When used in the elderly, turgor is best tested on the inner aspect of the thigh or over the sternum. Examination of the mouth for dryness of tongue and mucous membranes may be helpful, although medication and mouth breathing can alter this sign. Muscle weakness and sunkenness of eyes may also be present.
The elasticity of skin, or turgor, is an indicator of fluid status in most patients (Scales and Pilsworth, 2008). Assessing skin turgor is a quick and simple test performed by pinching a fold of skin. In a well-hydrated person, the skin will immediately fall back to its normal position when released.
Skin turgor (elasticity) has been mentioned by few studies, but most report its limitations when assessing hydration status in the elderly. The turgor is usually assessed by pulling the skin and observing how long it takes to return to the baseline state; with values longer than 2 seconds associated with dehydration.
Serial bodyweights are an accurate method of monitoring fluid status. If patients are able to weigh themselves regularly at home these measurements may be used for review, but nurses must ensure that they use the same scales, wear the same amount of clothing and weigh themselves at the same time every day.
Bioelectrical impedance analysis (BIA) is a measure of electrical impedance through the body, which can estimate total body water (TBW). The test, used routinely in US care homes, is non-invasive and has been promoted to assess hydration status.
In the US, the reference daily intake (RDI) for water is 3.7 litres per day (L/day) for human males older than 18, and 2.7 L/day for human females older than 18 including water contained in food, beverages, and drinking water.
A fluid balance chart is used to document a patient’s fluid input and output within a 24-hour period. This information is used to inform clinical decisions (such as medication and surgical interventions) from medical staff, nurses and dieticians, who all expect accurate figures in exact measurements (Georgiades 2016).
Further imaging: this could include a chest X-ray to assess for pulmonary oedema, an echocardiogram to assess cardiac function or an abdominal ultrasound to rule out ascites. Accurate fluid balance: including daily weights, urine output, fluid intake and stool chart. 4
Tests for dehydration
Hydration assessment comprised 7 physical signs of dehydration [tachycardia (>100 bpm), low systolic blood pressure (<100 mm Hg), dry mucous membrane, dry axilla, poor skin turgor, sunken eyes, and long capillary refill time (>2 seconds)], urine color, urine specific gravity, saliva flow rate, and saliva osmolality.
Nursing assessment of fluid balance is vital in determining fluid status and electrolyte balance. Measures can be taken to intervene to correct an imbalance either through fluid therapy, if there is a deficit, or diuretics in the case of fluid overload.
Vital Signs Weight: One of the most sensitive indicators of patient volume status changes is their body weight. Patient weight changes approximate a gold standard to determine fluid status.
A –> Measuring weight is the most reliable means of detecting changes in fluid balance. Weight loss would indicate that the dehydration is worsening, whereas weight gain would indicate restoration of fluid volume.
Assess for clinical signs and symptoms of dehydration, including thirst, weight loss, dry mucous membranes, sunken-appearing eyes, decreased skin turgor, increased capillary refill time, hypotension and postural hypotension, tachycardia, weak and thready peripheral pulses, flat neck veins when the patient is in the