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03 June 2021
Volume 30 · Issue 12
ISSN (print): 0966-0461
ISSN (online): 2052-2819
The calculation of fluid balance involves measuring the amount of fluid entering the body and comparing it to the amount of fluid leaving the body. The purpose is to determine whether there is a deficit or an excess of fluid (Bannerman, 2018). Understanding a patient's fluid status can give an indication of overall health. Osmoregulation, the process of maintaining osmotic pressure, is how the body controls fluid and electrolyte concentrations. This is particularly important for patients who are unwell or have conditions that affect the kidneys.
Maintenance of fluid balance is an important activity and is essential for optimal health. If a patient has too much or too little fluid, this imbalance can cause health problems. There are some pathophysiological conditions that can result in fluid overload, such as kidney disease and some types of heart disease. When overload occurs, the person finds it difficult to excrete excess water from the body, leading to oedema and serious health concerns. Dehydration occurs when the body is using more fluid than has been taken in or when there has been excessive fluid loss. The presence of oedema is a sign that fluid is in the wrong places. Patients who are oedematous may have fluid overload or be hypovolaemic.
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Observation: Fluid Balance Overview When the amount of fluid lost from the body is equal to the amount of fluid taken in, the body is in fluid balance. Fluid in our body is found within the body cells (intracellular), surrounding the cells (interstitial) and within the blood vessels (intravascular). It is our bodies' principal chemical component, comprising, on average, 60 percent of our weight. In obese individuals and the elderly, total body fluid can be significantly lower. Fluid is constantly being lost by the body through perspiration, expired air (as water vapour), urine, feaces, and negligible amounts in tears and saliva. It is replaced in our daily basic intake of food and drink. There is no easy answers as to how much water a person is required to drink each day. Studies have produced varying recommendations over the years, but in truth, each individual water requirements depend on many factors, including his health and how active he is. Monitoring Fluid Balance Monitoring of fluid balance is required for people with renal failure, electrolyte imbalance, or severe vomiting and diarrhea. It is also necessary for people with nasogastric tubes and drainage collection devices. In addition, those receiving intravenous therapy and those taking medicines such as diuretics and corticosteriods also need to have their fluid balance monitored. These measurements are important to help evaluate a persont fluid and electrolyte balance, to suggest various diagnosis, and allows for prompt intervention to correct the imbalance. Records of all intake and output must be kept meticulously in an Intake and Output Chart (I/O Chart). All amounts must be measured and record in milliliters. Do not estimate the amount. If the person is able to cooperate, he should be encouraged to help in keeping an accurate record of his daily fluid intake and output. At the end of a 24-hours period, add up the total intake and output. Evaluate the person's fluid status in relation to the disease process, medication regimen, diet, and activity ordered by your healthcare professionals. The person is said to be in negative fluid balance if his output is greater than his intake. Conversely, a positive fluid balance occurs when intake is greater than output. If the difference is alarming, consult your doctor. Keep the chart to show to the doctor, and start a fresh one for the next 24-hours. Items Required for Measuring Intake and Output
Reference Chart for Measuring Utensils
*Quantity may varies with different utensils. Return to Top Measuring Intake
Return to Top Dehydration Dehydration can be defined as "the excessive loss of water from the body". It can be caused by losing too much fluid (as in vomiting and diarrhea), not drinking enough water, or both. The best way to treat dehydration is to prevent it from occurring. Always encourage the person to drink during an illness, and remember that his fluid needs is greater when he has fever, vomiting, or diarrhea. If you suspect excessive fluid loss during an illness, inform your doctor immediately. DO NOT wait for signs of dehydration. Signs of dehydration include:
*1 Dry skin in an elderly is not a reliable indication of dehydration as skin automatically loses moisture and elasticity with age. A better barometer is the color of urine: clear or light-colored urine means well hydrated, whereas a dark concentrated color usually signals dehydration. *2 A capillary nail refill test can be done by pressing firmly on a fingernail bed for 5 seconds and measure the speed at which blood returns after the pressure is released. In normal person, capillary refilling should take less than 3 seconds. *3 You can test the hydration state of the person by simply pinching up the skin on his hand into a fold. If dehydrated, the skin may lack its normal elasticity and sag back into position slowly. Normally, skin springs right back into position. Return to Top |