Maristany Cleofé Pérez-Portabella, Segurola Gurruchaga Hegoi
Unidad de Soporte Nutricional Hospital Vall d'Hebrón, Barcelona.
Rev Enferm. 2011 Jan;34(1):59-64.
Water is an essential foundation for life, having both a regulatory and structural function. The former results from active and passive participation in all metabolic reactions, and its role in conserving and maintaining body temperature. Structurally speaking it is the major contributer to tissue mass, accounting for 60% of the basis of blood plasma, intracellular and intersticial fluid. Water is also part of the primary structures of life such as genetic material or proteins. Therefore, it is necessary that the nurse makes an early assessment of patients water needs to detect if there are signs of electrolyte imbalance. Dehydration can be a very serious problem, especially in children and the elderly. Dehydrations treatment with oral rehydration solution decreases the risk of developing hydration disorders, but even so, it is recommended to follow preventive measures to reduce the incidence and severity of dehydration. The key to having a proper hydration is prevention. Artificial nutrition encompasses the need for precise calculation of water needs in enteral nutrition as parenteral, so the nurse should be part of this process and use the tools for calculating the patient's requirements. All this helps to ensure an optimal nutritional status in patients at risk. Ethical dilemmas are becoming increasingly common in clinical practice. On the subject of artificial nutrition and hydration, there isn't yet any unanimous agreement regarding hydration as a basic care. It is necessary to take decisions in consensus with the health team, always thinking of the best interests of the patient.
水是生命的重要基础,具有调节和结构功能。调节功能源于其积极和被动地参与所有代谢反应,以及在保存和维持体温方面的作用。从结构上讲,它是组织质量的主要构成部分,占血浆、细胞内液和间质液基础的60%。水也是遗传物质或蛋白质等生命基本结构的一部分。因此,护士有必要尽早评估患者的水需求,以检测是否存在电解质失衡的迹象。脱水可能是一个非常严重的问题,尤其是在儿童和老年人中。用口服补液溶液治疗脱水可降低发生水合紊乱的风险,但即便如此,仍建议采取预防措施以降低脱水的发生率和严重程度。保持适当水合状态的关键在于预防。人工营养包括精确计算肠内营养和肠外营养中的水需求,因此护士应参与这一过程并使用计算患者需求的工具。所有这些有助于确保有风险的患者获得最佳营养状态。伦理困境在临床实践中越来越常见。关于人工营养和水合作用,在将水合作为基本护理方面尚未达成一致意见。有必要与医疗团队协商做出决策,始终考虑患者的最大利益。