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216 Unit 3: Basic Skills

Fluid is normally lost through urine, respira-

GUIDELINES
CARE OF THE RESIDENT WITH E DEMA
● Elevate the swollen extremity when possible.
●
Place a footstool under the feet of the resident
who is sitting.
●
Provide restorative skin care as explained in
Chapter 12.
●
Provide oral care frequently.
● Answer call signals promptly.
● Encourage the resident to follow the diet that is
ordered.
● Carefully measure and record all fluids taken in
and eliminated.
● Make sure that the resident and visitors are aware
of the need to measure fluids.
Care of the Resident with Edema
Residents with edema need special care to prevent
further complications.
Dehydration
The condition of having less than the normal
amount of fluid in the body is called dehydration.
Dehydration occurs when the resident loses too
much body fluid or does not take in enough fluid.
A person with low body weight can dehydrate very
quickly. Infants and the elderly are especially at
risk. It is important to observe early signs of dehy-
dration before they become more serious.
The signs and symptoms of dehydration include
tions, perspiration, and feces (bowel movement).
Abnormal losses of fluid can be caused by vomit-
ing, diarrhea, bleeding, or excessive perspiration.
Dehydration may occur as a complication of an ill-
ness or as a side effect of medication.
The most common cause of dehydration in the
elderly is an inadequate intake of fluid. Reasons
why the elderly resident may not drink enough
include
● Weakness and decreased mobility (has difficulty
reaching, opening, or pouring fluid)
● Difficulty swallowing
● Confusion (fails to recognize thirst, forgets to
drink, is unable to work the water fountain, or
fears being poisoned)
● Lack of assistance (fluids offered infrequently or
failure to assist)
● Fear of urinary incontinence (inability to con-
trol urine)
● Dislikes fluid offered (many people do not like
water)
Treatment for dehydration includes increasing the
amount of fluid intake. The doctor may order the
staff to “encourage fluids.” A specific amount of fluid
will be divided between shifts. Fluid must be offered
frequently, and residents must be encouraged to
drink. Accurate measuring and recording of fluid in-
take will be necessary. Let the nurse know if you can-
not get the resident to drink enough. Do not wait
until the end of the shift to report this information.

● Thirst Preventing Dehydration

● Very dry skin that is less elastic than normal The nursing assistant plays an important role in pre-
● Pale or ashen skin color venting dehydration. The following guidelines will
● Sunken eyes help protect residents from becoming dehydrated.
● Dry mouth and tongue
●

●
Dry mucous membranes
Weight loss ALTERNATIVE METHODS
● Decreased urinary output OF HYDRATION
● Concentrated urine Sometimes, despite all your efforts, the resident will
● Constipation not drink enough fluids. In that case, the doctor
● Rapid heart and respiratory rates may order fluids by a different route. Some
● Fever alternative methods for giving fluids are by nasogas-
● Irritability, confusion, and/or depression tric tube (NG tube), gastrostomy tube (G tube), or
● Weakness, twitching, or convulsions intravenous (IV). Caring for residents with these