Monitoring Dehydrated Patients - Key Notes

Arlo Guthrie — Mon, 20 Apr 2009 08:25:46 GMT

Current Revision posted to Revision Guide For Student Nurses - Part 2 by Arlo Guthrie on 4/20/2009 8:25:46 AM

PATIENT CHECK	THE NORMAL DOG	THE NORMAL CAT	NOTES
Body temperature. Take core body temperature and remember also to check extremities	38-38.5°C	38.3-38.7°C	Pyrexia increases fluid requirements. For every 1°C above normal, an extra 3mls/kg should be given
Colour Check the oral & genital mucosae; these should be moist	Pink		Pale mucous membranes may be indicative of hypovolaemia
Capillary refill time	Less than 2 seconds		Prolonged CRT may be indicative of hypovolaemia
Heart rate	60-180 beats/min	110-180 beats/min	Remember also to measure pulse rate, rhythm and depth
Respiratory rate	10-30 breaths/min	20-30 breaths/min	Any signs of dyspnoea must be reported to the vet immediately
Packed cell volume	37-55%	30-43%	A high PCV may be indicative of dehydration, whilst a low PCV may show hypoplastic anaemia or recent haemorrhage
Body weight	Refer to normal weight for sex & breed		It is very useful to have the patient's normal weight recorded; e.g. at time of annual vaccination so that comparisons may be made
Thirst	Normal water intake should be approximately 50ml/kg/24hrs	Normal water intake should be approximately 60ml/kg/24hrs	A polydipsic patient may have renal problems, whilst an animal that has not drunk for some time will need deficit fluid replacement in addition to maintenance requirements
Urine output	20mls/kg/24hrs		Oliguria is extremely dangerous due to the build up of urea and creatinine
Urine specific gravity	1.012-1.060	1.020-1.040	High urine specific gravity may indicate dehydration, shock or acute renal failure; low specific gravity may indicate polydipsia, pyometra or a chronic renal problem
Central venous pressure	3-7cms of water		A low CVP indicates that the patient is not well hydrated; high CVP indicates over-transfusion
Defecation	Firm and brown with no obvious materials present		Fluid loss from normal faeces is 10-20mls/kg/24hrs; diarrhoea incurs greater fluid losses
Plasma protein	55-77g/l	60/80g/l	Plasma protein is important in maintaining the vascular volume acting against the pull of the ISF; raised plasma protein may indicate dehydration
Blood urea	2-8mmol/l	3-15mmol/l	Waste product levels may be elevated in cases of dehydration
Blood creatinine	<120umol/l	<180umol/l	Waste product levels may be elevated in cases of dehydration
Blood sodium	135-155mmol/l	135-150mmol/l	Sodium levels may be raised or deficient, depending on the cause of dehydration
Blood potassium	3.5-5.5mmol/l	4.0-5.5mmol/l	Potassium levels may be raised or deficient depending upon the cause of dehydration
Fluid therapy equipment	Check I/V catheter and giving set at least once an hour for occlusions		Remember to remove dressing to check for thrombophlebitis; make adjustments to the volume of fluid administered as necessary
Drip additives Never add bicarbonate to drips containing calcium since a precipitate will form	Add to the infusion bag as necessary and record time, quantity and type of additive		Additives should only be administered at the direction of the veterinary surgeon; potassium chloride is commonly used in cases of hypokalaemia since there are inadequate amounts in Hartmans; sodium bicarbonate is available to treat acidosis
Skin elasticity	Normal skin will quickly return following 'tenting'		5-6% dehydration shows a subtle loss of skin elasticity, 6-8% dehydration shows marked tenting; the skin of an animal 10% dehydrated or more will stand in place
Discharges	Check for oral, nasal, ocular and genital discharges in addition to obvious losses such as haemorrhage		An abnormal vulval discharge in the bitch may be indicative of pyometra; remember that exudate from burns constitutes a huge fluid loss
Appetite	Anorexic animals may require force feeding in addition to fluid therapy	Anorexic animals may require force feeding in addition to fluid therapy; valium may be used as an appetite stimulant under the direction of the veterinary surgeon	Sodium chloride 0.18% with Dextrose 4% is commonly used to provide maintenance fluid requirements; however the glucose provided is not enough to provide long-term nutritional support
General demeanour	Ensure that you are familiar with the signs of pain and inflammation		A bored or depressed patient is unlikely to recover as quickly as an alert and happy one; remember to provide plenty of TLC

Monitoring Dehydrated Patients - Key Notes

Arlo Guthrie — Mon, 20 Apr 2009 07:34:37 GMT

Revision 2 posted to Revision Guide For Student Nurses - Part 2 by Arlo Guthrie on 4/20/2009 7:34:37 AM

KEY NOTES

PATIENT CHECK	THE NORMAL DOG	THE NORMAL CAT	NOTES
Body temperature. Take core body temperature and remember also to check extremities	38-38.5°C	38.3-38.7°C	Pyrexia increases fluid requirements. For every 1°C above normal, an extra 3mls/kg should be given
Colour Check the oral & genital mucosae; these should be moist	Pink		Pale mucous membranes may be indicative of hypovolaemia
Capillary refill time	Less than 2 seconds		Prolonged CRT may be indicative of hypovolaemia
Heart rate	60-180 beats/min	110-180 beats/min	Remember also to measure pulse rate, rhythm and depth
Respiratory rate	10-30 breaths/min	20-30 breaths/min	Any signs of dyspnoea must be reported to the vet immediately
Packed cell volume	37-55%	30-43%	A high PCV may be indicative of dehydration, whilst a low PCV may show hypoplastic anaemia or recent haemorrhage
Body weight	Refer to normal weight for sex & breed		It is very useful to have the patient's normal weight recorded; e.g. at time of annual vaccination so that comparisons may be made
Thirst	Normal water intake should be approximately 50ml/kg/24hrs	Normal water intake should be approximately 60ml/kg/24hrs	A polydipsic patient may have renal problems, whilst an animal that has not drunk for some time will need deficit fluid replacement in addition to maintenance requirements
Urine output	20mls/kg/24hrs		Oliguria is extremely dangerous due to the build up of urea and creatinine
Urine specific gravity	1.012-1.060	1.020-1.040	High urine specific gravity may indicate dehydration, shock or acute renal failure; low specific gravity may indicate polydipsia, pyometra or a chronic renal problem
Central venous pressure	3-7cms of water		A low CVP indicates that the patient is not well hydrated; high CVP indicates over-transfusion
Defecation	Firm and brown with no obvious materials present		Fluid loss from normal faeces is 10-20mls/kg/24hrs; diarrhoea incurs greater fluid losses
Plasma protein	55-77g/l	60/80g/l	Plasma protein is important in maintaining the vascular volume acting against the pull of the ISF; raised plasma protein may indicate dehydration
Blood urea	2-8mmol/l	3-15mmol/l	Waste product levels may be elevated in cases of dehydration
Blood creatinine	<120umol/l	<180umol/l	Waste product levels may be elevated in cases of dehydration
Blood sodium	135-155mmol/l	135-150mmol/l	Sodium levels may be raised or deficient, depending on the cause of dehydration
Blood potassium	3.5-5.5mmol/l	4.0-5.5mmol/l	Potassium levels may be raised or deficient depending upon the cause of dehydration
Fluid therapy equipment	Check I/V catheter and giving set at least once an hour for occlusions		Remember to remove dressing to check for thrombophlebitis; make adjustments to the volume of fluid administered as necessary
Drip additives Never add bicarbonate to drips containing calcium since a precipitate will form	Add to the infusion bag as necessary and record time, quantity and type of additive		Additives should only be administered at the direction of the veterinary surgeon; potassium chloride is commonly used in cases of hypokalaemia since there are inadequate amounts in Hartmans; sodium bicarbonate is available to treat acidosis
Skin elasticity	Normal skin will quickly return following 'tenting'		5-6% dehydration shows a subtle loss of skin elasticity, 6-8% dehydration shows marked tenting; the skin of an animal 10% dehydrated or more will stand in place
Discharges	Check for oral, nasal, ocular and genital discharges in addition to obvious losses such as haemorrhage		An abnormal vulval discharge in the bitch may be indicative of pyometra; remember that exudate from burns constitutes a huge fluid loss
Appetite	Anorexic animals may require force feeding in addition to fluid therapy	Anorexic animals may require force feeding in addition to fluid therapy; valium may be used as an appetite stimulant under the direction of the veterinary surgeon	Sodium chloride 0.18% with Dextrose 4% is commonly used to provide maintenance fluid requirements; however the glucose provided is not enough to provide long-term nutritional support
General demeanour	Ensure that you are familiar with the signs of pain and inflammation		A bored or depressed patient is unlikely to recover as quickly as an alert and happy one; remember to provide plenty of TLC

Monitoring the Dehydrated Patient - Key Notes

Arlo Guthrie — Tue, 14 Apr 2009 10:25:49 GMT

Revision 1 posted to Revision Guide For Student Nurses - Part 2 by Arlo Guthrie on 4/14/2009 10:25:49 AM

KEY NOTES

PATIENT CHECK	THE NORMAL DOG	THE NORMAL CAT	NOTES
Body temperature. Take core body temperature and remember also to check extremities	38-38.5°C	38.3-38.7°C	Pyrexia increases fluid requirements. For every 1°C above normal, an extra 3mls/kg should be given
Colour Check the oral & genital mucosae; these should be moist	Pink		Pale mucous membranes may be indicative of hypovolaemia
Capillary refill time	Less than 2 seconds		Prolonged CRT may be indicative of hypovolaemia
Heart rate	60-180 beats/min	110-180 beats/min	Remember also to measure pulse rate, rhythm and depth
Respiratory rate	10-30 breaths/min	20-30 breaths/min	Any signs of dyspnoea must be reported to the vet immediately
Packed cell volume	37-55%	30-43%	A high PCV may be indicative of dehydration, whilst a low PCV may show hypoplastic anaemia or recent haemorrhage
Body weight	Refer to normal weight for sex & breed		It is very useful to have the patient's normal weight recorded; e.g. at time of annual vaccination so that comparisons may be made
Thirst	Normal water intake should be approximately 50ml/kg/24hrs	Normal water intake should be approximately 60ml/kg/24hrs	A polydipsic patient may have renal problems, whilst an animal that has not drunk for some time will need deficit fluid replacement in addition to maintenance requirements
Urine output	20mls/kg/24hrs		Oliguria is extremely dangerous due to the build up of urea and creatinine
Urine specific gravity	1.012-1.060	1.020-1.040	High urine specific gravity may indicate dehydration, shock or acute renal failure; low specific gravity may indicate polydipsia, pyometra or a chronic renal problem
Central venous pressure	3-7cms of water		A low CVP indicates that the patient is not well hydrated; high CVP indicates over-transfusion
Defecation	Firm and brown with no obvious materials present		Fluid loss from normal faeces is 10-20mls/kg/24hrs; diarrhoea incurs greater fluid losses
Plasma protein	55-77g/l	60/80g/l	Plasma protein is important in maintaining the vascular volume acting against the pull of the ISF; raised plasma protein may indicate dehydration
Blood urea	2-8mmol/l	3-15mmol/l	Waste product levels may be elevated in cases of dehydration
Blood creatinine	<120umol/l	<180umol/l	Waste product levels may be elevated in cases of dehydration
Blood sodium	135-155mmol/l	135-150mmol/l	Sodium levels may be raised or deficient, depending on the cause of dehydration
Blood potassium	3.5-5.5mmol/l	4.0-5.5mmol/l	Potassium levels may be raised or deficient depending upon the cause of dehydration
Fluid therapy equipment	Check I/V catheter and giving set at least once an hour for occlusions		Remember to remove dressing to check for thrombophlebitis; make adjustments to the volume of fluid administered as necessary
Drip additives Never add bicarbonate to drips containing calcium since a precipitate will form	Add to the infusion bag as necessary and record time, quantity and type of additive		Additives should only be administered at the direction of the veterinary surgeon; potassium chloride is commonly used in cases of hypokalaemia since there are inadequate amounts in Hartmans; sodium bicarbonate is available to treat acidosis
Skin elasticity	Normal skin will quickly return following 'tenting'		5-6% dehydration shows a subtle loss of skin elasticity, 6-8% dehydration shows marked tenting; the skin of an animal 10% dehydrated or more will stand in place
Discharges	Check for oral, nasal, ocular and genital discharges in addition to obvious losses such as haemorrhage		An abnormal vulval discharge in the bitch may be indicative of pyometra; remember that exudate from burns constitutes a huge fluid loss
Appetite	Anorexic animals may require force feeding in addition to fluid therapy	Anorexic animals may require force feeding in addition to fluid therapy; valium may be used as an appetite stimulant under the direction of the veterinary surgeon	Sodium chloride 0.18% with Dextrose 4% is commonly used to provide maintenance fluid requirements; however the glucose provided is not enough to provide long-term nutritional support
General demeanour	Ensure that you are familiar with the signs of pain and inflammation		A bored or depressed patient is unlikely to recover as quickly as an alert and happy one; remember to provide plenty of TLC