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Patient Education
Dehydration and Geriatric Considerations of Care

Fictitious Patient - History

Age: 88 years old (89th year) Gender: Female History:

AFIB CABG (< 1 year ago) Valve Replacement (< 1 year ago) Hypertension UTI Diabetes Loop diuretic, anti-hypertensive and cardiac glycoside use.

Reason for Admission*

Alterations in level of consciousness; confusion, dizziness.

Diarrhea 3 days

Hypotension

Dizziness

*In this instance, medication use was not deemed to be a significant contributor to the patients clinical encounter.

Goals
Goal: To restore hydration through fluid infusion and minimize episodes of dehydration.

Why: Maintaining adequate fluid balance is an essential component of health across the life span; older adults are more vulnerable to shifts in water balance, both overhydration and dehydration, because of age-related changes and increased likelihood that they have several medical conditions. Dehydration is the more frequently occurring problem.

What do Seniors Need?

Why are Seniors are at risk for dehydration?
Answer: Since seniors often have a reduced sense of thirst, dehydration is one of the most frequent causes of hospitalization after age 65.

Where should they get their water from?

Answer: Diet through items consumed. 80% of water should be derived from fluid. 20% of water should be derived from food.

How much water should seniors Drink?

Answer: Most experts say you should drink at least eight or ten (8-ounce) glasses of water each day if you weigh 160 pounds. For every 25 pounds you are over this weight drink an extra glass. You need more if you exercise a lot or live in a hot climate. As you increase your fiber intake you also need to drink more water.

1, 2, 3 Sodium Sugar Diarrhea

Sodium: Foods high in sodium boost your body's sodium levels. To dilute the salt, your cells excrete water and send a thirst signal to your brain saying they need more water.

Foods that taste salty, such as French fries and salty snack foods, contain high amounts of sodium. But you might not be able to detect the high sodium levels in other foods, such as fast food meals, canned foods, deli meats, frozen dinners, processed baked goods and bottled condiments such as salad dressings.

1, 2, 3 Sodium Sugar Diarrhea

Sugar: Affects your body in the same way salt does, drawing water out of your cells and making you feel thirsty.

Ironically, sports drinks with sugar can actually quench your thirst more slowly than plain water because the sugar draws water from your cells. Moreover, the sugar in beverages such as fruit juices, vitamin water and sports drinks is absorbed by your body more slowly than plain water. You should eat snacks from two food groups to avoid feeling dehydrated, such as a piece of fruit plus a piece of cheese or fruit plus whole grain crackers.

1, 2, 3 Sodium Sugar Diarrhea

Diarrhea: Any food that causes diarrhea can also dehydrate you.

If you are lactose intolerant, those foods (foods that cause diarrhea) include most dairy products. Some lactose-intolerant people react to smaller amount of lactose in baked goods, cereals, soups, drinks, lunch meats, salad dressings and powdered drink supplements. Excess iron, either through iron supplements or too much red meat, also can cause diarrhea, according to the President's Council on Physical Fitness and Sports.

Signs and Symptoms

Dry or sticky mucous membranes in the mouth Skin that lacks its normal elasticity and sags back into position slowly when pinched up into a fold. Persistent fatigue, lethargy, muscle weakness or cramps, headaches, dizziness, nausea, forgetfulness, confusion, deep rapid breathing, or an increased heart rate. Decreased or absent urine output Decreased tears, sunken eyes

Patient Learning Needs

Emphasis on:

Need to notify healthcare provider if diarrhea occurs 3 or more times within a 24 hour period and/or for 3 consecutive days. Need for Self Monitoring: Medication use (diuretics) Voiding; malodorous or darkened urine. Decreased tears Bowel movements, constipation is an early sign Dizziness, dry mouth, rapid heart rate Fluid consumption Limit caffeine use Toileting Mobility

Family Learning Needs

Self:
Widowed, lives alone. Intervention: Ask client if they are thirsty, if they have eaten, and if so, what and how much water they are drinking; use hydration placemat to remind them.

Immediate

Family:

Relatives live out of state but call and visit often. Intervention: Include them during educational opportunities; in person, over the phone and/or through printed recommendations.

Senior

Group:

Considers members of her senior group family, talks to them often. They compare notes on current illnesses and seek solutions for problems that develop. Intervention: Suggest attendance at a senior meeting or small gathering of friends to educate on the importance of hydration.

Church

Community:

Considers her church and fellow parishioners as her family and/or the people who sustain her. Intervention: Review church literature, in addition to a conversation with parish nursing ministry, and look for opportunities to introduce and stress the importance of hydration.

Revisions Based on Outcomes

Hearing: Speak directly to patient and maintain eye contact. Vision: When providing printed material ensure large type is used. Glomerular Filtration Rate: Encourage consumption of fluid through small sips of water. Mobility: Promote mobility through participation in nonstrenuous activities while encouraging frequent rest periods. Memory: Use memory queues for recognition and awareness of healthy hydration options.

Measuring Effectiveness of Teaching

Assess skin turgor for tenting; sunken eyes, dry mucous membranes. Assess temperature and texture of skin. Assess frequency and quantity of voiding; normal is 60/ml/hr. Assess frequency of bowel movements.

References

http://www.thecoca-colacompany.com/ourcompany/ hal_hydrationcalculator.html

http://www.bottledwater.org/hydration-calculator

http://www.seniors-site.com/nutritio/water.html

Read more: http://www.livestrong.com/article/470551-whatfoods-make-you-feel-dehydrated/#ixzz1qbPrO0Wp