GI/GU: Oral fluids

Water is essential for human life. It’s the main substance in our bodies, making up more than 50% of a person’s body weight, and it’s directly involved in every biochemical reaction in each cell in our body.

Normally, the amount of total body water should be balanced through the ingestion and elimination of water, ins, and outs.

About 80% of our water intake comes from drinking fluids, the other 20% comes from the food we eat. Water content in food varies, but some fruits and vegetables, like watermelon or strawberries, are 90% water by weight.

Now, the recommended daily amount of fluid intake for an adult is around 10 to 20 glasses, which is about 1.5 liters to 3 liters.

As far as water output goes, we eliminate water through breathing, as humidified air leaves the body, as well as through sweating, urinating, and bowel movements.

Now, when water losses are greater than the intake, it results in dehydration. There are many causes of dehydration, ranging from not drinking an adequate amount of fluids throughout the day, to losing too much through vomiting, diarrhea, bleeding, burns, excessive sweating, or vigorous exercise.

So, it’s important to encourage clients to maintain proper hydration and recognize the various reasons why a client might not have adequate fluid intake.

Some groups like children and the elderly are more prone to dehydration. Children have a higher surface area to body mass ratio, so they end up losing more water through their skin.

The elderly have decreased thirst sensation and might be taking medications that alter their hydration status. Oftentimes, they also have chronic diseases that affect their kidneys’ ability to maintain a healthy water balance.

Individuals in comas or with dementia are also more susceptible to dehydration because they might not be able to express their thirst.Now, when the opposite happens, meaning that the intake is greater than the water losses, this can result in an excessive amount of fluid building up in the tissues.

And that’s known as edema. This could be caused by various conditions, particularly heart and kidney disease, where the body has trouble eliminating excess fluid.To maintain fluid balance, the healthcare provider may order an adjustment to the client’s fluid intake.

To assist with that, it’s important to, first, ask the nurse about the exact amount and type of fluids that should be provided.

For a dehydrated client, an “encourage” or “ force fluids” order means that the fluid intake should be increased. A good way to do that would be to serve them a variety of their favorite drinks as often as possible so the client doesn’t have to consume a large amount of fluid at one time.A client with edema could have a “restrict of fluids” order to limit their fluid intake each day.

In this case, it’s probably best to spread fluid intake as much as possible throughout the day, so that the person doesn’t get excessively thirsty.

It’s also important to promote regular oral hygiene so that the mouth remains moist. Some clients might be also be placed on an “NPO” or “nil per os status”, meaning nothing per mouth, for a short period of time before surgery or an exam.

This means they strictly can’t eat or drink anything. The water mug is taken away and an NPO sign is also placed above the bed so that visitors know they shouldn’t offer anything to the client.

Since this can be incredibly unpleasant, it’s important to remind the client that it’s only temporary and remember to frequently assist them with oral hygiene to keep the mouth from drying.Now, as a nursing assistant, you will need to provide drinking water to clients during every shift or every time their water mug gets empty.

Before you do that, make sure to ask the nurse about each client’s fluid orders, and whether they’re allowed to have ice or use straws.

Then, gather all the supplies you’ll need, including a cart covered with paper towels, an ice chest filled with ice, a cover for the ice chest, an ice scoop, a water mug, and a pitcher of water.

In some facilities, you’ll have to fill the client’s mug with water and ice instead of having a mobile ice chest. Move the cart to the client’s room door, identify the client and check if their mug is clean and intact.

Ask if they’d like ice and how much they prefer. Then take the scoop and fill the mug with ice.

To prevent possible infection, remember not to bring the scoop into contact with the mug or straw. Then leave the scoop on a towel.

Next, use the water pitcher or the sink to fill the mug with water. Position the mug on the over-bed table and check that the person can easily reach it.

Finally, remember to practice good hand hygiene. Alright, as a quick recap, most of our water intake comes from fluids, but we can also get some of it from food.

We lose water in a number of ways, such as breathing, sweating, urinating or defecating. When those losses are greater than the intake, dehydration can settle in, whereas when intake is greater than the losses, the result can be edema.

To maintain fluid balance, the healthcare provider may order to increase fluid intake or “force fluids”, decrease fluid intake or “restrict fluids” or put the client on an NPO status, meaning they aren’t allowed to drink