2. Why Care about Hydration?
Maintains blood
pressure
Transports minerals
and salt in blood
Detoxifies and
provides waste
removal
Body temp regulation
http://www.onedayhike.org/training/firstaid/dehydration.html
3. Consequences and Symptoms
of Dehydration
Decreased energy
Increased temperature
Increased confusion
Increased risk of mortality
Muscle cramps
Dizziness
Headaches
Wt loss
6. Diagnostic Tests for
Dehydration
Labs:
Serum osmolarity
Elevated BUN to creatinine ratio
(BUN:Cr)
Increased serum sodium
Decreased blood pressure
Important to compare status with
resident’s baseline cognition/alertness
7. How Much Fluid is Enough?
Determined by the Registered Dietitian
and listed in Nutrition Assessment
Based on body weight: ~30ml/kg
Adjusted based on clinical conditions,
swelling, edema, GI issues, fluid
restrictions
9. Role of Nursing Staff
Identifies baseline and monitors
changes
Monitor daily signs of
dehydration
Records and monitors input and
output
Provide fluids with meds and
PRN
Assist with fluid intake when
needed
10. Role of Therapies:
OT/PT/Restorative
Works with resident to improve ADL’s to
increase independence as able
Prescribe adaptive equipment to improve
intake
Offers fluids before and after physical activity
11. Role of Activities
Incorporate fluids into
social experiences
Offers refreshments
during activities and
during day
Provides pleasurable
atmosphere for
food/fluid consumption
12. Role of Food Service
Provides beverages and foods which
contribute to fluid status
Includes:
Water, coffee, tea, milk, juice, flavored
waters, soda
Fruits and vegetables
Soups, broths, gravies, yogurt
Gelatin, popsicles, hot cereal
Provide culturally appropriate and
preferred beverages and foods
13. Challenges
Education to the resident and family is key!
Fluid Restrictions
Heart conditions/volume control
Electrolyte imbalances
Tips and tricks: ice cubes, mouth swabs, avoid sugary
beverages
Thickened liquids
Swallowing difficulty
Aspiration pneumonia risk
Choking/coughing
Non-Compliance?
14. How Can We Help?
Identify needs and preferences
Ensure fluids are ready and appropriate to
drink
Make fluid intake pleasurable and varied
Encourage fluid intake multiple times per day
Encourage resident and family compliance to
restrictions and modifications
15. References
1. Godfrey, H., Cloete, J., Dymond , E. and Long, A. (2012) An exploration of the hydration care of
older people: A qualitative study. International Journal of Nursing Studies, 49 (10). pp. 1200-1211.
2. Faes MC, MD, MSc, Spigt MG, PhD, Olde Rikkert MGM, MD, PhD. Geriatrics and Aging. 2007;10(9):590-
596.
3. Ferry M. Strategies for ensuring good hydration in the elderly. Nutr Rev. 2005;63:S22–9
4. Maughan RJ, Griffin J: Caffeine ingestion and fluid balance: a review. J Hum Nutr Diet 2003, 16:411–
420.,
5. Texas Department of Aging and Disability Services. Hydration Care: Preventing Dehydration in Long-
Term Care Facilities. 2009. Web.
<http://www.dads.state.tx.us/qualitymatters/qcp/hydration/hydrationcareppt.pdf>.
6. Ruxton CHS. The impact of caffeine on mood, cognitive function, performance and hydration: a
review of benefits and risks. Nutr Bull 2008; 33: 15–25.
7. "Water: The Fountain of Life." Family Resource Center. Illinois Council on Long Term Care, n.d. Web.
8 Jul 2013. <http://www.nursinghome.org/fam/fam_018.html>.
8. Woodward, Michael. "Guidelines to Effective Hydration in Aged Care Facilities." . Hydralyte, n.d.
Web. 8 Jul 2013. <http://www.hydralyte.com/pdf/aged_care_brochure.pdf>.
9. American Journal of Lifestyle Medicine, "Medications May Affect Hydration Status." Andrea N. Walter,
MS, Thomas L. Lenz, MA, PAPHS. Am J Lifestyle Med. 2011;5(4):332-335.
<http://www.medscape.com/viewarticle/747333_3>
10. National Guideline Clearinghouse, Agency for Healthcare Research and Quality, U.S. Department of
Health and Human Services. "Dehydration and fluid maintenance in the long-term care setting."
<http://www.guideline.gov/content.aspx?id=15590>
