Wet vs. dry

[PJMommy]

How do docs and nurses decide if a pt is wet vs. dry? I understand basic values and clinical signs like CVP values or crackles in the lungs. But another nurse mentioned recently that a "dry" pt tends to have a labile BP and I realized that I don't have a good comprehensive knowledge of s/s of fluid status. Can someone provide a list of s/s we'd likely see in a "wet" pt and those in a "dry" pt? Or point me to where I can find this?

[neneRN, BSN, RN]

WET-SOB, rales, edema, HTN, JVD, difficulty lying flat, kind of restless, decreased O2 sats, gonna have orders for IV Lasix, NTG, maybe Natrecor, hopefully will have a foley filling up with very dilute urine...basically anything you would expect to see knowing there is too much fluid.

DRY-low BP, tachy, poor skin turgor, dry oral mucosa, dry skin, elevated BUN, ALOC, lots of times they're febrile (more of a cause than effect), poor urine output (darker concentrated urine appearance), wil have orders for IVF and usually antibiotics (infection is a very common cause of dehydration)

[Tweety, BSN, RN]

It gets tricky because pneumonia patients often sound wet to some people. I've seen a nurse mistakenly call an MD for a patient being wet and gave lasix, got no response and dried him out more.

[pricklypear]

Labile BP in dry patients can be caused by fluctuating SVR ; pipe diameter changing trying to compensate for low volume. Some patients may overcompensate by clamping down, increasing SVR, thus increasing BP. You may have an adequate BP, but you have crappy COs. If you have an artline, sometimes you can see an up and down pattern related to respirations, especially ventilated patients with deep, regular respirations.