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Hydration

When assessing hydration status, you may already have obtained clues
from the history. For example, a patient may have been admitted with
poor fl uid intake and may be thirsty. Sepsis, bleeding, or bowel obstruction
and vomiting can also cause a person to become dehydrated.

Examination

Begin with looking around the patient for any obvious clues, including
fl uid restriction signs, urinary catheter bag, or nutritional supplements.
Inspect face for sunken orbits (sign of moderatesevere dehydration).
Mucous membranes
Inspect the tongue and mucous membranes for moisture.
Dehydration will cause these surfaces to appear dry.
Skin turgor
Assess by gently pinching a fold of skin on the forearm, holding for a
few moments, and letting go.
With normal hydration, the skin will promptly return to its original
position, whereas in dehydration, skin turgor is reduced and the skin
takes longer to return to its original state.
0This sign is unreliable in elderly patients, whose skin may have lost
its normal elasticity.
Capillary refi ll
Test by raising the patient?s thumb to the level of the heart, pressing
hard on the pulp for 5 seconds and then releasing. Measure the time
taken for the normal pink color to return.
Normal capillary refi ll time should be <2 seconds; a prolongation is
indicative of poor blood supply to the peripheries.
Pulse rate
A compensatory tachycardia may occur in dehydration or in fl uid
overload.
Blood pressure
Check lying and standing blood pressure (b p. 50) and look for low
blood pressure on standing, which may suggest dehydration (along
with many other diagnoses).
Jugular venous pressure (JVP)

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