Nursing Management PDF

11/27/23, 4:32 AM Realizeit for Student Nursing Management To assess for FVD, the nurse monitors and measures fluid I&O at least every 8 hours, and sometimes hourly. Maintaining an accurate I&O is a particular challenge with patients in critical-care settings. As FVD develops, body fluid losses ex...

11/27/23, 4:32 AM Realizeit for Student Nursing Management To assess for FVD, the nurse monitors and measures fluid I&O at least every 8 hours, and sometimes hourly. Maintaining an accurate I&O is a particular challenge with patients in critical-care settings. As FVD develops, body fluid losses exceed fluid intake through excessive urination (polyuria), diarrhea, vomiting, or other mechanisms. Once FVD has developed, the kidneys attempt to conserve body fluids, leading to a urine output of less than 1 mL/kg/h in an adult. Urine in this instance is concentrated and represents a healthy renal response. Vital signs should be closely monitored in FVD. A decrease in body temperature often accompanies FVD, unless there is a concurrent infection. Skin and tongue turgor are monitored on a regular basis. In a healthy person, pinched skin immediately returns to its normal position when released (Weber & Kelley, 2018). This elastic property, referred to as turgor, is partially dependent on interstitial fluid volume. In a person with FVD, the skin flattens more slowly after the pinch is released. In a person with severe FVD, the skin may remain elevated for many seconds. Tissue turgor is best measured by pinching the skin over the sternum, dorsal surface of the hand, inner aspects of the thighs, or forehead. It is important to recognize skin turgor is normally diminished in old age. Tongue turgor is not affected by age, and evaluating this may be more valid than evaluating skin turgor (Sterns, 2017a). In a normal person, the tongue has one longitudinal furrow. In the person with FVD, there are additional longitudinal furrows and the tongue is smaller because of fluid loss. The degree of oral mucous membrane moisture is also assessed; a dry mouth may indicate either FVD or mouth breathing. Urine concentration is monitored by measuring the urine specific gravity. In a volume-depleted patient, the urine specific gravity should be greater than 1.020, indicating healthy renal conservation of fluid. Dark amber-colored urine is highly concentrated; whereas, clear yellow urine indicates a dilute urine. Mental function is eventually affected, resulting in confusion, lack of cognition, and delirium in severe FVD as a result of decreasing cerebral perfusion. Behavioral changes are particularly evident in older adults with FVD. Decreased peripheral perfusion can result in cold extremities. In patients with relatively normal cardiopulmonary function, a low central venous pressure is indicative of hypovolemia (Sterns, 2017a). Patients with acute cardiopulmonary decompensation require more extensive hemodynamic monitoring of pressures in both sides of the heart to determine whether hypovolemia exists. Hemodynamic monitoring is particularly important in critically ill patients (Mandel & Palevsky, 2019) https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IZsc2gfB3djkaGXwQ9ctgb2A3gz%2bCKrCW4cKwIi8CIqb… 1/4 11/27/23, 4:32 AM Realizeit for Student https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IZsc2gfB3djkaGXwQ9ctgb2A3gz%2bCKrCW4cKwIi8CIqb… 2/4 11/27/23, 4:32 AM Realizeit for Student https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IZsc2gfB3djkaGXwQ9ctgb2A3gz%2bCKrCW4cKwIi8CIqb… 3/4 11/27/23, 4:32 AM Realizeit for Student Preventing Hypovolemia To prevent FVD, the nurse identifies patients at risk and takes measures to minimize fluid losses. For example, if the patient has diarrhea, measures should be implemented to control diarrhea and replacement fluids given. This includes administering antidiarrheal medications and small volumes of oral fluids at frequent intervals. Correcting Hypovolemia When possible, oral fluids are given to help correct FVD, with consideration given to the patient’s likes and dislikes. The type of fluid the patient has lost is also considered, and fluids most likely to replace the lost electrolytes are appropriate. If the patient is reluctant to drink because of oral discomfort, the nurse assists with frequent mouth care and provides nonirritating fluids. The patient may be offered small volumes of oral rehydration solutions (e.g., Rehydralyte, Elete, and Cytomax). These solutions provide fluid, glucose, and electrolytes in concentrations that are easily absorbed. If nausea is present, an antiemetic may be needed before oral fluid replacement can be tolerated (Sterns, 2017a; Sterns, 2017b). If the deficit cannot be corrected by oral fluids, therapy may need to be initiated by an alternative route (enteral or parenteral) until adequate circulating blood volume and renal perfusion are achieved. Isotonic fluids are prescribed to increase ECF volume (Sterns, 2017b). https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IZsc2gfB3djkaGXwQ9ctgb2A3gz%2bCKrCW4cKwIi8CIqb… 4/4