Angelica Bernal

Morton Plant Mease- Upper Division- Summer 2014

EBP Project

The importance of maintaining patients hydrated.

The purpose of this paper is to demonstrate and support the evidence-based practice of
maintaining hospitalized patients hydrated. More than half-million hospital admissions a year in
the U.S are dehydration incidents (Van Leewun, 2014). While hospitalized, many patients have
to deal with various factors that serve a negative impact to the body, such as pain, financial
stress, emotional instability, and more importantly, surgical or medical procedures. In cases like
these, the internal functioning of the body then shifts to becoming the involved providers
priority. The body does not necessarily need to be in physical activity for dehydration to occur,
nor does the environment need to be hot for the body to sense dehydration. It is very likely, if not
almost certain, for patients to become dehydrated while being taken care of in a hospital setting.
Hydration can be defined as [t]he addition of water to a substance, tissue, or patient (Venes,
2014). A lot of times a dehydrated patient is being cared for, people tend to think the etiology is a
medical condition, but that is not the only factor that causes dehydration. Often it is seen that
patients are hospitalized because they are in pain; therefore, patients reduced the amount of
intake to avoid ambulating to the restroom which could increase the pain level, and later cause
dehydration. Another reason why patients may become dehydrated is because of diet restrictions.
During the patients stay in the hospital, visitors come and usually bring the patient food, which
almost always turns out to be outside of the restricted diet given by the provider. By nature,
humans avoid listening to what is right when what is wanted is prohibited. In this case, the
patient will most likely want what was brought by the visitor and will not consume what the
provider has requested. It is not unusual for patients to become dehydrated with various barriers
in hospitals. Over time, this issue could increase the risk of the patients health and recovery
time. When the body has less amount of water than what it requires, the minerals of the body
become unbalanced which also takes responsibility or the loss of function of the body.
There are several other reasons why someone can become dehydrated. When a patient is
given medications that have side effects such as nausea or vomiting, it is very likely for that
person to become hydrated as a lot of fluid is lost through emesis. Fever while hospitalized is
very common; therefore the excessive sweating could also lead to dehydration. Dehydration can
also be caused by excessively consuming alcohol. The reason being is alcohol is a diuretic,
meaning it causes one to void more often. It is not when one is drinking alcohol that the
dehydration occurs, but rather after the fact when one has what is called a hangover that the
body is dehydrated. Another way one can become dehydrated after increased voiding is if one is
diagnosed with diabetes. Diabetes causes the body to have high level of glucose in the
bloodstream; therefore the kidneys will work harder to get rid of the glucose by producing
urination.

From a patient standpoint, signs of dehydration include thirst, dizziness/light-headed,

sleepiness/tiredness, slight weight loss, and headache. Symptoms of dehydration may vary from
abnormal vital signs, such as an elevated blood pressure associated with a low heart rate, or vice
versa, to kidney stones, which would be consider chronic dehydration. The most common
manifestations include dry mucous membranes, poor skin turgor, and decreased pulse volume
(Venes, 2014). A sufficient amount of water intake is an essential factor of a well, balanced diet.
In addition, it is important for physical activity, and mental function. There is evidence that
proper hydration status is associated with a number of health benefits. These include a lower risk
of urolithiasis and UTIs, and a reduction in hypertension, fatal CAD, thromboembolism, and
cerebral infarcts. Good hydration is also linked to reduced incidence of constipation, exerciseinduced asthma and hyperglycemia in diabetic ketoacidosis. (Popkin, 2011).
It is very critical to prevent dehydration for survival. Water balance is regulated by
homeostatic mechanisms that are severely precise and sensitive whom control both water intake
and output (Holdsworth, 2014). By common sense, increasing the amount on intake is what
would generally help rehydrate the body, but there is other ways to prevent dehydration. For
pediatric patients drinking water could be hard to do, so other options of increasing fluid intake
could be sucking on flavored ice pops or popsicles. For adult patients, avoid drinking coffee,
dark sodas, or other drink that contain high level of caffeine. Highly caffeinated drinks increase
voiding which dehydrates the body even more. If a patient is on a high-protein diet, it is very
importance to almost double the amount of fluid intake. A healthcare provider could monitor the
patients blood urea nitrogen, BUN, which also shows how well one is hydrated. Overall, it is
best to avoid diets high in protein. Other sources of hydration in foods include Hamburgers (low
in fat), chicken breast, soup or stew, Jell0O, grapefruit, grapes, watermelon, fruit juice, sports
drinks or flavored water, and smoothies (Davis, 2005).
As a healthcare provider, it is almost entirely ones responsibility to monitor and care for
the many different negatively impacting factors a patient faces while hospitalized. When a
patient is dehydrated, the goal is to increase fluid intake which will maintain the urine output to
be greater than 30 milliliters per hour. In regards to vital signs, a well hydrated patient should
have a blood pressure greater than 90/60, a heart rate in the normal range of 60-100, and a
glucose level in between 70-299 mg/dl. As far as signs and symptoms, goals for dehydrated
patients include elastic skin turgor, and moist pink mucosal membranes. It is important to weigh
the patient daily because changes in weight can provide information on fluid balance and
replacement. Monitoring the I/O and vital signs will allow the healthcare provider to know how
well the goal is progressing. Assessing the neurological status is a great way to detect how
hydrated a patient is. Alteration in mental status can result from severe depletion and altered
sodium levels. This also puts the patient at risk for seizures, so it is essential for a patient to be
alert, awake and oriented. Regarding lab values, monitoring the potassium and calcium levels,
the serum ketones and acetone levels, and the hemoglobin, hematocrit and leukocyte count
values are important with patients who have diabetic ketoacidosis. It is essential for the

healthcare provider to monitor for effects of IV therapy because volume replacement is highly
needed to provide proper circulation, perfusion and oxygenation to the body. When a patient is
dehydrated, maintaining all of the tissues and organs with sufficient fluid is critical to avoid
severe dehydration. Initiating or administer IV therapy could help stabilize the body. This is
important for NPO patients who are unable to drink water or eat any food. The initial goal is to
correct the circulatory volume deficit. Most patients who are admitted to the hospital will be
given an isotonic saline because this solution rapidly expands the extracellular fluid volume.
After that goal is accomplished, then the healthcare provider could focus on the water deficit the
patient is experiencing. This is ideally resolved by giving a hypotonic solution. Another
intervention a healthcare provider can implement is simple education. Educating patients on
proper attire when exercising or working out plays a major role in how fast the body can become
dehydrated. Light weight clothing is should be a preferred and avoid wearing rubber clothing.
This kind of athletic wear first causes the body to swear excessively, meaning a significant
amount of fluid being lost. Secondly, this attire causes internal fever which then causes the body
to become dehydrated. The final advice on sportswear is for one to change clothes drenched in
sweat as soon as possible so the body doesnt soak up what it initially got rid of, causing an
electrolyte imbalance.
Two patients were being admitted to the hospital late afternoon after suffering from
severe dehydration. Ironically, the two were out sailing the sea when their sailboat began to sink.
Luckily, the four that were initially on board had a life raft available. Stranded, without a drop of
fresh water, the sailors began to feel thirst within a couple of hours. The day after the sinking
took place, dehydration kicked in. In the minds of the sailors, temperature was their biggest
concern. The cold weather had the four of them shivering for a few hours, but then severe thirst
set in. Surrounded by water, the sailors felt tortured as there was nothing they could do. On the
third day of being stranded in the cold, they were feeling delusional and later in the day, two of
the sailors decided to drink water from the ocean to quench their thirst. The next afternoon, those
two sailors, in complete delusional state, jumped into the ocean. On the fifth day, the remaining
two sailors were utterly overwhelmed and accepted the sad truth that they would soon face death.
That very same day, the two patients were rescued and immediately given ice cubes to suck
water out of and IV fluid to begin the rehydrating process. These two patients suffered from
acute mental alterations, but used their story to demonstrate the extreme importance of water and
fluids in ones daily life.
Stressing the importance of maintaining every patient well-hydrated should be implemented in
every care facility. Overall, hydrating the body adequately results in better health and well-being.
Staying hydrated is essential to the body because it primarily consists of water. Proper balance of
electrolytes minerals and fluids plays a huge role in many functions of the body, such as nerves
and muscles. Even though humans do not see the bodys water balance with great priority, since
we consume three meals a day on average, we also do not see that dehydration is only a couple

percent values away from occurring. As seen in the sailors experience, the human body slowly
starts to reduce its functions and symptoms rapidly commence. Drinking fluids serves with great
purpose to the human body by maintain a healthy status.

References
Davis, J., & Zelman, K. (2005). Top 10 ways to Stay Hydrated. WebMD, INC.
Holdsworth, J. (2014). The importance of human hydration: perceptions among healthcare
professionals across Europe. British Nutrition Foundation: Nutrition Bulletin, 16-24.
Popkin BM, DAnci KE & Rosenberg IH (2011). Water, hydration and health. Nutrition
Reviews, 68: 439-58.
Van Leewun, A., Poelhuis-Leth, D., & Bladh, M. (2014) Unbound Medicine, INC. Davis
Laboratory and Diagnotic Tests (Dehydration Analysis). Nursing Central.
Venes, D. (2014) Unbound Medicine, INC. [software]. Tabers Medical Dictionary (-hydration).
Nursing Central.