A patient was admitted 2 days ago with pneumonia and a history of angina. The patient is now having chest pain with a pulse rate of 108. Using the SBAR, which piece of data will the nurse use for B?

Choice A reason: Reduced skin turgor, a sign of fluid volume deficit, occurs due to decreased interstitial fluid, reducing skin elasticity. Dehydration from fluid loss impairs cellular hydration, slowing skin recoil. This is a key assessment finding, as it reflects low extracellular fluid volume, affecting tissue perfusion and requiring fluid replacement to restore homeostasis.

Choice B reason: Decreased blood pressure results from fluid volume deficit, reducing intravascular volume and cardiac output. Low fluid decreases venous return, triggering baroreceptors to signal sympathetic activation, though insufficient to maintain pressure. This is a critical sign, as it indicates compromised perfusion to organs, necessitating fluid resuscitation to restore hemodynamic stability.

Choice C reason: Increased urine output is incorrect, as fluid volume deficit reduces urine output due to decreased renal perfusion. The kidneys conserve fluid via antidiuretic hormone and renin-angiotensin-aldosterone system activation, concentrating urine. This sign does not correlate with dehydration, which typically presents with oliguria, making it an incorrect assessment finding.

Choice D reason: Increased heart rate (tachycardia) compensates for fluid volume deficit, as reduced blood volume lowers cardiac output. Sympathetic activation increases heart rate to maintain tissue perfusion despite low fluid. This is a key sign, reflecting the body’s attempt to compensate for hypovolemia, requiring fluid replacement to normalize cardiovascular function.

Choice E reason: Dry mouth and skin are classic signs of fluid volume deficit, as dehydration reduces salivary gland secretion and skin moisture. Low extracellular fluid impairs mucous membrane hydration and sweat production. These signs indicate systemic fluid loss, affecting cellular function and requiring documentation to guide fluid therapy for restoring hydration and tissue perfusion.

Choice A reason: Onion powder is a spice, not a fat, and contains negligible lipids or calories. It does not influence cholesterol metabolism, blood pressure, or insulin sensitivity, which are critical in managing hyperlipidemia, hypertension, and Type I diabetes. These conditions increase atherosclerosis risk via elevated LDL cholesterol, but onion powder has no role in lipid metabolism or cardiovascular health, making it irrelevant.

Choice B reason: Saturated fats, found in animal products and some plant oils, increase LDL cholesterol by enhancing hepatic production of very-low-density lipoprotein (VLDL). In patients with hypertension and Type I diabetes, this exacerbates atherosclerosis, raising cardiovascular risk. Limiting saturated fats reduces LDL levels, improves endothelial function, and supports glycemic control, aligning with dietary guidelines for these chronic conditions.

Choice C reason: Pepper is a spice with no significant fat content or impact on lipid metabolism. It does not contribute to cholesterol levels, blood pressure, or insulin resistance, which are concerns in hyperlipidemia, hypertension, and Type I diabetes. These conditions require limiting fats that elevate LDL, but pepper has no effect on lipid profiles or cardiovascular risk factors.

Choice D reason: Polyunsaturated fats, like omega-3 and omega-6 fatty acids, lower LDL cholesterol and reduce inflammation, benefiting cardiovascular health. In patients with hypertension and diabetes, these fats improve lipid profiles and endothelial function, reducing atherosclerosis risk. The dietician would encourage, not limit, polyunsaturated fats to support heart health and insulin sensitivity in managing these conditions.