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Cardio Exam
 
 

Fluid Status

 
 
 
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Dehydration

  • Look For

  • Abnormal obs - tachycardia, hypotension
  • Fluid balance chart - negative fluid balance, oliguria
  • Weight loss - an acute decrease in weight may indicate short-term change in fluid status
  • Dry mucous membranes - especially the tongue
  • Sunken eyes
  • Increased capillary refill time (>2 seconds)
  • Weak radial pulse
  • Decreased skin turgor - pinch a fold of skin on the patient’s arm and then release it. Decreased skin turgor is present if the fold takes an abnormal time to return to its normal contour.
  • Causes of Dehydration

  • Poor fluid intake
  • Fluid loss - diarrhoea, vomiting, sweating, diuresis (diabetes, diuretics)
  • Complications

  • Seizures
  • Renal failure
  • Hypovolaemic shock

Fluid Overload

  • Look For

  • Hypertension
  • Positive fluid balance in obs chart
  • Weight gain - look for a recent weight and compare to current weight
  • Bounding pulses
  • Raised JVP
  • Presence of S3 (gallop rhythm)
  • Crackles on lung field auscultation
  • Ascites - shifting dullness or fluid thrill
  • Pitting oedema to the sacrum and lower limbs, as well as elsewhere in the body in severe hypervolaemia
  • Causes of Fluid Overload

  • Excessive IV fluids
  • Heart failure
  • Renal failure
  • Hepatic cirrhosis
  • SIADH
  • Pregnancy
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