“Water is well known for its revitalising properties. Yet even though it is essential to health, it frequently gets overlooked as one of the six basic nutrients, along with carbohydrates, fats, vitamins, proteins and minerals. This can result in vulnerable individuals missing out on the support and guidance they need to help maintain a healthy level of hydration.” (RCN 2007) There can be no doubt that water is essential to life and becoming dehydrated can have a massive impact on a health, the Nursing Times (2014) identify the following as signs of dehydration:

Early signs of dehydration

·        Thirst sensation;

·        Dry mouth;

·        Headaches;

·        Reduced concentration;

·        Darker, more concentrated urine.

Signs of moderate dehydration

·        Reduced urine output, increasingly darker colour and stronger odour;

·        Increasingly dry mouth, cracked lips;

·        Dry eyes due to reduction in tears;

·        Lethargy and increased sleepiness;

·        Mild or increased confusion;

·        Irritability and agitation;

·        Worsening constipation;

·        Dizziness due to postural hypotension (drop of systolic BP by 20 mmHg), often resulting in falls;

·        Sunken eyes;

·        Unexpected reduction in wound exudate;

·        Reduced skin elasticity / turgor.

Signs of acute dehydration

·        Low systolic blood pressure (100 mmHg or less);

·        Rapid, thready pulse;

·        Increased respiration rate;

·        Cold extremities;

·        Reduced capillary refill time due to peripheral shut down;

·        Hyper or hypodelirium (agitation and severe confusion or conversely increased sleepiness and reduced responsiveness);

·        Reduced conscious level;

·        Greatly reduced urine output (oliguria).

With complications of dehydration including increased risk of pressure ulcers, renal failure,constipation, delirium and increased risk of falls (Campbell2011) to name but a few.  In addition to this “dehydration has been shown to increase by two-fold the mortality of patients admitted to hospital with a stroke and to increase the length of hospital stay for patients with community acquired pneumonia. dehydration is a problem that nurses need to be aware of.”(RCN2007)

Hydration (along with nutrition) has long be synonymous with quality of care and the Francis Report has solidified this by stating “Some patients were left with food and drink out of reach and offered inadequate or no assistance in consuming it. Even water or the means to drink it could be hard to come by” And whilst this is absolutely an impact of poor nursing care, dehydration and preventing dehydration are infinitely more complex.

This WeNurses discussion aims to ask some of the following questions in regard to dehydration:

1. What are the signs of dehydration?
2. Who is at risk of dehydration?
3. What can we, practically, do to prevent dehydration in the people we care for?
4. How do we “encourage fluids” in those who are more reluctant to drink?
5. How do we involve other MDT members, families and patients in preventing dehydration?
6. What are your top tips re hydration?