Question

As a senior student you are assigned to work with a preceptor in the Emergency Department. It is a very busy day and it seems as if every patient, regardless of chief complaint, has an issue with fluid, electrolyte, and/or acid-base balance. The first patient you see is a 37-year-old landscaper who is brought to the ED after collapsing on a job at the local country club. He is slightly confused but is able to tell you he feels dizzy and weak. His skin is flushed, dry, and with poor turgor. He has dry, sticky mucous membranes. The nurse identifies a nursing diagnosis of deficient fluid volume.

Describe how each of the following would change and the rationale for the change in the presence of deficient fluid volume: • Heart rate • Blood pressure • Serum hematocrit • Urinary output • Urine specific gravity • Weight

What is usually the first indicator that an individual needs more fluids?

The ED physician orders IV fluids for this patient. What types of fluids are indicated for a fluid volume deficit due to dehydration?

Answer 1

a)Heart rate:increased heart rate with less fluid available to the circulatory system,the heart pumps faster to bring oxygen to the body.

Blood pressure:Decreased blood pressure,in adults lower fluid volume means lower pressure in veins.

Rationale:,Decrease in circulating blood volume can cause hypotension

Serum hematocrit:(The percentage of RBC) increases unless fluid was lost due to hemorrhage

Rationale:hematocrit levels that are too high or too low indicate a blood disorder,dehydration or other medical conditions

Urinary output:Decreased urine output

Rationale:A normal urine output is considered normal not less than 30 ml/hour.concentrated urine denotes fluid deficit

Urine specific gravity:Elevated,indicating more highly concentrated urine.

Rationale:Elevated blood urea nitrogen suggests fluid deficit.urine specific gravity is likewise increased

Weight:weight loss due to fluid deficit,weight daily with same scale,and preferably at the same time of the day

Rationale:weight is the best assessment data for possible fluid volume imbalance .An increased in 2 lbs a week is consider normal

B)The elasticity of skin ,or turgor,is an indicator of fluid status in most patients,Assessing skin turgor is a quick and simple test performed by pinching a fold of skin.Thirst is an another indicator.

c) Initial management includes placement of an intravenous or intra osseous line and rapid administration of an isotonic crystalloid (eg ringer lactate,0.9%sodium chloride)Additional fluid boluses may be required depending on the severity of the dehydration.