Hydration!

glovedgoddess · Dec 3, 2010

for example, why is so important that a patient with a respiratory infection or tonsillitis is drinking a lot of fluids?

-for the resp infection patient, is the main concern to help loosen secretions and therefore promote healing?

-and for the tonsillitis patient would drinking lots of fluids help wash over the infected area, keeping it moist and washing out bacteria??

-what are the general reasons why good hydration is so important for any kind of patient in the hospital?

Esme12, ASN, BSN, RN · Dec 3, 2010

for example, why is so important that a patient with a respiratory infection or tonsillitis is drinking a lot of fluids?
-for the resp infection patient, is the main concern to help loosen secretions and therefore promote healing?
-and for the tonsillitis patient would drinking lots of fluids help wash over the infected area, keeping it moist and washing out bacteria??
-what are the general reasons why good hydration is so important for any kind of patient in the hospital?

hydration in important because of the need of water our body has. water is a vital nutrient in for our body because it helps to keep the body temperature down, reducing sweating and dehydration, aids the passage of food through the digestive system, and serves as a transport mechanism in the body by carrying nutrients, waste products and internal secretions.

water makes up most of our total body weight, around 50-60%. so it is vital we keep hydrated, and this doesn't mean only drinking water when thirsty, because by the time we are thirsty we are already dehydrated. and sometimes when we feel hungry it might be that this can mean that your body is asking for water beause it's dehydrated.

water can be lost very easily from our body in form of urine, faeces, evaporation from the skin and expired breath. so with and increased resp rate and cough the water loss is greater as would be with a temp. without proper volume it would become increasing more difficult to maintain normothermia,heart rate and b/p as well as the body's own infection fighting mechanisims

why is so important that a patient with a respiratory infection or tonsillitis is drinking a lot of fluids?

due to an increased resp rate, temp and cough there is a greater fluid loss. without proper balance the body cannot fight infection effectively. losening secretions to expectorate them is one reason for increased fluid intake otherwise they remain in the lung to breed infection and atelectasis and cause an impaired gas exchange. think about tonsilitis.......do you want to drink anything with a swollen hurting throat? they also usually mouth breathe which also causes an increase of senseless fluid loss that needs to be replaced

so with this information think why it would be important for any hospitalized patient to need hydration.

http://www.thebeverageinstitute.com/hydration/hydration_features.shtml

good luck!

glovedgoddess · Dec 4, 2010

Thank you Esme12! Very helpful =)

shaas, ASN, RN · Dec 7, 2010

Also, water is fundamental to all of the biochemical reactions (= cellular function), from building molecules to breaking larger molecules to smaller, usable parts. The reactions like hydrolysis, hydration rxn, dehydration synthesis, etc. are all of the reactions that involve water molecules. Note that a molecule has to have water to begin with, so that it could be dehydrated. Water is that integral and fundamental in your biochemical makeup. Our body is a huge biochemistry lab, whether we like or understand chemistry or not.

Without water, the entire gamut of cellular functions halt; you cannot adequately make T-cells to fight infection, synthesize ATP for energy via phosphorylation, or maintain proper blood volume and pressure. Also, to maintain cellular integrity, you need to maintain proper osmotic pressure. The list goes on and on... :)

glovedgoddess · Dec 7, 2010

Thanks that helps to put it into perspective!

MunoRN, RN · Dec 8, 2010

so with this information think why it would be important for any hospitalized patient to need hydration.
http://www.thebeverageinstitute.com/hydration/hydration_features.shtml
good luck!
the "beverage institute" is part of the coca cola corporation, so i'd take their enthusiastic advocacy of liberal fluid intake with a grain of salt (actually, they would probably prefer a spoonful of salt, then we'd drink even more).
like any treatment, fluids will be beneficial to some patients, of no significant effect to others, and dangerous with others. understanding when your patient will benefit from fluids is just as important as understanding when they won't, and just because some fluid is good, doesn't mean a lot is better.

CrazierThanYou · Dec 21, 2010

The "Beverage Institute" is part of the Coca Cola Corporation, so I'd take their enthusiastic advocacy of liberal fluid intake with a grain of salt (actually, they would probably prefer a spoonful of salt, then we'd drink even more).
Like any treatment, fluids will be beneficial to some patients, of no significant effect to others, and dangerous with others. Understanding when your patient will benefit from fluids is just as important as understanding when they won't, and just because some fluid is good, doesn't mean a lot is better.

I am sure glad someone pointed this out. I have a friend and fellow nursing student who has gotten the idea that anytime someone goes to the hospital for any reason, they MUST HAVE FLUIDS. She took her daughter to the ER with an ear infection last week and she's still throwing a fit because they "DIDN'T EVEN GIVE HER FLUIDS". She's driving me crazy! :yeah:

Mike R, ADN, BSN, RN · Dec 22, 2010

The "Beverage Institute" is part of the Coca Cola Corporation, so I'd take their enthusiastic advocacy of liberal fluid intake with a grain of salt (actually, they would probably prefer a spoonful of salt, then we'd drink even more).
Like any treatment, fluids will be beneficial to some patients, of no significant effect to others, and dangerous with others. Understanding when your patient will benefit from fluids is just as important as understanding when they won't, and just because some fluid is good, doesn't mean a lot is better.

One of my former instructors told us this story: She was with a student taking care of a CHF patient admitted for pneumonia. The patient needed some oral suctioning but the Yankauer didn't get much. The instructor told the student to keep working on it and left. The student remembered the fluids lecture and thought "increased fluids will help motility in clearing the airway" and increased the IV rate (patient was NPO for whatever reason). When the instructor came back an hour later, the patient was foaming pink froth at the mouth (but suctioning quite easily as the student pointed out). The instructor about had a heart attack. :eek:

Moral of the story: hydration is good, as MunoRN pointed out but each patient has their specific needs.

ImThatGuy, BSN, RN · Dec 22, 2010

One of my former instructors told us this story: She was with a student taking care of a CHF patient admitted for pneumonia. The patient needed some oral suctioning but the Yankauer didn't get much. The instructor told the student to keep working on it and left. The student remembered the fluids lecture and thought "increased fluids will help motility in clearing the airway" and increased the IV rate (patient was NPO for whatever reason). When the instructor came back an hour later, the patient was foaming pink froth at the mouth (but suctioning quite easily as the student pointed out). The instructor about had a heart attack.
Moral of the story: hydration is good, as MunoRN pointed out but each patient has their specific needs.

I picked up a lady with CHF once who had very audible rales bilaterally. I started an IV TKO, as was routine for basically everyone on the ambulance (better billing), and I sat down to write some information on her run slip. This was pre-laptop in the ambulance. I wrote down what I needed to write, looked up at the IV bag, and it was empty. I ran the whole the liter wide open. My bad lol. Gave another IV, that time TKO for sure, gave a nitro, and pushed some Lasix. She was already on 15 LPM NRB. Stuff like that is funny to me in hindsight.

MunoRN, RN · Dec 23, 2010

I picked up a lady with CHF once who had very audible rales bilaterally. I started an IV TKO, as was routine for basically everyone on the ambulance (better billing), and I sat down to write some information on her run slip. This was pre-laptop in the ambulance. I wrote down what I needed to write, looked up at the IV bag, and it was empty. I ran the whole the liter wide open. My bad lol. Gave another IV, that time TKO for sure, gave a nitro, and pushed some Lasix. She was already on 15 LPM NRB. Stuff like that is funny to me in hindsight.

That's interesting to hear that there are better reimbursements if you have an IV running, even at TKO, but not surprising.

We had an issue where I work of MD's ordering IV fluids for everyone, even if it was contraindicated such as with dialysis patients, CHF, Left sided MI, etc. For a while it was just the ED MD's that were doing it (apparently in the ED, IVF cures all). But then when our patients started to be admitted more by hospitalists than cardiologists, we starting seeing the problem continue to the floor as well. It was so common that we stopped even bothering to call to say we weren't going to run the fluids they ordered, we'd just leave a note explaining why it was contraindicated and often write them up as well, but it kept happening.

Our practice council took on the topic and was told by the Hospitalist Director that it was standard practice to order IVF at a rate of 100ml/hr on any patient who was classified as an observation patient since IVF running at 100ml or more an hour would usually change their classification to inpatient, since Medicare uses that as a qualifying factor to be an inpatient. He also explained that they get reimbursed better for everything that they have to do anyway such as the H&P, even a stress test gets a better reimbursement for an inpatient than an observation patient even the they each get the exact same test.

We got a policy put into effect that says they have to include an indication when ordering IVF which has helped some, although many still just order it without an indication and it gets D/C'd automatically.

Mike R, ADN, BSN, RN · Dec 23, 2010

Our practice council took on the topic and was told by the Hospitalist Director that it was standard practice to order IVF at a rate of 100ml/hr on any patient who was classified as an observation patient since IVF running at 100ml or more an hour would usually change their classification to inpatient, since Medicare uses that as a qualifying factor to be an inpatient. He also explained that they get reimbursed better for everything that they have to do anyway such as the H&P, even a stress test gets a better reimbursement for an inpatient than an observation patient even the they each get the exact same test.
We got a policy put into effect that says they have to include an indication when ordering IVF which has helped some, although many still just order it without an indication and it gets D/C'd automatically.

Though I hope most of us go into health care for the compassion of other human beings, I'm always humbled to remember that this is indeed just a business, lead by those in suits and ties. We have a few occurrences like that as well at the non-profit hospital I work at.