fluid balance charts amanda thompson learning & development lead educator (professional and...
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Fluid Balance Charts
Amanda Thompson Learning & Development Lead Educator (professional and clinical practice)
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What is Fluid Balance?
The balance of input and output of fluids in the body to allow metabolic processes to function correctly
Fluid in Fluid out
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Why is Fluid Balance Important?
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Fluid Balance
Achieving optimal hydration is an essential part of holistic care
Dehydration and over hydration can have serious clinical consequences
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Body Water Content age + body mass + body fat = Total body water The body water content of men is about 60% and is 50% in women where there is relatively more body fat and less skeletal muscle Body water declines throughout life and is generally around 45% of total body mass in old age
A fluctuation of 5-10% can have a serious impact on health. Depending on amount - loss of body mass leads to impaired cognitive function, headache, fatigue, dry skin, hypovolaemia, shock, organ failure and ultimately death
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Fluid CompartmentsCells
There are two main fluid compartments in the cells of the body:
the intracellular compartment contains slightly less than two-thirds by volumeThe remaining third is distributed in the extracellular fluid.
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How do we gain fluid?
How do we loose fluid?
How much fluid do we need each day?
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Average recommended Daily input and output of fluid
Water gain=Water loss
Intake: 2500ml
Output:2500ml
Metabolic(200ml/day)
GI Tract(100ml/day)
Ingested moist food800ml/day
Skin(600ml/day)
Ingested liquids1500ml/day
Kidneys(1500ml/day)
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In Hospital …Who is at risk of gaining too much fluid ?
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Fluid Overload
• Patients with heart failure• Patients with renal failure• Patients with liver failure• Increased antidiuretic hormone (ADH)
secretion – e.g. following head injury or major surgery.
• Over hydration (Iatrogenic)
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Presentation – Fluid overload
• Breathlessness (Dyspnoea)• Oedema• Reduced or increased urine output• Raised Blood Pressure / Low Blood
Pressure
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In Hospital …Who is at risk of loosing too much fluid ?
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Dehydration
• Inadequate intake of nutrition and fluidsDementia, Frailty, Fear of incontinence
• Excessive fluid loss :Diarrhoea, Vomiting, Haemorrhage, Sepsis, Fever, Burns
What does thirst feel like?
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Presentation-Dehydration?
• Dry mouth• Poor skin turgor• Low Blood Pressure• Raised heart rate• Raised respiratory rate• Poor urine output
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Clinical assessment of fluid balance
Observation Fluid Depletion Fluid Overload
Weight Loss Gain
BP Lowered (Smaller Pulse pressure)
Normal, low or raised
Respirations Rapid, shallow Rapid, moist cough
Pulse Rapid. Weak and Thready Rapid
Urine Output Reduced / concentrated Increased or decreased
Skin Dry, less elastic Oedematous
Saliva Thick, viscous Copious, frothy
Tongue Dry and coated Moist
Thirst Present No disturbance
Face Sunken eyes (severe) Periorbital oedema
Temperature May be raised No disturbance
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Negative Fluid BalanceDeficit in fluid volume = Output is greater than input / insufficient input
Positive Fluid BalanceFluid intake is greater than output / insufficient output
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Fluid Balance Charts
• Are legal documents and may be used in a court of law
• Must be completed in full, accurately and legibly
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Who is accountable for the assessment and monitoring of fluid balance?
Who is accountable for the recording of fluid input and fluid output?
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Completing a fluid balance chart accurately
RCHT Policy
Practice
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•the patient’s intake and output must be recorded accurately. Ambiguous comments, for e.g. pu’d ++. is not acceptable•Use every tool available to assure the best information. If not possible, use estimated amounts•Patient monitoring and review of the daily fluid balance chart should take place as often as required. •Nursing staff should include in the shift handover a clear indication of the patient requiring fluid balance monitoring and any who present concerns as this may mean reviewing the patient and completing the chart more regularly
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Barriers to accurate completion
• Poor compliance• Skill-Poor understanding• Skill-Lack of training• Time
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Solutions?• Nurse led assessment on admission• Appropriate placement on fluid
balance charts• Training, education and support• Frequent monitoring and on going
assessment• Follow the hospital policy
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Summary
Incorrect or poorly completed fluid balance charts and ineffective monitoring can result in detrimental effects on patient outcomes including; delayed medical review, unexpected patient deterioration, over or under- prescribing of fluids, prolonged hospital stay and in some cases, result in patient morbidity and mortality (NICE, 2007).
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Questions?