{"id":4819,"date":"2020-06-22T14:54:46","date_gmt":"2020-06-22T14:54:46","guid":{"rendered":"http:\/\/edren.org\/ren\/?page_id=4819"},"modified":"2020-06-22T15:05:43","modified_gmt":"2020-06-22T15:05:43","slug":"how-to-complete-a-fluid-assessment","status":"publish","type":"page","link":"https:\/\/edren.org\/ren\/education\/aki-cases\/aki-case\/how-to-complete-a-fluid-assessment\/","title":{"rendered":"How to Complete a Fluid Assessment"},"content":{"rendered":"\n<p>Being able to assess the fluid status of a patient is a key skill that you will regularly do as a junior doctor. It involves assessing if a patient is <strong>hypovolaemic<\/strong>, <strong>euvolaemic<\/strong> or <strong>hypervolaemic<\/strong> and then using this information to guide your clinical management going forwards.<\/p>\n\n\n\n<p><strong>Factors to consider before examining the patient<\/strong><\/p>\n\n\n\n<p style=\"color:#e01616\" class=\"has-text-color has-medium-font-size\"><strong>Read the notes and take a history!<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Why is this patient in hospital?<\/li><li>Reasons for admission which may affect fluid requirements include:<ul><li>Trauma<\/li><\/ul><ul><li>Burns<\/li><\/ul><ul><li>Fever<\/li><\/ul><ul><li>Surgical patients: pre or post op, NBM?<\/li><\/ul><ul><li>GI losses \u2013 vomiting, diarrhoea, stoma output<\/li><\/ul><\/li><li>What is their relevant past medical history?<ul><li>Renal disease<\/li><\/ul><ul><li>Heart failure<\/li><\/ul><ul><li>Pre or post op<\/li><\/ul><\/li><li>Drug history<ul><li>Diuretics<\/li><\/ul><ul><li>Drugs which can alter bowel habit<ul><li>E.g. antibiotics (diarrhoea), opioids (constipation)<\/li><\/ul><\/li><\/ul><\/li><li>Other factors<ul><li>Active bleeding?<\/li><\/ul><ul><li>Vomiting: how much, how often, blood?<\/li><\/ul><ul><li>Stools: how much, how often, blood?<\/li><\/ul><ul><li>Fever<\/li><\/ul><ul><li>Urine output<\/li><\/ul><ul><li>Thirst<\/li><\/ul><ul><li>Light-headedness \/ dizziness<\/li><\/ul><ul><li>Eating \/ drinking over the last day or so<\/li><\/ul><ul><li>Are they already receiving IV fluids?<\/li><\/ul><ul><li>Is there a fluid restriction in place?<\/li><\/ul><\/li><\/ul>\n\n\n\n<div class=\"wp-block-media-text alignwide is-stacked-on-mobile\" style=\"grid-template-columns:45% auto\"><figure class=\"wp-block-media-text__media\"><img loading=\"lazy\" decoding=\"async\" width=\"940\" height=\"623\" src=\"http:\/\/edren.org\/ren\/wp-content\/uploads\/2020\/06\/steehscope-1.png\" alt=\"\" class=\"wp-image-4821\" srcset=\"https:\/\/edren.org\/ren\/wp-content\/uploads\/2020\/06\/steehscope-1.png 940w, https:\/\/edren.org\/ren\/wp-content\/uploads\/2020\/06\/steehscope-1-300x199.png 300w, https:\/\/edren.org\/ren\/wp-content\/uploads\/2020\/06\/steehscope-1-768x509.png 768w, https:\/\/edren.org\/ren\/wp-content\/uploads\/2020\/06\/steehscope-1-150x99.png 150w\" sizes=\"auto, (max-width: 940px) 100vw, 940px\" \/><\/figure><div class=\"wp-block-media-text__content\">\n<p style=\"color:#e11717\" class=\"has-text-color has-large-font-size\"><strong>Examination<\/strong><\/p>\n<\/div><\/div>\n\n\n\n<p><strong>General Inspection<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Age of the patient<\/li><li>Obvious oedema from end of bed<\/li><li>Shortness of breath?<\/li><li>Colour \u2013 pallor?<\/li><li>Anything around the bed space \u2013 IV fluids, catheter, stoma, surgical drains etc.<\/li><li>Look in patient notes for fluid balance chart and Bristol stool chart \u2013 not always filled out but very helpful when it is<\/li><li>There may also be a daily weight chart \u2013 also very helpful!<\/li><li>Use this time to check medications if you haven\u2019t already too<\/li><\/ul>\n\n\n\n<p><strong>Hands<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Inspect: oedema, peripheral stigmata of disease<\/li><li>Temperature<\/li><li>Palpate the radial pulse: volume and rate<\/li><li>Capillary refill time: should be &lt;2<\/li><\/ul>\n\n\n\n<p><strong>Arms<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Check blood pressure \u2013 often a late sign but still helpful<\/li><li>Lying and standing BP<\/li><li>Assess skin turgor \u2013 gently pinch a fold of skin for a few seconds, assess how long it takes to return to normal<\/li><\/ul>\n\n\n\n<p><strong>Face<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Ask patient to open mouth to assess mucous membranes<\/li><li>Look to eyes for pallor and sunken eyes<\/li><\/ul>\n\n\n\n<p><strong>Neck<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Check JVP: if&nbsp; &gt;3cm consider fluid overload<\/li><\/ul>\n\n\n\n<p><strong>Chest<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Respiratory rate<\/li><li>Listen over 4 heart valves: added S3 gallop rhythm might be heard in fluid overload<\/li><li>Auscultate lungs \u2013 coarse crackles may indicate pulmonary oedema<\/li><li>Assess for sacral oedema at bottom of back<\/li><\/ul>\n\n\n\n<p><strong>Abdomen<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Assess for ascites: shifting dullness<\/li><\/ul>\n\n\n\n<p><strong>Legs<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Assess for peripheral oedema: if so, how far up does it go?<\/li><\/ul>\n\n\n\n<p><strong>Drains<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Look to catheters, stomas, surgical drains<\/li><li>Assess output volume, colour and type of output<\/li><\/ul>\n\n\n\n<p style=\"color:#e71414\" class=\"has-text-color has-medium-font-size\"><strong>Further tests<\/strong><\/p>\n\n\n\n<p><strong>Bloods:<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>FBC: drop in Hb suggests haemorrhage, raised haemocrit suggest dehydration<\/li><li>Urea\/creatinine: raised in dehydration, urea raised in upper GI haemorrhage<\/li><li>Sodium: raised in dehydration, low in fluid overload (dilutional)<\/li><\/ul>\n\n\n\n<p><strong>Imaging<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Chest X-ray: pulmonary oedema<\/li><li>Echocardiogram: heart failure<\/li><li>Bladder scan: urinary retention<\/li><\/ul>\n\n\n\n<p><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Being able to assess the fluid status of a patient is a key skill that you will regularly do as a junior doctor. It involves assessing if a patient is hypovolaemic, euvolaemic or hypervolaemic and then using this information to guide your clinical management going forwards. Factors to consider before\u2026<\/p>\n<p> <a class=\"continue-reading-link\" href=\"https:\/\/edren.org\/ren\/education\/aki-cases\/aki-case\/how-to-complete-a-fluid-assessment\/\"><span>Continue reading<\/span><i class=\"crycon-right-dir\"><\/i><\/a> <\/p>\n","protected":false},"author":7,"featured_media":0,"parent":4792,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_lmt_disableupdate":"","_lmt_disable":"","footnotes":""},"class_list":["post-4819","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/pages\/4819","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/users\/7"}],"replies":[{"embeddable":true,"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/comments?post=4819"}],"version-history":[{"count":1,"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/pages\/4819\/revisions"}],"predecessor-version":[{"id":4822,"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/pages\/4819\/revisions\/4822"}],"up":[{"embeddable":true,"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/pages\/4792"}],"wp:attachment":[{"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/media?parent=4819"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}