Question

Ms. Floyd, a 96-year-old woman, has been vomiting for 24 hours and is unable to eat or drink. She arrives on the unit after being admitted for dehydration. Ms. Floyd has a history of constipation and hypertension. She takes Metamucil, HTCZ, and metroprolol on a daily basis.

What factors may have predisposed Ms. Floyd to dehydration?

What types of fluids should be used to treat Mrs. Floyd’s condition?

What concerns should the nurse have about the condition of this patient?

What clinical signs and symptoms would indicate that dehydration has resolved?

When Mrs. Floyd is being discharged home, with whom would the nurse collaborate to assure that care is continued?  What discharge teaching will the nurse provide?

Answer 1

· Vomiting and diarrhea has predisposed Ms. Floyd to dehydration. Vomiting and diarrhea lead to excess of fluid loss from the body which can be converted to dehydration in older people. Moreover, inability to eat food in adults can also lead to dehydration.

· Ms. Floyd should be administered with ringer’s lactate solution and some normal saline (0.9% NaCl).

· Hypertension and excess of fluid loss are the major concern for the nurse. Some blood pressure medicine also lead to dehydration. Ms. Floyd is on hydrochlorothiazide medication and one of the common symptom of this drug is dehydration. It is concerning for the nurse to regulate both blood pressure and dehydration in the patient.

· Cured constipation, fatigue and vomiting would indicate that dehydration has been resolved for Ms. Floyd. Moreover, some improvement in her eating and drinking pattern would confirm the recovery.

· It is important for the nurse to inform someone about the condition and treatment pattern of Ms. Floyd after discharge. The nurse will collaborate with any of her family member or any full time care provider of Ms. Floyd. The discharge teaching will be provided by the teach-back method in which the guardian or care provider will be used to dictate the measures told to him/her. The nurse will educate the care provider to provide enough fluids to the patient and giver a healthy and fiber rich diet to the patient to relieve constipation. The care provider will be asked to report any signs and symptoms of dehydration in the patient if seen over the time.