FLUID BALANCE EXAMINATION Flashcards
How would you start any examination?
WIPER QQ Wash hands Introduce yourself Ask permission Expose the patient Reposition the patient
Ask if they are in any pain or discomfort
How exposed should the patient be for the fluid balance examination?
You will need to be able to see their arms, legs and abdomen.
How should the patient be positioned for the fluid balance examination?
Lying down at 45 degrees
Before inspection, what specific questions must you ask the patient at the beginning of a hydration assessment (or fluid balance examination)?
Have you had any diarrhoea or vomitting?
Do you feel dizzy on standing?
On inspection from the end of the bed as part of the fluid balance exam, what sort of things might you be looking for?
Whether the patient looks comfortable/pale/sweaty Breathless Catheter Obesity Cachexia NG tubes IV lines Stoma
Food or drink
BP cuff
Nil by mouth signs
Vomit bowels
What are you looking for in the hands and arms of patient whose fluid balance you are assessing?
Temperature Radial pulse character and rate - tachycardia in both dehydration and overload Capillary refill time Brachial pulse character and rate Skin turgor - back of the hand
Having inspected the patient’s hands and arms as part of the fluid balance examination, what would do you next?
Take a blood pressure, sitting and standing
What would you look for in the face of someone whose hydration status you were assessing?
Conjunctival pallor
Sunken eye balls
Dry/wet mouth (remember to ask them to stick their tongue out)
What would you look for in the neck of someone whose hydration status you were assessing?
JVP - remember to do hepatojugular reflex
Carotid pulse
What should you ask the patient before you assess the JVP and hepatojugular reflex?
Ask patient to turn head to the left
Ask if they are in any pain in their tummy
What would you look for on the chest of someone whose hydration status you were assessing?
Skin turgor
Central capillary refill time
Having inspected the patient’s chest as part of a fluid balance examination, what would you do next?
Palpate apex beat
Percuss chest - remember to do the back as well
Having percussed the chest as part of a fluid balance examination, what would you do next?
Auscultate the heart and chest
What are you looking for when auscultating the heart as part of the fluid balance examination?
A third heart sound, which would be indicative of overload
What are you looking for when auscultating the lungs as part of the fluid balance examination?
Crackles which could be a sign of pulmonary oedema, which could be a sign of overload
Whilst you have patient sitting forwards to assess their lung bases, what must you remember to assess?
Sacral oedema
Having auscultated the heart and lungs what would you look for as part of the fluid balance examination?
Ascites - recline the patient so they are lying flat
Ankle oedema
What are the causes of overload?
Iatrogenic - IV fluid overload
Cardiac failure
Renal failure
Increased ADH secretion for any reason (siADH)
How can the causes of dehydration be split?
Input
Output
What are the causes of dehydration where reduced input is the key factor?
Often elderly people eat and drink less
What are the causes of dehydration where increased output is the key factor?
Diabetes Drugs (eg diuretics) Diarrhoea Vomitting Fever - sweating Iatrogenic - insufficient fluid replacement during surgery Haemorrhage Sepsis
What are advised to do before approaching the patient to assess their hydration status?
Review the obs charts - looking specifically at BP, HR, urine output
Drugs charts - looking for any diuretics or nephrotoxic drugs and for any prescribed fluids
Review recent blood results - increased urea which is more than creatinine increase, increased albumin, increased haematocrit.
How would you manage a patient who is found to be dehydrated following a fluid balance examination?
Fluid challenge - 250-500 ml of Hartmann's Work out why they are dehydrated Increase oral intake of fluids Add maintenance IV fluids if required Adjust medication
How would you manage a patient who is found to be overloaded following a fluid balance examination?
Nitrates
Diuretics
CPAP if breathlessness is severe
Work out why they are overloaded
