College of Our Lady of Mt.

Carmel
Bachelor of Science in Nursing III

HEALTH PROMOTION
HYDRATION
 WHAT IS HYDRATION?
- is the process of replacing water in the body. This can be done through
drinking water, eating ice chips, eating foods that have high water content,
drinking other fluids or an intravenous or IV line. Being dehydrated is when
your body is lacking the water levels necessary to function optimally.
- Water is essential for human life. It accounts for 50-70 per cent of our body weight
and is crucial for most bodily functions.
 HYDRATION; WHY IT’S SO IMPORTANT?
- Your body depends on water to survive. Every cell, tissue, and organ in
your body needs water to work properly. For example, your body uses water
to maintain its temperature, remove waste, and lubricate your joints. Water
is needed for overall good health.
https://familydoctor.org/hydration-why-its-so-important/

CONDITIONS AFFECTING:

 Overhydration - Overhydration can occur when people drink much more water than their body
needs.
 Dehydration - occurs when more water and fluids leave the body than enter it.

DEHYDRATION
Whatever you do, make sure you get in those six to eight glasses, otherwise dehydration could cause a whole host of
problems. Here are a few side effects:

1. Persistent headaches. One of the first things you might notice when you’re dehydrated is a
throbbing headache. The good news? If dehydration is the cause, it should go away shortly after
you drink a large glass of water.
2. Sluggish bowel function. “There are water receptors in the colon, and they pull water from the
body to make the stools softer,” says Dr. Moghaddam. “If you don’t get enough water, hard stools
and constipation could be common side effects, along with abdominal pain and cramps.”
3. Dull skin. Dehydration shows up on your face in the form of dry, ashy skin that seems less radiant,
plump and elastic.
4. Fatigue. If you’re not replenishing your fluid intake, your energy levels could plummet and you
could experience fatigue and brain fog. So the next time you reach for another cup of coffee, see if
it’s water that you need instead.
5. Weight gain. “Sometimes people mistake thirst for hunger and they eat more, but really they just
need to drink more,” says Dr. Moghaddam. “Sometimes if you have a glass of water, the hunger
cues will go away.”
6. Dry mouth. If you’re not getting enough water, you can have dry mucous membranes—i.e., a lack
of saliva. This can make it difficult to talk, swallow, and even breathe. Luckily, this can easily be
solved by drinking water.
https://www.henryford.com/blog/2020/05/side-effects-of-not-drinking-water#:~:text=
%E2%80%9CIf%20you%20don't%20get,Fatigue.

SERIOUS CONDITION (If You Don’t Drink Enough Water)

 College of Our Lady of Mt. Carmel
Bachelor of Science in Nursing III
(DISCUSSION) - Any deficit in normal body water – through dehydration, sickness, exercise or heat stress – can
make us feel rotten. First, we feel thirsty and fatigued, and may develop a mild headache. This eventually gives way
to grumpiness, and mental and physical decline. We continually lose water via our breath, urine, feces and skin. By
the time you feel thirsty your body is already dehydrated; our thirst mechanism lags behind our actual level of
hydration.

Research shows that as little as 1 per cent dehydration negatively affects your mood, attention, memory and
motor coordination. Data in humans is lacking and contradictory, but it appears that brain tissue fluid
decreases with dehydration, thus reducing brain volume and temporarily affecting cell function. As you “lose” body
water without replacing it, your blood becomes more concentrated and, at a point, this triggers your kidneys to retain
water.

The result: you urinate less. The thicker and more concentrated your blood becomes, the harder it is for your
cardiovascular system to compensate by increasing heart rate to maintain blood pressure. When your dehydrated
body is “pushed” – such as when exercising or faced with heat stress – the risk of exhaustion or collapse increases.
This can cause you to faint, for instance, when you stand up too quickly. Less water also hampers the body’s
attempts at regulating temperature, which can cause hyperthermia (a body temperature greatly above normal).At a
cellular level, “shrinkage” occurs as water is effectively borrowed to maintain other stores, such as the blood. The
brain senses this and triggers an increased sensation of thirst.

Causes: Sometimes dehydration occurs for simple reasons: You don't drink enough because you're sick or busy, or
because you lack access to safe drinking water when you're traveling, hiking or camping. Other dehydration causes
include:

 Diarrhea, vomiting. Severe, acute diarrhea — that is, diarrhea that comes on suddenly and violently
— can cause a tremendous loss of water and electrolytes in a short amount of time. If you have
vomiting along with diarrhea, you lose even more fluids and minerals.

 Fever. In general, the higher your fever, the more dehydrated you may become. The problem
worsens if you have a fever in addition to diarrhea and vomiting.

 Excessive sweating. You lose water when you sweat. If you do vigorous activity and don't replace
fluids as you go along, you can become dehydrated. Hot, humid weather increases the amount you
sweat and the amount of fluid you lose.

 Increased urination. This may be due to undiagnosed or uncontrolled diabetes. Certain

medications, such as diuretics and some blood pressure medications, also can lead to dehydration,
generally because they cause you to urinate more.

Dehydration can lead to serious complications, including:

 Heat injury. If you don't drink enough fluids when you're exercising vigorously and perspiring
heavily, you may end up with a heat injury, ranging in severity from mild heat cramps to heat
exhaustion or potentially life-threatening heatstroke.

 Urinary and kidney problems. Prolonged or repeated bouts of dehydration can cause urinary tract
infections, kidney stones and even kidney failure.

 Seizures. Electrolytes — such as potassium and sodium — help carry electrical signals from cell to
cell. If your electrolytes are out of balance, the normal electrical messages can become mixed up,
which can lead to involuntary muscle contractions and sometimes to a loss of consciousness.

 Low blood volume shock (hypovolemic shock). This is one of the most serious, and sometimes
life-threatening, complications of dehydration. It occurs when low blood volume causes a drop in
blood pressure and a drop in the amount of oxygen in your body.

Risk factors: Anyone can become dehydrated, but certain people are at greater risk:
 College of Our Lady of Mt. Carmel
Bachelor of Science in Nursing III

 Infants and children. The most likely group to experience severe diarrhea and vomiting, infants and
children are especially vulnerable to dehydration. Having a higher surface area to volume area, they
also lose a higher proportion of their fluids from a high fever or burns. Young children often can't
tell you that they're thirsty, nor can they get a drink for themselves.

 Older adults. As you age, your body's fluid reserve becomes smaller, your ability to conserve water
is reduced and your thirst sense becomes less acute. These problems are compounded by chronic
illnesses such as diabetes and dementia, and by the use of certain medications. Older adults also may
have mobility problems that limit their ability to obtain water for themselves.

 People with chronic illnesses. Having uncontrolled or untreated diabetes puts you at high risk of
dehydration. Kidney disease also increases your risk, as do medications that increase urination. Even
having a cold or sore throat makes you more susceptible to dehydration because you're less likely to
feel like eating or drinking when you're sick.

 People who work or exercise outside. When it's hot and humid, your risk of dehydration and heat
illness increases. That's because when the air is humid, sweat can't evaporate and cool you as quickly
as it normally does, and this can lead to an increased body temperature and the need for more fluids.

Diagnosis

A doctor will use both physical and mental exams to diagnose dehydration. A patient presenting symptoms such as
disorientation, low blood pressure, rapid heartbeat, fever, lack of sweat, and inelastic skin will usually be considered
dehydrated.

Blood tests are often employed to test kidney function and to check sodium, potassium, and other electrolyte levels.
Electrolytes are chemicals that regulate hydration in the body and are crucial for nerve and muscle function. A urine
analysis will provide very useful information to help diagnose dehydration. In a dehydrated person, urine will be
darker in color and more concentrated – containing a certain level of compounds called ketones.

To diagnose dehydration in infants, doctors usually check for a sunken soft spot on the skull. They may also look for
a loss of sweat and certain muscle tone characteristics.

Prevention
To prevent dehydration, drink plenty of fluids and eat foods high in water such as fruits and vegetables. Letting
thirst be your guide is an adequate daily guideline for most healthy people.

People may need to take in more fluids if they are experiencing conditions such as:

 Vomiting or diarrhea. If your child is vomiting or has diarrhea, start giving extra water or an oral
rehydration solution at the first signs of illness. Don't wait until dehydration occurs.

 Strenuous exercise. In general, it's best to start hydrating the day before strenuous exercise.
Producing lots of clear, dilute urine is a good indication that you're well-hydrated. During the
 College of Our Lady of Mt. Carmel
Bachelor of Science in Nursing III

activity, replenish fluids at regular intervals and continue drinking water or other fluids after you're
finished.

 Hot or cold weather. You need to drink additional water in hot or humid weather to help lower your
body temperature and to replace what you lose through sweating. You may also need extra water in
cold weather to combat moisture loss from dry air, particularly at higher altitudes

 Illness. Older adults most commonly become dehydrated during minor illnesses — such as
influenza, bronchitis or bladder infections. Make sure to drink extra fluids when you're not feeling
well.

Addition: Avoid or limit drinks with caffeine like coffee, teas and soft drinks.
Avoid or limit drinks with alcohol.

https://www.mayoclinic.org/diseases-conditions/dehydration/symptoms-causes/syc-20354086#:~:text=Dehydration
%20can%20lead%20to%20serious,or%20potentially%20life%2Dthreatening%20heatstroke.

Treatments

Dehydration must be treated by replenishing the fluid level in the body. This can be done by consuming clear fluids
such as water, clear broths, frozen water or ice pops, or sports drinks (such as Gatorade). Some dehydration patients,
however, will require intravenous fluids in order to rehydrate. People who are dehydrated should avoid drinks
containing caffeine such as coffee, tea, and sodas.

Underlying conditions that are causing dehydration should also be treated with the appropriate medication. This may
include medication available to purchase over-the-counter or online, such as anti-diarrhea medicines, anti-
emetics (stop vomiting), and anti-fever medicines.

nursing interventions
Add the following appropriate nursing interventions to the plan of care pending more specific dietitian recommendations:

 Provide extra fluid with meals, including juice, soup, ice cream and sherbet, gelatin, water on trays.

 Serve beverages at activities.

 All staff should encourage at least 60 ml of fluid of the resident’s choice upon entering each resident’s room.

 Encourage the resident to consume at least 180 ml with medications. Residents who limit water intake may

accept sugar-free juices during medication pass.

 Offer Popsicles between meals.

 Pass juice or fluid cart at least twice a day.

 Record accurate I & O. Cumulate each shift. Evaluate daily compared with resident’s minimum fluid

requirements.

Prevention for Babies and Young Children

Children lose fluids and electrolytes just like adults do, so make sure your child has access to
plenty of water and other fluids, especially if they’re very physically active or if it’s a warm day.
And make sure your child eats plenty of fruits and veggies -- that contain lots of water.
 College of Our Lady of Mt. Carmel
Bachelor of Science in Nursing III

If your infant or young child is dehydrated, you can try the “baby” version of a sports drink,
like Pedialyte or Equalyte. If an over-the-counter solution isn’t available, give them small sips of
water. Don’t try to make up your own homemade version. Be sure to check with
you pediatrician if your child doesn’t get better quickly.

Prevention for Older Adults

Dehydration is especially dangerous for older adults because their bodies store less water. Some
points to remember:

 Don’t wait until you feel thirsty to drink. Make sure you’re drinking fluids all day
whether you’re thirsty or not.
 Make sure water is within easy reach day and night.
 Have between 6 and 8 cups of fluids a day. If temperatures are high or you have a fever,
drink more.
 Don’t skip meals. You typically get much of your fluids from regular meals.
 Drink fruit juices, sports drinks, milk, and broth, but avoid high-protein drinks and
alcoholic beverages. They can dehydrate you.
 Eat a balanced diet that includes fruits and vegetables. They contain large amounts of
water, salt, and vitamins and can help prevent dehydration.

Prevention During Exercise

Anyone who exercises, no matter what age or skill level, needs to make sure they get enough
fluids:

 Drink a cup of water about 4 hours before you exercise.

 Have another half-cup of water every 10 to 15 minutes while you’re exercising.
 Drink water after you’re done. If your body is producing plenty of light-colored urine,
that’s a good sign.

Following these general rules for exercise will not only help you stay hydrated, it’ll also keep
your heart rate and body temperature from getting too high, and your performance will improve.

OVERHYDRATION
 College of Our Lady of Mt. Carmel
Bachelor of Science in Nursing III

Over Hydration More Dangerous than Dehydration

 Overhydration can occur when people drink much more water than their body needs. People,
particularly athletes, who drink excessive water to avoid dehydration can develop overhydration.
People may also drink excessive water because of a psychiatric disorder called psychogenic polydipsia. The
result is too much water and not enough sodium. Thus, overhydration generally results in  low sodium levels
in the blood (hyponatremia), which can be dangerous. However, drinking large amounts of water usually
does not cause overhydration if the pituitary gland, kidneys, liver, and heart are functioning normally. To
exceed the body’s ability to excrete water, a young adult with normal kidney function would have to drink
more than 6 gallons of water a day on a regular basis.

 Overhydration is much more common among people whose kidneys do not excrete urine normally
—for example, among people with a disorder of the heart, kidneys, or liver, or among premature
infants, whose kidneys are immature. Certain drugs, such as some antidepressants, can also cause
overhydration in susceptible people.

 Serious condition

 People can develop overhydration if they have a disorder that decreases the body’s ability to
excrete water or increases the body's tendency to retain water.
 Drinking too much water rarely causes overhydration because normal kidneys easily excrete
excess water.
 Often, no symptoms occur, but in severe overhydration, people may become confused or have
seizures.
 Fluid intake is restricted, and diuretics may be given.

Symptoms
 Brain cells are particularly susceptible to overhydration and to low sodium levels in the blood.
When overhydration occurs slowly and is mild or moderate, brain cells have time to adapt, so only
mild symptoms (if any) like distractibility and lethargy may ensue. When overhydration occurs
quickly, vomiting and trouble with balance develop. If overhydration worsens, confusion, seizures,
or coma may develop.
 When overhydration occurs and blood volume is normal, the excess water usually moves into the
cells, and tissue swelling (edema) does not occur. When excess blood volume occurs, fluid can
accumulate in the lungs and lower legs.

Fluid Volume Excess

Fluid is very important to have in our bodies. It makes up the blood that transports oxygen and nutrients to
organs, hydrates our tissues and carries waste products outside our body when we urinate, breathe and sweat.
 College of Our Lady of Mt. Carmel
Bachelor of Science in Nursing III

In order to stay healthy, you must have the right amount of fluid in your body. When a person has too much
fluid, the condition is called fluid volume excess.

Symptoms
Think about how a dry sponge looks in its original shape compared to when it's filled with water. Just like the
sponge, people who have fluid volume excess look swollen and puffy. This is because the excess fluid in their
bodies has leaked into the tissues right beneath the skin. The medical term edema describes this appearance.
You commonly see this in the legs, ankles and feet. However, it can appear anywhere there is tissue, such as
the arms, abdomen, face and around the eyes.
In some cases, a person may have another form of edema, called pitting edema. This occurs when the body
part is so full of fluid you can press your fingertips into the skin and make indentations that slowly disappear.
Sometimes the skin is extremely stretched to where it appears shiny. There can also be excess fluid in the
abdomen that makes it look round and protruded. This is called distention.

Just like a water-filled sponge, the skin feels squishy. In severe situations, the skin feels moist or wet from the
fluid leaking out. When feeling the pulse in the wrist, it can feel very strong and forceful, which is called
a bounding pulse. The person may complain about a heaviness in his or her body, particularly in the chest,
arms and legs. Other complaints include headache, difficulty breathing, heart palpitations, fatigue and
confusion.

A stethoscope is the instrument used to listen to the heart and lungs. When there is excess fluid in the body,
these organs can sound a specific way. The heart may beat with an irregular rhythm or faster than
normal (tachycardia). The lungs may have a rattling sound when inhaling and exhaling, called rales or 
College of Our Lady of Mt. Carmel
Bachelor of Science in Nursing III
 College of Our Lady of Mt. Carmel
Bachelor of Science in Nursing III

Did You Know...

 Drinking too much water without replacing salt can be harmful, occasionally even in healthy
people.

Treatment

 Restriction of fluid intake

 Treatment of the cause of overhydration

Regardless of the cause of overhydration, fluid intake usually must be restricted (but only as advised by doctors).
Drinking less than a quart of fluids a day usually results in improvement over several days. If overhydration occurs
with excess blood volume because of heart, liver, or kidney disease, restricting the intake of sodium is also helpful
because sodium causes the body to retain water.

Drugs that tend to cause overhydration are stopped. Sometimes, doctors prescribe diuretics to increase the excretion
of sodium and water in the urine. Other types of drugs also can increase water excretion and are sometimes used to
treat overhydration when blood volume is normal. These drugs are generally used when a person is in the hospital
and can be carefully monitored.

Nursing Interventions
As a nurse, it is important to identify fluid volume excess so that specific interventions can be performed.
Like any liquid, the fluid in the body has weight. The nurse weighs the patient every day at the same time,
usually in the morning. The patient should have on the same amount of clothes when weighed on a standing scale
or have the same amount of covers removed when weighed on a bed scale. A weight measurement is a good
indicator of how much fluid is in the body when comparing the readings from day to day.
Nurses measure the amounts of fluids going in and out of the body over a period of time. The intake includes the
fluid that goes in the body. Here are some examples:

 Beverages (water, juice, milk, soda, coffee and tea)

 Liquid foods (broth and soup)
 Foods that become liquid at room temperature (ice chips, ice cream, gelatin and popsicles)
 Fluids received through an intravenous line (saline, multivitamins, blood transfusion)
 Nutritional supplements received through a feeding tube

The output is the fluid that goes out of the body. Urine is the most common type of output the nurse measures.
Other examples are the fluids from vomiting, diarrhea and bleeding.
Excess fluid in the body can gather in the arms and legs and lead to edema when the limbs are in downward
positions. Positioning the limbs above the heart facilitates fluid circulation back into the body. If the patient is in
bed, the foot of the bed can be elevated to help relieve fluid from the legs and feet, while pillows are used to
elevate the arms. The nurse might also encourage walking around, since moving the legs moves fluid from the
lower limbs.