Fluid needs are part of basic human physiological needs, which have a large proportion of body parts, nearly 90% of total body weight. Meanwhile, the rest is a solid part of the body. Body fluids contain oxygen, nutrients, and metabolic waste, such as carbon dioxide, all of which are called ions (Hidayat, 2006)
Body fluids consist of two main compartments separated by semiperniabel membranes. Both of these compartments are intracellular and extracellular compartments. About 65% of body fluids are in cells, or intracellular. The remaining 35% of body fluids are outside the cell, or extracellular. The extracellular compartment is further divided into three subdivisions:
- Interstitial: fluid consisting of lymph fluid, is a liquid that is between cells and around blood vessels (25%).
- Intravascular: is blood plasma found in the vascular or blood vessel system (8%).
- Transcellular: is a separate fluid from other body fluids that is protected by cell membranes and consists of spinal, synovial, peritocneal, pericardial and pleural fluid (2%).
Diarrhea is caused by abnormal transport of water and electrolytes in the intestine. Worldwide there are approximately 500 million children who suffer from diarrhea each year and 20% of all deaths in children living in developing countries are associated with diarrhea and dehydration (Wong, 2008).
Diarrhea in children under five if the frequency of defecation or stool is more than 3 times a day and is characterized by the consistency of liquid stools or mucus with or without blood in the stool. And deaths from diarrhea are not due to infection from bacteria or viruses, but dehydration or the body loses a lot of fluid.
Liquids and electrolytes are needed in order to maintain a healthy body condition. The balance of fluids in the body is one part of the homeostasis of fluid and electrolyte balance involving the composition and transfer of various body fluids, body fluids are solutions consisting of water (solvents) and certain substances (solutes). The balance of fluids and electrolytes depends on each other, if one is disturbed it will affect the other (Daniel, 2013).
Disruption of fluid volume is one of the basic human needs. Physiological that must be fulfilled if the patient has a lot of loss of water and electrolytes, then symptoms of dehydration occur. Especially diarrhea in children needs to get fast and appropriate treatment so that it does not affect the child's growth and development (Solikin, 2011).
Hypovolume is a lack of body fluids caused by inadequate intake or excessive loss. Many factors contribute to inadequate fluid intake, including inability to swallow or chew, inability to eat alone without assistance, lack of access to clean water and food, anorexia and nausea. Meanwhile, excessive fluid loss can occur when vomiting, diarrhea, bleeding, excessive diuretic use, trauma due to kidney disease (one or both), aldosterone deficiency, and blisters from burns and askites. Blisters occur when fluid moves into the interstitial space, but it doesn't really disappear from the body.
Clinical signs and symptoms that may be obtained on hypovolume clients include: dizziness, weakness, fatigue, syncope, anorexia, nausea, vomiting, thirst, mental disorder, constipation, oliguria. Depending on the type of loss of hypovolume fluid can be accompanied by acid-base, osmolar or electrolyte imbalances. Depletion of severe extracellular fluid can cause hypovolume shock. The mechanism of compensating the body for hypovolume conditions can be increased sympathetic nervous system excitability (increased heart rate, inotropic (heart contraction) and vascular resistance), thirst, release of antideuritic hormones (ADH), and aldosterone release. Long hypovolemic conditions can lead to acute kidney failure.
To identify problems with fluid and electrolyte balance and to collect data to develop a nursing plan, nurses need to conduct nursing studies. According to Aziz (2006) the things that need to be studied are as follows:
- Medical history
Nursing studies on fluid and electrolyte needs include the amount of fluid intake which can be measured by the amount of intake orally, parental or enteral. The number of outputs can be measured by the amount of urine production, feces, vomiting or other output, the status of fluid loss / excess, and changes in body weight that can determine the level of dehydration. - Related Factors
Related factors include factors that influence the problem of fluid needs, such as illness, diet, environment, age of development, and drug use. - Physical Studies
Physical assessment includes systems related to fluid and electrolyte problems, such as the integument system (skin turgor status and edema), cardiovascular system (jugular venous distension, blood pressure, and heart sounds), visual system (condition and eye fluid), neurological system (sensory / motor disorders, consciousness status, and the presence of reflexes), and the gastrointestinal system (the state of the mucosa of the mouth, tongue, and bowel sounds).
Goals and Outcomes :
Long-term Goals:
Fluid volume deficit will be overcome as evidenced by the presence of fluid balance and adequate hydration and good nutritional status.
Short Term Goals:
The amount of food and liquid entering the body is fulfilled during the 24 hour period
Outcomes:
- Not experiencing thirst.
- Showing good hydration (moist mucous membranes, being able to sweat, good skin turgor).
- Have adequate oral fluid intake.
Nursing Interventions :
1. Assess for signs and symptoms of dehydration (dry skin and mucous membranes, urination 8-9x / day and thirst)
R /: Know the causes of lack of fluid volume
2. Observing fluid input and output, nausea and vomiting (frequency, color and consistency)
R /: Knowing the input and discharge of fluids.
3. Monitor the patient's vital signs.
R /: To find out the patient's vital signs
4. Advise to drink a little but often
R/: Prevent nausea and vomiting.
5. Provide appropriate information about fluid requirements related to the disease.
R/ : Increase patient knowledge to maintain fluid balance.
