thirst in intubated patients

hodgieRN · Oct 28, 2012

Never heard about vented pt getting ice chips. Make sure they are not dehydrated. Just b/c they are getting IV fluids doesn't mean they're tanked up. Look at their mucosa, skin turgor. And make sure they are not hypernatremic.

But here's the thing...Thirst can be simple as wanting to feel fluids pass down the throat. They just want to chug something! There's almost an anxiety from not being able to drink. So, there are some things to reduce the anxiety. First, along with swabbing, make sure you use the mouth moisturizers. The glycerine swabs only work for couple minutes...that's why pts go through 10 packets of them in a hr. Move the mouth moisturizer all around the mouth. Take a small glob, put it on their tongue, and them to swish it around. I usually tell the family to bring chapstick or carmex and have them apply it as much as they want! Make sure you are doing mouth care every 4-6 hrs with the CHG (or peroxide) kits. The feeling of a clean mouth makes pts feels better. Swabbing the mouth is a quick fix. Sometimes, pt requesting the swab is actually a con to get you to slowly feed them water. "Can I have a swab...ok again....hold on, one more time," and then they motion you again in 15 minutes. They quickly learn to manipulate you into giving them a full cup of water with tiny, frequent doses. It's not anything mischievous...it's a basic reaction, an instinct, to accessing water. But if you get the moisturizer all in there, many times, they are happy. And, you have to watch the family b/c they are driven by a reaction to nurture a loved one. So, make sure they aren't waking the pt up and asking if he's thirsty. Of course, he is....but they doing that b/c they want to be the one that saves him from his situation. They want to say, "He was thirsty and b/c I is was there, thank god, he's not thirsty anymore. He's comfortable b/c I was able to intervene." But that's a natural reaction. It's ok to tell the family, "He's needs to rest. Try to not constantly remind him of something we can't completely fix at this time. We will do everything we can to make him as comfortable as possible. He's going to have thirst no matter what we do. Next time you come in, bring some chapstick. That will make him feel better." A lot of medications we give cause thirst. Narcotics do it, even anesthesia. The medications cause the body to release excess ADH, causing the pt to feel extremely thirsty. So, even giving them a little water won't do anything. They have to learn to go along with it.

If he is on sedation and not weaning, bump up the sedation. Keep him comfortable. If I'm on a vent feeling thirsty or hungry, knock me out until I'm ready to come off the vent!

Tell him being thirsty is normal. Tell him he is getting iv fluids or tube feeds for hydration. Inform him he can't drink anything b/c of the ET tube. Tell him he can have risk of aspiration. The lay person doesn't know the formalities of being intubated. They don't know why they can't speak. Many of them just want an answer to WHY they can't drink anything. They assume it's not a problem but if you can educate them, they will be more at ease with the concept.