Nursing the Nurse

1. Monitor cardiovascular, respiratory, neuromuscular,
renal, integumentary, and gastrointestinal status.

2. Prevent further fluid losses and increase fluid
compartment volumes to normal ranges.

3. Provide oral rehydration therapy if possible and
intravenous (IV) fluid replacement if the dehydration is
severe; monitor intake and output.

4. Generally, isotonic dehydration is treated with isotonic
fluid solutions, hypertonic dehydration with hypotonic
fluid solutions, and hypotonic dehydration with
hypertonic fluid solutions.

5. Administer medications as prescribed such as
antidiarrheal, antimicrobial, antiemetic, and antipyretic
medications, to correct the cause and treat any symptoms.

6. Administer oxygen as prescribed.

7. Monitor electrolyte values and prepare to administer
medication to treat an imbalance, if present.

1. Cardiovascular

a. Thready, increased pulse rate
b. Decreased blood pressure and orthostatic (postural)
hypotension
c. Flat neck and hand veins in dependent positions
d. Diminished peripheral pulses

2. Respiratory: Increased rate and depth of respirations

3. Neuromuscular
a. Decreased central nervous system activity, from
lethargy to coma
b. Fever

4. Renal
a. Decreased urinary output
b. Increased urinary specific gravity

5. Integumentary
a. Dry skin
b. Poor turgor, tenting present
c. Dry mouth

6. Gastrointestinal
a. Decreased motility and diminished bowel sounds
b. Constipation
c. Thirst
d. Decreased body weight

7. Hypotonic dehydration: skeletal muscle weakness


8. Hypertonic dehydration
a. Hyperactive deep tendon reflexes
b. Pitting edema

9. Laboratory findings
a. Increased serum osmolality
b. Increased hematocrit
c. Increased blood urea nitrogen (BUN) level
d. Increased serum sodiumlevel

Isotonic dehydration 
a. Inadequate intake of fluids and solutes
b. Fluid shifts between compartments
c. Excessive losses of isotonic body fluids

Hypertonic dehydration
conditions that increase fluid
loss, such as excessive perspiration, hyperventilation,
ketoacidosis, prolonged fevers, diarrhea, early-stage
renal failure, and diabetes insipidus

Hypotonic dehydration 
a. Chronic illness
b. Excessive fluid replacement (hypotonic)
c. Renal failure
d. Chronic malnutrition

Isotonic dehydration 

a. Water and dissolved electrolytes are lost in equal
proportions.
b. Known as hypovolemia, isotonic dehydration is the
most common type of dehydration.
c. Isotonic dehydration results in decreased
circulating blood volume and inadequate tissue
perfusion.

Hypertonic dehydration
a. Water loss exceeds electrolyte loss.
b. The clinical problems that occur result from
alterations in the concentrations of specific plasma
electrolytes.
c. Fluid moves from the intracellular compartment
into the plasma and interstitial fluid spaces,
causing cellular dehydration and shrinkage.


Hypotonic dehydration 
a. Electrolyte loss exceeds water loss.
b. The clinical problems that occur result from fluid
shifts between compartments, causing a decrease in
plasma volume.
c. Fluid moves from the plasma and interstitial fluid
spaces into the cells, causing a plasma volume
deficit and causing the cells to swell.