Download Fluids and Hydration Inservice

Fluids and Hydration Staff In-service
Use
A nutrition staff member should deliver this in-service to nurses, nursing assistants, and
kitchen staff. Serve a hydration pass as a snack.
Introduction
Water is an essential nutrient, meaning the body cannot function without it. Water has
many functions, including helping the body to maintain a stable temperature, carrying
nutrients and waste throughout the body, and acting as a lubricant around joints. Some
people, especially those who have difficulty feeding themselves or those who have
cognitive problems, may have trouble drinking enough. Without enough fluid, the body
can become dehydrated.
As people age their thirst mechanism becomes less sensitive. For that reason, even
healthy older people may not drink enough to maintain proper hydration because they do
not feel thirsty. Patients in medical facilities need fluids regularly (unless they are on a
fluid restriction) at meals, med-passes, before and after personal care, and during
activities to maximize fluid intake.
Objectives
Following the in-service, staff will know:
 Three risk factors for dehydration
 Physical signs of dehydration
 Five ways to increase fluid intake in patients
Outline
I. Patients who have the following are at risk for becoming dehydrated:
 Dementia/cognitive impairment
 Fever
 Diarrhea/vomiting
 Dependence on staff for eating and drinking
 Difficulty swallowing
 Use of certain medications
 Excessive sweating
 Draining wounds or pressure ulcers
 Depression
II. The following are signs of dehydration that you might see in a patient:
 Rapid weight loss
 Dry or sunken eyes
 Dry mouth
 Changes in mental status
 Fever
 Vomiting
 Concentrated urine/decreased urine volume
 Dizziness
 Change in mental status
 Increased combativeness or confusion
III. Appropriate interventions for plan of care:
 Offer fluids frequently throughout the day (at med-passes, before and after personal
care, at activities, and before bedtime)
 Provide early morning beverage carts, mid-day hydration carts, or evening beverage
carts
 Put extra fluids on meal trays
 Serve ice chips, ice cream, fruit ices, soups, gelatins, and other foods with highfluid content
 Monitor at-risk patients for physical signs of dehydration
 Refer patient to speech and language pathologist, if patient appears to have
difficulty swallowing
 Recommend adaptive equipment for eating and drinking, if appropriate
 Report signs/symptoms of dehydration to nursing staff
Activity
You are a kitchen aide in a nursing home. As part of your job, you empty trays at the end
of meals and load the dishwasher. You noticed that Mrs K is not drinking her tea, water,
or milk for a few days. What should you do?
Answer: Report this to the dietary manger or dietitian in your department. That person
will follow up with nursing to work on an intervention to increase fluid intake for Mrs K.
Fluid and Hydration
Pretest and Posttest
Name: _______________________
Date: ________________________
Department: __________________
1. Which of the following does not put a patient at risk for dehydration?
a. Inability to feed oneself
b. Fever
c. Constipation
d. Vomiting
2. True or false: Those who have sudden changes in mental status may become
dehydrated.
3. What can a nursing assistant do to help increase a patient’s fluid intake?
a. Offer fluids before personal care at each shift
b. Offer more fluid at the end of a meal
c. Encourage fluids at snack time
d. All of the above
4. True or false: Sometimes dehydration is related to medications.
5. True or false: Elderly people often get thirsty.
Answer key
1.
2.
3.
4.
5.
c. Constipation
True
d. All of the above
True
False
Reference and recommended reading
Agency for Healthcare Research and Quality, National Guidelines Clearinghouse.
Dehydration and fluid maintenance. Available at:
http://www.guideline.gov/content.aspx?id=15590&search=dehydration+and+fluid+maint
enancehttp://www.guideline.gov/content.aspx?id=15590&search=dehydration+and+fluid
+maintenance. Accessed October 28, 2010.
Review Date 12/10
G-1466