What to assess?

When rehydrating a severely dehyrated patient, what do you assess first and why?

A) Skin Turgor
B) Pulse rate
C) Ca+ levels
D) urine specific gravity

Good question. They are all good choices and if any are abnormal they are evidence of dehydration. However, which should you assess first? Since the patient is being rehydrated, you would want to check urine specific gravity because it is a specific for evaluating the concentrating power of the kidney and is a measure of the hydration status of the patient. It is measured very easily and quickly using a dipstick. Specific gravity in a dehydrated patient will be abnormally high compared to a patient who is overhydrated who will have a low specific gravity.

Not being able to explain the rationale and being an instructor doesn't let her off the hook.

The question specifically stated that the patient was being rehydrated and wanted to know how to assess rehydration status. Anybody can get an alteration in their pulse rate for any reason. If you want to assess hydration status, a urine specific gravity with a dip stick is going to do it for you. You can also tell her that she can find this information in Mosby's Diagnostic and Laboratory Test Reference, 4th edition, by Kathleen Deska Pagana and Timothy James Pagana on page 868 under the section for urinalysis where it discusses specific gravity.

Pulse rate can be affected by too many other factors. Temp, pain, fear, anxiety....all of which your "severly dehydrated" pt will most likely have. I would go by urine output and spec. gravity of urine (if readily available)....my favorite thing however is to LOOK AT YOUR PT! How do they look compared to when you first assesed them? That should always be our first tool: our eyes!.