Author Question: List at least six things you will monitor to assess C.W.'s fluid balance. What would be ... (Read 81 times)

Caiter2013 · **on:** Jun 25, 2018

List at least six things you will monitor to assess C.W.'s fluid balance.

What would be monitored?

Question 2

C.W. receives a total of 4 units of packed red blood cells (PRBCs), 5 units of fresh frozen plasma (FFP), and several liters of crystalloids to keep his mean BP above 60 mm Hg.

On the second day in the MICU, his
total fluid intake is 8.498 L and output is 3.66 L. His hemodynamic parameters after fluid resuscitation are
pulmonary capillary wedge pressure (PCWP) 30 mm Hg and cardiac output (CO) 4.5 L/min.

Calculate his fluid balance and identify whether it is positive or negative.

Why will you want to monitor his fluid status very carefully?

ankilker · **Reply #1 on:** Jun 25, 2018

Answer to Question 1

Urinary output: Monitor urine output hourly. With inadequate volume to perfuse the kidneys, the
urinary output will drop below 30 mL/hr.
Fluid intake: Compare output and intake. Fluid intake includes anything that is liquid at room
temperature. Do not forget to include intravenous products.
Daily weight: Fluid weight is lost or gained rapidly and is an excellent indicator of changes in fluid
volume.
VS: As the intravascular volume rises in response to IV fluids, the BP can be expected to increase and
the heart rate to decrease.
CO and PCWP: Both are good measures of left ventricular function and preload. The PCWP is already
high; an increase could be a first indication of fluid overload.
Mental status: This is a good indication of cerebral perfusion and Sao2.
Lungs: Crackles and dyspnea are indicators of pulmonary edema.
Heart sounds: An increase in the baseline murmur and gallops could indicate fluid overload.

Answer to Question 2

His fluid balance is positive, 4.838 L. (Subtract the output, 3.66 L, from the total fluid intake of
8.498 L).

C.W. needs fluids and blood products to replace the lost blood volume, but because of his history
of HF, it would be easy to overload him with fluids and exacerbate his heart failure, resulting in
pulmonary edema.