Dehydration is a medical condition that results from an imbalance between the available amount of water in the body and the physiological need for water (Hoffman et al., 2018). Water is crucial in many body processes as it is a primary component in almost all body biomolecules. Without enough water, the body cannot function properly. Metabolism processes in the body that occur in the liver are hindered. Dehydration can be categorized as mild, moderate, or severe, based on the quantity of fluid lost from the body.
The 78-year-old female diagnosis was made after the careful history and clinical examination by a consultant doctor. Probable causes of dehydration in the patient include the side effects of using diabetic medications, which cause much of micturition (Priya et al., 2021). Urinating frequently is one of the most typical causes of dehydration. Besides frequent urination, other possible causes of dehydration are fever, gastroenteritis, osmotic diuresis, and diarrhea. The first reflex to losing water is to replace the lost water by drinking water, but this does not often happen because of some physiological problems. The patient could not replace the water lost because she never felt the urge to drink any water.
To diagnose and determine the degree of dehydration, several tests were performed in the lab. Some physicians can diagnose dehydration based on physical examination only. Determination of the degree or extent of dehydration requires that several laboratory tests be performed. Indications such as low blood pressure (hypotension) when changing position, i.e., orthostatic hypotension, increased heart rate (tachycardia), and limited blood flow and perfusion to the limbs, are potential dehydration indicators (Cutsforth-Gregory et al. 2019). It is crucial to determine the extent of dehydration to decide on the choice of drugs to use. The degree of dehydration can be mild, moderate, or severe, depending on the manifesting signs and symptoms.
Pathophysiology of Dehydration
As earlier stated, dehydration is a condition where there is a negative fluid balance in an individual’s body. There are several dehydration causes, but those that stand out are either decreased or increased fluid output. Intake of fluid occurs by ingestion of foods that contain fluid content in them. Usually, fluid is eliminated from the body through the renal system, the gastrointestinal system, the skin, and the breath. Fluid shifts such as ascites, capillary leaks, and effusions can also cause dehydration.
The reduction in extracellular and intracellular fluid volumes is attributed to decreased total body water content. Typical clinical manifestations of dehydration are associated with decreased intravascular volume and the physiological compensation of the decrease in whole-body water. Hypovolemic shock is the ultimate eventuality of a progressing dehydrated patient. The shock then results in multiple organ system failures, which eventually leads to death.
The degree of dehydration is described using two principal measures, i.e., the osmolarity and severity. Assuming the patient has an average serum glucose level, serum glucose acts as the best measurement mode of the degree of dehydration. In terms of osmolarity, dehydration can be classified as isonatremic, hyponatremic, or hypernatremic. Dehydration that is isonatremic occurs when the fluid lost is equal in sodium concentration to that in the blood. Water containing sodium is lost at the same measure and interval in both the extravascular and intravascular partitions.
Hyponatremic dehydration is evident when the fluid lost has increased sodium ions compared to those in the blood. In this type of dehydration, more sodium is lost as compared to water loss. Intravascular water shifts to the extravascular space because the serum sodium level is low. This loss increases intravascular fluid loss. On the other hand, hypernatremic dehydration occurs when the quantity of fluid lost has low sodium levels than the blood. Extravascular fluid now shifts to the intravascular space because the serum sodium level is high; hence this shift minimizes intravascular volume loss.
Understanding the causes of dehydration is crucial in ensuring a positive prognosis. Gastroenteritis and osmotic diuresis are the other significant causes of dehydration. The presence of diarrhea and vomiting accelerates the development of dehydration. Pain in the oral cavity severely limits the oral intake of fluid, which implies replacing the lost fluid presents a significant challenge. Tissue catabolism and excessive fluid loss are the primary causes of weight loss in dehydrated patients. Any febrile illness causes some minor fluid loses and also causes anorexia.
Signs and Clinical Symptoms
Depending on the extent of the dehydration, patients present in diverse ways. The mild form of dehydration’s significant signs includes thirst, dry mouths (sometimes even the tongue), reduced urination, dark urine, dehydrated skin, severe head pains, and spasmodic muscle contractions. Severe indications of dehydration include: not being able to urinate, dark-colored urine, drowsiness, tachycardia, tachypnea, sunken eyes, somnolence, depletion of energy, mental confusion, and high level of irritation.
Past Medical History
The 78-year-old woman had been earlier diagnosed with several diseases. She was diagnosed having type 2 diabetes. This kind of diabetes develops in adulthood; that is why it is sometimes referred to as adult-onset diabetes. Glucose is the primary source of energy for body metabolism processes. In type 2 diabetes, there is an impairment in glucose regulation as a source of energy. Type 2 diabetes leads to the accumulation of glucose in the blood, leading to immune problems.
In type 2 diabetes, the pancreas does not produce the required amount of insulin. This hormone converts excess glucose to other metabolites such as glycogen to be used later when there is a physiological need. If the hormone is deficient, it implies that the extra sugar will accumulate in the body cells. This deficiency makes the cells insensitive to insulin, and hence they take in a small amount of sugar.
Possible complications of type 2 diabetes include sleep apnea, fungal and bacterial skin infections, slow healing of wounds, eye damage, hearing impairment, dementia, limb neuropathy, and kidney disease. Prevention measures to avoid diabetes include eating healthy foods, exercising more often, losing weight, and moderating sugar intake. Medications that treat diabetes and intake of insulin supplements will help manage type 2 diabetes. Diabetic medications include Metformin and Thiazolidinediones. Metformin is the most appropriate and first-line drug in treating diabetes. Prevention rather than cure is the most effective way of combating type 2 diabetes and its associated complications.
The patient was also diagnosed with atrial fibrillation, where the heart rate is often rapid and irregular, causing low blood flow to tissues. Atrial fibrillation can cause intravascular blood clotting, stroke, and other heart-related problems. Common symptoms of the condition include shortness of breath, fatigue, and palpitations. The patient may also have a reduced capability to do any exercise. Female patients may also present with pain in the chest.
Apparent causes of atrial fibrillation are as follows: abnormal valves of the heart, coronary artery disease, cardiac attack, sick sinus syndrome, diseases of the lung, prior cardiac surgery, viral infections, high blood pressure, and stress that results from persistent illness (Lipshultz et al. 2019). Old age is a significant risk factor as people are prone to develop atrial fibrillation. Other risk factors include underlying cardiac disease, elevated blood pressure, obesity, drinking alcohol, and genetic predisposition. The treatment provides interventions to prevent any possible development of heart disease.
The patient was also diagnosed with dementia. Dementia is the loss of general cognitive functions such as memory and problem-solving skills. It encompasses a wide range of other mental diseases, such as Alzheimer’s disease. The most common symptom of dementia is associated with anterograde amnesia. Dementia patients cannot learn new information efficiently. Old age is a risk factor because the older one is, the more damage the nerves. Treatment of dementia is based on the underlying mechanism of cause. Therapies that do not include drugs have proved to be more effective over the recent past (Cutsforth-Gregory et al., 2019). Dementia and its associated diseases can be managed with proper adherence to the medications prescribed.
Pathophysiology of Type 2 Diabetes
Type 2 diabetes encompasses two effective presentations, i.e., insulin resistance on the periphery and insulin secretion that is not enough from the pancreas’ beta cells. Increased fatty acid levels that are not protein-bound and cytokines produced before inflammation in plasma cause insulin resistance. It results in decreased transport of excess glucose to the target tissues. Much glucose is also produced in the liver without being converted to glycogen for storage. Increased carbohydrate intake also contributes to raised blood glucose levels. Insufficient secretion of insulin contributes to the massive accumulation of glucose in the body.
Pathophysiology of Atrial Fibrillation
Atrial fibrillation results from structural changes in the heart structures due to environmental or diet factors. It is caused by degeneration of heart valves in the right and left atrium. Abnormal changes in the ventricles, atria, nodes, or even the valves result in impulses that trigger the heart abnormally leading. This malfunction leads to uncoordinated contraction and relaxation of the atria resulting in atrial fibrillation and then results in a chaotic rhythm.
Pathophysiology of Dementia
Dementia results from a significant loss of neurons that are responsible for memory and all other cognitive functions. It can be stimulated by environmental factors such as infections, toxins, and dangerous metals such as zinc, iron, and copper. Continued accumulation and deposition of beta-amyloid in the brain and cerebral vasculature stimulates a complex cascade of events leading to neuronal degeneration, loss of neuronal synapses, and neurotransmitters’ deficiency. All these signs lead to the progression of dementia and its forms.
Pathophysiology of Arthritis
All the joint structures undergo pathophysiological changes, including the articular surface, synovium, ligaments, and subchondral bone. The first place to experience this change is articular cartilage. Chondrocytes produce cytokines and chemokines that induce and progress inflammation. The process decreases collagen synthesis and also increases degradative proteases. The inflammatory process results in swelling of tissues, cartilage fibrillation, and erosion. The most common risk factors include previous injury, high impact activities, and muscle weakness.
Pathophysiology of Hypothyroidism
Hypothyroidism is of two types, i.e., primary and secondary hypothyroidism. Primary hypothyroidism results from atrophy or permanent loss of the thyroid tissue. In comparison, secondary hypothyroidism is caused by insufficient thyroid gland activation to produce its hormones. It is primarily driven by an already existing pituitary or hypothalamic disease. Secondary hypothyroidism is due to hypothalamic deficiency of the thyroid releasing hormone. Additionally, peripheral resistance to the hormonal effects of thyroid hormone influences the progression of the disease.
- Levothyroxine: levothyroxine is a prescription drug used in the treatment of hypothyroidism. The 78-year-old woman is suspected of having low levels of the thyroid hormone. The patient was given the medication in the dosage form of a tablet. Common side effects of levothyroxine include hyperphagia, weight loss, being highly sensitive to heat, diaphoresis, severe headache, overactivity, being easily irritated, high-grade mood changes, and insomnia. Levothyroxine interacts with other drugs such as amitriptyline and protriptyline to cause arrhythmias.
- Metformin: it used to treat type 2 diabetes because it lowers and regulates high blood glucose. Controlling high blood glucose helps prevent blindness, neurological issues, limb loss, sexual dysfunction, and kidney damage. Common side effects include retching, vomiting, looseness of the bowel, and a metallic taste. Metformin interactions with other drugs do not cause severe consequences.
- Meloxicam: is used to treat arthritis in alleviating pain, swelling at the joints, and stiffness. The side effects profile includes the following: stomach upset, dizziness, diarrhea, and nausea. The severe side effects include easy bleeding, persistent headache, mood swings, kidney problems, stiff neck, unusual fatigue. Drugs and products that interact with meloxicam include aliskiren, A.C.E. inhibitors, A.R.B.s, cidofovir, lithium, methotrexate furosemide.
- Coumadin: coumadin is sodium combined with warfarin. It is used to treat blood clotting disorders, and it also prevents the formation of new blood clots within the vascular system. Side effects profile encompasses the following; nausea, anorexia, stomach, and abdominal pain. The drug might cause severe bleeding. Signs of bleeding include dark urine, hematemesis, severe headache, fainting, sharp acute chest pain, and frequent epistaxis.
Patient Education and Counseling
Patient education and counseling refer to providing information to a patient on how to use the medications effectively. This is a service professionally offered by pharmacists and nurses before giving the patient a drug. The information can either be provided orally or in written form. The patient is advised on dosage, proper storage instructions, diet, expected side effects, or adverse reactions to the drug she is using.
Nursing care plan
Diagnosis #1: Dehydration
R.T: Steve Johnson
A.E.B: Carol Myles
The patient will: replace the fluids fully by the end of the week. Her skin turgor will get back to normal before the end of the week.
Short-term goal: the patient to drink more water daily as recommended by the doctor.
Long-term goal: maintain the fluid balance in the body.
Diagnosis #2: Type 2 Diabetes
R.T: Raymond Sigmond
A.E.B: Dorcas Wright
The patient will: manage high sugar levels
Short-term goal: patient to take the prescribed medication as dictated by the doctor.
Long-term goal: regular monitoring blood sugar levels.
Diagnosis #3: Arthritis
R.T: Herald Cooper
A.E.B: Paula Charlotte
The patient will: drink a lot of water.
Short term goal: the patient doesn’t complain of migratory pain
Long-term goal: substantial compliance to medications.
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Priya, G., Kalra, S., Dasgupta, A., & Grewal, E. (2021). Diabetes insipidus: A pragmatic approach to management. Cureus, 13(1). Web.