Case Study Help - D5.25NS

shaas, ASN, RN · Dec 6, 2010

I think that the primary goal of hydration therapy in UTI patients is to aggressively hydrate to accomplish adequate urine output, prevent any (further) occlusion in the urinary ract by maintaining the acidic urine pH. So, maintaining a nice acidic urine pH should also be considered.

Now, given that there is no lab values of glucose or electrolyte levels, I'm assuming that this is a case isotonic dehydration due to bacterial infection. Again, we don't know if this case is hypertonic or hypotonic dehydration.

So, I'm thinking:

1) hydrating with isotonic solution such as Lactated Ringer's or normal saline would be better.

2) Volume of 75 mL/h seems inadequate to promote adequate urine output. A glass/cup of water is about 250 mL, so, 200-mL/hr range would be therapeutic (and, of course, the time limit needed. I'm recalling min of 1500 mL/day for an adult).

3) continue to monitor her and her lab values to make sure there is no fluid-related edema, which can lead to more serious problems.

I hope our experienced nurses and students chime in to give you more definitive and clinically-sound answers.

Good luck!

soushee · Dec 6, 2010

Thanks so much for your reply! I was thinking the solution was inappropriate, and something isotonic would be more appropriate, but wasn't quite sure due to all the conflicting stuff I was reading online. According to the info I have on the study, all lab values were normal except for WBCs and bacteria in the urine culture, so I ventured to guess that electrolytes were normal.

Later on in the case they give that her I&O was 520mL I and 140mL O over 8 hours, and asked if it was significant, which I responded yes to, as we are taught that output should be over 30mL/hr. Then they ask what could account for this, and I responded dehydration or inadequate intake... am I on the right track there?

I don't have to go into huge detail in my answer (and I'm sure they don't expect it seeing as we don't even cover this stuff until later semesters), but I want to give it a good try.

shaas, ASN, RN · Dec 6, 2010

No prob. I appreciate your posting the case. So, it seems like an isotonic dehydration. So, yeah, you're on the right track with isotonic IV fluid therapy.

I feel that both her daily fluid intake and urine output would fall in the very low range if she stops comsuming fluid after that 8-hr period. If the average rate of consumption and output for 8-hr period is that, then it makes a different story (multiply those I&O by 3 and you have a normal intake and abnormal output for the day). Continuous intake for the day would be 520 mL x 3 = 1560 mL and output would be 140 mL x 3 = 420 mL

So, the intake and output are inadequate if she drinks less than 1200-1500 mL/day (remember, food contains water, too, so the normal, total fluid intake is over 1500 mL) and excretes in urine less than 1500 mL/day. FYI - Dehydration is one of the contributing factors (other than pathogens) for UTI in elderly folks as well as others who don't consume enough fluid.

I really hope others chime in. :)