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Module 2 : Clinical Assessment



Fluid balance chart


The nurses will record the daily inputs and outputs of fluid from a patient. In a nil by mouth (NBM) patient this is particularly important as all fluids must be given IV.


Below is an example of a daily fluid balance chart showing some of the possible fluid inputs and outputs that may be recorded (click the image to enlarge).




The nurses cannot record insensible losses, however bear in mind a  ‘healthy’ patient will  lose approximately 800-1000ml (See Physiology : Fluid balance in health to revise this). The example fluid balance chart states insensible losses as 800ml of ‘evaporation’ to help remind nurses to include this in their total fluid balance calculation. Although this inclusion depends on the hospital trust.


It is important to bear in mind that sick patients  e.g. with burns and fever will have much higher insensible losses – appreciation of this will rely on your own clinical judgement.


It is important to appreciate however, that fluid balance charts can only be used as a rough guide for what has gone in and out of the body as it is extremely difficult to accurately measure this. In addition an accurate account demands generally unavailable nurse time. Therefore clinical assessment is always more reliable than the fluid balance chart. Only in unusual situations, in which there are very high fluid losses such in the case of a massive diuresis (e.g. sometimes after kidney transplants), is an accurate fluid balance chart an important determinant of fluid prescription; often then IV fluids are prescribed as recorded output +30ml per hour, for instance, to account for insensible losses.


  Test Yourself !  
  The patient on the fluid balance chart is apparently in negative fluid balance, on clinical assessment however they appear to be euvolemic, what might explain this?

How did you do?

Often on a busy ward nurses can forget to record a patient's fluid inputs or outputs. Patients that are not nil by mouth can drink variable amounts throughout the day which can be difficult to accurately record and patients not catheterised may also forget to void into a bottle/commode pan for measuring.


In addition the insensible losses stated as an average on the fluid balance chart may be an overestimation for that day. Daily insensible losses can be widely variable depending on many factors including the state of the patient's health and their activity levels that day.





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