Nursing Interventions for Dehydration

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Questions and Answers

What should you give to patients to provide oral fluids?

Only through IV

Only large quantities

At bedtime only

In frequent small amounts (correct)

How often should fluids be offered to older patients?

Every 1 to 2 hours

What are some comfort measures that can be provided?

Oral hygiene and lip skin moisturizer

During enteral feeding, provide additional plain water ______.

boluses Signup and view all the answers

What is the purpose of giving medication in this context?

To control nausea, vomiting, diarrhea, and fever Signup and view all the answers

What type of medication is Promethazine also known as?

Phenergan Signup and view all the answers

What is Lorepidamide commonly used for?

Antidiarrheal Signup and view all the answers

Which of the following are considered antipyretics?

All of the above Signup and view all the answers

What are the priority nursing interventions for dehydration?

Safety and restore fluid balance Signup and view all the answers

Monitor the patient receiving IV therapy for signs of fluid ______.

overload Signup and view all the answers

How often should vital signs be monitored to evaluate response to therapy?

Every 2 hours Signup and view all the answers

What should you monitor in terms of pulse?

Rate, pressure, and quality Signup and view all the answers

How often should urine output and daily weight be measured?

Every 8 hours Signup and view all the answers

What should you check MD orders for?

The amount of fluid per day Signup and view all the answers

When administering prescribed IV fluids, what should be considered for patients with kidney, heart, and lung issues?

Administer at a safe rate Signup and view all the answers

What signs should be monitored for evaluating response to therapy?

Bounding pulses, difficulty breathing, and neck vein distention Signup and view all the answers

Assess IV site every hour for ______.

infiltration, extravasation, phlebitis, pain, swelling, cordlike veins, low drip rate Signup and view all the answers

What are the two most important areas to monitor during IV therapy?

Cardiovascular and kidneys Signup and view all the answers

What safety precautions should be observed for patients with dehydration?

Assess for orthostatic BP, muscle strength, orient patient to environment Signup and view all the answers

List some measures to keep patients safe.

Call bell, assist with ambulation, use assistive devices Signup and view all the answers

What environment safety measures should be taken?

Clean spills, good lighting, bed lowest position, breaks on, objects within reach, relative with patient Signup and view all the answers

What is the role of delegating CNA?

To give 2 to 4 ounces of fluid every hour and document the exact amount Signup and view all the answers

Study Notes

Fluid Volume Deficit/Dehydration Interventions

Administer oral fluids in frequent small amounts to promote hydration.
Encourage older patients to drink fluids every 1 to 2 hours to meet hydration needs.
Provide comfort measures, including oral hygiene and moisturizers for lips and skin, to enhance patient comfort.
During enteral feeding, supplement with additional plain water boluses to prevent dehydration.
Administer medications to control symptoms like nausea, vomiting, diarrhea, and fever related to dehydration.

Medications

Promethazine (Phenergan) acts as an antiemetic to relieve nausea.
Loperamide (Imodium) serves as an antidiarrheal to manage diarrhea.
Antipyretics such as Tylenol and ibuprofen are used to reduce fever.

Priority Nursing Interventions

Focus on safety and restoration of fluid balance as primary goals in managing dehydration.
Monitor patients receiving intravenous (IV) therapy for signs of fluid overload.
Evaluate response to therapy by monitoring vital signs every 2 hours.
Assess pulse rate, pressure, and quality to gauge patient response to treatment.

Monitoring and Assessment

Measure urine output and daily weight every 8 hours to track fluid status.
Check medical orders for specified daily fluid intake.
Administer prescribed IV fluids at a safe rate, especially for patients with kidney, heart, or lung issues.
Watch for bounding pulses, difficulty breathing, and neck vein distention as indicators of therapy response.

IV Site and Safety Monitoring

Assess the IV site hourly for complications like infiltration, extravasation, phlebitis, swelling, pain, or low drip rate.
Monitor cardiovascular and kidney function, which are crucial during IV therapy.
Implement safety precautions by assessing orthostatic blood pressure and muscle strength, and orienting the patient to their environment.

Patient Safety Measures

Utilize call bells, offer assistance with ambulation, and use assistive devices to ensure patient security.
Maintain a safe environment by cleaning spills, ensuring good lighting, keeping the bed at the lowest position, using brakes on equipment, and keeping personal items within reach.
Delegate tasks to Certified Nursing Assistants (CNA) to provide patients with small fluid amounts every hour and ensure documentation of exact intake.

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Description

This quiz focuses on nursing interventions aimed at managing fluid volume deficits and dehydration. It covers various strategies such as encouraging fluid intake, providing comfort measures, and specific practices during enteral feeding. Test your knowledge on these essential nursing skills!