SUPPORT IN PRACTICE
Addressing dehydration Maintaining an adequate fluid intake is vital for health. Under normal circumstances, humans require about 2.5 litres of fluid per day. Dehydration occurs when the body loses more fluid than it takes in, and can be the result of either inadequate fluid intake or excessive fluid loss. To assess a patient’s state of hydration, ask if he or she feels thirsty. If the patient is dehydrated, the mouth, lips and tongue will be dry and furry in appearance. The elasticity of the skin (turgor) is also used as an indicator of dehydration. Dehydrated patients will also
Signs of dehydration Thirst Light-headedness or confusion Dry mucous membranes Skin turgor
JASMINE CHIN
Common sense and vigilance are vital to ensure patients’ optimum fluid levels are maintained, says Robin Lewis
her ability to drink. For example, patients who have had a stroke or abdominal surgery may be nil by mouth either awaiting surgery or a swallowing assessment. Older patients who are frail, confused or unable to pour a drink for themselves can become dehydrated quickly. The high ambient temperature of the ward environment, limited access to drinks and infection can all contribute to dehydration.
Keep a record
Example of a fluid balance chart Input
Output
Oral drinks
Urine –minimum 0.5ml/kg/hour
Intravenous fluids
Vomit
Nasogastric or PEG feeds
Drains
have reduced urine output and their urine will be strong smelling and dark in colour. It is important to establish if the patient’s illness affects his or
Legal advice Richard Griffith on the Mental Capacity Act Frequently, I am asked by healthcare assistants (HCAs) what the Mental Capacity Act 2005 has to do with their practice as they are not concerned with formal assessments of decision-making capacity or determinations of patients’ best interests. The reality is that the act underpins HCAs’ practice when providing care for a person who lacks the ability to make decisions. As HCAs care for such patients, they have a legal duty to apply the act’s code of practice.
Failing to discharge this duty could result in prosecution for ill-treating or wilfully neglecting a patient who lacks capacity in this area. So far this year in England and Wales, there have been 220 prosecutions covering 750 offences, and many of those workers charged have been HCAs. Three were found guilty of rough handling, shouting at and assaulting patients who lacked capacity. In another case, three HCAs were convicted for scaring dementia patients with a puppet. Wilful neglect does not necessarily involve harm to the patient but occurs when the carer deliberately fails in their duty. An HCA was convicted of wilful neglect when she lowered a patient
It is important to keep a fluid balance chart if a patient is at risk of dehydration (see box). Patients who need help with drinking should be identified, so it is vital to know they are on a fluid balance chart when you are serving meals and drinks, emptying catheters or taking patients to the toilet. It is vital that the patient’s fluid balance chart is kept up to date and reviewed regularly, and that any significant imbalance between intake and output is reported to a staff member NS Robin Lewis is senior lecturer (research) at Sheffield Hallam University
into a bath, then left her unattended. The patient slipped under the water in the HCA’s absence and had to be resuscitated. In another case, a nurse and HCA claimed that they helped a patient with dementia into bed and checked him during the night. The patient was found asleep under his undisturbed bed the next morning NS Richard Griffith is lecturer in law at Swansea University Mental Capacity Act 2005 code of practice tinyurl.com/MCAPracticecode RCN mental health forum tinyurl.com/RCNMHForum
74 august 20 :: vol no 51 :: 2014 STANDARD Downloaded from28 RCNi.com by ${individualUser.displayName} on Sep 06, 2016. For personal use only. NoNURSING other uses without permission. Copyright © 2016 RCNi Ltd. All rights reserved.
Addressing dehydration Maintaining an adequate fluid intake is vital for health. Under normal circumstances, humans require about 2.5 litres of fluid per day. Dehydration occurs when the body loses more fluid than it takes in, and can be the result of either inadequate fluid intake or excessive fluid loss. To assess a patient’s state of hydration, ask if he or she feels thirsty. If the patient is dehydrated, the mouth, lips and tongue will be dry and furry in appearance. The elasticity of the skin (turgor) is also used as an indicator of dehydration. Dehydrated patients will also
Signs of dehydration Thirst Light-headedness or confusion Dry mucous membranes Skin turgor
JASMINE CHIN
Common sense and vigilance are vital to ensure patients’ optimum fluid levels are maintained, says Robin Lewis
her ability to drink. For example, patients who have had a stroke or abdominal surgery may be nil by mouth either awaiting surgery or a swallowing assessment. Older patients who are frail, confused or unable to pour a drink for themselves can become dehydrated quickly. The high ambient temperature of the ward environment, limited access to drinks and infection can all contribute to dehydration.
Keep a record
Example of a fluid balance chart Input
Output
Oral drinks
Urine –minimum 0.5ml/kg/hour
Intravenous fluids
Vomit
Nasogastric or PEG feeds
Drains
have reduced urine output and their urine will be strong smelling and dark in colour. It is important to establish if the patient’s illness affects his or
Legal advice Richard Griffith on the Mental Capacity Act Frequently, I am asked by healthcare assistants (HCAs) what the Mental Capacity Act 2005 has to do with their practice as they are not concerned with formal assessments of decision-making capacity or determinations of patients’ best interests. The reality is that the act underpins HCAs’ practice when providing care for a person who lacks the ability to make decisions. As HCAs care for such patients, they have a legal duty to apply the act’s code of practice.
Failing to discharge this duty could result in prosecution for ill-treating or wilfully neglecting a patient who lacks capacity in this area. So far this year in England and Wales, there have been 220 prosecutions covering 750 offences, and many of those workers charged have been HCAs. Three were found guilty of rough handling, shouting at and assaulting patients who lacked capacity. In another case, three HCAs were convicted for scaring dementia patients with a puppet. Wilful neglect does not necessarily involve harm to the patient but occurs when the carer deliberately fails in their duty. An HCA was convicted of wilful neglect when she lowered a patient
It is important to keep a fluid balance chart if a patient is at risk of dehydration (see box). Patients who need help with drinking should be identified, so it is vital to know they are on a fluid balance chart when you are serving meals and drinks, emptying catheters or taking patients to the toilet. It is vital that the patient’s fluid balance chart is kept up to date and reviewed regularly, and that any significant imbalance between intake and output is reported to a staff member NS Robin Lewis is senior lecturer (research) at Sheffield Hallam University
into a bath, then left her unattended. The patient slipped under the water in the HCA’s absence and had to be resuscitated. In another case, a nurse and HCA claimed that they helped a patient with dementia into bed and checked him during the night. The patient was found asleep under his undisturbed bed the next morning NS Richard Griffith is lecturer in law at Swansea University Mental Capacity Act 2005 code of practice tinyurl.com/MCAPracticecode RCN mental health forum tinyurl.com/RCNMHForum
74 august 20 :: vol no 51 :: 2014 STANDARD Downloaded from28 RCNi.com by ${individualUser.displayName} on Sep 06, 2016. For personal use only. NoNURSING other uses without permission. Copyright © 2016 RCNi Ltd. All rights reserved.
