1.

FLUID VOLUME DEFICIT

a. NCP 1

ASSESSEMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

Subjective: "Deficient Short term: INDEPENDENT: *Urine analysis Short term:

“nanghihina Fluid After 30 *Obtain specimens provides information After 30 minutes the patien
ako at Volume minutes of for analysis of altered about retention or required fluid replacement o
nagkatrangkaso associated nursing sodium levels (e.g., loss of sodium and the liters. The patient blood pres
ng apat na to intervention, serum and urine ability of the kidneys to 122/74, pulse rate decrea
araw, at hindi inadequate the patient sodium, urine to concentrate or resting level of 74, and resp
ko din kayang fluid intake will be able osmolality, and urine dilute urine in decreased to 12/minute. Th
uminom ng as seen by to required specific gravity) as response to fluid output increased as the fluid
may mga likido blood fluid indicated. changes and was adequate at > 0.5 m
naduduwal at pressure replacement the time of discharge. Outco
of a total of
nasusuka ako” 90/60, dry
5 liters. The
as vervalized by mucous * Monitor for cardiac *The heart responds
patient
the patient. membranes, manifestations of to a loss of fluid by
blood
reduced pressure hypernatremia (e.g., increasing the heart
urine increased to tachycardia, rate to compensate
production, 122/74, orthostatic with an increase in
and a rise in pulse rate hypotension). cardiac output. Low
Objective: hematocrit." decreased fluid volume leads to a
-Height: 160 to a resting fall in blood pressure.
cm (5′3′′) level of 74,
-Weight: 66.2 and *Monitor vital signs *Vital sign changes
kg (146 lb) Mild respirations as appropriate. such as increased
fever: 38.6°C decreased heart rate, decreased
(101.5°F) to blood pressure, and
-Pulse: 86 BPM 12/minute. increased
-Respirations: The patient temperature indicate
urine output
24/minute hypovolemia.
increased
Scant urine
as the fluid
output was
- BP: 102/84 replaced
mm Hg and was
adequate at
> 0.5
mL/kg/hour
by the time
of
discharge.

Long term:
After a week DEPENDENT:
of nursing *Administer *Patient has
intervention, IV therapy as signs of
the patient prescribed. severe fluid
totally back volume
her/his deficit. The
normal vital patient will
signs probably
require
intravenous
replacement
of fluid. This is
especially true
because her
oral intake is
limited
because of
nausea and
vomiting.

*Give fluids as *Encourage

appropriate. the patient to
drink as much
water as she
can when her
nausea fades,
replacing any
lost volume.
PATHOPYSIOLOGY:
The number of people aged 65 years and over has increased significantly across the
developed world, a likely result of advances in medical care. Between 1999 to 2000 and 2009 to
2010, there was a 66% rise across England in hospitalization of persons over the age of 75 years.
Older adults are susceptible to dehydration and electrolyte abnormalities, causes of which are
multifactorial, ranging from physical disability restricting access to adequate fluid intake to
iatrogenic causes including polypharmacy and the unmonitored use of diuretics and other drugs.
(Allison S.P. Lobo D.N. (2004) Physical disability in older adults can limit access to water, (Gaspar P.M.
1999;) whilst incontinence-associated embarrassment may lead older adults to restrict their oral
fluid intake. Furthermore, those from lower socioeconomic backgrounds, living alone, with pre-
existing comorbidities, or on multiple drugs are more susceptible to dehydration and electrolyte
disturbances, and are at increased risk of associated morbidity and mortality. (Foroni M. Salvioli G.
Rielli R. Goldoni C.A. Orlandi G. Zauli Sajani S. et al. 2007) Poor patient education has also been reported
to lead to high rates of dehydration-related hospital readmissions after discharge, particularly in
surgical patients. (Hari M. Rosenzweig M. 2012) Dehydration has been shown to be the main reason
for readmission following formation of a defunctioning ileostomy, with those on diuretics being
at increased risk. Higher mortality rates at one year have been noted in those readmitted to
hospital after surgery for hip fracture, a significant proportion of which were related to
dehydration. Age-related physiological changes, including renal senescence also increase the
susceptibility of the older adult population to dehydration. Dehydration of as little as 2% of total
body water can result in a significant impairment in physical, visuomotor, psychomotor and
cognitive performances. (Grandjean A.C. Grandjean N.R. 2007) Furthermore, a study reported a 17%,
30-day mortality in older adults with the principal diagnosis of dehydration as per the ICD
classification, with the one-year mortality being close to 50%. Older adults are also susceptible
to water retention and related electrolyte abnormalities. These are exacerbated at times of
physiological stress, such as in the perioperative period (Desborough J.P. 2000) and a positive fluid
balance has been shown to be an independent risk factor for mortality in critically ill patients
with acute kidney injury. The aim of this narrative review of the current literature is to highlight
the key aspects of age-related pathophysiological changes that affect fluid and electrolyte
balance in older adults and underpin their importance in the perioperative period.
2. FLUID VOLUME EXCESS
NCP 1

Assessment Diagnosis Planning Intervention Rationale Evaluation

PATHOPYSIOLOGY:
JFFGCF