Hydration Staus Examination

Question 1

What are you looking for in the surrounding area?

Answer 1

Drips / IV lines
Vomit bowls
Catheter
Food/drink 
NBM sign 
Stoma

Question 2

What are you looking for on general inspection?

Answer 2

Does the patient look well
Does the patient look breathless (SOB - indicate pulmonary oedema)
Any obvious oedema
Body habitus

Question 3

What signs are you looking for in the hands

Answer 3

Cap refill
Skin turgor - pinch skin on back of hand
Radical pulse - tachycardia can suggest dehydration

Question 4

What change in blood pressure would indicate postural hypotension

Answer 4

Lying and standing BP

Difference of >20mmHg

Question 5

What signs are you looking for in the face?

Answer 5

Sunken eyes - dehydrated
Periorbital oedema - fluid overload
Dry mucus membranes - dehydration

Question 6

How would the JVP indicate fluid status

Answer 6

Not visible - ? Dehydration

>4cm raised - ? Fluid Overload

Question 7

What signs are you looking for in the chest?

Answer 7

Parasteral heave - suggests RHF and fluid overload
Apex beat displaced - suggests LHF and fluid overload
Heart valves - listen for 3rd heart sound (S3 heard in fluid overload)
Lung bases - crackles suggest LHF? Fluid overload

Question 8

What would sacral or ankle oedema suggest?

Answer 8

Fluid overload

Right sided heart failure

Question 9

What sign would you look for in the abdomen?

Answer 9

Ascites (shifting dullness)

Question 10

What would you want to review at the end of the examination

Answer 10

Lying and standing BP
Fluid balance chart 
Observation chat 
Fluid prescription chart
Stool chart - Diarrhoea ?
Medication charts - meds that alter fluid balance 
CXR - signs of pulmonary oedema

Question 11

How would the bloods change in dehydration

Answer 11

FBC - Haematocrit is often raised
U&E - Urea and creatinine raised (due to less kidney filtration)
Albumin - raised

Question 12

If you suspected ascites what would you do?

Answer 12

Abdominal ultrasound

Question 13

What imaging would be best to assess fluid status?

Answer 13

Chest X-ray - pulmonary oedema
Echocardiogram - assess for heart failure
Bladder scan - assess urinary retention
Abdominal ultrasound - look for Ascites

Question 14

What are the main causes of fluid overload?

Answer 14

Iatrogenic
Cardiac failure
Renal failure
Increased ADH secretion (SIADH or diabetes insipidus)

Question 15

What are the main causes of dehydration?

Answer 15

Age - thirst decreases, people tend to eat/drink less
Diabetes 
Diarrhoea and vomiting  
Drugs - diuretics 
Haemorrhage and sepsis

Question 16

If a patient appeared dehydrated how would you manage this?

Answer 16

Severely dehydrated - give fluids
Find the cause of dehydration
Encourage oral intake
Alter medications e.g, diuretic if needs be

Question 17

If a patient is suffering from fluid overload how would you treat them?

Answer 17

Diuretics
CPAP - if patient is breathless due to pulmonary oedema
Find the cause of the overload?