Dehydration, Hypovolemic Shock, And Small Bowel Obstruction: Symptoms, Nursing Care, And Treatment

1. What signs and symptoms did Stan present with that may indicate that he is dehydrated? What nursing care and management is required for the patient presenting with dehydration?

2. One complication of dehydration is hypovolaemic shock. What indicators would you be looking for in a patient with hypovolaemic shock and what would your nursing care be for a patient with this condition?

3. Stan is diagnosed with a Small bowel obstruction (SBO), what is the nursing care and treatment of a person with a small bowel obstruction (SBO)?

Signs and Symptoms that Indicate Stan is Dehydrated

Dehydration is a condition that occurs when the amount of the water which enters the body is less the amount of water leaving the body. Even low levels of dehydration can cause severe damage to the human body. According to Oates & Price (2017), the human body needs roughly 75% water, and without this amount, it cannot survive. The body is believed to have a regular water management system which keeps the water level in the body balanced the mechanism also tells us when we need to take some water. The first symptom of dehydration which Stan experienced is a lot of thirsty, decreased urine production and the urine was dark in color. Urine color is used to indicate the level of dehydration a person is in. Clear urine means that a person is well hydrated while dark urine indicates that a person is dehydrated and some precaution actions should be taken (Oates & Price, 2017). However, for the case of Stan who is old dehydration can occur without thirst. As the condition progress to moderate dehydration, Stan may start experiencing symptoms like weakness in his muscles, severe headache, dry mouth, and dizziness. Severe dehydration may cause his body to lack sweat, have sunken eyes and have dry skin.

Nurses and the entire medical care teams prefer prevention as the essential treatment for dehydration. Patients like Stan should be advised to consume a lot of fluids and foods that have high water content such as fruits and vegetables (Bunn, Jimoh, Wilsher & Hooper, 2015). These foodstuffs are considered enough for the prevention of dehydration to older people and even young ones. Nurses and medical care officers should warn people about the kind of exercises and activities which they perform during extreme heat or the hottest part of the day. If someone has to exercise they should, therefore, take plenty of fluids as the body loses a lot of water through sweating in this kind of weather (Paulis, Everink, Halfens, Lohrmann & Schols, 2018). Medical attention should be paid to young and old people as they are more prone to dehydration and they should be supplied with plenty of fluids.

Hypovolemic shock is a life-threatening condition which occurs when the body loses more than 20% blood or fluids.  Lose the plenty amounts of fluids from the body makes the heart not able to pump a sufficient amount of blood and fluids in the body. This infection is very much prevalent in young children and old people (Miller et al., 2016). There are several indicators which show that a patient is suffering from hypovolemic shock. These indicators vary with the level of the infection. However, all the level requires emergency medical attention and treatment. At early stages, patients may experience nausea, headache, fatigue, dizziness and profuse sweating. As the condition worsens, a patient may have pale skin due to losing o excess fluids, rapid heart rate, difficulties in breathing and may be confused.

Nursing care and Management for Dehydration

If not treated, hypovolemic shock can lead to death. In case a person is suffering from this infection before taken to the hospital should be given first aid in which the patient is laid flat with their feet elevated like 12inches. In case the person is suspected from the head, neck or back injuries should not be moved. First aiders should keep the person warm to avoid hypothermia, and lastly, the person should not be given fluids through the mouth. Once the person suspected to have hypovolemic shock is taken to the hospital, the nurses and the medical team members should provide them with fluids and blood products through an intravenous line. This is done to replenish the blood lost and booster blood circulation. Medications which improves heart pumping capabilities like dopamine and dobutamine should be considered to allow the flow of blood throughout the body (Urden, Stacy & Lough, 2017). Nurses should also administer the use of antibiotics as they prevent septic shock and bacterial infections.

Before treatment of small bowel obstruction, the medical care team should first diagnose and test if the patient is suffering from this infection (Behman et al., 2017). The doctor or the nurse has to check the medical history of the patients. They do so by asking the patient about any previous abdominal or pelvic surgeries. The doctors can also perform a physical examination in which they observe the abdominal area to check any swelling or surgical scars. The patients also need a complete blood test and abdominal x-rays which helps the doctors to know if the small bowel is obstructed (Thornblade, Truitt, Davidson, Flum & Lavallee, 2017). After diagnosis and examination for small bowel obstruction, the doctors can proceed with the treatment in which the patient has to be hospitalized. The patient will, therefore, be given intravenous fluids in the veins and bowel rest with nothing to eat. In case the patient is having nausea, and vomiting doctors can use anti-emetics which relieves them. According to Rice et al. (2018), surgery may be done in cases where the small intestine is completely blocked. This is significant because nurses and doctors can identify the cause of the bowel obstruction and they are in a position to give the correct treatment.

Stan who is suffering from small bowel obstruction may have been diagnosed with the infection after the following was found in his laboratory tests. Adhesions may have been found in his results which are small scars which occur after a person had to go through abdominal or pelvic surgery. Hernias were also seen in his laboratory results which are segments of intestine which break due to weakened part of the abdominal wall (Wallace et al., 2015). Inflammatory diseases which narrow the bowel were also found in his test results. Malignant tumors which in most of the times are caused by cancer could have been found in his laboratory results even though they account for a small percentage of small bowel obstruction (Burke et al., 2015). This causes made Stan lack appetite for food which worsened his health condition. He could also experience nausea and vomiting. As the situation worsened, Stan suffered severe constipation.

Indicators for Hypovolemic Shock

Conclusion

Patients should seek medical attention in case their health condition is deteriorating so that the best advice about the disease can be given to them and so that the doctors can treat the infection before the situation worsened. Medical care team should advise patients who are suffering from infections which are caused by lack of enough fluids in the body to take a lot of fluids to prevent this disease. Lack of blood in the body can make the heart not been able to perform its function properly. Therefore doctors should advise patients to go for blood transfusion which replenishes the lost blood and boosters the circulatory system.

References

Behman, R., Nathens, A. B., Byrne, J. P., Mason, S., Hong, N. L., & Karanicolas, P. J. (2017). Laparoscopic surgery for adhesive small bowel obstruction is associated with a higher risk of bowel injury: a population-based analysis of 8584 patients. Annals of surgery, 266(3), 489-498.

Bunn, D., Jimoh, F., Wilsher, S. H., & Hooper, L. (2015). Increasing fluid intake and reducing dehydration risk in older people living in long-term care: a systematic review. Journal of the American Medical Directors Association, 16(2), 101-113.

Burke, R. E., Juarez-Colunga, E., Levy, C., Prochazka, A. V., Coleman, E. A., & Ginde, A. A. (2015). Rise of post–acute care facilities as a discharge destination of US hospitalizations. JAMA internal medicine, 175(2), 295-296.

Miller, S. C., Lima, J. C., Intrator, O., Martin, E., Bull, J., & Hanson, L. C. (2016). Palliative care consultations in nursing homes and reductions in acute care use and potentially burdensome end?of?life transitions. Journal of the American Geriatrics Society, 64(11), 2280-2287.

Oates, L. L., & Price, C. I. (2017). Clinical assessments and care interventions to promote oral hydration amongst older patients: a narrative systematic review. BMC nursing, 16(1), 4.

Paulis, S. J., Everink, I. H., Halfens, R. J., Lohrmann, C., & Schols, J. M. (2018). Prevalence and Risk Factors of Dehydration Among Nursing Home Residents: A Systematic Review. Journal of the American Medical Directors Association.

Rice, A. D., Patterson, K., Reed, E. D., Wurn, B. F., Robles, K., Klingenberg, B., ... & Wurn, L. J. (2018). Decreasing recurrent bowel obstructions, improving quality of life with physiotherapy: Controlled study. World journal of gastroenterology, 24(19), 2108.

Thornblade, L. W., Truitt, A. R., Davidson, G. H., Flum, D. R., & Lavallee, D. C. (2017). Surgeon attitudes and practice patterns in managing small bowel obstruction: a qualitative analysis. journal of surgical research, 219, 347-353.

Urden, L. D., Stacy, K. M., & Lough, M. E. (2017). Critical Care Nursing-E-Book: Diagnosis and Management. Elsevier Health Sciences.

Wallace, A., Downs, E., Gates, P., Thomas, A., Yates, P., & Chan, R. J. (2015). Provision of survivorship care for patients with haematological malignancy at completion of treatment: a cancer nursing practice survey study. European Journal of Oncology Nursing, 19(5), 516-522.