Editing Medical-Surgical Nursing (section)

=== Fluid Volume ===

Fluid volume deficit presents with thirst, dry mucous membranes, poor skin turgor over the sternum or forehead, flat neck veins, tachycardia, orthostatic hypotension, decreased urine output with concentrated dark urine, elevated urine specific gravity, elevated hematocrit and blood urea nitrogen, and acute weight loss. Fluid volume excess presents with bounding pulse, distended neck veins, crackles, dyspnea, peripheral or sacral edema, and acute weight gain.

Nursing application: daily weight taken at the same time, on the same scale, in similar clothing is the single most reliable indicator of fluid status. A gain of one kilogram equals roughly one liter of retained fluid. Intake and output records support the weight but do not replace it.