A nurse is caring for a client with gastroenteritis and is documenting the clinical manifestations indicating dehydration. What would indicate the patient is dehydrated?

Dry axilla, tongue and oral mucosa
Flat jugular veins
Orthostatic hypotension
Rapid weight loss

Explanation

Each day, approximately 3-to-6 liters of fluid are secreted by the stomach, pancreas, gallbladder, and intestines into the lumen of the gastrointestinal tract, with almost all being reabsorbed, so that only 100-to-200 ml are lost in the stool. However, volume depletion may ensue if the secreted fluid cannot be reabsorbed or if secretion exceeds the capacity for reabsorption due either to increased secretion or reduced reabsorption (such as with diarrhea).

• Dehydrated patients often have a dry tongue and oral mucosa, and a dry axilla has been shown to be particularly indicative of the diagnosis.

• Orthostatic hypotension is one of the most sensitive indicators of decreased fluid volume.

• Flat jugular veins (venous pressure less than or equal to 5 cm H20) in a supine position is noted in clients with dehydration.

• Rapid weight loss is an early and common result of fluid loss, because water is a major portion of body weight.

• Crackles can be heard on auscultation over the lungs when there is fluid overload. This is not associated with dehydration.

• Cyanosis may result when alveolar fluid accumulation leads to impaired oxygen and carbon dioxide transport between the capillaries and the alveoli. This is not associated with dehydration.

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