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CNA Training: Recognizing the Signs of Dehydration

Dehydration is a to a great extent a larger problem than malnutrition in long-term care. The symptoms are most frequently atypical and can easily mistaken for other illnesses of delirium. As a Certified Nursing Assistant you are responsible for helping the people you take care of be as active, independent, and healthy as possible.  Recognizing the signs of dehydration in the residents we take care of is a part of our CNA training.

The normal aging process can cause changes that can increase the risk for fluid imbalance and dehydration. This can cause elderly residents less capable of maintaining fluid balance compared to the younger population. Diseases such as kidney, heart, diabetes and cancer can affect fluid balance.  Some types of medication can cause fluid imbalances. 

Common reasons for inadequate fluid intake and abnormal loss of fluids include:

Decreased content of body water
Age-related changes decrease thirst response
Physical or mental inability to consume fluids independently
Depression, alteration in mood, or cognitive status
Renal changes
Dysphagia
Poor dietary intake (food is up to 80% fluid)
Lack of available fluid
Warm environmental temperature
Delirium
Gastrointestinal distress
Apathy
Bedrest, causing physiological changes and fluid loss
Immobility

Certified Nursing Assistants need to offer more fluids to residents in their care to prevent dehydration.  You will first determine from the nurse and care plan if the resident has a special fluid order to encourage fluids.  Some residents may be on restricted fluids, NPO or thickened fluids.  The symptoms of dehydration among the elderly can be alarmingly swift and can quickly result in a life-threatening situation.

Signs and symptoms of dehydration include:

Sunken cheeks or eyeballs
Dry, brown tongue and mucous membranes
Furrows or lines in tongue
Dry, inelastic skin
Poor skin turgor
Weight loss
Concentrated urine
Constipation and impaction
Nausea and anorexia
Greater than three-pound weight loss within seven days
Delusions, dizziness, delirium
Unsteady gait
Headache
Flushed appearance

Dehydration is a common and dangerous problem that threatens the lives of many elderly nursing home residents. Educating residents, family, and healthcare staff about the dangers of dehydration is the key to tackling this health problem. By taking a proactive approach to preventing dehydration, the healthcare can make great progress in reducing unnecessary hospitalizations and maximizing resident health and well-being.