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9 Caring for the patient who
has problems with
elimination
The body must have
enough fluids to stay
healthy. Over half of an
adult's weight is made
up of
fluids.
The
amount or volume of
fluids
in
the body
remains more or less
constant.
A person
takes in fluid through drinking water and other liquids and through
eating foods that contain some liquid. This volume is balanced by
the amount of fluid the person loses in breathing, perspiration, urine,
and the fluid in solid wastes eliminated from the gastrointestinal
tract.
The body fluids contain electrolytes such as sodium, potassium,
chloride, phosphate and calcium. In the healthy person these
electrolytes are in balance. Some diseases cause fluid or
electrolyte imbalances. When a person is ill, the nurse must pay
close attention to the amount of fluids the person takes in and
excretes, making sure that the fluids and electrolytes are balanced.
There are two types of fluid problems: too little fluid and too
much fluid.
IN HEALTH
INTAKE=OUTPUT
Nursing care of the sick
128 \
Too little fluid
Too little fluid (dehydration) can be the result of taking in too little fluid
or losing too much.
Common reasons for taking in too little fluid:
• unable to swallow
• nausea
•
lack of appetite
• confusion.
Common reasons for losing too much fluid:
• diarrhoea and vomiting
• excess sweating
• blood loss during surgery
•
fluid loss from bad burns
•
fever
•
too much urination, as with uncontrolled diabetes
• drainage from wounds.
Always look for
the signs of
dehydration. One of the easiest
signs to see is lack of elasticity in
the skin tissues. When you pinch
normal skin, it immediately goes
back to its usual position. If the
person is dehydrated, the skin will
go back to its flat position more
slowly. For adults, the best places
to test are the forehead, sternum and inner thigh. Test the abdomen
or mid-thigh for children. (Skin elasticity is not always a reliable sign