Which condition is most likely to have a nursing diagnosis of fluid volume deficit?
A. Appendicitis
B. Pancreatitis
C. Cholecystitis
D. Gastric ulcer
Correct Answer: B. Pancreatitis
Hypovolemic shock from fluid shifts is a major factor in acute pancreatitis. The other conditions are less likely to exhibit fluid volume deficit. Early fluid therapy is the cornerstone of treatment and is universally recommended; however, there is a lack of consensus regarding the type, rate, amount, and endpoints of fluid replacement. The basic goal of fluid depletion should be to prevent or minimize the systemic response to inflammatory markers.
Option A: A client with appendicitis may be at risk for deficient fluid volume. The peritoneum reacts to irritation and infection by producing large amounts of intestinal fluid, possibly reducing the circulating blood volume, resulting in dehydration and relative electrolyte imbalances.
Option C: A client with cholecystitis may be at risk for deficient fluid volume. Prolonged vomiting, gastric aspiration, and restricted oral intake can lead to deficits in sodium, potassium, and chloride. Maintain accurate record of I&O, noting output less than intake, increased urine specific gravity.
Option D: A client with a gastric ulcer may be at risk for deficient fluid volume. The erosion of an ulcer through the gastric or duodenal mucosal layer may cause GI bleeding. The client may develop anemia. If bleeding is brisk, changes in vital signs and physical symptoms of hypovolemia may develop rapidly.
No comments:
Post a Comment