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Module 6 : Summary

 

 

Module 2 Summary : Clinical Assessment

 

  • In order to gauge a patient’s fluid status, there are a variety of simple clinical assessments and tools which can be used to build this impression. This includes a focused patient history, observation of clinical signs, use of fluid balance charts, daily patient weighing and serum urea and electrolytes.  In the case of critically ill patients and high risk patients intraoperatively, invasive monitoring of fluid status can be used. 
  • When taking a patient history it is necessary to ascertain fluid losses e.g. vomiting or diarrhoea as well as conditions which predispose to retaining fluid e.g.  heart failure and renal failure.
  • There are various clinical signs which alert to a status of fluid deficit or overload. They tend to lack sensitivity but in combination have greater weighting. Signs of fluid deficit may include postural hypotension, tachycardia, dry mucous membranes and oliguria. Signs of fluid overload may include hypertension, peripheral pitting odema and pulmonary oedema which causes bibasal crackles on auscultation.
  • Fluid balance charts are often used in hospital patients to monitor fluid inputs and outputs. When interpreting these charts it is important to appreciate that there may be a level of inaccuracy in the recordings and a rough estimate of insensible losses should be factored into the fluid balance calculation.
  • For patients prone to retaining fluid, daily weighing  can be a useful indicator of fluctuations in fluid, whereby 1kg of weight loss equates to 1kg of fluid loss.
  • Serum biochemistry results can also be used to give an impression of fluid status. The most important results to look at are urea, creatinine, and sodium levels, all of which may rise in dehydration.

 

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