This chapter addresses the fundamental nursing role of managing hydration. Water is a basic nutrient and is essential to sustaining human life. In the developed world, we often take for granted the basic commodity of clean and plentiful water, but in other parts of the world water can have a profound effect on human health, in both the reduction and the transmission of disease (World Health Organization, 2011). For health, body water and electrolytes must be maintained within a limited range of tolerances. For nurses working in acute or primary care settings anywhere in the world, it is important to have a clear understanding of fluid and electrolyte homeostasis to assess haemodynamic status, to anticipate and recognize deterioration in status, and to implement appropriate corrective interventions. Developing knowledge and associated skills around this topic will be facilitated by reflecting upon your clinical experiences as a student or as a qualified nurse, and your ability to link theory and practice. Your basic foundation of knowledge should include an understanding of how fluid is gained and lost from the body, the distribution of water between different compartments within the body, the processes by which fluid and electrolytes move between the intracellular and extracellular environments (Pocock and Richards, 2009; Cowen and Ugboma, 2011), and knowledge of the different types of intravenous replacement fluid (Endacott et al., 2009: 249–73). Equally important is an insight into the use of criteria such as clinical/ outcome indicators and benchmarking, what to use on what occasions, and how to use such tools to your best advantage. Armed with this knowledge, you will be well equipped to assess each patient’s needs and to make clinical decisions about the most appropriate evidence-based nursing interventions to be used. The state of water balance within the body is principally maintained by the osmoreceptors in the hypothalamus. These are best described as ‘sensors’ that detect the osmolarity (concentration) of the blood to stimulate or suppress the thirst mechanism, as well as regulate the amount of antidiuretic hormone (ADH) released by the posterior pituitary gland. When a person is becoming dehydrated, the thirst centre will be stimulated and usually he or she will seek fluid to rehydrate him or herself.
Care management of the patient with amputation in the inferior limb
