You are receiving an 85 years old patient with diarrhea and dehydration. For which of the following symptoms of dehydration should the nurse assess?

Appeared in: RUHS, Jaipur, PB B.Sc Nursing Entrance-2019

Explanation

In elderly patients, dehydration often manifests with neurological symptoms like confusion or disorientation due to reduced cerebral perfusion and electrolyte imbalances.
Poor skin turgor, where pinched skin returns to place slowly, is a classic sign of fluid volume deficit, indicating loss of interstitial fluid.
The combination of a key neurological change (disorientation) and a classic sign of volume loss (poor turgor) makes this the most accurate answer.

Option A: Dehydration leads to the kidneys conserving water, resulting in dark, concentrated urine, not pale urine. The heart compensates for low fluid volume with tachycardia (a rapid heart rate), not bradycardia (a slow heart rate).
Option C: Dehydration causes hemoconcentration, which leads to an increased hematocrit level, not a decreased one. Hypothermia is not a typical sign of dehydration.
Option D: Lung congestion (crackles on auscultation) is a hallmark sign of fluid volume excess (overload), which is the opposite of dehydration. Abdominal discomfort is likely related to the underlying diarrhea but is not a direct indicator of hydration status.

Clinical Relevance

Nursing practice connection: Use the key finding related to Assessment of Dehydration in Geriatric Patients to guide bedside assessment, documentation, and the next nursing action.
Early recognition of dehydration in the elderly is critical as it can rapidly progress to confusion, falls, acute kidney injury, and hypovolemic shock.
A nurse's priority is to assess for safety risks associated with disorientation (e.g., fall precautions) and to initiate rehydration protocols promptly as prescribed.
What if? If the patient also had a history of congestive heart failure (CHF), the nurse would need to rehydrate with extreme caution, using smaller fluid volumes and frequently auscultating the lungs for crackles to prevent pushing the patient from dehydration into fluid overload.

How to Approach the Question

First, identify the core clinical problem: dehydration in a high-risk patient (85 years old).
Second, recall the pathophysiology of dehydration (fluid volume deficit). Think about how the body compensates: the heart speeds up (tachycardia), the kidneys hold onto water (dark urine), and fluid shifts out of tissues (poor turgor).
Third, recognize that elderly patients often present with atypical signs, with confusion being a very common early indicator.
Fourth, evaluate each option against the expected signs of dehydration.
Option A (Pale urine, bradycardia) and Option C (Decreased hematocrit) present findings opposite to what is expected in dehydration.
Option D (Lung congestion) is a sign of fluid overload, the opposite condition.

Concept Tested & Keywords

Concept Tested: Assessment of Dehydration in Geriatric Patients
Stem keywords: 85 years old, diarrhea, dehydration, symptoms
Lead-in keywords: assess
Clinical cues: 85 years old patient: Indicates a geriatric patient, who is at higher risk for dehydration and may present with atypical symptoms like confusion before showing classic signs.

QCHVmt9Y6nx-upieNwITvL

E6 Nursing Fundamentals Potter Perry 12e Part 5 p. 63-65

E6 Nelson Textbook of Pediatrics(2024) — Volume 2 p. 152-154

Practise the full RUHS, Jaipur, PB B.Sc Nursing Entrance-2019

Attempt every question from this paper in a timed mock, then review the full solution for each one.