INTRODUCTION
Fluid balance abnormalities are either an overload of fluid or a decrease in effective fluid.
Fluid overload is clinically known as Edema.
Edema occurs most commonly in soft tissues of the extremities. It is possible to occur in any tissue.
Decreases in fluid overload are commonly referred to as dehydration.
FUNCTIONS OF FLUID
It helps to regulate the body’s temperature.
Body temperature has an important role as a thermo-regulator, regulating the overall body
temperature.)
If body becomes too hot, water is lost through sweat and evaporation of this sweat from the skin
surface removes heat from the body.
It transports nutrients and gases throughout the body.
It carries cellular waste products to excretion sites.
FLUID IMBALANCE
A fluid imbalance may occur when you lose more water or fluid than your body can take it. It can also
occur when you take in more water or fluid than your body is able to get rid of.
Fluid balance is very essential for health.
Patient’s fluid balance may disrupt through – illness, injury, surgery & treatments.
FLUID IMBALANCE
Hypovolemia (fluid volume deficit).
Hypervolemia (fluid volume excess).
HYPOVOLEMIA
Body starts to lose water all the time.
Person experiences thirst reflex and take fluids and eat foods that contain water.
Dehydration refers to a fluid loss of 1% or more of body weight
CAUSES
Diarrhea, burns, diuretic therapy, fever, impaired thirst, vomits, etc.
SYMPTOMS
Mild
Moderate
Severe
Mild fluid loss –
Increased heart rate
Weight loss
Restlessness
Anxiety
Moderate fluid loss –
Confusion
Dizziness
Irritability
Extreme thirst
Rapid pulse
Decreased urine output (10-30m¹/hr.)
Severe fluid loss –
Decreased cardiac output.
Unconsciousness
Weak or absent pulse
HYPERVOLEMIA
Refers to an excess of fluid (water and sodium)
Causes –
Early renal failure, Heart failure, IV therapy, excessive ingestion.
Symptoms –
Rapid pulse, hypertension, acute weight gain, edema
Assessment of fluid balance in body –
Three elements ;
Review of fluid balance charts.
Clinical assessment.
Review of blood chemistry.
REVIEW OF FLUID BALANCE CHART –
Intake amount of fluids should be equal to output amounts.
INTAKE –
Water, Juices, Tea, Coffee, IV fluids, etc.
OUTPUT –
Urine, Blood drainage, etc.
Record all fluid intake in the sheet.
Calculate the total at the
End of each shift.
If intake (I) more than output (O) – Edema.
If intake (I) less than output (0) – Dehydration.
ASSESSMENT OF EDEMA
Apply finger pressure
To an area near the ankle.
Release the pressure & check whether indentation remains in
The edematous tissue.
0+0mm pitting indicates – No pitting edema.
1+2mm pitting indicates – Depression that disappears.
2+4mm pitting indicates – Depression that disappears in 10-15 seconds.
3+6mm pitting indicates – Moderate pitting, depression that may last for more than 1 minute.
4+8mm pitting indicates (severe pitting) – depression that may last for more than 2 minutes.
ASSESSMENT OF DEHYDRATION
Observe vital signs – pulse, BP, respiratory rate.
Skin elasticity [However, this assessment is not
Reliable indicator for older patient as skin elasticity reduces with age].
Lift the skin of hand with 2 fingers & then let go → If skin doesn’t fall right back to normal, patient is
dehydrated
