Hydration and Nutrition PPT for Keiro
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Transcript of Hydration and Nutrition PPT for Keiro
Interdisciplinary
Approaches to
Hydration
Lindsey Callihan MS, RD, CD
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
Consequences and Symptoms
of Dehydration
Decreased energy
Increased temperature
Increased confusion
Increased risk of mortality
Muscle cramps
Dizziness
Headaches
Wt loss
Risk Factors for Dehydration
in Elderly
Altered thirst sensations
Impaired cognition/dementia
Increased fluid losses (vomiting, diarrhea, fever, uncontrolled Diabetes)
Medications
Fluid restrictions
Thickened liquids, assisted feeding
Clinical Signs of Dehydration
Decreased consciousness
Poor skin turgor
Dry mouth, lips, tongue
Confusion
Dizziness
Headaches
Dark (concentrated) urine
Rapid heart rate
Constipation
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
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
Hydration Team
Doctors
Dietitians
Speech Therapists
Nursing Staff
OT/PT/Restorative
Activities
Foodservice
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
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
Role of Activities
Incorporate fluids into
social experiences
Offers refreshments
during activities and
during day
Provides pleasurable
atmosphere for
food/fluid consumption
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
ChallengesEducation 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?
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
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>