The nurse who is caring for an older client with severe dehydration knows that the best indicators of hydration status are

capillary refill time
dry tongue and oral mucosa
heart rate


• For every liter of fluid lost, the cardiac output decreases by 1 L/min, and the heart rate increases 8 beats/min.

• Capillary refill time is a good indicator of hydration status, with a prolonged peripheral venous filling time of more than 5 seconds noted in severe dehydration.

• The mucous membranes of the mouth and eyes become dry even though fluid is recruited from the interstitial spaces. The lips can crack, and furrows may be seen on the tongue. Swallowing can become difficult.


• Thirst is an indicator of hydration, but not one of the best since the elderly have decreased sensations of thirst, and some conditions (like hyperglycemia) may affect thirst as well.

• Soft and sunken eyes may be noted in clients with dehydration, but this is not the best indicator of hydration status.

• Decreased skin turgor occurs when the skin tissues tend to stick together because of the decreased interstitial fluid. However, skin turgor is not diagnostic of dehydration in older adults because tenting commonly results from loss of elastin in the skin in this group.

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