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Nursing Guide to Dehydration: Nursing Diagnosis, Interventions, & Care Plans

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Updated On 8 Minute Read

Dehydration is a physiological state resulting from excessive loss of body fluids, commonly water, which disrupts normal metabolic functions. It can range from mild to life-threatening and is classified as isotonic, hypertonic, or hypotonic depending on the relative loss of water and electrolytes.  

Dehydration affects all age groups but is especially dangerous in infants, older adults, and individuals with chronic illnesses. Nurses are instrumental in early recognition, intervention, and prevention of dehydration across care settings. 

Nutrition and Hydration Assessment in Older Adults

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Etiology and epidemiology 

Dehydration occurs when fluid output exceeds intake. This imbalance can develop quickly and result in compromised cellular and organ function. Fluid loss may occur through various mechanisms, and when not promptly corrected, dehydration can progress to hypovolemic shock or kidney injury. It may result from inadequate intake, excessive fluid loss, or a combination of both.  

Common causes include: 

  • Diarrhea and vomiting: This leads to rapid fluid and electrolyte loss.
  • Excessive sweating: This is due to heat exposure, exercise, or fever.
  • Fever: This increases insensible water loss through skin and respiration.
  • Burns: This causes significant fluid shifts and loss through damaged skin
  • Diuretics and other medications: This can induce excessive urinary excretion.
  • Poor fluid intake: This is often secondary to altered mental status, physical limitations, or restricted access to fluids.
  • Diabetes mellitus and insipidus: This can cause osmotic or water diuresis, respectively. 

Vulnerable populations include: 

  • Older adults: They may have a diminished thirst response, altered kidney function, and barriers to accessing fluids.
  • Infants and young children: They have a higher surface area-to-body weight ratio and rely on caregivers for hydration.
  • Hospitalized patients: Those who are NPO (nothing by mouth), recovering from surgery, or experiencing acute illness often have reduced intake and increased losses.
  • Individuals with disabilities or cognitive impairment: They may be unable to recognize or communicate thirst. 

Global estimates indicate that dehydration contributes to significant morbidity and mortality, particularly in children under age five in low-resource settings where diarrheal diseases are prevalent. Dehydration is also a leading cause of preventable emergency visits in older adults, emphasizing the need for proactive assessment and prevention in at-risk populations. 

ICD-10 code 

The ICD-10-CM code for dehydration is E86.0 — Dehydration. 

Assessment 

Clinical presentation 

  • Dry mucous membranes
  • Thirst
  • Decreased urine output (oliguria)
  • Dark-colored urine
  • Tachycardia
  • Hypotension
  • Lethargy or confusion
  • Poor skin turgor
  • Sunken eyes (especially in infants)
  • Dizziness or orthostatic hypotension 

Diagnostic tests 

  • Serum electrolytes: Evaluate sodium and potassium to detect hypernatremia or hypokalemia, which may result from disproportionate fluid or electrolyte loss. Blood urea nitrogen (BUN) and creatinine levels provide insight into renal perfusion and potential prerenal azotemia associated with hypovolemia. An elevated BUN-to-creatinine ratio is a common indicator of dehydration.
  • Urinalysis: A concentrated urine sample with high specific gravity (>1.030) typically reflects reduced fluid intake or increased loss. Additional findings may include ketonuria or proteinuria depending on the severity and underlying cause of dehydration.
  • Hemoglobin and hematocrit: Elevated hemoglobin and hematocrit levels suggest hemoconcentration due to plasma volume contraction. These values should be interpreted alongside other markers and clinical signs.
  • Vital signs and weight monitoring: Monitor trends in blood pressure (especially orthostatic changes), heart rate, and temperature to assess hydration status. Daily weight measurements provide a sensitive and non-invasive tool to detect subtle changes in fluid balance, especially in hospitalized or at-risk individuals. 

Management 

Medical treatment 

  • Oral rehydration therapy (ORT): This is recommended for mild to moderate dehydration, especially in children. ORT uses specially formulated solutions containing glucose and electrolytes in optimal ratios to enhance absorption in the gastrointestinal tract. Commercially available products or homemade recipes with clean water, salt, and sugar can be effective if prepared correctly.
  • Intravenous (IV) fluid replacement: This is indicated for moderate to severe dehydration, particularly when oral intake is inadequate or not tolerated. Isotonic solutions, such as 0.9% normal saline or lactated Ringer’s, restore extracellular fluid volume efficiently. The rate and volume of administration depend on the patient’s weight, severity of dehydration, and comorbid conditions.
  • Electrolyte correction: Guided by laboratory results, correcting imbalances such as hyponatremia, hypernatremia, hypokalemia, or hyperkalemia is essential. For example, potassium supplementation may be administered cautiously in cases of hypokalemia, while sodium levels should be adjusted slowly to avoid complications like central pontine myelinolysis.
  • Treat underlying cause: Management should address primary contributors such as infections (e.g., antibiotics for bacterial gastroenteritis), fever (antipyretics), uncontrolled diabetes (insulin and glucose monitoring), or medication effects (e.g., withholding or adjusting diuretics). Symptom relief and supportive care, including antidiarrheals or antiemetics when appropriate, may also be necessary. 

Nursing care plan 

Nursing considerations 

Nurses must evaluate fluid status continuously and intervene quickly to prevent complications such as hypovolemic shock, acute kidney injury, or electrolyte disturbances. This involves frequent monitoring of intake and output, assessment of vital signs, mental status, skin integrity, and laboratory values. Nurses should collaborate closely with interdisciplinary teams to ensure prompt intervention and fluid replacement, adjusting care based on evolving clinical indicators. 

In addition to physical assessments, nurses must confirm the accuracy of IV fluid administration rates, watch for signs of fluid overload during rehydration therapy, and report any adverse effects such as pulmonary edema or worsening hypotension.  

Patient-centered education should also be integrated throughout care, helping individuals and caregivers understand the importance of early symptom recognition, maintaining hydration, and adhering to prescribed rehydration protocols post-discharge. 

Assessment 

A comprehensive nursing assessment is critical for identifying the presence and progression of dehydration. Nurses should perform the following: 

  • Fluid intake/output (I&O) records: Track oral, enteral, and parenteral intake alongside all measurable output (urine, emesis, drains, etc.). A significant negative fluid balance may indicate active dehydration.
  • Weight trends over time: Daily weights, taken at the same time each day using the same scale, provide valuable insights into acute fluid losses or gains. A loss of more than 2% of body weight in 24 hours can signify clinically significant dehydration.
  • Skin turgor and mucous membrane moisture: Assess for delayed skin turgor (especially over the sternum or forearm in adults) and dry, sticky oral mucosa. Note that skin turgor may be less reliable in elderly patients due to reduced skin elasticity.
  • Level of consciousness and neurological status: Monitor for lethargy, confusion, irritability, or restlessness, which may indicate cerebral hypoperfusion.
  • Vital signs (especially pulse and blood pressure trends): Evaluate for tachycardia, hypotension, narrow pulse pressure, and orthostatic changes. Persistent abnormalities warrant immediate fluid resuscitation and further evaluation.
  • Capillary refill and peripheral perfusion: Prolonged refill time and cool extremities suggest impaired perfusion and should be documented.
  • Laboratory correlation: Interpret clinical signs in conjunction with lab findings such as elevated hematocrit, serum sodium, and BUN-to-creatinine ratio to enhance diagnostic accuracy. 

Nursing diagnosis/risk for 

  • Deficient fluid volume related to excessive fluid loss or inadequate intake
  • Risk for electrolyte imbalance
  • Impaired tissue perfusion
  • Risk for injury (e.g., falls due to dizziness) 

Interventions 

  • Monitor and document I&O, noting changes promptly.
  • Encourage oral fluid intake when appropriate, and use rehydration solutions as prescribed.
  • Administer IV fluids and medications as ordered.
  • Educate the patient and caregivers on the importance of fluid balance.
  • Evaluate for signs of improvement (e.g., clearer urine, stable vitals).
  • Provide oral hygiene to enhance comfort and stimulate fluid intake. 

Expected outcomes 

  • Patient maintains adequate hydration status with stable vital signs.
  • Urine output returns to normal levels.
  • Patient verbalizes understanding of hydration needs and prevention strategies.
  • Laboratory values normalize (electrolytes, BUN/creatinine). 

Individual/caregiver education 

  • Encourage regular fluid intake, especially during illness, hot weather, or physical exertion.
  • Educate about early signs of dehydration (e.g., thirst, dry mouth, reduced urination).
  • Discuss the importance of ORT in children and when to seek medical attention.
  • Instruct patients on safe medication use, especially with diuretics.
  • Advise older adults and caregivers on strategies to prevent dehydration despite reduced thirst perception. 

Visual summary 

Key signs and symptoms of dehydration by severity: 

Severity Signs & Symptoms 
Mild Thirst, dry mouth, slight decrease in output 
Moderate Tachycardia, dizziness, dark urine 
Severe Hypotension, confusion, anuria, sunken eyes 

Hydration interventions overview: 

Treatment Level Intervention Type Notes 
Mild Oral fluids, ORT Encourage frequent small sips. 
Moderate Oral or IV fluids Monitor vitals and I&O closely. 
Severe IV fluids, hospitalization May require electrolyte correction and labs. 

Dehydration assessment decision tree 

  1. Assess symptoms and fluid intake/output.
    1. Dry mouth? Decreased urination? Fatigue?
    2. → Yes → Proceed to step 2.
    3. → No → Continue routine monitoring.
  2. Evaluate severity.
    1. Mild: Only thirst and slight dry mucosa → Start ORT
    2. Moderate: Dark urine, dizziness, elevated HR → Oral or IV rehydration, labs
    3. Severe: Confusion, hypotension, sunken eyes → Emergency IV therapy and monitoring
  3. Check contributing factors.
    1. Fever? Vomiting? Medication-related? NPO status?
    2. → Address underlying causes concurrently.
  4. Monitor response to treatment.
    1. Are vitals stabilizing? Urine output improving?
    2. → Yes → Continue current management.
    3. → No → Escalate care (e.g., lab work, consult). 

FAQs

Resources 

References 

Jennifer Oh, BSN, RN

Jennifer Oh, BSN, RN

Jennifer Oh, BSN, RN, has worked in med-surg telemetry and case management in Temple, Texas. She enjoys the opportunity to help the patients and families and wants to share her insights and experience with other nurses to help them on their journey toward success in the field.