Arellano University College of Nursing Pasay City

Case Study of Patient with Dehydration
SUBMITTED BY: FACISTOL, GIAN MARIE V.

SUBMITTED TO: MS. EVELYN BAUTISTA, R.N., MAN

I.

Introduction

DEHYDRATION (hypohydration) is defined as the excessive loss of body fluid. It is literally the removal of water . In physiological terms, it entails a deficiency of fluid within an organism. Dehydration of skin and mucous membranes can be called medical dryness. Dehydration can be mild, moderate, or severe based on how much of the body's fluid is lost or not replenished. When it is severe, dehydration is a life-threatening emergency. Water is a critical element of the body, and adequate hydration is a must to allow the body to function. Up to 75% of the body's weight is made up of water. Most of the water is found within the cells of the body (intracellular space). The rest is found in the extracellular space, which consists of the blood vessels (intravascular space) and the spaces between cells (interstitial space).

There are three types of dehydration: hypotonic or hyponatremic (primarily a loss of electrolytes, sodium in particular), hypertonic or hypernatremia (primarily a loss of water), and isotonic or isonatremic (equal loss of water and electrolytes). In humans, the most commonly seen type of dehydration by far is isotonic (isonatraemic) dehydration which effectively equates with hypovolemia, but the distinction of isotonic from hypotonic or hypertonic dehydration may be important when treating people who become dehydrated. Physiologically, dehydration, despite the name, does not simply mean loss of water, as water and solutes (mainly sodium) are usually lost in roughly equal quantities to how they exist in blood plasma. In hypotonic dehydration, intravascular water shifts to the extravascular space, exaggerating intravascular volume depletion for a given amount of total body water loss. Neurological complications can occur in hypotonic and hypertonic states. The former can lead to seizures, while the latter can lead to osmotic cerebral edema upon rapid rehydration.

Dehydration occurs when the amount of water leaving the body is greater than the amount being taken in. The body is very dynamic and always changing. This is especially true with water in the body. We lose water routinely when we:

breathe and humidified air leaves the body (this can be seen on a cold day (the breath you see in the air is water that has been exhaled) sweat to cool the body

or are in an area without potable water. lack the facilities or strength to drink. The thirst mechanism signals the body to drink water when the body is dry. Sometimes it is not possible to consume enough fluids because we are too busy. too much water loss. diarrhea. or some combination of the two. sweating. Table 1 Daily Fluid Requirement Body weight 10 pounds 20 pounds 30 pounds 40 pounds 50 pounds 75 pounds 100 pounds 150 pounds 200 pounds Daily fluid requirements (approximate) 15 ounces 30 ounces 40 ounces 45 ounces 50 ounces 55 ounces 50 ounces 65 ounces 70 ounces The body is able to monitor the amount of fluid it needs to function. In a normal day. Dehydration is commonly caused by loss of body fluids through prolonged vomiting. Eliminate waste by urinating or having a bowel movement. As well. . a person has to drink a significant amount of water to replace this routine loss. hormones like anti-diuretic hormone (ADH) work with the kidney to limit the amount of water lost in the urine when the body needs to conserve water. The immediate causes of dehydration include not enough water. and frequent urination.

Objectives A. Since we are client. B. disease process and management. III.The signs and symptoms of dehydration range from minor to severe and include:      Increased thirst Weakness Palpitation Sluggishness fainting Inability to sweat      Dry mouth and swollen tongue Dizziness Confusion Fainting Decreased urine output II. May this case study would help the students to understand and describe normal laboratory values for commonly ordered dehydration. To have knowledge to the client medication and be familiar to that medication. To formulate a workable nursing care plan on the subjective and objective cues gathered through nurse-patient interaction to be able to help the patient recover. usual clinical manifestations and possible complications of this condition. 2.centered we really should consider our patient’s comfort and this study will give the students sufficient knowledge that will help them to plan and implement nursing care plans that will satisfy patient’s needs. pathophysiology of the patient’s condition. . General Objectives This study aims to convey familiarity and to provide an effective nursing care to a patient diagnosed with dehydration through understanding the patient history. To discuss the anatomy and physiology. Significance of the Study: This study will enable the students to understand better about dehydration and the different risk factors for developing the disease. 3. Specific Objectives 1.

that’s why they rushed the client to the hospital. dizziness and suffering watery stool. S/P ileostomy (1994) .IV. Biographical Data DATE OF ADMISSION: June 26. Patient’s Profile A. Brgy Biwas Tanza Cavite AGE: 17 years old DATE OF BIRTH: December 07. Chief Complaint The client was complaining abdominal pain in his right lower quadrant. JMPA GENDER: Male CIVIL STATUS: Single OCCUPATION: Student NATIONALITY: Filipino CLINICAL AREA: MS Ward Room 505 ADDRESS: 930 San Agustin St. Final Diagnosis Acute Gastroenteritis with moderate Dehydration. 2012 NAME: Mr. C.1994 BIRTH PLACE: Cavite RELIGIOUS PREFERENCES: Roman Catholic B.

History of Past illness The client had fever. The patient had no history of accident or any injury. . At first. cough and colds. Metronidazole. dizziness and suffering watery stool. The client still complaining abdominal pain so the family decided to rush the client at Divine Grace Medical Center the next day.V. Health History A. DPT. they consult to the clinic they gave medication Buscopan IM. B. He had completed all vaccination including BCG. the client was complaining abdominal pain in his right lower quadrant. History of Present illness Prior to admission. But after drinking the medications. mumps and chicken pox. He was hospitalized in year 1994 ileostomy at birth due the ruptured of the ileus at Philippine General Hospital. The patient had never been any of the childhood disease such as measles. Oral Polio Vaccine. MMR and Hepatitis B vaccine.

VI.000 /mm3 /mm3 mm/hr 0.2 23-33 sec .000 0.65 0.5. Laboratory Findings COMPLETE BLOOD COUNT RESULT UNITS g/ dL % mil/mm3 /mm3 Date Requested: June 26.44 *HIGH 4.9-1.73 *HIGH 0.55-0. 2012 REFERENCE VALUE 12-14 0.9 *HIGH 0.0 5000-10000 150-400.37-0.27 % 70-120 0.42 4-5.70 5300 222.35 0-20 13-17 HEMOGLOBIN HEMATOCRIT RBC COUNT WBC COUNT PLATELET COUNT DIFFERENTIAL COUNT SEGMENTERS LYMPHOCYTES MONOCYTES ESR PROTINE CONTROL % ACTIVITY INR APTT RATION 14.23-0.

Hemoglobin count also referred to as hemoglobin level indicates your blood's oxygen-carrying capacity. usually due to some kind of infection.INTERPRETATION: HIGH HEMOGLOBIN Indicates an above-average concentration of oxygen-carrying proteins in your blood. INTERPRETATION: HIGH SEGMENTERS One of the types of neutrophils found in the blood. The main component of red blood cells. because each cell may not have the same amount of hemoglobin proteins. They would be elevated if the overall white count is up. A high hemoglobin count is somewhat different from a high red blood cell count. Dehydration produces a falsely high hematocrit that disappears when proper fluid balance is restored. INTERPRETATION: HIGH HEMATOCRIT High hematocrits can be seen in people living at high altitudes and in chronic smokers. .

URINALYSIS Rountine Color Characteristic Reaction S. Hazy 6.0-7.030 Negative Negative 0-2/ hpf 0-2/hpf . 2012 Normal Values Light yellow to amber Clear 4.010 Negative (-) Trace * 2-3 *HIGH 8-10 *HIGH Date Requested: June 26.0 1.010-1.0 1.P Gravity Sugar Protein RBC Pus Cells Epithelial Urates Amorphous Phosphate Bacteria Mucus Thread Few Results Yellow SL.

But too many of them may signal a problem somewhere in your urinary tract. . tumors which erode the urinary tract anywhere along its length. upper and lower Uri urinary tract infections. INTERPRETATION: HIGH RBC Hematuria is the presence of abnormal numbers of red cells in urine due to: glomerular damage. as trace amounts of protein are excreted in your urine as part of normal urine production. kidney trauma. acute tubular necrosis. Your lab will usually report the result as number of cells counted per high power field of the microscope (hpf) or number of WBCs/mL of urine. INTERPRETATION: HIGH PUS CELLS A few pus cells or a white blood cell in urine is quite normal. renal infarcts. A high number of pus cells in urine are called pyuria. urinary tract stones. This is a symptom known as proteinuria. and physical stress. nephrotoxins. The concern is when you have too much protein in your urine.INTERPRETATION: PROTEIN: TRACE Protein in your urine. the commonest of which is a urinary tract infection (UTI).

VII. ANATOMY AND PHYSIOLOGY DIGESTIVE SYSTEM .

After being in the stomach. plus a few other organs (like the liver and pancreas) that produce or store digestive chemicals. The digestive system is essentially a long. twisting tube that runs from the mouth to the anus. It then enters the jejunum and then the ileum (the final part of the small intestine).After being chewed and swallowed. food enters the duodenum. The esophagus is a long tube that runs from the mouth to the stomach. sack-like organ that churns the food and bathes it in a very strong acid (gastric acid).The human digestive system is a complex series of organs and glands that processes food. Food in the stomach that is partly digested and mixed with stomach acids is called chyme. In the small intestine . the food enters the esophagus.The stomach is a large. In order to use the food we eat our body has to break the food down into smaller molecules that it can process. the first part of the small intestine. This muscle movement gives us the ability to eat or drink even when we're upside-down.the mouth: The digestive process begins in the mouth. it also has to excrete waste. On the way to the stomach: the esophagus . In the stomach . Food is partly broken down by the process of chewing and by the chemical action of salivary enzymes (these enzymes are produced by the salivary glands and break down starches into smaller molecules). In the small intestine. Most of the digestive organs (like the stomach and intestine) are tube-like and contain the food as it makes its way through the body. It uses rhythmic. bile (produced in the liver and stored in the gall . wave-like muscle movements (called peristalsis) to force food from the throat into the stomach. The Digestive Process The start of the process .

food passes into the large intestine. Food then travels upward in the ascending colon. some of the water and electrolytes (chemicals like sodium) are removed from the food. In the large intestine . Escherichia coli and Klebsiella) in the large intestine help in the digestion process.bladder). and other digestive enzymes produced by the inner wall of the small intestine help in the breakdown of food. The first part of the large intestine is called the cecum (the appendix is connected to the cecum). Many microbes (bacteria like Bacteroides. In the large intestine.Solid waste is then stored in the rectum until it is excreted via the anus . goes back down the other side of the body in the descending colon. The end of the process .pancreatic enzymes. Lactobacillus acidophilus. The food travels across the abdomen in the transverse colon.After passing through the small intestine. and then through the sigmoid colon.

The part of the large intestine that run downwards after the transverse colon and before the sigmoid colon.The first part of the large intestine. the appendix is connected to the cecum. stored in the gall bladder. Appendix .Food in the stomach that is partly digested and mixed with stomach acids.The part of the large intestine that run upwards. it is C-shaped and runs from the stomach to the jejunum. .Digestive System Glossary Anus .A digestive chemical that is produced in the liver.The first part of the small intestine. Duodenum . and secreted into the small intestine. Chyme . Cecum . Bile .The opening at the end of the digestive system from which feces (waste) exits the body. it is located after the cecum.A small sac located on the cecum. Ascending colon . Descending colon . Chyme goes on to the small intestine for further digestion.

where food enters the body. When you swallow. Ileum . When you breathe.The last part of the small intestine before the large intestine begins.A large organ located above and in front of the stomach. Gall bladder .The first part of the digestive system. the epiglottis automatically closes. the epiglottis opens so that air can go in and out of the windpipe.The flap at the back of the tongue that keeps chewed food from going down the windpipe to the lungs. sac-like organ located by the duodenum.The long tube between the mouth and the stomach. Jejunum . Liver . and makes bile (which breaks down fats) and some blood proteins.The long.Epiglottis . coiled mid-section of the small intestine. It filters toxins from the blood. It uses rhythmic muscle movements (called peristalsis) to force food from the throat into the stomach. .A small. Mouth . Esophagus . it is between the duodenum and the ileum. It stores and releases bile (a digestive chemical which is produced in the liver) into the small intestine. Chewing and salivary enzymes in the mouth are the beginning of the digestive process (breaking down the food).

a sack-like.An enzyme-producing gland located below the stomach and above the intestines.you cannot control it. Peristalsis is involuntary .When food enters the stomach. Salivary glands . It is also what allows you to eat and drink while upside-down. Stomach . Saliva contains enzymes that break down carbohydrates (starch) into smaller molecules.Rhythmic muscle movements that force food in the esophagus from the throat into the stomach. Sigmoid colon .The part of the large intestine that runs horizontally across the abdomen . it is churned in a bath of acids and enzymes. Transverse colon . muscular organ that is attached to the esophagus. where feces are stored before they are excreted.The lower part of the large intestine.The part of the large intestine between the descending colon and the rectum.Pancreas . Both chemical and mechanical digestion takes place in the stomach. Enzymes from the pancreas help in the digestion of carbohydrates.Glands located in the mouth that produce saliva. fats and proteins in the small intestine. Peristalsis . Rectum .

VIII. PATHOPHYSIOLOGY .

IX. reduce the incidence of GI hemorrhage associated with stress-related ulcers.treatment of GERD . Diarrhea. Constipation. PMSRanitidine.prevent paclitaxel hypersensitivity. . Abdominal Pain. Cirrhosis of the liver. Headache. Histamine H2 receptor blocking drug Competitively gastric acid secretion by blocking the effect of histamine H2 receptors. and Nausea and Vomiting. GenRanitidine. Do not confuse ranitidine with rimantadine (An antiviral) Ranitidine Hydrochloride ApoRanitidine. RhoxalRanitidine -Short term treatment of active.treatment of endoscopically diagnosed erosive esophagitis and for maintenance of healing of erosive esophagus . Nu-Ranit. benign gastric ulcer and maintenance after healing of the acute ulcer . impaired renal or hepatic function. Brand Name DRUG STUDY Uses Classification Action Contraindication Side effects Generic Name Drug Name Nursing Intervention Do not confuse Zantac with Xanax (An antianxiety drug) or with Zyrtec (an H1 receptor blocker). NovoRanitidine.

-Patients with edema or ascites may have lower peak concentrations due to expanded extracellular fluid volume. Gentamicin. History of  hypersensitivity to or toxic reaction with any  aminoglycoside antibiotic. -It is a type of aminoglycoside antibiotic. throat and lips Hearing loss Damage to the part of the ear that controls balance. and C2. CBCs. -Used to fight a wide variety of infections caused by bacteria. Safe use during pregnancy (category C) or lactation is not established       Feeling sick and being sick Inflammation of the lining of any part of the mouth. gums. urinary tract (including kidney s and bladder) and blood. Reduction in Dose may be clinically indicated. . and to prevent infection in ears and eyes after they have been damaged. They differ slightly structurally. eyes.Gentamicin Sulfate Alcomicin. -Ensure adequate hydration of patient before and during therapy.  RatioGentamicin     -Infection include Antibiotic GI tract. chest (including lungs). -Monitor renal function tests. and display approximatel y the same antibiotic Activity. In general this drug is used to A powerful antibiotic produced by Micromonosporapu rpurea as a mixture of three main components Called gentamicin C1. tongue . such as rash Convulsions Liver -Avoid long-term therapies because of increased risk of toxicities. giving rise to dizziness. serum drug levels during long-term therapy. Consult with prescriber to adjust dosage. -It is used to kill the bacteria and clear up the infection. -It also used to treat severe bacterial infections in newborn babie s. a spinning sensation and unsteadiness Kidney damage Allergic (hypersensitiv ity) reactions. Minims. such as infection in the ears. C1. -Cleanse area before application of dermatologic preparations. such as cheeks.

problems. . -Benefits of being on this drug can include treatment of infections caused by bacteria and prevention of bacterial infections in eyes and ears that have been damaged and relief of pain caused by such infections. fight infections by susceptible bacteria.

X. hypotension depending . moist skin. Nagtatae din ako” as verbalized by the patient. NURSING CARE PLAN Problem: Fluid Volume Deficit / Fluid Loss Assessment Data Collection Cues Subjective Cue: “Masakit ang tyan ko at nahihilo.0 C PR: 64 bpm RR: 23 cpm BP: 120/70 mmHg Diagnosis Collaborative Problem Fluid Volume Deficit Related to Dehydration as evidenced by Decreased Urine Output. conditions with fluid encouraged Volume deficit. moist skin. good skin Turgor Goal Met. Evaluation Rationale for Nursing Expected Patient Intervention outcome After 8 hours of the nursing intervention the Patient will able to maintained adequate fluid volume as evidenced by Urine output of 50-60ml/hr. Increased HR along with decreased BP and elevated Observed for temperature. Within 8 hours of the nursing intervention The patient will be able to maintain adequate fluid volume as evidenced by: urine output of 50-60ml/hr. postural BP is present in changes. temperature also increases fluid loss by increasing Palpated metabolism. Objective Cue: Patient manifested: -Weakness -Dry Skin -Irritability -Poor Skin Turgor V/S T: 36. and weight loss. and degrees of postural skin Turgor. and good skin Turgor To gain trust and full of cooperation of the patient. gradual Increased body Position changes. noted changes in body Temperature. Planning Goal/Objectives Implementation Nursing Intervention Independent: Provide rapport to the patient. peripheral pulses assessed capillary refill. Patients may mucous experience varying membranes. Monitored vital signs.

Relieves thirst and aids in body fluid Replacement. Encouraged increase in fluid intake and consumption of foods high in fluid content. . Dependent: Administered IV fluids as ordered.on degree of fluid Observed for changes in mental status. Excessive fluid loss through regulatory mechanisms failure may result in severe dehydration. Decreased cerebral perfusion may result in changes in mentation. Turned patient q2h and provided support For body prominences. and shock. Patients with fluid volume deficit are more at risk for skin Breakdown. circulatory collapse. Aggressive fluid replacement may be required to correct fluid volume deficit.

and to maintain body regularly. DISCHARGE PLANNING Instruct patient to take all the prescribed medications at the proper time and dosage for the specific duration as the doctor has ordered. Erceflora vial . such as in the shade or an airconditioned area. Medication Environment/Exercise Walking Exercise: Is most basic and best exercise for the children to help get fresh air.800mg tab -Take 1 tablet twice a day for three days -Take the drug at the same time each day.XI.Take 1 vial twice a day to consume seven more vials -Take the medication after meals. Environment: Get out of direct sunlight and lie down in a cool spot. Zinc Syrup -Take 15 mL once a day for two weeks -Vitamins supplements that he will take for two weeks. . Co-trimaxole . -Take the medication after meals. -Avoid using 2-4 hours after taking other medications.

Make sure that they can engage physical exercise. to helps prevent Dehydration -Co-trimaxole .800mg tab BID Walking Exercise. Avoid juices and coffee. To prevent abdominal pain Advise the patient to encourage praying to God as the Family does every day and to strengthen their faith. Instruct patient to take all the prescribed medications at the proper time and dosage for the specific duration. Tell to them to get out of the direct sunlight. Instruct the patient to return to the Attending Physician for follow up check-up and for emergency medical assistance. Inform them to do walking exercise to help get fresh air. Health Teaching - Explain the Dehydration to the Patient. . and to maintain their body regularly.Treatment - Increase Oral Fluid intake. and advise them to eat foods that a lots of vitamins and minerals to enhance body immunity. Out Patient (follow up consultation) - Diet Spiritual - Diet as Tolerated Increase oral fluid intake: To prevent the dehydration.

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