Hydration Status

Question 1

End of bed

Answer 1

Surrounding area - drips, vomit bowls, catheter, food, drinks, stoma

GI - well / unwell, breathless, obvious oedema, body habitus

Question 2

Hands & Arms

Answer 2

Temp and cap refill
Skin tugor
Radial pulse - rate and rhythm (tachy in dehydration but also may occur in overload)
BP - hypo (dehydration), hyper (overload), lying and standing (> 20 difference = postural hypotension)

Question 3

Neck and head

Answer 3

Carotid pulse volume - weak / thready (dehydration), bounding (possible overload)
JVP - not visible (dehyrdation?), > 4cm raised (overload)
Eyes - sunken / periorbital oedema
Mouth - dry mucous membranes
Temperature? - risk of dehydration

Question 4

Chest

Answer 4

Parasternal heave - right heart dilatation?
Apex beat - displaced left heart dilation?
Auscultate precordium - 4 cardiac areas - listen for third heart sound (best heard at apex)
Lung bases

Question 5

Other

Answer 5

Sacral oedema
Ankle oedema
Review fluid balance chart, obc chart, drugs chart, blood results, CXR

Relevant investigations - U&Es, albumin, regular obs, closely monitor fluid balance, daily weights, CXR