Fluid Imbalance

SarahRN1987 · Jul 26, 2011

I vote "A."

classicdame, MSN, EdD · Jul 26, 2011

daily weight would be a late sign. You want to know asap to prevent complications.

honeykrown, MSN, NP · Jul 26, 2011

The patient doesn't have to pee every hr, but then the total volume of fluid release should be measured. The average should be 30ml/hr or urine output. So if from 2pm till 7pm the patient voided 200ml then the average output is 40ml/her which is still good.

nola1202 · Jul 26, 2011

agree with above, look up how to calcuate fluid output ml/kg. Daily weight is a good intervention when dealing with the cardiac, copd, kidney pt, but a gain of 3-5 lbs in 24 hours is good for observation intervention on a less critical pt.

chrelyne · Jul 26, 2011

they key pont in your question is "response to treatment" so A is right. Once treatment/intervention is started, output over the next few hours should change for the better, if not treatment needs to be changes/increased/adjusted. Waiting till tomorrow to check the weight cannot be right cause pt can be getting worse and you missed it.

LadyinScrubs, ASN, RN · Jul 26, 2011

question on an exam:
when evaluating the response to treatment for a patient with a fluid imbalance, the best assessment indicator to include is:
a.hourly urine output
b. daily weights[/quote]
this question rang a bell; i had a similar question.
- the nurse evaluating a client with a fluid imbalance monitors which of the following because it is the most sensitive indicator of body fluid balance? urine output
rationale: the most reliable indicator of fluid status is monitoring the client’s daily weight. urine output, serum electrolyte levels, and vital signs are ways to monitor fluid status, but not as reliable indicators.
as you can see, i chose urine output...and was wrong.

xtxrn, ASN, RN · Jul 26, 2011

The patient doesn't have to pee every hr, but then the total volume of fluid release should be measured. The average should be 30ml/hr or urine output. So if from 2pm till 7pm the patient voided 200ml then the average output is 40ml/her which is still good.

However, if you've got a frail, petite patient, they may not fall into the 30 ml/hr....that number is an estimate based on the average for an adult-- middle ground, but just an estimate for minimal output --, but the pedi calculations can be useful for a tiny patient- 1ml/kg/hr..... :) And, a big patient can be dehydrated with 30ml/hr..... also look at urine color, odor, turbidity.

This is a question IMHO that really isn't covered by the answers provided... :) :twocents:

nurseprnRN, BSN, RN · Jul 26, 2011

unless you have a foley, you don't really know what uo is. also, there are many other ways for patients to lose fluids-- vomiting, in stool, diaphoresis, respiratory tree losses breathing dry air, wound fluids .... and if you are only looking at uo, you're completely missing the big picture (and this is a big-picture question). also, when your patient goes home, you'll have taught him to weigh himself every morning after he gets up and empties his bladder, and to report any weight gain to his primary care, because edema doesn't show up in most folks until you're ten liters over your dry weight (ooooh! ever heard that term?), and you don't want to wait until they're already in early chf, do you?

so... the answer to this absolutely classic question is, and always has been, and always will be: daily weights.

LadyinScrubs, ASN, RN · Jul 26, 2011

[...] so... the answer to this absolutely classic question is, and always has been, and always will be: daily weights.

thank you. now i understand so much better...thanks for taking the time to answer.

akulahawkRN, ADN, RN, EMT-P · Jul 26, 2011

From food intake or exercise/BMR output (calories) a daily weight won't change that much. Fluid in or out will... at at 8 lbs / gallon, it doesn't take much fluid in or out to cause >2 lb weight gain or loss.

Unless your patients are "Biggest Loser" contestants, you won't see massive gains or losses on a daily weight... Those BL contestants will lose on average about 1-2 lbs per day. Most people aren't willing to run a 3500-7000 calorie deficit every day!

chrelyne · Jul 27, 2011

Both arguments are making good points BUT you are adding what if's to the question and not answering what the questions is asking. In the original, it is asking about response to treatment, so I would go with Urine output, (give lasix, increase urine output is what you want) in the other post to this thread it is asking about monitoring (not treatment response) so daily weights (gain 3 lbs in 24 hours, something is going on) makes more sense..