Dehydration

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1. DehydrationDehydration

2. 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 weight neonates, approximately 75% of the body weight
is water content; by adulthood, the percentage is water content; by adulthood, the percentage
has decreased to approximately 60%; in the has decreased to approximately 60%; in the
elderly, only about 55% of the body weight is elderly, only about 55% of the body weight is
water content. The sharpest decline in fluid water content. The sharpest decline in fluid
volume occurs within the first 10 years of life.volume occurs within the first 10 years of life.

3. DehydrationDehydration

DehydrationDehydration—— excessive loss of fluid from excessive loss of fluid from
the bodythe body—— occurs when the loss of fluid occurs when the loss of fluid
exceeds the fluid intake.exceeds the fluid intake.

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

5. Other causes of fluid loss includeOther causes of fluid loss include::

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 insipidusdiabetes mellitus with polyuria or diabetes insipidus

fistulasfistulas

excessive use of laxativesexcessive use of laxatives

aggressive diuretic therapyaggressive diuretic therapy

FeverFever

excessive fluid removal with hemodialysis or peritoneal excessive fluid removal with hemodialysis or peritoneal
dialysis therapy dialysis therapy

6. Possible causes of reduced fluid Possible causes of reduced fluid
intake includeintake 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.

7. The pathophysiology of dehydrationThe pathophysiology of dehydration

The pathophysiology of dehydration involves a The pathophysiology of dehydration involves a
number of mechanisms. The loss of body fluids number of mechanisms. The loss of body fluids
causes an increase in blood solute 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 and regain fluid balance between intracellular and
extracellular spaces, water molecules shift out of extracellular spaces, water molecules shift out of
the cells into the concentrated blood the cells into the concentrated blood

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

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

10. 
Other complications include renal failure Other complications include renal failure
from decreased renal perfusion and, from decreased renal perfusion and,
without intervention, death without intervention, death

11. What happens in hypovolemic What happens in hypovolemic
shockshock

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 shifting hemorrhage or third-space fluid shifting

External fluid loss can result from severe External fluid loss can result from severe
bleeding or from severe diarrhea, diuresis, bleeding or from severe diarrhea, diuresis,
or vomiting or vomiting

12. 
Inadequate vascular volume leads to decreased Inadequate vascular volume leads to decreased
venous return and cardiac output venous return and cardiac output

The resulting drop in arterial blood pressure The resulting drop in arterial blood pressure
activates the bodyactivates the body’’s compensatory mechanisms s compensatory mechanisms
in an attempt to increase vascular volume in an attempt to increase vascular volume

If compensation is unsuccessful, If compensation is unsuccessful,
decompensation and death may occur.decompensation and death may occur.

14. AssessmentAssessment

An assessment may reveal numerous symptoms An assessment may reveal numerous symptoms
affecting many body systems 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 neck 3- . Physical findings may include flattened neck
veins related to decreased circulating fluid veins related to decreased circulating fluid
volumevolume

4- sunken eyeballs related to decreased total 4- sunken eyeballs related to decreased total
fluid volume with consequent dehydration of fluid volume with consequent dehydration of
connective tissue and aqueous humor connective tissue and aqueous humor

15. 
5- Urine will be dark amber in color and 5- Urine will be dark amber in color and
decreased in volume 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 weakness , 7- The patient may also exhibit weakness ,
irritability irritability

16. Diagnostic testsDiagnostic tests

HematocritHematocrit is elevated. is elevated.

Serum osmolalitySerum osmolality is elevated (greater than 300 is elevated (greater than 300
mOsm/kg; in patients with diabetes insipidus, mOsm/kg; in patients with diabetes insipidus,
osmolality ranges from 50 to 200 mOsm/kg).osmolality ranges from 50 to 200 mOsm/kg).

Serum sodium levelSerum sodium level is elevated (greater than is elevated (greater than
145 mEq/L).145 mEq/L).

Urine specific gravityUrine specific gravity is greater than 1.030 (in is greater than 1.030 (in
patients with diabetes insipidus, specific gravity patients with diabetes insipidus, specific gravity
is usually less than 1.005).is usually less than 1.005).

17. TreatmentTreatment

The patient with severe dehydration will require The patient with severe dehydration will require
I.V. fluid replacement. I.V. fluids should be I.V. fluid replacement. I.V. fluids should be
hypotonic, low-sodium solutions, such as hypotonic, low-sodium solutions, such as
dextrose 5% in water dextrose 5% in water

Avoid rapid administration of the I.V. solutions, Avoid rapid administration of the I.V. solutions,
because this will cause fluid to move from the because this will cause fluid to move from the
veins into the cells and result in edema. Fluids veins into the cells and result in edema. Fluids
should be administered gradually, over a period should be administered gradually, over a period
of 48 hours.of 48 hours.

18. ALERTALERT

Rapid administration of I.V. solution Rapid administration of I.V. solution
can cause edema, which in turn can cause edema, which in turn
may progress to cerebral edema, a may progress to cerebral edema, a
potentially fatal complicationpotentially fatal complication

19. nursing diagnosesnursing diagnoses

Deficient fluid volume related to inadequate fluid Deficient fluid volume related to inadequate fluid
intake and active fluid lossintake and active fluid loss

Decreased cardiac output related to decreased Decreased cardiac output related to decreased
fluid volumefluid volume

Impaired oral mucous membranes related to Impaired oral mucous membranes related to
dehydrationdehydration

Risk for injury related to dizziness or Risk for injury related to dizziness or
hypotensionhypotension

20. Nursing interventionsNursing interventions

1- Obtain a patient history to determine the cause of the 1- Obtain a patient history to determine the cause of the
fluid imbalance.fluid imbalance.

2- Insert a urinary catheter, as ordered for accurate 2- Insert a urinary catheter, as ordered for accurate
monitoring of fluid output.monitoring of fluid output.

3- Encourage the patient to increase oral intake of fluid3- Encourage the patient to increase oral intake of fluid

4- Provide oral fluids of the patient4- Provide oral fluids of the patient’’s preference, and s preference, and
place within easy reach.place within easy reach.

5- Assist the patient if he5- Assist the patient if he’’s unable to feed himself or s unable to feed himself or
hold a cup.hold a cup.

6- Avoid acidic juices if the patient has impaired oral 6- Avoid acidic juices if the patient has impaired oral
membrane integrity membrane integrity

21. Nursing interventionsNursing interventions

7- Provide I.V. fluid replacement if the patient can7- Provide I.V. fluid replacement if the patient can’’t orally consume t orally consume
adequate amounts of fluid.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 orthostatic 11- Institute safety precautions if the patient is experiencing orthostatic
hypotension, dizziness, or alterations in mental statushypotension, 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), and obtain Review medications that can contribute to fluid loss (diuretics), and obtain
an order to discontinue or adjust dosean order to discontinue or adjust dose

22. MonitoringMonitoring

1- Assess and record weight at the same 1- Assess and record weight at the same
time each day.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 fluid 3- Assess and record daily intake of fluid
intake and output.intake and output.

4- Monitor color and amount of urine 4- Monitor color and amount of urine
output output

23. 
5- Monitor serum electrolytes and urine 5- Monitor serum electrolytes and urine
osmolality.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 mental 7- Assess and record changes in mental
status or neurologic functions status or neurologic functions

24. 
Closely monitor very young patients and elderly Closely monitor very young patients and elderly
patients for dehydration, because individuals in patients for dehydration, because individuals in
these groups are susceptible to fluid loss due to these groups are susceptible to fluid loss due to
inability to communicate thirst or obtain fluid inability to communicate thirst or obtain fluid
without assistance without assistance

Inaccurate assessment of output related to Inaccurate assessment of output related to
absorbent products such as diapers also places absorbent products such as diapers also places
these patients at risk. Fluid loss may also occur these patients at risk. Fluid loss may also occur
in these populations due to diarrhea or vomiting, in these populations due to diarrhea or vomiting,
or due to perspiration caused by fever or due to perspiration caused by fever

25. Patient teachingPatient teaching

1- Describe and provide information on causes of fluid 1- Describe and provide information on causes of fluid
loss or decreased oral intake of 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 fluid importance of maintaining proper nutrition and fluid
intake.intake.

3- Refer the patient to home care services if continued 3- Refer the patient to home care services if continued
monitoring or I.V. fluid administration is required.monitoring or I.V. fluid administration is required.

4- Discuss signs and symptoms of dehydration, and 4- Discuss signs and symptoms of dehydration, and
instruct the patient and his family to immediately report instruct the patient and his family to immediately report
this information to their health care provider this information to their health care provider

26. Patient teachingPatient teaching

5- Teach the patient and his family how to 5- Teach the patient and his family how to
monitor daily intake and output and monitor daily intake and output and
weight.weight.

6- Provide information on medications and 6- Provide information on medications and
dietary supplements that can cause dietary supplements that can cause
diuresis and lead to dehydration.diuresis and lead to dehydration.

27. Prepared by ; Jaber AlnamiPrepared by ; Jaber Alnami
ER staff Nurse(Sabya General ER staff Nurse(Sabya General
Hospital)Hospital)

Thank YouThank You

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