Fluid intake

The body excretes tritium with a biological half-life of 8—14 d (10.5 d average) (75), which can be reduced significantly with forced fluid intake. For humans, the estimated maximum permissible total body burden is 37 MBq (1 mCi). The median lethal dose (LD q) of tritium assimilated by the body is estimated to be 370 GBq (10 Ci). Higher doses can be tolerated with forced fluid intake to reduce the biological half-life. 

Cry stalluria (crystals in the urine) may occur during administration of a sulfonamide, although this problem occurs less frequently with some of the newer sulfonamide preparations. This potentially serious problem often can be prevented by increasing fluid intake during sulfonamide therapy. 

Maintaining Adequate Fluid Intake and Output Because one adverse reaction of the sulfonamide dragp is altered elimination patterns, it is important that the nurse helps the patient maintain adequate fluid intake and output. The nurse can encourage patients to increase fluid intake to 2000 mL or more a day to prevent crystal-luria and stone formation in the genitourinary tract, as well as to aid in the removal of microorganisms from the urinary tract. It is important to measure and record the intake and output every 8 hours and notify the primary health care provider if the urinary output decreases or the patient fails to increase his or her oral intake... 

Because renal impairment is common in older adults the nurse should give the sulfonamides with great caution. There isan increased danger of the sulfonamidescausng additional renal damage when renal impairment is already present. An increase of fluid intake up to 2000 mL (if the older adult can tolerate this amount) decreases the risk of crystals and stones forming in the urinary trad. 

Nephrotoxicity may occur with the administration of these drugs Early signs of this adverse reaction may become apparent by a decrease in urine output. The nurse should measure and record the fluid intake and output and notify the primary health care provider if the output is less than 500 mi/d. Any changes in the fluid intake-and-output ratio or in the appearance of the urine may indicate nephrotoxicity. 

INEFFECTIVE TISSUE PERFUSION RENAL The patient taking an aminoglycoside is at risk for nephrotoxicity. The nurse measures and records the intake and output and notifies the primary health care provider if the output is less than 750 ml/day. It is important to keep a record of the fluid intake and output as well as a daily weight to assess hydration and renal function. The nurse encourages fluid intake to 2000 ml/day (if the patient s condition permits). Any changes in the intake and output ratio or in the appearance of the urine may indicate nephrotoxicity. The nurse reports these types of changes to the primary health care provider promptly. The primary health care provider may order daily laboratory tests (ie, serum creatinine and blood urea nitrogen [BUN]) to monitor renal function. The nurse reports any elevation in the creatinine or BUN level to tiie primary health care provider because an elevation may indicate renal dysfunction. 

The nurse reports patient complaints of difficulty hearing or tinnitus (ringing in the ears) to the primary health care provider before the next dose is due. In addition, the nurse monitorsthe fluid intake and output and bringsany decrease in the urinary output to the attention of the primary health care provider. 

B. limit his fluid intake to 1200 mL per day while taking the drug... 

RISK FOR INEFFECTIVE TISSUE PERFUSION RENAL When the patient is taking a drag tiiat is potentially toxic to die kidneys, die nurse must carefully monitor fluid intake and output. In some instances, die nurse may need to perform hourly measurements of die urinary output. Periodic laboratory tests are usually ordered to monitor the patient s response to therapy and to detect toxic drag reactions. Seram creatinine levels and BUN levels are checked frequentiy during the course of therapy to monitor kidney function. If the BUN exceeds 40 mg dL or if the serum creatinine level exceeds 3 mg cIL, the primary health care provider may discontinue the drug therapy or reduce the dosage until renal function improves. 

The nurse must carefully monitor fluid intake and output because this drug may be nephrotoxic (harmful to the kidneys). In some instances, the nurse may need to perform hourly measurements of the urinary output. Periodic laboratory tests are usually ordered to monitor the patient s response to therapy and detect toxic drug reactions. 

Unless ordered otherwise, the nurse should save all stools that are passed after the drug is given. It is important to visually inspect each stool for passage of the helminth. If stool specimens are to be saved for laboratory examination, the nurse follows hospital procedure for saving the stool and transporting it to the laboratory. If the patient is acutely ill or has a massive infection, it is important to monitor vital signs every 4 hours and measure and record fluid intake and output. The nurse observes the patient for adverse drug reactions, as well as severe episodes of diarrhea. It is important to notify the primary health care provider if these occur. 

If the patient is acutely ill or has vomiting and diarrhea, the nurse measures the fluid intake and output and observes the patient closely for signs of dehydration. If dehydration is apparent, the nurse notifies the primary health care provider. If the patient is or becomes dehydrated, oral or IV fluid and electrolyte replacement may be necessary. The nurse takes vital signs every 4 hours or as ordered by the primary health care provider. 

The nurse monitors fluid intake and output and notifies the primary health care provider of any change in the fluid intake-output ratio. The nurse should notify the primary health care provider if there is any sudden change in the patient s condition. 

DRUGS USED FOR GOUT. The nurse encourages a liberal fluid intake and measures the intake and output. The daily urine output should be at least 2 liters. An increase in urinary output is necessary to excrete the urates (uric acid) and prevent urate acid stone formation in the genitourinary tract. 

The nurse provides adequate fluids and reminds tire patient frequently of the importance of increasing fluid intake If the patient fails to increase the oral intake, the nurse informs the primary health care provider. In some instances, it may be necessary to administer intravenous fluids to supplement the oral intake when the patient fails to drink about 3000 mL of fluid per day. 

URINARY RETENTION. The ongoing assessment for a patient witii urinary retention includes measuring and recording die fluid intake and output. The nurse must notify die primary healdi care provider if the patient fails to void after drug administration. 

If a cholinergic drug is ordered for the prevention of urinary retention, die nurse measures and records the fluid intake and output. If die amount of each voidingis insufficient or die patient fails to void, the nurse palpates the bladder to determine its size and notifies the primary healdi care provider. 

DIARRHEA. When these dragp are used orally they occasionally result in excessive salivation, abdominal cramping, flatus, and sometimes diarrhea The patient is informed that these reactions will continue until tolerance develops, usually within a few weeks. Until tolerance develops, the nurse ensures that proper facilities, such as a bedside commode, bedpan, or bathroom, are readily available. The patient is encouraged to ambulate to assist the passing of flatus. If needed, a rectal tube may be used to assist in the passing of flatus. The nurse keeps a record of the fluid intake and output and tlie number, consistency, and frequency of stools if diarrhea is present. The primary health care provider is informed if diarrhea is excessive because this may be an indication of toxicity. 

MANAGING CONSTIPATION. Constipation caused by decreased gastric motility can be a problem widi cholinergic dm. The nurse urges the patient to increase fluid intake up to 2000 mL daily (if healdi conditions permit), eat a diet high in fiber, and obtain adequate exercise The primary healdi care provider may prescribe a stool softener, if necessary, to prevent constipation. 

If constipation occurs, relieve it by eating foods high in fiber, increasing fluid intake and exercising if condition permits. 

For patients receiving lithium, the nurse increases the oral fluid intake to about 3000 mL/d. It is important to keep fluids readily available and to offer extra fluids throughout waking hours. If there is any question regarding the oral fluid intake, the nurse monitors intake and output. 

Drink plenty of fluids. A fluid intake of 1500 to 2000 mL is recommended. 

Stresses need for fluid intake to liquefy secretions. 

Continual cardiac monitoring assists the nurse in assessing the patient for adverse drug reactions. If the patient is acutely ill or is receiving one of these drugs par-enterally, the nurse measures and records the fluid intake and output. The primary health care provider may order subsequent laboratory tests to monitor the patient s progress for comparison with tests performed in the preadministration assessment, such as an ECG, renal and hepatic function tests, complete blood count, serum enzymes, and serum electrolytes. The nurse reports to the primary care provider any abnormalities or significant... 

B. Limit fluid intake during the evening hours. 

OILE ACID SEQUESTRANTS. Fhtients taking the antihyperlipidemic dragp, particularly the bile acid sequestrants, may experience constipation. The dragp can produce or severely worsen preexisting constipation. The nurse instructs the patient to increase fluid intake, eat foods high in dietary fiber, and exercise daily to help prevent constipation. If the problem persists or becomes... 

MANAGING CONSTIPATION. Constipation may be a problem when a patient is taking oral iron preparations. The nurse instructs the patient to increase fluid intake to 10 to 12 glasses of water per day (if the condition permits), eat a diet high in fiber, and increase activity. An active lifestyle and regular exercise (if condition permits) help to decrease tiie constipating effects of iron. If... 

Hyperkalemia (increase in potassium in the blood), a serious event, may be seen with the administration of potassium-sparing diuretics. Hyperkalemia is most likely to occur in patients with an inadequate fluid intake and urine output, those with diabetes or renal disease tiie elderly, and those who are severely ill. In patients taking spironolactone, gynecomastia (breast enlargement in tiie male) may occur. This reaction appears to be related to both dosage and duration of therapy. The gynecomastia is usually reversible when therapy is discontinued, but in rare instances, some breast enlargement may remain. 

TH E PATIEN T WITH ED EM A. Fhtients with edema caused by heart failure or other causes are weighed daily or as ordered by the primary health care provider. A daily weight is taken to monitor fluid loss. Weight loss of about 2 lb/d is desirable to prevent dehydration and electrolyte imbalances. The nurse carefully measures and records the fluid intake and output every 8 hours. The critically ill patient or the patient with renal disease may require more frequent measurements of urinary output. The nurse obtains the blood pressure, pulse, and respiratory rate every 4 hours or as ordered by the primary health care provider. An acutely ill patient may require more frequent monitoring of the vital signs. 

To prevent a fluid volume deficit, the nurse encourages oral fluids at frequent intervals during waking hours. A balanced diet may help prevent electrolyte imbalances. The nurse encourages patients to eat and drink all food and fluids served at mealtime The nurse encourages all patients, especially the elderly, to eat or drink between meals and in the evening (when allowed). The nurse monitors the fluid intake and output and notifies the primary health care provider if the patient fails to drink an adequate amount of fluid, if the urinary output is low, if the urine appears concentrated, if tiie patient appears dehydrated, or if signs and symptoms of an electrolyte imbalance are apparent. 

Explains the rationale for increasing fluid intake to at least 2000 mL/d (unless contraindicated) to aid in physical removal of bacteria... 

Encourages continued increased fluid intake even if. symptoms subside. 

Elderly patients often have a decreased thirst sensation and must receive encouragement to increase fluid intaka The nurse offers fluids at regular intervals to elderly patients or those who seem unable to increase dieir fluid intake without supervision. 

The nurse measures the fluid intake and output, especially when the primary health care provider orders an increase in fluid intake or when a kidney infection is being treated. The primary health care provider may also order daily urinary pH levels when methenamine or nitrofurantoin is administered. These drugs work best in acid urine failure of the urine to remain acidic may require administration of a urinary acidifier, such as ascorbic acid. 

Obstruction of the esophagus, stomach, small intestine, and colon has occurred when bulk-forming laxatives are administered without adequate fluid intake or in patients with intestinal stenosis. 

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