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Dehydration Prevention: Facilities Must Monitor Intake & Output

beaker.jpgDehydration poses a major threat to the overall health of nursing home patients as the condition may exacerbate existing complications or cause other conditions to manifest themselves.  Dehydrated patients may be at risk for conditions such as kidney failure, low blood volume (hypovolemic shock), electrolyte imbalances, development of decubitus ulcers or death.

Consequently, nursing homes must appreciate the risk of patients becoming dehydrated and implement measures to ensure that patients remain well hydrated.  Depending on the person’s risk for dehydration, a nursing home may order fluid intake and output to be measured by staff either during a specific time period or over an extended period of time. 

Many nursing homes have adapted I & O monitoring for the following patient / conditions: tube feeding, catheterized patients, urinary tract infections, physician orders for increased / decreased fluids, patients receiving intravenous fluids or other medical conditions that put the patient at risk for fluid imbalance.

Commonly referred to as I and O, nursing home staff will monitor the amount of fluids a patient takes in compared with the amount of fluid a client puts out.  While it may be impossible to every form of fluid intake and output (such as fluid loss from perspiration or respiration) most measures of  I and O will simply measure the amount of fluid a patient drinks and voids by urinating, vomiting or through bowel movements.  If a patient received of artificial fluids in from feeding tubes, intravenous fluids and blood transfusions should be noted as well.

While the individual fluid needs of patients will vary depending on factors including their size, activity level and medication usage, most adults require approximately 2500 ml of fluids on a daily basis for their bodies to function optimally.  Staff should encourage patients to drink water and other fluids and keep them easily accessible so patients can access them easily. 

Rather than looking at fluid intake on a 24-hour basis, some nursing homes have broken patient fluid intake down by shift-related period to help staff more accurately measure if patients are receiving enough during more active parts of the day: ½ of total daily fluid goal, evening: 1/3 of total daily fluid goal and night: 1/6 of total daily fluid goal.

In addition to physically measuring fluid intake and output, nursing homes and other medical facilities should be aware of physical signs of dehydration in patients such as:

  • Weight loss
  • Dry skin
  • Weak pulse
  • Concentrated urine-  dark or foul smelling
  • Loss of skin elasticity
  • Cracked lips
  • Sunken eyes

Related:

Jury Blames Manor Care Nursing Home For Dehydration Death Of Patient

The Burden and Outcomes Associated with Dehydration among US Elderly (pdf) American Journal of Public Health

Doctor Alleges Dehydration & Malnutrition In Nursing Home Lawsuit On Behalf Of Relative

DEHYDRATION IN THE ELDERLY- A SHORT REVIEW (pdf) JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 79, NO. 10, 1987

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