I have noticed that I don't share the same view on Physician ordered fluid restrictions as most of the nurses I work with. I agree with educating the patient about why they need to limit their fluid intake as well as addressing issues that might be causing a patient's desire for water such as a dry mouth or chronic cough. I also agree that we shouldn't offer water beyond the fluid restriction when a patient isn't asking for water. I disagree with the idea that a patient who is capable of making their own medical decisions can be denied water even if they have exceeded their fluid restriction when they ask for water.
Some nurses draw the line at getting water for patients, saying that if the patient wants to get their own water then that is out of their control, leaving only ambulatory patients with the ability to obtain water. Other nurses take it even further, putting bed alarms on patients so they can yell at them when they get up to get water.
I agree it is frustrating to be treating a patient for fluid overload when they drink more fluids than they should, and care contracts are often appropriate (if we admit you to the hospital then you have to abide by your fluid restriction or you'll be discharged) but even prisoners of war can't be denied water, this strikes me as potential abuse.
Pain usually won't kill you either, yet we give pain medications anyway even though giving narcotics is probably the most dangerous thing we do as nurses. From an ethical standpoint, we seem to accept trading some risk for in order to provide patient comfort in some instances and not others, and I'm curious as to how we make that decision.
I find this topic interesting, if there were clear and universally agreed upon answers, I would have lost interest long ago.
Too much pain med will kill you, but some is beneficial. The same goes for water. I won't give 10mg of Dilaudid when the order says 1mg. I won't give 3L of water a day when the patient has orders restricting them to 1L.
In both cases the patient may find their own source. I'll educate first, then document their intake best I can, watch for changes in their health and notify the doctor.
Specializes in Psych, Addictions, SOL (Student of Life).
A mentally competent patient has the right to refuse treatment or intervention. In California they cannot be made to discharge and can stay in that hospital bed refusing care until they die. The first order would be to get a psych consult to determine capacity and once established educate and document that the patient understands the consequences up to and including death and are willing to take their chances.
canoehead, BSN, RN
6,909 Posts
Too much pain med will kill you, but some is beneficial. The same goes for water. I won't give 10mg of Dilaudid when the order says 1mg. I won't give 3L of water a day when the patient has orders restricting them to 1L.
In both cases the patient may find their own source. I'll educate first, then document their intake best I can, watch for changes in their health and notify the doctor.