AIIMS Delhi NO- 2019
Medical & Surgical Nursing
Medium
Which of the following patient is at risk of fluid volume deficit?
Appeared in: AIIMS Delhi NO- 2019
Explanation
- An ileostomy is a surgical procedure that creates an opening from the ileum (the last part of the small intestine) to the surface of the abdomen.
- This procedure bypasses the large intestine (colon), which is the primary site for water and electrolyte absorption from digested food.
- As a result, the stool (effluent) from an ileostomy is liquid, high in volume, and continuous.
- This leads to a significant loss of both fluid and electrolytes (like sodium and potassium), placing the patient at a high and constant risk for fluid volume deficit (dehydration).
Why Other Options Were Wrong
- Option A: Wound irrigation involves introducing fluid to a wound, not removing it from the body's total volume. The amount of fluid lost from wound drainage is typically not enough to cause a systemic fluid deficit. In rare cases of extensive irrigation, fluid can be absorbed, leading to fluid volume excess.
- Option C: Patients with cardiac disease, particularly heart failure, are at high risk for fluid volume excess (hypervolemia). The heart's weakened pumping ability leads to fluid retention, causing symptoms like edema (swelling) and pulmonary congestion.
- Option D: This option is incorrect because a valid answer (Ileostomy) is present in the options.
Related Visual
- No visual required for this question type.
Clinical Relevance
- Nursing practice connection: Use the key finding related to Risk factors for fluid volume deficit to guide bedside assessment, documentation, and the next nursing action.
- Nurses must meticulously monitor the intake and output of patients with an ileostomy, paying close attention to the volume and consistency of the effluent.
- Patient education is a critical nursing responsibility. Patients must be taught the signs and symptoms of dehydration (e.g., thirst, dry mouth, dizziness, dark urine) and the importance of maintaining a high fluid intake (2-3 liters/day).
- Assessing peristomal skin integrity is vital, as the liquid, enzyme-rich effluent can cause rapid skin breakdown.
How to Approach the Question
- First, identify the key concept in the question: 'fluid volume deficit'. This means you are looking for a condition that causes the body to lose a significant amount of fluid.
- Next, evaluate each option's effect on the body's fluid balance.
- Consider 'Patient with wound irrigation'. This procedure adds fluid to a local area. It does not cause systemic fluid loss. Eliminate this option.
- Consider 'Ileostomy'. Recall the function of the gastrointestinal tract. The large intestine's main job is to absorb water. An ileostomy bypasses the large intestine. Therefore, water is not absorbed, leading to large amounts of liquid stool and fluid loss. This is a strong candidate.
- Consider 'Patient with cardiac disease'. Think about common conditions like heart failure. A weak heart leads to fluid backup and retention, causing fluid volume excess. This is the opposite of what the question asks. Eliminate this option.
- Based on the analysis, the patient with an ileostomy is the only one at direct risk for significant fluid volume deficit.
Concept Tested & Keywords
- Concept Tested: Risk factors for fluid volume deficit
- Stem keywords: patient, risk, fluid volume deficit
- Lead-in keywords: Which
- Negative lead-in flag: false
Question ID
QBI51iY0FxQjSQF58Wnxqp
Reference Book
E6 Nursing Fundamentals Potter Perry 12e Part 5 p. 60-62
E6 Nursing Fundamentals Taylor p. 777-779
Practise the full AIIMS Delhi NO- 2019
Attempt every question from this paper in a timed mock, then review the full solution for each one.
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