Keeping Good Records It will be useful to keep well-organized notes on your family or whoever you are caring for at home. Each day, write down the patient’s vital signs. Include their temperature, pulse rate, breathing rate, blood pressure, and weight if they can stand. Repeat the vital signs three times daily in routine patients and more often in very sick patients. You can get a clear picture of how the patient is doing from these simple measurements.
An important part of the daily record is to measure the patient’s fluid intake and output. To do this, you will need to keep track of the fluid they are taking in as well as passing out especially for children not in diapers. Measure the urine output using a large measuring cup. The amount of fluid we take in each day is always more than the amount passed out because of insensible losses. Insensible losses include fluid lost through the skin as perspiration, water vapor in the breath, and fluid in the stool. If the patient is not drinking enough fluid their output of urine will fall off, and the urine will become darker and concentrated. If this happens, encourage them to drink more fluids.
Identification Of Dehydration When patients have a fever, vomiting, and/or diarrhea, they lose much more water from the body than is commonly appreciated.
Symptoms of dehydration include weakness, dizziness, headache, confusion, and fainting.
Signs of dehydration include dryness of the mouth, decreased saliva, lack of or very small urine volume that is dark and highly concentrated, sunken eyes, loss of skin elasticity, low blood pressure, especially upon sitting up or rising from the sitting to the standing position, and fast pulse rate, especially when moving from the lying to sitting or standing positions.
Treatment Of Dehydration The Oral Re-hydration Solution (ORS) is an excellent treatment for all causes of dehydration. It is just what the thirsty body needs to restore the lost fluid. The water, salt, and sugar in the formula team up to speed the patient’s recovery. The quantity of sugar in the ORS can be varied depending on patient preference. It can be increased up to 4 tbsp or reduced to 2 tbsp if desired by the patient. For some people, the ORS will taste too salty. In this case, increase the water content to 1.5 or even 2 quarts leaving the remainder of the formula unchanged.
The Adult ORS formula for dehydration
1-quart clean water
1 level tsp table salt
3 tbsp table sugar
If you detect or suspect that dehydration is developing, administer the ORS by mouth.
If the patient is too ill to drink, someone must sit with them and administer the fluids using a teaspoon or the baby bottle to get one spoonful or dribble from the bottle down the patient’s throat until she is strong enough to drink alone. Don’t stop until the patient has been able to keep down at least a quart of fluids, which may take several hours. You will know you are making headway with fluid therapy when the patient becomes more alert and begins urinating, an indication that their fluid deficit is partially restored. While these are good signs, more remains to be done. With sick patients like these, you need to “push the fluids” so don’t let your guard down. If they are too weak to use a glass and straw or squeeze bottle, try an 8 oz. baby bottle, which may be easier to handle.
Your patient will be very tired. Let them sleep for a couple of hours and then get them to drink more fluids. Be consistent; it is really important. You can drink the ORS plain or add fruit flavorings or natural herbs like tea, vanilla, cloves, cinnamon, or mint. A number of excellent powdered fruit drink products are available at the grocery store that can be mixed with the ORS. Once the patient is well hydrated and eating, there is no further need for the ORS. Even if the patient is not eating but can drink and remains well hydrated, you can switch them to one of the other fluids listed for use with the clear liquid diet such as juice, bouillon, or tea.