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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