Fluid restriction question

[General E. Speaking, RN, RN]

Let's say the doc orders a 1500ml/24hrs fluid restriction. How do you interpret that? In my experience, I think this means to restrict oral intake. I had a new nurse criticize me for giving too much fluid during my 7a-7p shift. This was based on the fact that with the IVF the patient was receiving, she went over. I had left the 7p-7a shift approximately 240 ml for their shift (counting only oral intake).

In the past if the docs really want to restrict ALL the fluids, they will order their antibiotics to be mixed with less fluid than the standard mix. This patient was on Dopamine going at only 2.3ml/hr requiring a NS KVO gtt to prevent the line from clotting off. But she was on numerous IV antibiotics.

I did ask the renal doc the next day and he agreed that it meant 1500ml/24 hr oral intake restriction.

I guess my point is that I routinely see fluid restriction orders and since it is not specified assume it mans oral restriction. Is this something new that they are teaching? Most of the nurses that I asked agreed with me.

How do you interpret it?

[leslie :-D]

i agree that it is open to interpretation.

next time an order is written for fluid restrictions, have doc specify what type of intake.

leslie

[klone, MSN, RN]

If I were to see that, I would assume fluid meant fluid. ALL fluid, IV and oral. I would ask for written clarification.

[General E. Speaking, RN, RN]

Thanks for the replies. I see the need for clarification but this generic order is written all the time. Am I the only nurse who assumes the doc means oral intake?

More responses would be appreciated!

[merlee]

Most of the time it refers to oral intake. I have seen docs write to limit all fluids, but then they are usually using a limited amount of IV fluid, as well.

I suppose a better order might be to limit oral intake to 1500cc/24hrs.

And I'v seen the sinks turned off in some rooms so the patients can't get any extra water. Then you need to check what the visitors are attempting to sneak in......

[leslie :-D]

Am I the only nurse who assumes the doc means oral intake?

it's dangerous to assume anything, esp for the pts.

what if i pt has advanced chf and the doc writes 1500 mls/24 hrs?

(and he meant for total intake?)

that extra 1500 is a serious implication for someone whose heart cannot tolerate it.

leslie

[chillchick]

i don't take it to mean oral intake at all - because regardless of mode of intake, it is going to affect fluid volume in the body, right?

i interpret things incorrectly a lot though, haha, so i always ask. it may annoy people, but patient safety/best practice is most important. thanks for posting this though, it's an interesting point.xo

[OttawaRPN]

Nope that order isn't clear enough, always clarify. Intake is all intake unless specified po.

[LittleOneRN]

I recently clarified a similar order with a nephrologist. He responded in a condescending tone that he was quite aware of what the IV intake was as he ordered most of it, and that it (the order) is always considered oral intake I can't wait to call and clarify with him again in the future, just to make a point of a better order needed :)

[NurseStephRN]

i have never had a physician write a fluid restriction order for PO and IV. I've always seen them write for a restriction of PO fluids... A CHF pt, renal failure pt or whatever, they most likely won't be on IVF most likely be on diuretics, so they'll be getting rid of the excess fluid.

on my cardiac unit we've never taken a fluid restriction to include IVF.

[K+MgSO4, BSN]

When I get a fluid restriction order the doc will at the same time usually drop the IVT right back as well to a minimal rate or cease it completely.

Also Daily weights are now becoming more common than extremely aggressive fluid restrictions according to one of the cardiology docs who came to do a consult on one of our surg pt with a complex history.

O the joy of being a centre for colorectal excellence! We get the stuff no other surgeons would touch with a barge pole :)

[Medic2RN, BSN, RN, EMT-P]

When I worked in the ICU step down, the fluid restrictions always pertained to the PO fluids. We never combined IV and PO in our restriction. Come to think of it, I don't remember any of those patients receiving any IV fluid other than antibiotics or small doses intravenously.

I would get clarification from the Doc to be sure. :)