He has a history of hypertension, type II diabetes, and chronic renal failure. What do you think was the cause of his dehydration. Could it have been the dialysis he received earlier that day. Or could it be a complication of his diabetes? Thanks
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Consider the effects of his medications. Diarrhea?
the kidney failure
renal failure leads to edema, which allows fluid to be located within the interstitum rather than the capillaries (aka blood vessels) so you can be hyperosmotic in regard to solute concentration (aka sodium levels in blood). dehydration could also be due to administration of diuretics—since the pt is renal compromised and could have been prescribed a thiazide, loop or potassium sparing diuretic—fluid leaves the body via urine excretion more quickly. this is given typically to a patient with edema. and also in regard to dialysis, there are strict rules on fluid intake and fluid loss—output must balance input so perhaps your patient is partially dehydrated due to this treatment as well–he would have been restricted on how much he drinks.
it shud be due to the dyalysis, dehydration is not a complication of diabetes mellitus.
Spikegirl9999 definitely has a head on her shoulders. Now – with my attempts to remember nursing school and those dreaded nursing care plans, please remember a few things… it is your job to identify an actual or possible problem; do not diagnose or think that it is up to you to figure out whether the chicken or the egg came first…this is applied science only. anyway, consider a few more things: any recent new illness/infection that could help create some insensible loss,ie, n/v, ls? bacterial vs: viral infection? (resp,GI or GU) , any recent increase in glucose levels that would signal infection? Did your patient come from the community or from a longterm or shorterm care facilility? It is not uncommon for dehydration to be the admitting dx for individuals coming from another facility…many times a true diagnosis but many times it is a slap in the face to the other facility. With your pt’s medical hx to have labs that would suggest dehydration are not all that far fetched. Look a little further though, dehydration is most likely not the only culprit. In regards to your ccp – remember that this pt is at risk for dehydration as well as fluid overload with medical history given, glucose will most likely need more monitoring as well and don’t forget actually weighing the pt. All and all it comes down to a dietary consult to re-evaluate fluid restriction, monitoring I & O, monitor and cover DM as RX, communication with dialysis, management of other dxs such as HTN and treat any possible infections recently acquired.
the question comes down to if hes still making urine or not. if the kidney function is impaired to the point where the body doesnt fluid balance of its own accord at all the it would have to be the dialysis, but not that that they dialized too much off him, probably that they messed some sodium levels leaving him hypotonic if they went too low on the sodium, hyper tonic if the went to high on them(like spikegirl said)
if he is still making urine its a whole different bag of works…
is he on a diuretic?
is he diuresing in response to chroniclly high blood sugars?
is he sweating alot for some reason? (drug toxicities, cardiac/pulmanry issues)
lastly, is this his full history? specifically this is flu season, does he have diahrea or some other reason for fluid loss like c diff or something?
ive heard from a nephrologist here at work that a esrd patient that follows thier fluid restrictions will have a normal life, but that the % of the population thats compliant with that is under1%.
The dialysis is the cause of the dehydration. That is what dialysis does, it removes fluid or ‘dehydrates’ the patient…a therapeutic dehydration.
Your care plan should be all about fluid and electrolyte management.