What signs and symptoms did Stan present with that may indicate that he is dehydrated?
1. What signs and symptoms did Stan present with that may indicate that he is dehydrated? What nursing care and management is required for the patient presenting with dehydration?
Stan has sign and symptoms of poor skin turgor,dry oral mucous membrane,vomiting, less frequent urination and fatigue.Managing dehydration
ehydration must be treated by replenishing the fluid level in the body. This can be done by consuming clear fluids such as water, clear broths, frozen water or ice pops, or sports drinks (such as Gatorade). Some dehydration patients, however, will require intravenous fluids in order to rehydrate. People who are dehydrated should avoid drinks containing caffeine such as coffee, tea, and sodas.
Underlying conditions that are causing dehydration should also be treated with the appropriate medication. This may include medication available to purchase over-the-counter or online, such as anti-diarrhea medicines, anti-emetics (stop vomiting), and anti-fever medicines.
Prevention is really the most important treatment for dehydration. Consuming plenty of fluids and foods that have high water content (such as fruits and vegetables) should be enough for most people to prevent dehydration.
People should be cautious about doing activities during extreme heat or the hottest part of the day, and anyone who is exercising should make replenishing fluids a priority.
Since the elderly and very young are most at risk of being dehydrated, special attention should be given to them to make sure they are receiving enough fluids.
Medical News Today (2017). What you should know about dehydration, Retrived from: https://www.medicalnewstoday.com/articles/153363.php
Appropriate management of the severely dehydrated and uraemic patient is challenging and there is no specific guidance in the literature. Clinicians must use their judgement and discretion when tailoring alternative available guidelines for use in individual patient cases.
Since at least 1949, it has been understood that the mainstays of treatment for uraemia included the meticulous correction of water and electrolyte disturbance, with water balance taking precedence over electrolytes.1 Today’s clinician has a greater ability to monitor, measure and modify fluid and electrolytes, but this still must be done with caution and an awareness of the potential risks.
There are, broadly, two theoretical approaches one could take to correcting this patient’s severe dehydration and uraemia:
1. Management of hypernatraemia by estimating and correcting the fluid deficit according to serum sodium levels and managing the patient as per existing management of hypernatraemia guidelines (e.g. Adrogué),2 or
2. Managing and correcting the hyperosmolar state, but the only available guidance here is the hyperosmolar hyperglycaemic state (HHS) guideline where the hyperosmolar state is secondary to an elevated glucose (although these patients are additionally profoundly dehydrated and may have an elevated sodium too).3
Formulae hypothetically allow a clinician to calculate a patient’s free water deficit by utilising the extracellular sodium concentration as a surrogate marker of hydration status. Hypotonic solutions (5% dextrose in water, 0.2% sodium chloride in 5% dextrose in water and 0.45% sodium chloride in water) are recommended as the intravenous resuscitation fluids in the accompanying guidance excepting in the presence of ‘frank circulatory compromise’, when ‘isotonic’ solutions such as 0.9% sodium chloride are advised. The theory is that dehydration culminating in a relative water deficit is visible to the clinician via the measured sodium concentration.
NCBI, (2017 , Management of severe dehydration,Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5665131/
2. One complication of dehydration is hypovolaemic shock. What indicators would you be looking for in a patient with hypovolaemic shock and what would your nursing care be for a patient with this condition?
mild symptoms
Mild symptoms can include:
· headache
· fatigue
· nausea
· profuse sweating
Severe symptoms
Severe symptoms, which must be taken seriously and warrant emergency medical attention, include:
· cold or clammy skin
· rapid, shallow breathing
· weakness
· weak pulse
· blue lips and fingernails
· lightheadedness
The sign of external hemorrhaging is visible, profuse bleeding from a body site or area of injury.
Signs and symptoms of internal hemorrhaging include:
· abdominal pain
· black, tarry stool (melena)
· chest pain
While some symptoms like abdominal pain and sweating can point to something less urgent like a stomach virus, you should seek immediate medical attention when seeing groupings of these symptoms together. This is especially true for the more serious symptoms. The longer you wait, the more damage can be done to your tissues and organs.
If you have any signs of hemorrhaging or of hemorrhagic shock, seek medical attention immediately.
once at a hospital, a person suspected of having hypovolemic shock will receive fluids or blood products via an intravenous line, to replenish the blood lost and improve circulation. Treatment revolves around controlling loss of fluid and blood, replacing what’s been lost, and stabilizing damage that both caused and resulted from the hypovolemic shock. This will also include treating the injury or illness that caused the shock, if possible.
These include:
blood plasma transfusion
platelet transfusion
red blood cell transfusion
intravenous crystalloids
Doctors may also administer medications that increase the heart’s pumping strength to improve circulation and get blood where it’s needed. These include:
dopamine
dobutamine
epinephrine
norepinephrine
Antibiotics may be administered to prevent septic shock and bacterial infections.
Close cardiac monitoring will determine the effectiveness of the treatment you receive.
Health line,(2017) Hypovolemic shock, Retrieved from:https://www.healthline.com/health/hypovolemic-shock#emergency-care
*monitor for signs and symptoms of hypokalemia,fatigue,muscle weakness,decreased bowel motility,dysrhythmias, shallow breathing,weak thread post, monitor continuous intake output* ssist client in selecting foods rich in potassium as such as banana, fruit juices, melon, citrus fruits, and fresh vegetables
SCRIBD, (2018), Nursing care plan for hypokalaemia,https://www.scribd.com/document/278680359/Hypokalemia-Nursing-Care-Plan
3. Stan is diagnosed with a Small bowel obstruction (SBO), what is the nursing care and treatment of a person with a small bowel obstruction (SBO)?
· In the stable patient a thorough assessment is the next step including a detailed history, a detailed examination, blood tests including FBC, EUC, LFTs, lipase, BSL, an ECG and a CXR. Beta-HCG in women of childbearing age, VBG for lactate.
· If an alternative diagnosis is made at this time then the steps further down the pathway can be curtailed
Plain films: Initial imaging should include upright CXR and erect/supine AXR films (or lateral decubitus film if the patient cannot sit upright) – these have a sensitivity of 70-83% and specificity of 67-83% for small bowel obstruction. Plain film findings that suggest small bowel obstruction include:
· Dilated loops of bowel with air fluid levels – presence of >5 fluid levels.
· Proximal bowel dialation with distal bowel collapse – proximal small bowel dilated more than >2.5cm.
· Gasless abdomen
· CT abdomen: provides more information than plain films. May be useful to identify the specific site (i.e. transition point) and severity of the obstruction (partial vs complete). It will also give information about the aetiology, by identifying hernias, masses or inflammatory changes, and potential complications, such as ischaemia or perforation.
Management
Emergency surgery is indicated in:
· Perforation or impending perforation
· Strangulated small bowel obstruction
Patients considered for emergency surgery should be receive preoperative antibiotic prophylaxis and made NBM in preparation for surgery in addition to supportive case detailed below.
All patients should receive supportive care:
· NBM until surgical review
· IV fluids
· Monitoring of urine output
· Analgesia
· Anti-emetics can be a useful for emesis and/or nausea in cases where surgery is contraindicated (ondansetron 4mg IV q8H prn)
· NG tube for gastric decompression only when vomiting or severe symptoms as a result of gastric distention
Patients who do not require emergency surgery are initially treated conservatively for 48-72 hours. Failure to respond to conservative treatment would lead to consideration for surgery.
Gastrografin may be diagnostic and therapeutic in SBO due to surgical adhesions. The appearance of water-soluble contrast in the colon on an abdominal X ray within 24 hours of its administration predicts resolution of an adhesive small bowel obstruction. While gastrografin does not reduce the need for surgery it does reduce hospital stay in those patients who do not require surgery.
Emergency care Institute NSW, (2028), Small bowel obstructions, Retrieved from: https://www.aci.health.nsw.gov.au/networks/eci/clinical/clinical-resources/clinical-tools/abdominal-emergencies/bowel-obstruction/small-bowel-obstruction
4. In evaluating Stan Checketts’ laboratory results, what might his lab results indicate in relation to Stan’s condition? These lab results can be found in the vSim simulation or below.
The kidneys maintain the blood creatinine in a normal range. Creatinine has been found to be a fairly reliable indicator of kidney function. Elevated creatinine level signifies impaired kidney function or kidney disease, As the kidneys become impaired for any reason, the creatinine level in the blood will rise due to poor clearance of creatinine by the kidneys. Abnormally high levels of creatinine thus warn of possible malfunction or failure of the kidneys. It is for this reason that standard blood tests routinely check the amount of creatinine in the blood. Blood urea nitrogen (BUN) level is another indicator of kidney function. Urea is also a metabolic byproduct which can build up if kidney function is impaired. The BUN-to-creatinine ratio generally provides more precise information about kidney function and its possible underlying cause compared with creatinine level alone. BUN also increases with dehydration.
MedicineNet, (2018), Creatinine. Retrieved from: https://www.medicinenet.com/creatinine_blood_test/article.htm#what_is_creatinine
A high hemoglobin count indicates an above-normal level of hemoglobin in your blood. Hemoglobin (often abbreviated as Hb or Hgb) is the oxygen-carrying component of red blood cells.
A high hemoglobin count is somewhat different from a high red blood cell count, because each cell may not have the same amount of hemoglobin proteins. Therefore, you could have a high hemoglobin count even if your red blood cell count falls within the normal range.
The threshold for a high hemoglobin count is slightly different from one medical practice to another. It’s generally defined as more than 17.5 grams (g) of hemoglobin per deciliter (dL) of blood for men and 15.5 g/dL for women. In children, the definition of a high hemoglobin count varies with age and sex. Hemoglobin count may also vary due to time of day and how well-hydrated you are.
Mayo Clinic, (2018),Haemoglabin level count, retrieved from:https://www.mayoclinic.org/symptoms/high-hemoglobin-count/basics/definition/sym-20050862
4.In evaluation Stans lab results. What might his lab results indicate in relation to Stan’s condition.
Hypernatremia is a common electrolyte problem that is defined as a rise in serum sodium concentration to a value exceeding 145 mmol/LIt is strictly defined as a hyperosmolar condition caused by a decrease in total body water. relative to electrolyte content. Hypernatremia is a “water problem,” not a problem of sodium homeostasis. hypernatremia is caused by impaired thirst and/or restricted access to water, often exacerbated by pathologic conditions with increased fluid loss.
The development of hyperosmolality from the water loss can lead to neuronal cell shrinkage and resultant brain injury. Loss of volume can lead to circulatory problems (eg, tachycardia, hypotension). Rapid free-water replacement can cause cerebral edema.
Medscape, (2017), Hypernatraemia, Retrieved from: https://emedicine.medscape.com/article/241094-overview
Chloride is an important electrolyte that is responsible for maintaining the acid-base (pH) balance in your body, regulating fluids, and transmitting nerve impulses. The normal range for chloride in adults is roughly between 98 and 107 milliequivalents of chloride per liter of blood
our kidneys play an important role in the regulation of chloride in your body, so an imbalance in this electrolyte may be related to a problem with these organs. It may also be caused by other conditions, like diabetes or severe dehydration, which can affect the ability of your kidneys to maintain chloride balance.
Healthline, (2017), Hyperchloremia, Retrieved from:https://www.healthline.com/health/hyperchloremia
A hematocrit (he-MAT-uh-krit) test measures the proportion of red blood cells in your blood. Red blood cells carry oxygen throughout your body. Having too few or too many red blood cells can be a sign of certain diseases.
The hematocrit test, also known as a packed-cell volume (PCV) test, is a simple blood test.
A hematocrit test is part of a complete blood count (CBC). Measuring the proportion of red blood cells in your blood can help your doctor make a diagnosis or monitor your response to a treatment.
A lower than normal hematocrit can indicate:
· An insufficient supply of healthy red blood cells (anemia)
· A large number of white blood cells due to long-term illness, infection or a white blood cell disorder such as leukemia or lymphoma
· Vitamin or mineral deficiencies
· Recent or long-term blood loss
A higher than normal hematocrit can indicate:
· Dehydration
· A disorder, such as polycythemia vera, that causes your body to produce too many red blood cells
· Lung or heart disease
Mayo Clinic, (2018), Haematocrit test, Retrieved from:https://www.mayoclinic.org/tests-procedures/hematocrit/about/pac-20384728
A white blood cell (WBC) count is a test that measures the number of white blood cells in your body. This test is often included with a complete blood count (CBC). The term “white blood cell count” is also used more generally to refer to the number of white blood cells in your body. There are several types of white blood cells, and your blood usually contains a percentage of each type. Sometimes, however, your white blood cell count can fall or rise out of the healthy range.
Purpose of a WBC count
Having a higher or lower number of WBCs than normal may indicate an underlying condition. A WBC count can detect hidden infections within your body and alert doctors to undiagnosed medical conditions, such as autoimmune diseases, immune deficiencies, and blood disorders. This test also helps doctors monitor the effectiveness of chemotherapy or radiation treatment in people with cancer.
Healthline, (2018),White Blood cell count, Retrieved from: https://www.healthline.com/health/wbc-count#purp
