Some residents in nursing homes don't have the same sense of thirst,
and they must be encouraged to drink. If they aren't encouraged to
drink and monitored, they can become dehydrated very quickly. Most good
nursing homes simply monitor their intake. It only takes a few seconds
for a CNA to write down the amount the resident drank. These amounts are
then totaled. The resident dietician will have calculated the basic fluid
needs for each resident. An average amount of fluid may be around 1800ccs
a day. The nursing staff then will compare the amount required to the
amount actually consumed, and this will give a good idea of the fluid
status of the resident.
Even though this process of watching fluids is simple, many nursing homes
don't take the time to do it. Some facilities are so understaffed,
the CNAs will either not perform this charting or will just write false
numbers down. Since many of the residents can't communicate fully,
they will become dehydrated right under their noses. Family of residents
need to constantly look out for this problem. Make sure there is a water
pitcher in the room, within reach, and that it actually has water in it.
Go to the facility right after lunch time, and look at the food tray before
the staff picks it up. Was the food eaten, were drinks consumed, and estimate
the percentages. Write down what you see. Do this for a few days. Then,
ask to look at the resident's chart if you suspect lack of fluid intake.
I can't tell you how many times CNAs write the patient is drinking
right, while the truth is they don't know.
I have had
cases
were CNAs were told by their managers to simply write something down whether
they actually did it or not. I have had many CNAs chart things on days
they did not work. I have seen nurses chart the delivery of care for days
after patients have died. I have seen nurses chart "drinking fluids
well" for a week and then die the next day from
dehydration. In a nutshell, you can't always trust the medical chart in nursing
homes. The staff there can be so over-worked, they will simply write down
anything at the end of their shift. Most nursing home chains run their
facilities so under-staffed, the nurses and CNAs are set up for failure
while the chains literally make millions of dollars.
