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Nursing Care Plans for Dehydration; Diagnosis and Interventions with Examples

Nursing Care Plans for Dehydration; Diagnosis and Interventions with Examples

Introduction

Dehydration occurs when a person uses or loses more fluid than they take in, and the body doesn’t have enough water and other fluids to carry out its normal functions. If the fluids lost are not replaced, a person gets dehydrated. Anyone may become dehydrated, but the condition is hazardous for young children and older adults.  

The most common cause of dehydration in young children is severe diarrhea and vomiting. Older adults naturally have a lower volume of water in their bodies and may have conditions or take medications that increase the risk of dehydration.

This means that even minor illnesses, such as infections affecting the lungs or bladder, can result in dehydration in older adults.

Dehydration also can occur in any age group if you don’t drink enough water during hot weather — especially if you are exercising vigorously.

You can usually reverse mild to moderate dehydration by drinking more fluids, but severe dehydration needs immediate medical treatment.

This blog post discusses nursing care plans for dehydration together with the diagnosis, causes, symptoms and interventions with elaborate examples .As you follow along, remember that our qualified writers are always ready to help in any of your nursing assignments. All you need to do is place an order with us!

Disclaimer: The information presented in this article is not medical advice; it is meant to act as a quick guide to nursing students for learning purposes only and should not be applied without an approved physician’s consent. Please consult a registered doctor in case you’re looking for medical advice.

Symptoms of Dehydration

Thirst isn’t always a reliable early indicator of the body’s water needs. Many people, particularly older adults, don’t feel thirsty until they’re dehydrated. That’s why it’s essential to increase water intake during hot weather or when you’re ill.

The signs and symptoms of dehydration also may differ by age.

Infant or young child

  1. Dry mouth and tongue
  2. No tears when crying
  3. No wet diapers for three hours
  4. Sunken eyes, cheeks
  5. Sunken soft spot on top of the skull
  6. Listlessness or irritability

Adult

  1. Extreme thirst
  2. Less frequent urination
  3. Dark-colored urine
  4. Fatigue
  5. Dizziness
  6. Confusion

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Causes of Dehydration

Sometimes dehydration occurs for simple reasons: You don’t drink enough because you’re sick or busy or lack access to safe drinking water when traveling, hiking, or camping.

Other dehydration causes include:

Diarrhea, vomiting. Severe, acute diarrhea — that is, diarrhea that comes on suddenly and violently — can cause a tremendous loss of water and electrolytes in a short amount of time. If you have vomiting and diarrhea, you lose even more fluids and minerals.

Fever. In general, the higher your fever, the more dehydrated you may become. The problem worsens if you have a fever in addition to diarrhea and vomiting.

Excessive sweating. You lose water when you sweat. If you do vigorous activity and don’t replace fluids as you go along, you can become dehydrated. Hot, humid weather increases the amount you sweat and the amount of fluid you lose.

Increased urination. This may be due to undiagnosed or uncontrolled diabetes. Certain medications, such as diuretics and some blood pressure medications, also can lead to dehydration, generally because they cause you to urinate more.

Risk Factors of Dehydration

Anyone can become dehydrated, but certain people are at greater risk:

Infants and children. The most likely group to experience severe diarrhea and vomiting, infants and children are especially vulnerable to dehydration. Having a higher surface area to volume area, they also lose a higher proportion of their fluids from a high fever or burns. Young children often can’t tell you that they’re thirsty, nor can they get a drink for themselves.

Older adults. As you age, your body’s fluid reserve becomes smaller, your ability to conserve water is reduced, and your thirst sense becomes less acute. These problems are compounded by chronic illnesses such as diabetes and dementia and by the use of certain medications. Older adults also may have mobility problems that limit their ability to obtain water for themselves.

People with chronic illnesses. Having uncontrolled or untreated diabetes puts you at high risk of dehydration. Kidney disease also increases your risk, as do medications that increase urination. Even having a cold or sore throat makes you more susceptible to dehydration because you’re less likely to feel like eating or drinking when you’re sick.

People who work or exercise outside. When it’s hot and humid, your risk of dehydration and heat illness increases. When the air is humid, sweat can’t evaporate and cool you as quickly as it normally does, leading to increased body temperature and the need for more fluids.

Complications of Dehydration

Dehydration can lead to severe complications, including:

Heat injury. Suppose you don’t drink enough fluids when you’re exercising vigorously and sweating heavily. In that case, you may end up with a heat injury, ranging in severity from mild heat cramps to heat exhaustion or potentially life-threatening heatstroke.

Urinary and kidney problems. Prolonged or repeated bouts of dehydration can cause urinary tract infections, kidney stones, and even kidney failure.

Seizures. Electrolytes — such as potassium and sodium — help carry electrical signals from cell to cell. If your electrolytes are out of balance, the normal electrical messages can become mixed up, leading to involuntary muscle contractions and sometimes to a loss of consciousness.

Low blood volume shock (hypovolemic shock). This is one of the most serious and sometimes life-threatening complications of dehydration. It occurs when low blood volume causes a drop in blood pressure and a drop in the amount of oxygen in your body.

Prevention of Dehydration

To prevent dehydration, drink plenty of fluids and eat foods high in water, such as fruits and vegetables. Letting thirst be your guide is an adequate daily guideline for most healthy people.

People may need to take in more fluids if they are experiencing conditions such as:

Vomiting or diarrhea. If your child is vomiting or has diarrhea, start giving extra water or an oral rehydration solution at the first signs of illness. Don’t wait until dehydration occurs.

Strenuous exercise. In general, it’s best to start hydrating the day before strenuous exercise. Producing lots of clear, dilute urine is a good indication that you’re well-hydrated. During the activity, replenish fluids at regular intervals and continue drinking water or other fluids after you’re finished.

Hot or cold weather. You need to drink additional water in hot or humid weather to help lower your body temperature and to replace what you lose through sweating. In cold weather, you may also need extra water to combat moisture loss from dry air, particularly at higher altitudes.

Illness. Older adults most commonly become dehydrated during minor illnesses — such as influenza, bronchitis, or bladder infections. Make sure to drink extra fluids when you’re not feeling well.

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Diagnosis of Dehydration

The diagnosis of dehydration is often reliant on the presence of the signs and symptoms and physical examination results. Other procedures such as blood tests and urine tests can also be performed to confirm the diagnosis.

Physical Examination

This will include the assessment of the presence of signs and symptoms and basic vitals signs measurement. Having low blood pressure is highly associated with dehydration, and it is taken after standing up from a lying or sitting position. Also, a higher than normal heart rate may be noted in dehydration, part of the body’s compensatory mechanism.

Blood tests

Electrolyte levels and kidney functions test may be performed to confirm the diagnosis. Higher electrolytes level may be expected as they may be diluted due to low blood volume secondary to dehydration.

Urinalysis

A simple urine test may help check for the presence of dehydration. It is also a helpful way to check for infections that are likely in dehydrated individuals.

Treatment for Dehydration

Dehydration can easily be corrected through the replacement of the lost fluid. However, several factors need to be taken into account, such as the severity of dehydration, the age of the patient, and the cause of the fluid loss. The treatment may also be slightly different for children and adults.

In Infants:

Seeking the help of a healthcare provider is strongly recommended when dehydration is suspected in an infant. If the dehydration is due to diarrhea, increasing the frequency of feeding and giving extra fluids are recommended. However, it is discouraged to give fruit juices as it may make diarrhea worse.

Hospitalization may be necessary in cases of moderate to severe dehydration.

In Children:

It is recommended that dehydrated children be given fluids with electrolytes because pure water can dilute the little electrolytes left in their system.

Offer fluids more frequently.

Hospital management may be necessary in severe cases of dehydration. Treatment may include intravenous fluid infusion.

In Adults:

Most adults can reverse dehydration through increasing oral fluid intake.

Working in cooler places can help reduce water loss.

Sports drinks containing electrolytes and carbohydrates are often helpful.

Hospital management of dehydration may be required in severe cases or if the individual is not responding to earlier treatments.

Nursing Care Plans for Dehydration Based on Diagnosis

Nursing Care Plan 1: Diagnosis – Fluid Volume Deficit

Related to blood volume loss secondary to gastrointestinal bleeding as evidenced by hematemesis, HB of 70, skin pallor, the blood pressure level of 85/58, and lightheadedness

Desired Outcome

The patient will have an absence of GI bleeding, hemoglobin (HB) level of over 100, blood pressure level within normal range, full level of consciousness, and normal skin color.

InterventionsRationales
Assess vital signs, particularly blood pressure level.Hypovolemia due to GI bleeding may lower blood pressure levels and put the patient at risk for hypotensive episodes that lead to shock.
Commence a fluid balance chart, monitoring the input and output of the patient. Include episodes of vomiting, gastric suctioning, and other gastric losses in the I/O charting.To monitor the patient’s fluid volume accurately.
Start intravenous therapy as prescribed. Electrolytes may need to be replaced intravenously.     Encourage oral fluid intake of at least 2000 mL per day if not contraindicated.To replenish the fluids and electrolytes lost from vomiting or other gastric losses and to promote better blood circulation around the body.
Educate the patient (or guardian) on how to fill out a fluid balance chart at the bedside.To help the patient or the guardian take ownership of the patient’s care, encourage them to drink more fluids as needed, or report any changes to the nursing team.
Administer blood transfusion as prescribed.To increase the hemoglobin level and treat anemia, dehydration, and hypovolemia related to GI bleeding.

Nursing Care Plan 2: Diagnosis – Risk for Fluid Volume Deficit

Due to osmotic diuresis secondary to diabetes.

Desired Outcome

 The patient will demonstrate adequate hydration and balanced fluid volume

InterventionsRationales
Assess vital signs and signs of dehydration.Hyperglycemia may cause Kussmaul’s respirations and/or acetone breath. Hypotension and tachycardia may result from hypovolemia or low levels of intravascular volume.
Commence a fluid balance chart, monitoring the input and output of the patient.To monitor patient’s fluid volume accurately and effectiveness of actions to monitor signs of dehydration.
Start intravenous therapy as prescribed. Encourage oral fluid intake of at least 2500 mL per day if not contraindicated.To replenish the fluids lost from polyuria and to promote better blood circulation around the body.
Educate the patient (or guardian) on how to fill out a fluid balance chart at the bedside.To help the patient or the guardian take ownership of the patient’s care, encourage them to drink more fluids as needed, or report any changes to the nursing team.
Monitor patient’s serum electrolytes and recommend electrolyte replacement therapy (oral or IV) to the physician as needed.Sodium is one of the important electrolytes that are lost when a person passes urine. Hyponatremia or low serum sodium level may cause brain swelling.
Encourage proper oral hygiene.Dehydration may cause dryness of the oral mucosa. Proper mouth care can also encourage the patient to have more interest in drinking fluids.

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Nursing Care Plan 3: Diagnosis – Fluid Volume Deficit

Related to dehydration due to fever as evidenced by the temperature of 39.0 degrees Celsius, skin turgidity, dark yellow urine output, profuse sweating, and blood pressure of 89/58.

Desired Outcome

Within 48 hours of nursing interventions, the patient will have a stabilized temperature within the normal range and will verbalize feeling more comfortable.

InterventionsRationales
Commence a fluid balance chart, monitoring the input and output of the patient.To monitor patient’s fluid volume accurately and effectiveness of actions to reverse dehydration.
Start intravenous therapy as prescribed. Encourage oral fluid intake.To replenish the fluids lost from profuse sweating and to promote better blood circulation around the body.
Educate the patient (or guardian) on how to fill out a fluid balance chart at the bedside.To help the patient or the guardian take ownership of the patient’s care, encourage them to drink more fluids as needed, or report any changes to the nursing team.
Monitor patient’s serum electrolytes and recommend electrolyte replacement therapy (oral or IV) to the physician as needed.Sodium is one of the important electrolytes that are lost when a person is sweating. Hyponatremia or low serum sodium level may cause brain swelling.
Remove excessive clothing, blankets, and linens. Adjust the room temperature.To regulate the environment’s temperature and make it more comfortable for the patient.
Administer the prescribed antibiotic and anti-pyretic medications.Use the antibiotic to treat bacterial infection if present, which is the underlying cause of the patient’s hyperthermia. Antibiotics are not required if the infection is viral. Use the fever-reducing medication to stimulate the hypothalamus and normalize the body temperature.
Offer a tepid sponge bath.To facilitate the body in cooling down and to provide comfort.
Elevate the head of the bed.Head elevation helps improve the expansion of the lungs, enabling the patient to breathe more effectively.

References

  • ncbi.gov
  • scholar.google.com

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