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1. DehydrationDehydration

2. DehydrationDehydration
 essential to body function and health. Wateressential to body function and health. Water
content decreases from birth to old age; incontent decreases from birth to old age; in
neonates, approximately 75% of the body weightneonates, approximately 75% of the body weight
is water content; by adulthood, the percentageis water content; by adulthood, the percentage
has decreased to approximately 60%; in thehas decreased to approximately 60%; in the
elderly, only about 55% of the body weight iselderly, only about 55% of the body weight is
water content. The sharpest decline in fluidwater 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 fromexcessive loss of fluid from
the bodythe body—— occurs when the loss of fluidoccurs 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 ofthird-space fluid shift, or a combination of
these factors can cause fluid volumethese factors can cause fluid volume
losseslosses

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 peritonealexcessive fluid removal with hemodialysis or peritoneal
dialysis therapydialysis therapy

6. Possible causes of reduced fluidPossible 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 aThe pathophysiology of dehydration involves a
number of mechanisms. The loss of body fluidsnumber of mechanisms. The loss of body fluids
causes an increase in blood solutecauses an increase in blood solute
concentration that increases osmolality.concentration that increases osmolality.
 Serum sodium levels rise. In an attempt toSerum sodium levels rise. In an attempt to
regain fluid balance between intracellular andregain fluid balance between intracellular and
extracellular spaces, water molecules shift out ofextracellular spaces, water molecules shift out of
the cells into the concentrated bloodthe 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 retentionwater intake and increased water retention
in the kidneys, usually restores fluidin the kidneys, usually restores fluid
balance. But without sufficient water in thebalance. But without sufficient water in the
extracellular space, fluid continues to shiftextracellular 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 impairingcausing the cells to shrink and impairing
cellular functioncellular function

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

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

11. What happens in hypovolemicWhat happens in hypovolemic
shockshock
 In hypovolemic shock, vascular fluidIn hypovolemic shock, vascular fluid
volume loss causes extreme tissuevolume loss causes extreme tissue
hypoperfusionhypoperfusion
 Internal fluid losses can result fromInternal fluid losses can result from
hemorrhage or third-space fluid shiftinghemorrhage or third-space fluid shifting
 External fluid loss can result from severeExternal fluid loss can result from severe
bleeding or from severe diarrhea, diuresis,bleeding or from severe diarrhea, diuresis,
or vomitingor vomiting

12.  Inadequate vascular volume leads to decreasedInadequate vascular volume leads to decreased
venous return and cardiac outputvenous return and cardiac output
 The resulting drop in arterial blood pressureThe resulting drop in arterial blood pressure
activates the bodyactivates the body’’s compensatory mechanismss compensatory mechanisms
in an attempt to increase vascular volumein 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 symptomsAn assessment may reveal numerous symptoms
affecting many body systemsaffecting many body systems
 1- orthostatic hypotension due to increased1- orthostatic hypotension due to increased
systemic vascular resistance and decreasedsystemic vascular resistance and decreased
cardiac outputcardiac output
 2- . Tachycardia induced by the sympathetic2- . Tachycardia induced by the sympathetic
nervous system to increase cardiac outputnervous system to increase cardiac output
 3- . Physical findings may include flattened neck3- . Physical findings may include flattened neck
veins related to decreased circulating fluidveins related to decreased circulating fluid
volumevolume
 4- sunken eyeballs related to decreased total4- sunken eyeballs related to decreased total
fluid volume with consequent dehydration offluid volume with consequent dehydration of
connective tissue and aqueous humorconnective tissue and aqueous humor

15.  5- Urine will be dark amber in color and5- Urine will be dark amber in color and
decreased in volumedecreased in volume
 6- diminished skin turgor due to6- diminished skin turgor due to
decreased fluid in the dermal layerdecreased fluid in the dermal layer
 7- The patient may also exhibit weakness ,7- The patient may also exhibit weakness ,
irritabilityirritability

16. Diagnostic testsDiagnostic tests
 HematocritHematocrit is elevated.is elevated.
 Serum osmolalitySerum osmolality is elevated (greater than 300is 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 thanis elevated (greater than
145 mEq/L).145 mEq/L).
 Urine specific gravityUrine specific gravity is greater than 1.030 (inis greater than 1.030 (in
patients with diabetes insipidus, specific gravitypatients 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 requireThe patient with severe dehydration will require
I.V. fluid replacement. I.V. fluids should beI.V. fluid replacement. I.V. fluids should be
hypotonic, low-sodium solutions, such ashypotonic, low-sodium solutions, such as
dextrose 5% in waterdextrose 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 thebecause this will cause fluid to move from the
veins into the cells and result in edema. Fluidsveins into the cells and result in edema. Fluids
should be administered gradually, over a periodshould be administered gradually, over a period
of 48 hours.of 48 hours.

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

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

20. Nursing interventionsNursing interventions
 1- Obtain a patient history to determine the cause of the1- Obtain a patient history to determine the cause of the
fluid imbalance.fluid imbalance.
 2- Insert a urinary catheter, as ordered for accurate2- 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, ands 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 ors unable to feed himself or
hold a cup.hold a cup.
 6- Avoid acidic juices if the patient has impaired oral6- Avoid acidic juices if the patient has impaired oral
membrane integritymembrane 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 consumet 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 orthostatic11- 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 obtainReview 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 same1- 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 fluid3- Assess and record daily intake of fluid
intake and output.intake and output.
 4- Monitor color and amount of urine4- Monitor color and amount of urine
outputoutput

23.  5- Monitor serum electrolytes and urine5- Monitor serum electrolytes and urine
osmolality.osmolality.
 6- Monitor active losses of fluid from6- Monitor active losses of fluid from
drainage, suctioning, vomiting, ordrainage, suctioning, vomiting, or
bleeding.bleeding.
 7- Assess and record changes in mental7- Assess and record changes in mental
status or neurologic functionsstatus or neurologic functions

24.  Closely monitor very young patients and elderlyClosely monitor very young patients and elderly
patients for dehydration, because individuals inpatients for dehydration, because individuals in
these groups are susceptible to fluid loss due tothese groups are susceptible to fluid loss due to
inability to communicate thirst or obtain fluidinability to communicate thirst or obtain fluid
without assistancewithout assistance
 Inaccurate assessment of output related toInaccurate assessment of output related to
absorbent products such as diapers also placesabsorbent products such as diapers also places
these patients at risk. Fluid loss may also occurthese 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 feveror due to perspiration caused by fever

25. Patient teachingPatient teaching
 1- Describe and provide information on causes of fluid1- 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 the2- Provide information on the care plan and the
importance of maintaining proper nutrition and fluidimportance of maintaining proper nutrition and fluid
intake.intake.
 3- Refer the patient to home care services if continued3- 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, and4- Discuss signs and symptoms of dehydration, and
instruct the patient and his family to immediately reportinstruct the patient and his family to immediately report
this information to their health care providerthis information to their health care provider

26. Patient teachingPatient teaching
 5- Teach the patient and his family how to5- Teach the patient and his family how to
monitor daily intake and output andmonitor daily intake and output and
weight.weight.
 6- Provide information on medications and6- Provide information on medications and
dietary supplements that can causedietary 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 GeneralER staff Nurse(Sabya General
Hospital)Hospital)

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