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Added on 10/23/2011

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A Client is at risk for fluid volume exess. Which nursing intervention would ensure the most accurate monitoring of the client's fluid status?

1. Measuring and recording fluid intake and output
2. Weighing the client daily at the same time each day
3. Assessing vital signs every 4 hours
4. Checking the lungs for crackles every shift

Explanation

Increased fluid volume leads to rapid weight gain: 2.2 pounds (1kg) for each liter of fluid retained. Weighing the client at the same time and with the client wearing similar clothing provides more objective data than measuring fluid intake and output, which may be inaccurate because of omitted measurements such as insensible losses.

Contributor

Andrew
Member since: April 2011
(Boynton Beach,FL) Original question source

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