Levels of evidence (I – VI) are defined at the end of the "Major Recommendations" field.
Parameters of Assessment (Mentes & the Iowa Veterans Affairs Nursing Research Consortium, 2004 [Level I])
- Health history
- Specific disease states: dementia, congestive heart failure, chronic renal disease, malnutrition, and psychiatric disorders such as depression (Albert et al., 1989, 1994 [both Level III]; Warren et al., 1994 [Level IV])
- Presence of co-morbidities: more than four chronic health conditions (Lavizzo-Mourey, Johnson, & Stolley, 1988 [Level IV])
- Prescription drugs: number and types (Lavisso-Mourey, Johnson, & Stolley, 1988 [Level IV])
- Past history of dehydration, repeated infections (Mentes, 2006 [Level IV])
- Physical Assessments (Mentes & the Iowa Veterans Affairs Nursing Research Consortium, 2004 [Level I])
- Vital signs
- Height and weight
- Body mass index (BMI)
- Review of systems
- Indicators of hydration
- Laboratory Tests
- Urine specific gravity (Wakefield et al., 2002; Mentes, Wakefield, & Culp, 2006 [both Level IV])
- Urine color (Wakefield et al., 2002; Mentes, Wakefield, & Culp, 2006 [both Level IV])
- Blood urea nitrogen (BUN)/creatinine ratio
- Serum sodium
- Serum osmolality
- Individual fluid intake behaviors (Mentes, 2006 [Level IV])
Nursing-Care Strategies
- Risk Identification (Mentes & the Iowa Veterans Affairs Nursing Research Consortium, 2004 [Level I]).
- Identify acute situations: vomiting, diarrhea, or febrile episodes
- Use a tool to evaluate risk: Dehydration Appraisal Checklist
- Acute Hydration Management
- Monitor input and output (Weinberg et al., 1994 [Level I]).
- Provide additional fluids as tolerated (Weinberg et al., 1994 [Level I]).
- Minimize fasting times for diagnostic and surgical procedures (American Society of Anesthesiology Task Force on Preoperative Fasting, 1999 [Level I]).
- Ongoing Hydration Management
- Calculate a daily fluid goal (Mentes & the Iowa Veterans Affairs Nursing Research Consortium, 2004 [Level I]).
- Compare current intake to fluid goal (Mentes & the Iowa Veterans Affairs Nursing Research Consortium, 2004 [Level I]).
- Provide fluids consistently throughout the day (Ferry, 2005 [Level V]; Simmons, Alessi, & Schnelle, 2001 [Level II]).
- Plan for at-risk individuals
- Fluid rounds (Robinson & Rosher, 2002 [Level IV]).
- Provide two 8-oz. glasses of fluid, one in the morning and the other in the evening (Robinson & Rosher, 2002 [Level IV]).
- "Happy Hours" to promote increased intake (Musson et al., 1990 [Level V]).
- "Tea time" to increase fluid intake (Mueller & Boisen, 1989 [Level V]).
- Offer a variety of fluids throughout the day (Simmons, Alessi, & Schnelle, 2001 [Level II]).
- Fluid regulation and documentation
- Teach able individuals to use a urine color chart to monitor hydration status (Armstrong et al., 1998; Armstrong et al., 1994; Mentes, Wakefield, & Culp, 2006 [all Level IV]).
- Document a complete intake recording including hydration habits (Mentes & the Iowa Veterans Affairs Nursing Research Consortium, 2004 [Level I]).
- Know volumes of fluid containers to accurately calculate fluid consumption (Burns, 1992 [Level IV]; Hart & Adamek, 1984 [Level III]).
- Maintenance of body hydration (Mentes & Culp, 2003 [Level III]; Robinson & Rosher, 2002 [Level IV]; Simmons, Alessi, & Schnelle, 2001 [Level II]).
Follow-Up Monitoring of Condition
- Urine color chart monitoring in residents with better renal function (Armstrong et al., 1994, 1998; Wakefield et al., 2002 [all Level IV]).
- Urine specific-gravity checks (Armstrong et al., 1994, 1998; Wakefield et al., 2002 [all Level IV]).
- 24-hour intake recording (Metheny, 2000 [Level VI]).
Definitions:
Levels of Evidence
Level I: Systematic reviews (integrative/meta-analyses/clinical practice guidelines based on systematic reviews)
Level II: Single experimental study (randomized controlled trials [RCTs])
Level III: Quasi-experimental studies
Level IV: Non-experimental studies
Level V: Care report/program evaluation/narrative literature reviews
Level VI: Opinions of respected authorities/Consensus panels
Reprinted with permission from Springer Publishing Company: Capezuti, E., Zwicker, D., Mezey, M. & Fulmer, T. (Eds). (2008) Evidence Based Geriatric Nursing Protocols for Best Practice, (3rd ed). New York: Springer Publishing Company.
