What is the primary nursing intervention for a patient presenting with mild dehydration?

B) Encourage increased oral fluid intake

A) Administer intravenous fluids immediately

B) Encourage increased oral fluid intake

C) Restrict fluid intake to prevent overload

D) Monitor for signs of fluid overload

A nurse is assessing a 28-year-old female patient with mild dehydration. Which of the following is the most appropriate nursing intervention to address the patient's condition?

B) Encourage increased oral fluid intake, particularly oral rehydration solutions

A) Administer intravenous fluids immediately

B) Encourage increased oral fluid intake, particularly oral rehydration solutions

C) Restrict fluids to prevent overhydration

D) Initiate a high-protein diet to promote recovery

A patient with mild hyponatremia is advised to use oral rehydration solutions instead of plain water. What is the primary reason for this recommendation?

B) To prevent further dilution of electrolytes

A) To ensure adequate hydration

B) To prevent further dilution of electrolytes

C) To decrease the frequency of diarrhea

What is the most appropriate initial nursing intervention for a patient with mild hyponatremia due to increased fluid intake?

B) Encourage the use of oral rehydration solutions with electrolytes

D) Increase sodium intake through diet

What is the most appropriate nursing intervention to prevent dehydration in a patient with diarrhea?

B) Provide oral rehydration solutions with balanced electrolytes

A) Encourage intake of clear fluids only

B) Provide oral rehydration solutions with balanced electrolytes

C) Restrict fluid intake to avoid overstimulation of the gastrointestinal tract

D) Administer anti-diarrheal medication immediately

A patient experiencing mild dehydration has been adhering to a revised hydration plan with oral rehydration solutions. Which of the following vital signs indicates stability in the patient's condition?

B) Blood pressure of 118/76 mmHg

C) Respiratory rate of 20 breaths per minute

Which of the following interventions is most likely responsible for the patient's reduction in bloating and abdominal discomfort?

A) Adherence to a low-FODMAP diet

C) Gradual reduction of follow-up visits

D) Monitoring vital signs regularly

What is the most likely cause of the patient's intermittent episodes of mild diarrhea?

B) Inconsistent adherence to the low-FODMAP diet

C) Elevated inflammatory markers

gastroentritis - Nursing Case Study

Pathophysiology

• Primary mechanism: Infection - Gastroenteritis is often caused by viruses (like norovirus) or bacteria (such as E. coli), which invade the gastrointestinal tract, leading to inflammation of the stomach and intestines.

• Secondary mechanism: Immune response - The body’s immune system reacts to these pathogens by releasing chemicals that increase gut motility and fluid secretion, resulting in diarrhea and vomiting.

• Key complication: Dehydration - Due to fluid loss from vomiting and diarrhea, dehydration can occur, which is critical to address as it affects electrolyte balance and can lead to further complications if not managed promptly.

Patient Profile

Demographics:

28-year-old female, office worker

History:

• Key past medical history: No significant medical history

• Current medications: Multivitamin supplement

• Allergies: None

Current Presentation:

• Chief complaint: Mild abdominal discomfort and diarrhea

• Key symptoms: Nausea, two episodes of loose stools, mild abdominal cramping

• Vital signs: Temperature 98.6°F, heart rate 78 bpm, blood pressure 118/76 mmHg, respiratory rate 16 breaths per minute

Section 1

Initial Assessment Findings:

During her initial assessment, the 28-year-old female patient appeared alert and oriented, with no acute distress noted. Her skin was slightly dry, and she reported feeling more thirsty than usual, suggestive of mild dehydration. Upon further questioning, the patient confirmed that her fluid intake had been minimal since the onset of symptoms. Bowel sounds were hyperactive upon auscultation, consistent with increased gut motility. A gentle palpation of the abdomen revealed generalized tenderness, particularly in the lower quadrants, but no guarding or rebound tenderness was observed, which helped rule out more severe complications such as appendicitis.

The nursing assessment prioritized evaluating the patient's hydration status. Capillary refill time was slightly prolonged at 3 seconds, and her mucous membranes appeared dry. This supported the clinical suspicion of mild dehydration due to fluid loss from diarrhea. The patient was encouraged to increase her fluid intake, emphasizing oral rehydration solutions to replenish lost electrolytes and maintain hydration status. Education was provided on the importance of maintaining adequate fluid intake, signs of worsening dehydration, and when to seek further medical attention.

Vital signs remained stable with a heart rate of 78 bpm, blood pressure of 118/76 mmHg, and respiratory rate of 16 breaths per minute, indicating no immediate hemodynamic instability. This stability allowed for the continuation of outpatient management. The focus was placed on monitoring her intake and output closely, reinforcing dietary modifications such as a bland diet to minimize gastrointestinal irritation, and scheduling a follow-up to reassess her condition. This initial assessment phase aimed to prevent further dehydration and provide supportive care to promote recovery.

Section 2

Response to Interventions:

Over the course of the next 24 hours, the patient adhered to the recommended increase in fluid intake and dietary modifications. She reported feeling slightly better, although episodes of diarrhea persisted, they were less frequent. Her thirst abated somewhat, and her energy levels improved marginally. Vital signs were reassessed, showing a stable heart rate of 76 bpm, blood pressure at 116/74 mmHg, and a respiratory rate of 16 breaths per minute. These findings suggested that her hemodynamic status remained stable, reinforcing the effectiveness of the hydration strategy implemented.

A follow-up assessment of her hydration status revealed a slight improvement. Capillary refill time was now under 2 seconds, and her mucous membranes appeared less dry. The patient was able to demonstrate understanding of the educational points provided, verbalizing the importance of maintaining her fluid intake and recognizing signs of worsening dehydration. Input and output monitoring showed a positive trend toward balance, indicative of effective fluid management.

However, the patient mentioned experiencing mild fatigue and muscle cramps, prompting a review of her electrolyte status. Given the ongoing fluid loss through diarrhea, a basic metabolic panel was ordered to assess for potential electrolyte imbalances. The results indicated a mild hyponatremia, with sodium levels at 134 mmol/L (normal range: 135-145 mmol/L), likely due to the dilutional effect of increased fluid intake. This finding highlighted the need to adjust her oral rehydration solution to ensure it contained adequate electrolytes to prevent further imbalance. Education was reinforced regarding the importance of using oral rehydration solutions specifically designed for electrolyte replenishment, as plain water alone might exacerbate the electrolyte disturbances. This adjustment in her care plan aimed to address the mild hyponatremia and prevent any progression to more significant complications.

Section 3

Over the following 12 hours, the patient continued to adhere to the revised hydration plan, incorporating an oral rehydration solution with balanced electrolytes. As a result, her symptoms showed further improvement. She experienced fewer episodes of diarrhea, and her energy levels increased, allowing her to engage in light activities without excessive fatigue. Her vital signs remained stable, with a heart rate of 74 bpm, blood pressure at 118/76 mmHg, and a respiratory rate of 14 breaths per minute, indicating continued stability in her overall condition.

A repeat basic metabolic panel was conducted to monitor her electrolyte levels. The results showed that her sodium levels had returned to a normal range of 136 mmol/L, reflecting the effectiveness of the adjusted rehydration strategy. Additionally, her potassium levels were within normal limits, confirming that the electrolyte-enhanced fluids were sufficient in maintaining balance. The patient was educated on the importance of continuing this balanced intake, even as her symptoms improved, to prevent relapse or further complications.

Despite the positive trend, the patient reported mild abdominal discomfort and bloating, prompting a reassessment of her gastrointestinal status. It was noted that her bowel sounds were active, and there was no significant abdominal tenderness, suggesting that these symptoms were likely due to transient adjustments in her digestive system as it recovered. She was advised to maintain a bland diet and avoid irritants such as caffeine and dairy, which could exacerbate her symptoms. These recommendations aimed to support her recovery while minimizing gastrointestinal distress, ensuring a smooth transition back to her normal health status.

Section 4

As the patient's journey continued, her mild abdominal discomfort and bloating persisted, prompting the healthcare team to perform a new set of diagnostic evaluations to ensure there were no underlying complications. An abdominal ultrasound was conducted to rule out any structural abnormalities or obstructions. The results were unremarkable, confirming that her gastrointestinal system was intact, and there were no signs of obstruction or organomegaly.

Meanwhile, her stool sample was analyzed to identify any residual pathogens that might be contributing to the lingering symptoms. The stool analysis revealed no pathogenic bacteria or parasites, suggesting that the gastroenteritis had resolved and the remaining symptoms were likely due to post-infectious irritable bowel syndrome (IBS), a common short-term complication following gastrointestinal infections. These findings reassured both the patient and the care team that her recovery was on track, albeit with some lingering functional symptoms.

In response to these diagnostic outcomes, the nursing team reinforced the importance of dietary modifications and continued education on symptom management. The patient was encouraged to maintain her hydration regimen and follow a low-FODMAP diet to mitigate bloating and discomfort. Fiber intake was adjusted to prevent exacerbation of symptoms, with a focus on soluble fiber to aid digestion gently. The patient was reassured that these symptoms were manageable and expected to resolve gradually as her gut flora and digestive function returned to normal. This comprehensive approach aimed to support her return to full health without complications.

Section 5

As the days progressed, the patient demonstrated a positive response to the interventions implemented by the healthcare team. Her adherence to the low-FODMAP diet and hydration regimen resulted in a noticeable reduction in bloating and abdominal discomfort. The patient reported feeling more energetic and was able to resume some of her daily activities with minimal discomfort. Vital signs remained stable, with a blood pressure of 118/76 mmHg, heart rate of 72 beats per minute, and a temperature of 98.6°F, indicating no signs of systemic infection or distress.

The nursing team continued to monitor her progress closely, conducting regular assessments to ensure her recovery was on track. During these assessments, the patient expressed some concerns about intermittent episodes of mild diarrhea, occurring once or twice a day. A review of her dietary intake suggested that these episodes might be linked to occasional deviations from the low-FODMAP guidelines. The nursing staff provided additional education on identifying potential dietary triggers and emphasized the importance of maintaining dietary consistency to manage her symptoms effectively.

Laboratory results showed improvement in inflammatory markers, with a C-reactive protein (CRP) level of 3 mg/L, further reassuring the team that there was no ongoing inflammation. Electrolyte levels remained within normal ranges, and a follow-up complete blood count (CBC) revealed no abnormalities, indicating her body's recovery process was progressing smoothly. With these positive indicators, the care team felt confident in gradually reducing the frequency of her follow-up visits, while still encouraging the patient to reach out with any concerns or changes in her condition. This approach ensured she remained supported throughout her recovery journey, fostering confidence in managing her health independently.