الفهرس 
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Abstract
Maintenance of fluid balance is considered critical to sustaining many bodily functions, including metabolic and biochemical reactions, transport of nutrients and thermo-regulation. The average adult has roughly 65% fluid mass, with this value being slightly lower in females than males. Body fluids may classify into intracellular fluid compartment and extracellular fluid compartments (Chen, et al., 2020).
Hydration is important for proper physiological function in humans. Alterations in hydration level can cause physical and cognitive impairments in healthy adults. Illness affects hydration status in many ways. The patient may be unable to ingest food or liquids, there may be a problem with absorption from the intestinal tract, or there may be kidney impairment that affect excretion or reabsorption of water and electrolytes (Besler, et al., 2020).
Any disease that affects circulation such as “heart failure” will affect distribution and composition of body fluids. Extra fluid is lost when metabolic rate is accelerated, such as occurs in fever, burn, trauma, sepsis, thyroid crisis, hot environment, and states of extreme stress. Patients on mechanical ventilator, those with rapid respirations, and those with severe diarrhea, vomiting or excessive amount of fistula drainage also lose greater amount of fluids. Any critically ill patient is at risk for fluid and electrolyte imbalance (Stromberg, 2020).
Aim of the study:
This study was aimed to assess the factors affecting hydration status among critically ill patients through:
1.Assess critically ill patient’s hydration status.
2. Assess factors affecting hydration status among critically ill patient.
Research Questions:
To fulfill the aims of the current study, the following research questions were formulated:
1- What is the current critical ill patient’s hydration status?
2- What are the factors affecting hydration status among critically ill patients?
Subject and methods:
Research design: A descriptive exploratory design was utilized to achieve the aim of the present study
Setting: The current study was carried out in four different intensive care unit (ICU) at Elzaitoun specialized hospital, Egypt, Cairo. These units are Medical Intensive Care Unit 1, Medical Intensive Care Unit 2, the Cardiac Care Unit (CCU), and Open-heart Intensive Care unit
Subjects: A convenient sample of 100 patients were included in this study.
Study tools:
Two tools were utilized to collect data pertinent to the current study; it was developed by the researcher in English language.
I. Patient’s Hydration Status Physical Assessment Tool:
This tool was used to assess the hydration status of patients; and consists of three parts as follows:
- The first part: is concerned with demographic characteristics of patients under the study, it consists of seven questions regarding age, gender, marital status, educational level, occupation, and date of ICU admission.
- The second part: is concerned with patient’s clinical data, it includes questions about present, past history, and family history. It includes five questions.
- The third part: this part is divided into five sections as follow; assessment of vital signs, assessment of oxygenation and ventilation status, physical examination of body systems (cardiovascular system, respiratory system, integumentary system, gastrointestinal system, urinary system), general signs of altered hydration status, fluid balance chart and laboratory investigations.
2-Factors Affecting Hydration Status of Critically Ill Patient Assessment Tool:
It was used to assess factors affecting hydration status of critically ill patients. This tool is classified into four parts, which includes patient related factors, environmental related factors, nurses related factors, and physicians related factors.
Results of the study:
This study revealed the following results:
- Fifty nine (59%) of the studied patients were males.
- Fifty one (51%) of studied patients age ≤ 60 years old.
- Fifty one (51%) of the studied patients suffering from fluid volume deficit (dehydration), (33%) of the patients had fluid volume excess (overhydration) and (16%) of the studied patients were EU hydrated.
- There is a significant relation between patient’s hydration status and age, history of ischemic heart disease (IHD), vital signs, consciousness level, cumulative fluid balance, diuretics, betablockers, anticonverting enzyme (ACEI) medications.
- There is no statistically significant relation between hydration status and demographic data, lab investigation, and presence of infection.
Conclusion:
Based on the findings of this study it can be concluded that the present study reveals that about half of the patients suffering from fluid volume deficit, and more than one third suffering from overhydration. Dehydration (fluid volume deficit) is more common than overhydration (fluid volume excess) among critically ill patients. Also, it can be concluded that there were many factors affecting patients’ hydration status such as: previous history (comorbidities), respiratory infection, deterioration in level of consciousness, vomiting, fever, impaired skin integrity, overweight, smoking and use of antibiotic, antiacid, calcium channel blockers, beta blockers, and diuretics medications.
Recommendations
Based on findings of the present study, the following recommendations are suggested:
Recommendations related to patients:
1. Regular follow up for all patients with hydration alterations to evaluate their health conditions and to detect complications early.
2. Monitoring of fluids intake and output should be done.
3. Training programs for the critical care nurses regarding importance of hydration and the risk factors affecting hydration status of critically ill patient.
5. Availability of written guidelines, booklets, policies regarding fluid balance monitoring.
6. Correct the shortage in nursing staff number to decrease risk of fluid balance monitoring error.
7 Establishment of continuing educational programs including evidence-based guidelines to improve nurses’ knowledge and practice regarding fluid balance monitoring.
Recommendations for further researches:
1. Replication of the study on a larger probability sample selected from different geographical area in Egypt is recommended to obtain more generalized data.
2. Further studies have to be carried out in order to assess hydration status of patients.
3. Further researches should be conducted to raise awareness of patients’ and nurses’ staff about hydration status and factors affecting hydration status.