Which of the following patient is at risk of fluid volume deficit?

AIIMS Delhi NO- 2019

Medical & Surgical Nursing

Medium

Appeared in: AIIMS Delhi NO- 2019

Explanation

An ileostomy is a surgical procedure that diverts the ileum (small intestine) to an opening (stoma) on the abdomen, bypassing the large intestine (colon).
The primary function of the colon is to absorb water and electrolytes from digested food.
By bypassing the colon, the patient loses this critical water-absorbing function, resulting in frequent, high-volume, liquid stool (effluent).
This continuous loss of fluid and electrolytes places the patient at a significant and constant risk for developing fluid volume deficit (hypovolemia) and dehydration.

Option A: Wound irrigation involves introducing fluid to a wound. It does not cause fluid loss. In some situations, particularly with large wounds or certain types of irrigation solutions, the body can absorb fluid, potentially leading to fluid volume excess, not deficit.
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 and backup in the circulatory system, causing symptoms like edema and pulmonary congestion.
Option D: This option is incorrect because a correct answer is available. A patient with an ileostomy is a classic example of someone at risk for fluid volume deficit.

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 prioritize monitoring fluid balance in patients with new ileostomies. This includes strict intake and output measurement, daily weights, and assessing for signs of dehydration like tachycardia, hypotension, and poor skin turgor.
Patient education is a critical nursing role. Patients with ileostomies need to understand their increased fluid needs (often 2-3 liters per day) and be able to recognize the early signs of dehydration to seek timely intervention.
What if the patient had a sigmoid colostomy instead of an ileostomy? The risk of fluid volume deficit would be significantly lower. Because a colostomy is created from the large intestine, much of the colon's water-absorbing capacity remains intact, resulting in more formed stool and less fluid loss.

How to Approach the Question

First, identify the key concept in the question stem: 'fluid volume deficit'. This means you are looking for a condition that causes the body to lose more fluid than it takes in.
Evaluate each option by considering its physiological effect on the body's fluid balance.
Consider 'Patient with wound irrigation'. This procedure adds fluid to the body locally. It does not cause systemic fluid loss. Eliminate this option.
Consider 'Ileostomy'. Recall the function of the gastrointestinal tract. The large intestine's primary role is water absorption. An ileostomy bypasses the large intestine. Therefore, significant water loss will occur. This is a strong candidate.
Consider 'Patient with cardiac disease'. Think about common conditions like heart failure. A failing heart pump leads to fluid backup and retention, causing fluid volume excess. This is the opposite of a deficit. Eliminate this option.
Based on the analysis, the patient with an ileostomy is the only one with a clear physiological reason for being at high risk for fluid volume deficit.

Concept Tested & Keywords

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