GuidelinesOther guideline
Gastroenteritis Appendix 1: Hydration Check Form
Form for continuous assessment of hydration
Hydration Check
| Weight g | ↑ | ↓ |
| Vomiting | Y | N |
| Stools | ||
| Input | Maintenance | |
| Rehydration | ||
| OL |
Intravascular Status | ||
LOC | ↓ | Normal |
Peipheries | Cool | Warm |
CRT | Prolonged | Normal |
Pulses | Weak | Strong |
Tachycardia | Present | Absent |
Assessment | Shocked | Not Shocked |
Extravascular Status | |||
| Mucous Membranes | Dry | Moist | |
| Eyes sunken | Yes | No | |
| Fontanelle | Sunken | Normal | |
| Skin turgor | Abnormal | Normal | |
| Assessment | 10% dry | 5% dry | Well hydrated |
| Plan . |
Paste into the clinical record in appropriate place