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

 Eliminate waste by urinating or having a bowel movement.

In a normal day, a person has to drink a significant amount of water to replace this routine loss.

Table 1 Daily Fluid Requirement

Body weight Daily fluid requirements (approximate)

10 pounds 15 ounces
20 pounds 30 ounces
30 pounds 40 ounces
40 pounds 45 ounces
50 pounds 50 ounces
75 pounds 55 ounces
100 pounds 50 ounces
150 pounds 65 ounces
200 pounds 70 ounces

The body is able to monitor the amount of fluid it needs to function. The thirst mechanism signals the body to drink water
when the body is dry. As well, 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.

Dehydration is commonly caused by loss of body fluids through prolonged vomiting, diarrhea, sweating, and frequent
urination. The immediate causes of dehydration include not enough water, too much water loss, or some combination of
the two. Sometimes it is not possible to consume enough fluids because we are too busy, lack the facilities or strength to
drink, or are in an area without potable water.
The signs and symptoms of dehydration range from minor to severe and include:

Increased thirst Dry mouth and swollen tongue

Weakness Dizziness
Palpitation Confusion
Sluggishness fainting Fainting
Inability to sweat Decreased urine output

II. Significance of the Study:

This study will enable the students to understand better about dehydration and the different risk factors for developing the
disease. May this case study would help the students to understand and describe normal laboratory values for commonly
ordered dehydration. Since we are client- centered we really should consider our patients comfort and this study will give
the students sufficient knowledge that will help them to plan and implement nursing care plans that will satisfy patients
needs.

III. Objectives
A. 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, disease process and management.

B. Specific Objectives
1. To discuss the anatomy and physiology, pathophysiology of the patients condition, usual clinical manifestations and
possible complications of this condition.

2. To have knowledge to the client medication and be familiar to that medication.

3. 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.
 IV. Patients Profile

A. Biographical Data

DATE OF ADMISSION: June 26, 2012 CLINICAL AREA: MS Ward Room 505

NAME: Mr. JMPA ADDRESS: 930 San Agustin St. Brgy Biwas Tanza Cavite

GENDER: Male AGE: 17 years old

CIVIL STATUS: Single DATE OF BIRTH: December 07,1994

OCCUPATION: Student BIRTH PLACE: Cavite

NATIONALITY: Filipino RELIGIOUS PREFERENCES: Roman Catholic

B. Chief Complaint

The client was complaining abdominal pain in his right lower quadrant, dizziness and suffering watery stool, thats
why they rushed the client to the hospital.

C. Final Diagnosis

Acute Gastroenteritis with moderate Dehydration; S/P ileostomy (1994)

V. Health History

A. History of Present illness

Prior to admission, the client was complaining abdominal pain in his right lower quadrant, dizziness and
suffering watery stool. At first, they consult to the clinic they gave medication Buscopan IM, Metronidazole.
But after drinking the medications. The client still complaining abdominal pain so the family decided to rush
the client at Divine Grace Medical Center the next day.

B. History of Past illness

The client had fever, cough and colds. He had completed all vaccination including BCG, DPT, Oral Polio
Vaccine, MMR and Hepatitis B vaccine. The patient had no history of accident or any injury. The patient had
never been any of the childhood disease such as measles, mumps and chicken pox. He was hospitalized in
year 1994 ileostomy at birth due the ruptured of the ileus at Philippine General Hospital.
 VI. Laboratory Findings

COMPLETE BLOOD COUNT Date Requested: June 26, 2012

RESULT UNITS REFERENCE VALUE

HEMOGLOBIN 14.9 *HIGH g/ dL 12-14

HEMATOCRIT 0.44 *HIGH % 0.37-0.42

RBC COUNT 4.70 mil/mm3 4-5.5.0
WBC COUNT 5300 /mm3 5000-10000
PLATELET COUNT 222,000 150-400,000
DIFFERENTIAL COUNT
SEGMENTERS 0.73 *HIGH /mm3 0.55-0.65
LYMPHOCYTES 0.27 /mm3 0.23-0.35
MONOCYTES
ESR mm/hr 0-20
PROTINE 13-17
CONTROL

% ACTIVITY % 70-120
INR 0.9-1.2

APTT sec 23-33

RATION
INTERPRETATION:

HIGH HEMOGLOBIN
Indicates an above-average concentration of oxygen-carrying proteins in your blood. The main component of red blood
cells. Hemoglobin count also referred to as hemoglobin level indicates your blood's oxygen-carrying capacity. A high
hemoglobin count is somewhat different from a high red blood cell count, because each cell may not have the same
amount of hemoglobin proteins.

INTERPRETATION:

HIGH HEMATOCRIT
High hematocrits can be seen in people living at high altitudes and in chronic smokers. Dehydration produces a falsely
high hematocrit that disappears when proper fluid balance is restored.

INTERPRETATION:

HIGH SEGMENTERS
One of the types of neutrophils found in the blood. They would be elevated if the overall white count is up, usually due to
some kind of infection.
 URINALYSIS Date Requested: June 26, 2012

Rountine Results Normal Values

Color Yellow Light yellow to amber

Characteristic SL. Hazy Clear

Reaction 6.0 4.0-7.0

S.P Gravity 1.010 1.010-1.030

Sugar Negative (-) Negative

Protein Trace * Negative

RBC 2-3 *HIGH 0-2/ hpf

Pus Cells 8-10 *HIGH 0-2/hpf

Epithelial Urates

Amorphous Phosphate
Bacteria Few

Mucus Thread
INTERPRETATION:

PROTEIN: TRACE
Protein in your urine, as trace amounts of protein are excreted in your urine as part of normal urine production. The
concern is when you have too much protein in your urine. This is a symptom known as proteinuria.

INTERPRETATION:

HIGH RBC
Hematuria is the presence of abnormal numbers of red cells in urine due to: glomerular damage, tumors which erode the
urinary tract anywhere along its length, kidney trauma, urinary tract stones, renal infarcts, acute tubular necrosis, upper
and lower Uri urinary tract infections, nephrotoxins, and physical stress.

INTERPRETATION:

HIGH PUS CELLS

A few pus cells or a white blood cell in urine is quite normal. But too many of them may signal a problem somewhere in
your urinary tract, the commonest of which is a urinary tract infection (UTI). 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. A high number of
pus cells in urine are called pyuria.
VII. ANATOMY AND PHYSIOLOGY

DIGESTIVE SYSTEM
 The human digestive system is a complex series of organs and glands that processes food. In order to use the food we
eat our body has to break the food down into smaller molecules that it can process; it also has to excrete waste. 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. The digestive system is essentially a long, twisting tube that runs from the mouth to the anus, plus a few other
organs (like the liver and pancreas) that produce or store digestive chemicals.

The Digestive Process

The start of the process - the mouth:

The digestive process begins in the mouth. 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).

On the way to the stomach: the esophagus

- After being chewed and swallowed, the food enters the esophagus. The esophagus is a long tube that runs from the
mouth to the stomach. It uses rhythmic, wave-like muscle movements (called peristalsis) to force food from the throat into
the stomach. This muscle movement gives us the ability to eat or drink even when we're upside-down.

In the stomach

- The stomach is a large, sack-like organ that churns the food and bathes it in a very strong acid (gastric acid). Food in the
stomach that is partly digested and mixed with stomach acids is called chyme.

In the small intestine

- After being in the stomach, food enters the duodenum, the first part of the small intestine. It then enters the jejunum and
then the ileum (the final part of the small intestine). In the small intestine, bile (produced in the liver and stored in the gall
bladder),pancreatic enzymes, and other digestive enzymes produced by the inner wall of the small intestine help in the
breakdown of food.

In the large intestine

- After passing through the small intestine, food passes into the large intestine. In the large intestine, some of
the water and electrolytes (chemicals like sodium) are removed from the food. Many microbes (bacteria like Bacteroides,
Lactobacillus acidophilus, Escherichia coli and Klebsiella) in the large intestine help in the digestion process. The first part
of the large intestine is called the cecum (the appendix is connected to the cecum). Food then travels upward in
the ascending colon. The food travels across the abdomen in the transverse colon, goes back down the other
side of the body in the descending colon, and then through the sigmoid colon.

The end of the process

- Solid waste is then stored in the rectum until it is excreted via the anus
Digestive System Glossary
Anus

- The opening at the end of the digestive system from which feces (waste) exits the body.

Appendix

- A small sac located on the cecum.

Ascending colon

- The part of the large intestine that run upwards; it is located after the cecum.

Bile

- A digestive chemical that is produced in the liver, stored in the gall bladder, and secreted into the small intestine.

Cecum

- The first part of the large intestine; the appendix is connected to the cecum.

Chyme

- Food in the stomach that is partly digested and mixed with stomach acids. Chyme goes on to the small intestine for
further digestion.

Descending colon

- The part of the large intestine that run downwards after the transverse colon and before the sigmoid colon.

Duodenum

- The first part of the small intestine; it is C-shaped and runs from the stomach to the jejunum.
Epiglottis

- The flap at the back of the tongue that keeps chewed food from going down the windpipe to the lungs. When you
swallow, the epiglottis automatically closes. When you breathe, the epiglottis opens so that air can go in and out of the
windpipe.

Esophagus

- The long tube between the mouth and the stomach. It uses rhythmic muscle movements (called peristalsis) to force food
from the throat into the stomach.

Gall bladder

- A small, sac-like organ located by the duodenum. It stores and releases bile (a digestive chemical which is produced in
the liver) into the small intestine.

Ileum

- The last part of the small intestine before the large intestine begins.

Jejunum

- The long, coiled mid-section of the small intestine; it is between the duodenum and the ileum.

Liver

- A large organ located above and in front of the stomach. It filters toxins from the blood, and makes bile (which breaks
down fats) and some blood proteins.

Mouth

- The first part of the digestive system, where food enters the body. Chewing and salivary enzymes in the mouth are the
beginning of the digestive process (breaking down the food).
Pancreas

- An enzyme-producing gland located below the stomach and above the intestines. Enzymes from the pancreas help in
the digestion of carbohydrates, fats and proteins in the small intestine.

Peristalsis

- Rhythmic muscle movements that force food in the esophagus from the throat into the stomach. Peristalsis is involuntary
- you cannot control it. It is also what allows you to eat and drink while upside-down.

Rectum

- The lower part of the large intestine, where feces are stored before they are excreted.

Salivary glands

- Glands located in the mouth that produce saliva. Saliva contains enzymes that break down carbohydrates (starch) into
smaller molecules.

Sigmoid colon

- The part of the large intestine between the descending colon and the rectum.

Stomach

- a sack-like, muscular organ that is attached to the esophagus. Both chemical and mechanical digestion takes place in
the stomach.When food enters the stomach; it is churned in a bath of acids and enzymes.

Transverse colon

- The part of the large intestine that runs horizontally across the abdomen
VIII. PATHOPHYSIOLOGY
 IX. DRUG STUDY
Drug Name Uses Classification Action Contraindication Side effects Nursing
Brand Name Generic Intervention
Name
Ranitidine Apo- -Short term Histamine H2 Competitively Cirrhosis of the Headache, Do not confuse
Hydrochloride Ranitidine, treatment of receptor gastric acid liver, impaired Abdominal Zantac with Xanax
Gen- active, benign blocking drug secretion by renal or hepatic Pain, (An antianxiety drug)
Ranitidine, gastric ulcer and blocking the function. Constipation, or with Zyrtec (an H1
Novo- maintenance effect of Diarrhea, and receptor blocker). Do
Ranitidine, after healing of histamine H2 Nausea and not confuse ranitidine
Nu-Ranit, the acute ulcer receptors. Vomiting. with rimantadine (An
PMS- - treatment of antiviral)
Ranitidine, GERD
Rhoxal- - treatment of
Ranitidine endoscopically
diagnosed
erosive
esophagitis and
for maintenance
of healing of
erosive
esophagus
- prevent
paclitaxel
hypersensitivity;
reduce the
incidence of GI
hemorrhage
associated with
stress-related
ulcers.
Gentamicin Alcomicin, -Infection include Antibiotic A powerful History of Feeling sick -Avoid long-term
Sulfate Minims, GI tract. antibiotic hypersensitivity to and being therapies because of
Gentamicin, -Used to fight a produced by or toxic reaction sick increased risk of
Ratio- wide variety of Micro- with any Inflammation toxicities. Reduction
Gentamicin infections monosporapu aminoglycoside of the lining in
caused by rpurea as a antibiotic. Safe of any part of Dose may be
bacteria, such as mixture of use during the mouth, clinically indicated.
infection in the three main pregnancy such as -Patients with edema
ears, eyes, chest components (category C) or cheeks, or ascites may have
(including lungs), Called lactation is not gums, tongue lower peak
urinary tract gentamicin established , throat and concentrations due to
(including kidney C1, C1, and lips expanded
s and bladder) C2. They extracellular fluid
Hearing loss
and blood. differ slightly volume.
structurally, Damage to -Cleanse area before
-It also used to the part of the
treat severe and display application of
approximatel ear that dermatologic
bacterial controls
infections y the same preparations.
antibiotic balance, -Ensure adequate
in newborn babie giving rise to
s, and to prevent Activity. hydration of patient
dizziness, a before and during
infection in ears spinning
and eyes after therapy.
sensation -Monitor renal
they have been and
damaged. function tests, CBCs,
unsteadiness serum drug levels
-It is a type of Kidney during long-term
aminoglycoside damage therapy.
antibiotic.
Allergic Consult with
-It is used to kill (hypersensitiv prescriber to adjust
the bacteria and ity) reactions, dosage.
clear up the such as rash
infection.
Convulsions
In general this
Liver
drug is used to
 fight infections problems.
by susceptible
bacteria.
-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.
 X. NURSING CARE PLAN

Problem: Fluid Volume Deficit / Fluid Loss

Assessment Diagnosis Planning Implementation Evaluation

Data Collection Collaborative Goal/Objectives Nursing Rationale for Nursing Expected Patient
Cues Problem Intervention Intervention outcome
Independent:
Subjective Fluid Volume Within 8 hours of After 8 hours of the
Cue: Deficit Related to the nursing Provide rapport To gain trust and full nursing intervention
Masakit ang Dehydration as intervention to the patient. of cooperation of the the Patient will able
tyan ko at evidenced by The patient will patient. to maintained
nahihilo. Decreased Urine be able to Monitored vital adequate fluid
Nagtatae din Output, and maintain signs; noted Increased HR along volume as
ako as weight loss. adequate fluid changes in body with decreased BP evidenced by Urine
verbalized by volume as Temperature. and output of 50-60ml/hr,
the patient. evidenced by: elevated moist skin, good skin
urine output of Observed for temperature, Turgor Goal Met.
Objective Cue: 50-60ml/hr, moist postural BP is present in
Patient skin, and good changes; conditions with fluid
manifested: skin Turgor encouraged Volume deficit.
-Weakness gradual Increased body
-Dry Skin Position changes. temperature also
-Irritability increases fluid loss
-Poor Skin by increasing
Turgor Palpated metabolism.
peripheral pulses
V/S assessed
T: 36.0 C capillary refill, Patients may
PR: 64 bpm mucous experience varying
RR: 23 cpm membranes, and degrees of postural
BP: 120/70 skin Turgor. hypotension
mmHg depending
 on degree of fluid
Observed for
changes in
mental status. Excessive fluid loss
through regulatory
mechanisms failure
Encouraged may result in severe
increase in fluid dehydration,
intake and circulatory collapse,
consumption of and shock.
foods high in fluid
content. Decreased cerebral
perfusion may result
in changes in
Turned patient mentation.
q2h
and provided Relieves thirst and
support aids in body fluid
For body Replacement.
prominences.

Dependent:
Patients with fluid
Administered IV volume deficit are
fluids as ordered. more at risk for skin
Breakdown.

Aggressive fluid
replacement may be
required to correct
fluid volume deficit.
XI. DISCHARGE PLANNING

Medication Instruct patient to take all the prescribed medications at the proper time and dosage for
the specific duration as the doctor has ordered.

Co-trimaxole - 800mg tab

-Take 1 tablet twice a day for three days
-Take the drug at the same time each day.
-Avoid using 2-4 hours after taking other medications.
-Take the medication after meals.
Erceflora vial - Take 1 vial twice a day to consume seven more vials
-Take the medication after meals.
Zinc Syrup -Take 15 mL once a day for two weeks
-Vitamins supplements that he will take for two weeks.

Environment/Exercise Walking Exercise: Is most basic and best exercise for the children to help get fresh air,
and to maintain body regularly.

Environment:

- Get out of direct sunlight and lie down in a cool spot, such as in the shade or an air-
conditioned area.
Treatment - Increase Oral Fluid intake, to helps prevent Dehydration
- -Co-trimaxole - 800mg tab BID
- Walking Exercise.

Health Teaching - Explain the Dehydration to the Patient.

- Inform them to do walking exercise to help get fresh air, and to maintain their
body regularly.
- 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.
- Make sure that they can engage physical exercise, and advise them to eat foods
that a lots of vitamins and minerals to enhance body immunity.

Out Patient (follow up - Instruct the patient to return to the Attending Physician for follow up check-up and
consultation) for emergency medical assistance.

Diet - Diet as Tolerated

- Increase oral fluid intake: To prevent the dehydration.
- Avoid juices and coffee, To prevent abdominal pain
Spiritual - Advise the patient to encourage praying to God as the Family does every day and
to strengthen their faith.