PREVENTING DEHYDRATION

Objectives:

  1. Define dehydration and list at least two reasons we need to be attentive to it in the LTC setting.
  2. List at least ten reasons the elderly are at higher risk for dehydration.
  3. Identify and recognize signs and symptoms of depression.
  4. Identify and describe each component of hydration management.

What is dehydration?

·  Excessive fluid loss that disrupts normal body function

Why do we need to worry about it?

·  Dehydration is list among the top forms of nursing home abuse/neglect

·  The occurrence of dehydration is considered as a “sentinel event”; which means it should rarely, if ever, occur. Defined by The Joint Commission as “an event that reaches a patient and results in any of the following: death, permanent harm, severe temporary harm and intervention required to sustain life.”

·  Federal nursing home laws mandate adequate hydration

There may be severe survey penalties related to actual harm. (See Scope and Severity Scale attached.)

REASONS ELDERLY AT RISK / SIGNS/SYMTPOMS OF DEHYDRATION
Body contains less water d/t age-related changes in body composition
Decreased renal function; kidneys less able to conserve water
May not feel thirst
May not be able to voice need for fluids (ex. aphasia, dementia)
Inadequate support/assistance to obtain/drink fluids
Resistance to drinking d/t fear of increased need for toilet
Fever
GI symptoms: diarrhea, vomiting
Uncontrolled diabetes/high blood sugars
Diuretics
Poor p.o. intake
Depression / Dry mouth/thirst
Dry skin/poor turgor
Decreased urination/small amounts/dark color
Constipation
Headaches
Feeling weak/ill
Cramping of limbs
Confusion, irritability
Delirium
Low blood pressure
More rapid pulse
Rapid breathing
Severe:
Sunken eyes
Seizures
High levels of sodium/death

How can we prevent dehydration?

Have a fluid management plan!

A. Calculate fluid needs using calculation from the CMS Surveyor Guidelines:

Calculation:

Body weight in # X 30cc = recommended daily fluid intake in cc’s

2.2

Example:

152# = 69.09 69.09 x 30cc = 2073cc (rounded up from 2072.7)

2.2

B. Set fluid goal.

C. Develop a written plan for fluid delivery to meet goal. Include:

·  Goals for fluid amounts for each shift (night shift should not be excluded, as fluids can be provided during rounds)

·  Amount of fluids for each meal

·  Amount of fluids with med passes

·  Amount of fluids during rounds

·  Amount of fluids with activities

D. Incorporate alternative fluids into plan (soup, jello, popsicles, ice cream, etc.)

E. Monitor adherence to plan. Document resident’s acceptance/refusal of fluids offered.

It may be hard to reach your goal, but make sure that you deliver at least 1500cc/day!

FLUID MANAGEMENT PLAN

Resident: ______Room #: ______

24-Hour Fluid Goal: ______

DAY SHIFT / EVENING SHIFT / NIGHT SHIFT / TOTAL
Shift Goal = / Shift Goal = / Shift Goal =
MEALS
Breakfast
Lunch
Dinner
HS Snack
MED PASSES (list time)
______am
______pm
______pm
______pm
______am
______am
ROUNDS
______am
______am
______pm
______pm
______pm
______pm
______pm
______pm
______am
______am
______am
______am
ACTIVITIES:
OTHER:
TOTALS:

Notes:

·  Offer fluids regularly during the day; provide preferred beverages

·  Make liquids readily available all day (at bedside or chairside in geriatric institutions) by placing containers such as small bottle of water or sippy cups

·  Encourage consumption of fluids with medication

·  Provide for at least 1500cc / day