Skin turgor

In assessing Ms. Potter, age 52 years, in the emergency department you find that she has a decreased urinary output, concentrated urine, and poor skin turgor and is confused. She reports nausea and states she has been vomiting all morning. Explain what is the most important information obtained from your assessment of Ms. Potter. Determine what action you would take first. 

G)ld clammy skin, decreased skin turgor, apprehension, confusion, irritability, anxiety, hypotension, postural hypotension, tachycardia, headache, tremors, convulsions, abdominal cramps, nausea, vomiting, diarrhea Hypernatremia... 

TBW depletion (often referred to as dehydration ) is typically a more gradual, chronic problem compared to ECF depletion. Because TBW depletion represents a loss of hypotonic fluid (proportionally more water is lost than sodium) from all body compartments, a primary disturbance of osmolality is usually seen. The signs and symptoms of TBW depletion include CNS disturbances (mental status changes, seizures, and coma), excessive thirst, dry mucous membranes, decreased skin turgor, elevated serum sodium, increased plasma osmolality, concentrated urine, and acute weight loss. Common causes of TBW depletion include insufficient oral intake, excessive insensible losses, diabetes insipidus, excessive osmotic diuresis, and impaired renal concentrating mechanisms. Long-term care residents are frequently admitted to the acute care hospital with TBW depletion secondary to lack of adequate oral intake, often with concurrent excessive insensible losses. 

The clinical scenario and the severity of the volume abnormality dictate monitoring parameters during fluid replacement therapy. These may include a subjective sense of thirst, mental status, skin turgor, orthostatic vital signs, pulse rate, weight changes, blood chemistries, fluid input and output, central venous pressure, pulmonary capillary wedge pressure, and cardiac output. Fluid replacement requires particular caution in patient populations at risk of fluid overload, such as those with renal failure, cardiac failure, hepatic failure, or the elderly. Other complications of IV fluid therapy include infiltration, infection, phlebitis, thrombophlebitis, and extravasation. 

Fluid replacement ORT 50 mL/kg over 2-4 hours ORT 100 mL/kg over 2-A hours Lactated Ringers 40 mL/kg in 15-30 minutes, then 20-40 mL/kg if skin turgor, alertness, and pulse have not returned to normal or Lactated Ringers or normal saline 20 mL/kg, repeat if necessary, and then replace water and electrolyte deficits over 1-2 days, followed by ORT 100 mL/kg over 4 hours... 

Patients with hypovolemic hyponatremia present with decreased skin turgor, orthostatic hypotension, tachycardia, and dry mucous membranes. 

Clinical signs of dehydration in children include tachycardia, loss of skin turgor and dry tongue. 

Skin turgor and mucous membranes to evaluate hydration status... 

Bowel sounds for peristalsis, and mucous membranes and skin turgor for hydration... 

Monitor for signs of dehydration, such as decreased skin turgor, and dizziness... 

Most patients with DKA appear ill and weak. They are usually hypotensive and have poor skin turgor, indicating severe dehydration. If the patient is able to give a history, symptoms of polyuria, polydipsia, and weight loss are invariably present. The breath may have a classic fruity odor due to the excretion of acetone in expired breath. Acetone arises from the spontaneous, nonenzymatic decarboxylation of acetoacetate ... 

The patient discussed in the illustrative case presented with orthostatic hypotension, poor skin turgor, dry mucous membrane, a ketotic odor to the breath, elevations in BUN and creatinine, and ketoacidosis. She had severe extracellular volume depletion, which can be estimated using the following clinical criteria ... 

Ringer s lactate TO ml/kg in t5-30 minutes, then 20-T0 ml/kg it skin turgor, alertness, and puke have not returned to normal or... 

Dry mucous membranes 0 Poor skin turgor ° Decreased urine output 0 Tachycardia... 

If used as an antiemetic assess for dehydration (poor skin turgor, dry mucous membranes, longitudinal furrows in tongue). 

Before administration Check baseline hydration status (skin turgor, mucous membranes, urinary status). Obtain electrolytes if diarrhea has been moderate to severe for more than 2 days. 

Evaluate edema, skin turgor, mucous membranes for hydration status. 

Evaluate hydration status by assessing mucous membranes, skin turgor. 

ECF loss Thirst, anorexia, nausea, lightheadedness, orthostatic hypotension, syncope, tachycardia, oliguria, decreased skin turgor and sunken eyes, shock, coma, death... 

Depletional hyponatremia (excess loss of Na ) is almost always accompanied by a loss of ECF water, but to a lesser extent tlian the Na loss. Hypovolemia is apparent in the physical examination (orthostatic hypotension, tachycardia, decreased skin turgor). Loss of isosmotic or hypertonic fluid is the cause and this can occur through renal or extrarenal losses. If urine Na is low (generally <10 mmol/L), the loss is extrarenal (see Figure 46-2) because the kidneys are properly retaining filtered Na in response to increased aldosterone (stimulated by the hypovolemia and hyponatremia). Causes of extrarenal loss of Na" in excess of H2O include losses from the gastrointestinal tract or skin (see Figure 46-2). 

Skin capillary refill - delayed Skin turgor - decreased Urine - reduced (oliguria)... 

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