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Summary
This article reviews the physiology that underpins normal fluid balance and discusses how fluid balance can be affected by illness. Clinical assessment of hydration and the importance of fluid balance record keeping are explained. Recommendations are made to improve fluid balance management in clinical practice and the professional importance of record keeping is highlighted.
Keywords
Fluid and electrolyte balance; Hydration; Record keeping
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Aims and intended learning outcomes
This article aims to improve nurses' understanding of the normal mechanisms that control fluid balance and how fluid balance is affected by illness. A comprehensive hydration assessment is described and the importance of accurate fluid balance records is explained. Recommendations are made to improve the clinical management of fluid balance. After reading this article and completing the Time out activities you should be able to:
* Discuss the normal physiology of body water, including fluid compartments and the movement of water and electrolytes between compartments, normal fluid balance and maintenance of blood volume.
* Explain how illness can affect fluid balance and identify patients who will be vulnerable to disturbance of their fluid balance.
* Complete a comprehensive hydration assessment.
* Complete a fluid balance chart accurately, recognising when fluid intake or urine output is abnormal, and formulate a plan to resolve this.
* Reflect on your practice, identifying areas for development in relation to fluid balance documentation and demonstrating insight into the professional importance of fluid balance records.
Introduction
Maintenance of an adequate fluid balance is vital to health. Inadequate fluid intake or excessive fluid loss can lead to dehydration, which in turn can affect cardiac and renal function and electrolyte management. Inadequate urine production can lead to volume overload, renal failure and electrolyte toxicity. Attention to fluid intake and output, and careful completion of fluid balance charts, are important elements of nursing practice. Poor fluid balance management and poor record keeping have been identified as contributing factors to the poor outcome of some acutely unwell hospital patients...