Hydration Protocol Flashcards
Normal Fluid needs
30ml/kg/day with minimum of 1500ml/day.
1ml/ 1 kcal for obese individual
Pressure ulcer fluid needs
30-40 ml/kg/day
CHF
Congestive Heart Failure - 20-25 ml.kg//day
UTI
Urinary Tract Infection - 35ml/kg.day until UTI resolved, then proceed with normal needs
ESRD
End Stage Renal Disease - determined by physician
Resident on tube feeding
- Determine how much fluid is being taken orally and assess the resident’s ability to ingest that amount consistently.
- total amount of fluid given through IV if the resident is on IV therapy
- Determine free water content. Most contain 80 to 85% (800 to 850), calorie-dense products contain less water (60 to 70%)
- total amount of H2O in flushes
- substract resident’s water intake (total of steps 1 to 4) form total requirement.
- Recomend amount of any additional fluid needed.
Isonatremic / isotonic dehydration
Serum Na level: 130 - 150 mEq/L. Decrease intake, refusal to consume food and water, large volume losses caused by diarrhea or vomiting.
Hyponatremic/ Hypotonic dehydration
Serum Na level: <130 mEq/L. Loss of more Na than H2O, numerous etiologies, often due to use of diuretics.
Hypernatremic/ Hypertonic Dehydration
Serum Na level: >150 mEq/L. Loss of more H2O than Na resulting in elevated serum sodium concentrations is often observed in Pt with fever.
Signs and Symptoms of mild dehydration
Level of consciousness: Alert. Capillary refill: 2 seconds Mucous membranes: normal Heart rate (60-80 bph): slight increase Respiratory rate: Normal (12-18 breaths/min) Blod pressure: normal skin turgor: normal eyes: normal urine output/color: decreases/normal
Signs and Symptoms of moderate dehydration
Level of consciousness: lethargic Capillary refill: 4 seconds Mucous membranes: Dry Heart rate (60-80 bph): increased Respiratory rate: Increased (12-18 breaths/min) Blood pressure: normal with orthostasis skin turgor: Slow eyes: sunken urine output/color: oliguria (little) / light yellow
Signs and symptoms of severe dehydration
Level of consciousness: unresponsive Capillary refill: > 4 seconds Mucous membranes: parched and cracked Heart rate (60-80 bph): rapid Respiratory rate: hyperpnea (12-18 breaths/min) Blood pressure: decreased skin turgor: tenting eyes: very sunken urine output/color: oliguria (little) / anuria (kidney failing to produce urine) light yellow
Nutrition Screening Assessment Implement Level 1
Residents have 5% or greater weight loss in 30 days, 10% or greater weight loss in 180 days or insidious weight loss (x 30/90/180)?
1) proper environment 2)favorite foods 3) 2-day calorie count 4) assistance w/ meals 5) verbal cueing 6) praise for good intake 7) discussion w/ family (social worker involvement) 8) six small meals 9) weekly weights 10) reevaluate in 1 week
Nutrition Screening Assessment Implement Level 2
Does Involuntary weight persist? 1) initiate 1-2 fortified foods from ben a fit program 2) evaluate the use of six small feedings 3) consider swallow evaluation 4) continue weekly weight 5) consider lab work u including CBC, SMA, Albumin, LFT’s
Nutrition Screening Assessment Implement Level 3
Initiate med pass program: ( 90 ml Hi cal or other 2 cal/ml) product, 3 times per day) Evaluate need for 6 meals a day. continue weekly weights. Consider MTV, reevaluate after 1 week.
