is hypotonic dehydration?
Electrolyte loss exceeds water loss.
Why does hypertonic dehydration cause clinical problems?
Results in clinical problems due to alterations in concentrations of specific plasma electrolytes.
Why does hypotonic dehydration result in clinical problems?
Clinical problems occur as a result of fluid shifts between compartments, causing a decrease in plasma volume.
What occurs in the body during hypotonic dehydration? (Where do the fluids shift, what is the effect?)
Fluid moves from the plasma and interstitial fluid spaces into the cells, causing a plasma volume deficit and causing the cells to swell.
What are the causes of isotonic dehydration? (3)
Inadequate intake of fluids and solutes.
Fluid shifts between compartments.
Excessive losses of isotonic body fluids.
What are the causes of hypertonic dehydration? (Give 7 examples)
Conditions that increase fluid loss, such as: Excessive perspiration Hyperventilation Ketoacidosis Prolonged fevers Diarrhea Early-stage kidney disease Diabetes insipidus
What are the causes of hypotonic dehydration? (4)
Chronic illness
Excessive fluid replacement (hypotonic)
Kidney disease
Chronic malnutrition
Which body systems are the most important to assess in cases of dehydration?
Cardiovascular Respiratory Neuromuscular Renal Integumentary Gastrointestinal
What are the cardiovascular signs and symptoms of fluid volume deficit? (6)
Thready, increased pulse rate.
Decreased blood pressure and orthostatic hypotension.
Flat neck and hand veins in dependent positions.
Diminished peripheral pulses.
Decreased central venous pressure.
Dysrhythmias.
What are the respiratory signs and symptoms of fluid volume deficit? (2)
Increased rate and depth of respirations.
Dyspnea
What are the neuromuscular signs and symptoms of fluid volume deficit? (3)
Decreased CNS activity, from lethargy to coma.
Fever, depending on the amount of fluid loss.
Skeletal muscle weakness.
What is the renal symptom of fluid volume deficit?
Decreased urine output.
What are the integumentary symptoms of fluid volume deficit? (3)
Dry skin
Poor turgor, tenting
Dry mouth
What are the gastrointestinal symptoms of fluid volume deficit? (4)
Decreased motility and diminished bowel sounds.
Constipation.
Thirst.
Decreased body weight.
What are the laboratory findings that indicate fluid volume deficit? (5)
Increased serum osmolality Increased hematocrit Increased BUN Increased serum sodium level Increased urine specific gravity
What are the interventions the nurse should implement when caring for a patient with fluid volume deficit?
(7)
- Monitor cardio, resp, neuromuscular, renal, integumentary, and gastro status.
- Prevent further fluid losses and increase fluid compartment volumes to normal range.
- Provide oral rehydration therapy (or IV if severe or oral not possible.
- Monitor ins and outs.
- Administer meds as prescribed (antidiarrheal, antimicrobial, antiemetic, antipyretic, etc)
- Administer oxygen PRN
- Monitor electrolyte values and prepare to administer medication to treat an imbalanace if present.
