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Patient information nausea and vomiting, abdomen is distended, poor skin turgor, dry mucous membranes, not urinated since yesterday, dizzy and week all evening he thought it might be the flu but decided to come in because the stomach pain were getting worse.

HR-130, Res-29, Bp-108/78, Temp- 37, spo2-90, skin turgor/cold

1. Identification of signs and symptoms of dehydration is specific to Stan and made clear through clear and concise discussions supported by evidence.

2. The indicators of hypovolaemic shock and the appropriate nursing care for a patientwith hypovolaemic shock is made clear throughclear and concise discussions supported by evidence

3. The nursing care and treatment for a patient with a small bowel obstructionis madeclear through clear and concise discussion supported by evidence

4. Discussion on what the lab results indicate for Stan’s condition is made clear through clear and concise discussions supported by evidence

Identifying Signs and Symptoms of Dehydration

1. The symptoms of dehydration ranges from mild to severe condition. In this case the patient has been suffering from nausea, vomiting and distend abdomen that are considered as the mild symptoms of dehydration. In addition, dry mucus membrane and poor skin turgor has been found that are also the symptoms of dehydration. During dehydration heart rate and respiratory rate increases as the patient suffers from rapid heartbeat and breathing (Weber et al., 2013). In this case the report of the patient has shown that the heart rate is 130 which is greater than the normal heart rate and respiratory rate is 29 that is also higher than the normal. Furthermore, the patient has not been urinated for a long time that is another severe symptom of dehydration and the condition has led to the stomach pain, dizziness or lack of energy (Fortes et al., 2015). Such symptoms of the patient has led to the diagnosis of dehydration.

The case has indicated that the patient has been suffering from severe dehydration and in this case immediate nursing care is essential in order to recover from the condition. The most effective management of dehydration include drinking plenty of fluids. It is important to encourage the patient to intake 180 ml of fluid with medication and if the patient refuse to drink, then sugar free juice may be provided. The patient may be provided intravenous fluid for replacement of the fluid loss due to dehydration. Some sport drinks that helps to maintain the electrolytes in the body may be provided. Effective medication such as acetaminophen or ibuprofen may be provided. However, as the patent has been vomiting, the medication may be provided by the intravenous fluid (Gulanick & Myers, 2013). Such treatment would be helpful for the patient in order to recover faster.

2. As severe dehydration could lead to the consequence of hypovolemic shock, it is important to introduce proper diagnosis process in order to identify the risk of hypovolemic shock (Annane et al., 2013). In order to diagnose blood test is required for identify imbalance in the electrolytes, ECG need to be done to monitor the heart rate, endoscopy of gastrointestinal organs need to be done to identify any haemorrhaging shock and examination of the catheter is needed to measure the amount of urine. Such tests provide indications such as rapid heart rate, weakness, weak pulse, cold skin, blood in the urine and stool, chest pain, distended abdomen and pain in stomach (Wang et al., 2013). Such indications lead to the identification of the risk of hypovolemic shock.

Nursing Care for Hypovolaemic Shock

It is important to provide proper treatment for hypovolemic shock otherwise it could lead to some severe health conditions such as damage to the kidney, gangrene of leg and arms and heart attack as well. Nursing interventions include supply of fluids through intravenous line in order to improve circulation. Effective medications include dopamine, epinephrine, dobutamine, norepinephrine and others. Antibiotics may be provided to the patient in order to prevent the urinary infection related to dehydration or septic shock. In some severe cases transfusion of blood plasma, platelets and red blood cells may be needed. Intravenous crystalloids may be provided to the patient to improve the strength of heart’s pumping and improve circulation and reduce the effect of hypovolemic shock. Close cardiac monitoring would help to identify the effectiveness of the treatment (Pham, Santucci & Yang, 2014).

3. As the patient has diagnosed with small bowel obstruction, it is important to provide adequate nursing care and treatment to help the patient in order to get rid of the illness. Treatment of bowel obstruction depends on the severity of the obstruction. If the obstruction is obtained to be partial or an ileus obstruction, it is possible to improve the condition of the patient by resting the bowels that means providing nothing to eat but liquids only (Gallacher, 2016). In this case intravenous fluid is provided to the patient to maintain the electrolyte imbalance and manage dehydration. In some severe cases catheter may be inserted to the bladder of the patient in der to drain the urine. A tube may be inserted from the nose to the intestine in order to relieve the swelling and pressure of the bowel. Antinausea medication may be provided in order to reduce the vomiting. Antibiotics may be provided in order to reduce the infection in an effective manner (Taylor & Lalani, 2013). If such medical interventions fail to provide proper improvement to the patient’s condition, it is important to provide surgical interventions (Di Saverio et al., 2013).

4. The report of the patient has shown that blood test has been done for a full blood count, for recognizing electrolyte imbalance and for monitoring the glucose level. It has been found that people with diabetes are more vulnerable to dehydration, because the high glucose level in the blood leads to the decrease in the hydration level (Pruhova et al., 2013). However, in this case the blood glucose level of the patient is normal thus, dehydration have not occurred due to diabetes. The full blood count have shown that the number of platelets is normal, while the amount of haemoglobin, red blood cell and white blood cell has increased. Due to dehydration the amount of water has reduced in the intravascular space of the patient, thus the concentration of haemoglobin red blood cell and white blood cell has increased and the full blood count has indicated haemoglobin, red blood cell and white blood cell count greater than the normal (Gaw et al., 2013). The venous blood analysis for measuring electrolytes has indicated that the amount of bicarbonate, potassium and urea is normal for the patient, however, increase in the sodium, chloride and creatinine has been found. In case of dehydration, body contains a little amount of water for dissolving sodium in the body fluids. The water loss exceeds the sodium loss thus, amount of sodium increases in the blood (Cieza et al., 2013). For such reason the blood report of the patient has shown high sodium level. Similarly, due to less water content the chloride level of blood has increased. The kidney filters creatinine from the blood, but in case of improper function of kidney, increase in the creatinine level in the blood occur (Jimenez et al., 2014). The report of the patient has indicated increase in the creatinine level thus, it can be said that the function of the kidney get affected due to dehydration.

Treatment for Patient with Small Bowel Obstruction

References:

Annane, D., Siami, S., Jaber, S., Martin, C., Elatrous, S., Declère, A. D., ... & Trouillet, J. L. (2013). Effects of fluid resuscitation with colloids vs crystalloids on mortality in critically ill patients presenting with hypovolemic shock: the CRISTAL randomized trial. Jama, 310(17), 1809-1817.  doi:10.1001/jama.2013.280502. Retrieved from https://jamanetwork.com/journals/jama/fullarticle/1752245

Cieza, J. A., Hinostroza, J., Huapaya, J. A., & León, C. P. (2013). Sodium chloride 0.9% versus Lactated Ringer in the management of severely dehydrated patients with choleriform diarrhoea. The Journal of Infection in Developing Countries, 7(07), 528-532. doi:10.3855/jidc.2531. Retrieved from file:///C:/Users/User/Downloads/2531-Article%20Text-22386-1-10-20130715.pdf

Di Saverio, S., Coccolini, F., Galati, M., Smerieri, N., Biffl, W. L., Ansaloni, L., ... & Fraga, G. P. (2013). Bologna guidelines for diagnosis and management of adhesive small bowel obstruction (ASBO): 2013 update of the evidence-based guidelines from the world society of emergency surgery ASBO working group. World journal of emergency surgery, 8(1), 42. doi.org/10.1186/1749-7922-8-42. Retrieved from https://wjes.biomedcentral.com/articles/10.1186/1749-7922-8-42

Fortes, M. B., Owen, J. A., Raymond-Barker, P., Bishop, C., Elghenzai, S., Oliver, S. J., & Walsh, N. P. (2015). Is this elderly patient dehydrated? Diagnostic accuracy of hydration assessment using physical signs, urine, and saliva markers. Journal of the American Medical Directors Association, 16(3), 221-228. Doi.org/10.1016/j.jamda.2014.09.012. Retrieved from https://www.jamda.com/article/S1525-8610(14)00614-8/fulltext

Gallacher, B. (2016). Small Bowel Obstruction. Nursing the Acutely Ill Adult, 256. ISBN 978-1-137-46551-1. Retrieved from https://books.google.co.in/books?hl=en&lr=&id=K2-CDAAAQBAJ&oi=fnd&pg=PA256&dq=small+bowel+obstruction&ots=Ob5ML7I0K1&sig=GTKaZr1Y2yFK2yQimUOBSb8guME#v=onepage&q=small%20bowel%20obstruction&f=false

Gaw, A., Murphy, M., Srivastava, R., Cowan, R. A., & O'Reilly, D. S. J. (2013). Clinical Biochemistry E-Book: An Illustrated Colour Text. Elsevier Health Sciences. ISBN 978-0-7020-5179-1. Retrieved from https://books.google.co.in/books?hl=en&lr=&id=RjUvZEKTbQYC&oi=fnd&pg=PP1&dq=dehydration+and+blood+test+book&ots=NVjF5qNEeY&sig=gOWSslIUZAqflZesf0Az0Pa2ZdU#v=onepage&q=dehydration%20and%20blood%20test%20book&f=false

Gulanick, M., & Myers, J. L. (2013). Nursing Care Plans-E-Book: Nursing Diagnosis and Intervention. Elsevier Health Sciences. ISBN 978-0-323-09137-4. Retrieved from https://books.google.co.in/books?hl=en&lr=&id=s0k4bLSbqowC&oi=fnd&pg=PP1&dq=nursing+care+for+dehydration&ots=_S-qT48d8y&sig=x_8O3Zvz9vNBkXkzfAt3uAMk8Iw#v=onepage&q=nursing%20care%20for%20dehydration&f=false

Jimenez, C. A. R., Ishimoto, T., Lanaspa, M. A., Rivard, C. J., Nakagawa, T., Ejaz, A. A., ... & Glaser, J. (2014). Fructokinase activity mediates dehydration-induced renal injury. Kidney international, 86(2), 294-302. doi.org/10.1038/ki.2013.492. Retrieved from https://www.sciencedirect.com/science/article/pii/S0085253815302982

Pham, H., Santucci, S., & Yang, W. H. (2014). Successful use of daily intravenous infusion of C1 esterase inhibitor concentrate in the treatment of a hereditary angioedema patient with ascites, hypovolemic shock, sepsis, renal and respiratory failure. Allergy, Asthma & Clinical Immunology, 10(1), 62. Doi.org/10.1186/s13223-014-0062-9. Retrieved from https://aacijournal.biomedcentral.com/articles/10.1186/s13223-014-0062-9

Pruhova, S., Dusatkova, P., Neumann, D., Hollay, E., Cinek, O., Lebl, J., & Sumnik, Z. (2013). Two cases of diabetic ketoacidosis in HNF1A-MODY linked to severe dehydration: is it time to change the diagnostic criteria for MODY?. Diabetes care, 36(9), 2573-2574. doi.org/ 10.2337/dc13-0058. Retrieved from https://care.diabetesjournals.org/content/36/9/2573

Taylor, M. R., & Lalani, N. (2013). Adult small bowel obstruction. Academic Emergency Medicine, 20(6), 527-544. doi.org/10.1111/acem.12150. Retrieved from https://onlinelibrary.wiley.com/doi/full/10.1111/acem.12150

Wang, J., Liang, T., Louis, L., Nicolaou, S., & McLaughlin, P. D. (2013). Hypovolemic shock complex in the trauma setting: a pictorial review. Canadian Association of Radiologists Journal, 64(2), 156-163. Doi.org/10.1016/j.carj.2013.03.002. retrieved from https://www.carjonline.org/article/S0846-5371(13)00020-X/fulltext

Weber, A. F., Mihalik, J. P., Register-Mihalik, J. K., Mays, S., Prentice, W. E., & Guskiewicz, K. M. (2013). Dehydration and performance on clinical concussion measures in collegiate wrestlers. Journal of athletic training, 48(2), 153-160. doi: 10.4085/1062-6050-48.1.07. Retrieved from https://www.natajournals.org/doi/pdf/10.4085/1062-6050-48.1.07?code=nata-site

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