Question I got wrong on my test!

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Mr. A came into the hospital with naseau and vomiting for the past 4 days. What is the most accurate way to determine the extent of his fluid loss?

1) Weight him daily

2) skin turgor

quite frankly i think those going with daily wts are "reading too much into the question".....were are you to objectively going to get the info to compare with?.....even if the patient knows and is honest; a very big if. All "made for home use" scales are marked "not legal for trade" meaning their accuracy is NOT guarenteed.

So...you have NOTHING to compare the info you gain when you weigh him now, to. So, no helpful knowlege has been gained.

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So tell us then how skin turgor is going to show the extent of the fluid loss? it's not, and further more, you don't the pts. age or anything or he might tent normally and it mean nothing, so the same thing could be argued as it could about the weight. the question is poorly worded and needs more information. and as a general rule of thumb it's always going to be weight to determine the extent of the loss

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Specializes in Emergency Dept. Trauma. Pediatrics.
So tell us then how skin turgor is going to show the extent of the fluid loss? it's not, and further more, you don't the pts. age or anything or he might tent normally and it mean nothing, so the same thing could be argued as it could about the weight. the question is poorly worded and needs more information. and as a general rule of thumb it's always going to be weight to determine the extent of the loss

The answer should be weight if it wasn't worded so poorly, you can't determine the extent of fluid loss by weight when you have no baseline or your baseline is 4 days into the episode. Turgor would show dehydration along with other signs if their was a lot of fluid loss. I just saw it in a 5 month old baby that was in for dehydration from diarrhea and vomiting x2 days.

Explain how if I patient is admitted after 4 days of v&d how you will be able to tell the extent of their weight loss by putting them on the scale. you have NOTHING to base it off of and you can't wait a few days to find out the extent, they need to be treated.

If it were my exam I would have put the weight because I know that is what they were getting at. BUT the question is worded poorly without reading into it.

"Mr. A came into the hospital with naseau and vomiting for the past 4 days. What is the most accurate way to determine the extent of his fluid loss?"

The question implies that the N&V happened prior to coming into the hospital which would make it impossible for them to tell the EXTENT of it with daily weights. They need a baseline on the same scale.

My Dr office just had a scale reading 20 lbs off for adults. My 30 lb daughter it read correctly, for adults though it was not. I thought my home scale was wrong I bought a new scale and it was reading the same as my previous one. It was the Dr's one that was wrong and next time I went in they had a new scale. You need to use the same scale and can't just go off what someone says. Most people don't weigh themselves daily especially if they are to busy being sick for 4 days.

So in my opinion, the question is worded poorly without even having to read into it.

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i just said as a general rule of thumb it's by weight. but you can argue that you don't have enough info to base it off of weight and as skin turgor (ie: they didn't say his age etc. as they didn't say anything about his weight. so it can go the same ways for each option). its a crappy question.

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Specializes in Emergency Dept. Trauma. Pediatrics.

You asked how skin turgor could show the extent of fluid loss, it can help with determining dehydration better then a weight can without any baseline. You would obviously use it in combination with other things, but if you have NOTHING to go off of and a person comes in 4days post signs and symptoms and you are looking at the extent. The turgor is going to be more helpful then their weight.

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depending on the pts age. among a few other things. older pts. tent without being dehydrated, so it doesn't necessarily show signs of dehydration. i'm just saying the arguments can go both ways.

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Specializes in Emergency Dept. Trauma. Pediatrics.
depending on the pts age. among a few other things. older pts. tent without being dehydrated, so it doesn't necessarily show signs of dehydration. i'm just saying the arguments can go both ways.

yes and for elderly we try to go to areas that don't lose their elasticity as bad to check. BUT my point is, in real life if given that exact same situation in the question, were to happen, initially a skin turgor would tell you more then the weight because you have nothing to compare the weight too. The skin turgor might not be a definitive test but it would be a stepping stone in determining the extent of fluid loss right away for a pt. that was just admitted.

And I ask you, how could weight be used when you have nothing to base the weight on. How can you determine the EXTENT of the fluid loss after 4 days on a new admit without the base weight at the beginning of this? You keep saying it can be argued both ways but I am not seeing how the weight can be argued given the specifics given in the question.

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it can be argued by arguing weight, you don't have a baseline. arguing skin turgor, it isn't always acurate either depending on the pt

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You have a valid point regarding no baseline...however, given that, then there would be no right answer since while the skin turgor test can point you in the right direction, it - unto itself - cannot determine the extent of anything. Weight can determine how much fluid loss there is...but to your point you need a baseline. And in thinking this thing out loud (or in print:)) and considering how we're often tested by our professor, you sometimes have to go with the best answer, even if not definitively 'the best' answer. To me, that would be 'weight' since it can be used to measure fluid loss, provided you have a baseline and skin tugor can never tell how much fluid was lost...

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You have a valid point regarding no baseline...however, given that, then there would be no right answer since while the skin turgor test can point you in the right direction, it - unto itself - cannot determine the extent of anything. Weight can determine how much fluid loss there is...but to your point you need a baseline. And in thinking this thing out loud (or in print:)) and considering how we're often tested by our professor, you sometimes have to go with the best answer, even if not definitively 'the best' answer. To me, that would be 'weight' since it can be used to measure fluid loss, provided you have a baseline and skin tugor can never tell how much fluid was lost...

that's exactly what i was trying to say!

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Mr. A came into the hospital with naseau and vomiting for the past 4 days. What is the most accurate way to determine the extent of his fluid loss?

1) Weight him daily

2) skin turgor

Laura, what were the other options for answers?

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Specializes in Emergency Dept. Trauma. Pediatrics.
You have a valid point regarding no baseline...however, given that, then there would be no right answer since while the skin turgor test can point you in the right direction, it - unto itself - cannot determine the extent of anything. Weight can determine how much fluid loss there is...but to your point you need a baseline. And in thinking this thing out loud (or in print:)) and considering how we're often tested by our professor, you sometimes have to go with the best answer, even if not definitively 'the best' answer. To me, that would be 'weight' since it can be used to measure fluid loss, provided you have a baseline and skin tugor can never tell how much fluid was lost...

I already said that for a nursing school test I would say weight, but in real life it wouldn't work the way it was described in the question, which is why I said it was a bogus question. Weight can only determine how much fluid is lost when you have an accurate weight to go off. With the information given in the question, the weight wouldn't have been an option (again in real life) so although the turgor wouldn't have been definitive it would be a better estimate then weight.

I asked how the weight could be argued WITH THE INFORMATION GIVEN. Not IF you have a baseline, that is reading to much into the question. With the information given how could weight be best at determining the extent of the fluid loss this pt. had???

Not sure how I am not being clear with what I am saying, but apparently I need to re-clarify again that for a test I would put weight but that it's a badly worded question, that wouldn't be right in the real world with the info given.

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