Elderly patient does not want fluids, what do you do as a SN?

Nursing Students Student Assist

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Hi. I just finished a case study on an elderly woman living outside of an assisted living situation. However, next semester I will be working with real elderly people living in an assisted living situation. My case study covered dehydration and issues concerning problems with the GI tract.

Anyway it dawned on me that although I understand the concepts presented to me in my assignment, I do not know how to deal with a real clinical situation, where my patient will REFUSE to intake fluids to prevent dehydration.

As a social worker in my former life, if people refused treatment we documented it and moved on or the law stepped in to enforce treatment. How does a Student Nurse convince his/her patient to take in fluids and/or follow treatment plans? Assume that said student is new to the patient so no real relationship is established AND the Student Nurse does not want to fail clinical that day. :lol2: Thanks.

Specializes in Utilization Management.
I agree with the posts, but question how DNR fits into the situation. I mean, a DNR only applies is the person needs CPR, right? I am a Hospice RN Case Manager and it seems that all too often, people confuse a DNR with Do Not Treat......:nono: You know what I mean?

Cheryl

I've been in healthcare way too long to confuse the two, Cheryl. Here in Florida we get cases like this all the time. We treat our DNRs, they have procedures, they have interventions, and they have basically whatever they like. Or not.

Let's suppose my patient is an alert, oriented, 96-year-old patient who's in the hospital for failure to thrive, and for no apparent reason, the patient is refusing food and drink, as well as other forms of nutrition. Family wanted him to get a G-Tube, doctor wanted him to get a G-tube.

The patient remained adamantly against it, telling every caregiver who came into the room what he wanted. This particular patient passed his psych eval with flying colors, no depression, no real issues except that "when my time comes, I go and that's that."

I'm guessing that we probably wound up referring the case to Hospice so he could get the care he needed at home.

He never gave in, never ate a bite, and never conceded on the G-tube issue.

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I'm all for coaxing a little but not to the point of alienation. Some with dementia say no to everything, or they say no one minute and say yes the next.

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Specializes in Gerontology, Med surg, Home Health.
yes some patients need a little coaxing, especially with the elderly population. I've learned how to influence them a little more to get them to drink and eat.

I just read a very interesting article about a study done by a gerontologist. He had hundreds of subjects in his study about dehydration and thirst in the elderly.

He says that along with many other senses which diminish as one ages, the sense of thirst does as well. Instead of asking them if they were thirsty or wanted water, he just offered a cold glass and asked them to take just one sip. Once the water was tasted, it triggered the desire to drink more.

I'm not sure it'd work with everyone but you might want to give it a try.

Or to try another tack--I had a patient who didn't like to drink because she really didn't like to have to get up to pee. When I explained that the less water she drank the greater the chance of dehydration, urinary tract infections, mental status changes, and WRINKLES she started to drink more! Believe me...it was the threat of wrinkles that changed her mind.

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