Deficient Fluid Volume

By Gil Wayne, RN - Oct 21, 2016

ADVERTISEMENT
8 36SHARES
a 0 Facebook d 0 f 3 h 33 s v
ADVERTISEMENT

Deficient Fluid Volume:Decreased intravascular, interstitial, and/or intracellular fluid. This refers to
dehydration, water loss alone without change in sodium.

Deficient fluid volume is a state or condition where the fluid output exceeds the fluid intake. It
happens when water and electrolytes are lost as they exist in normal body fluids. Common sources
of fluid loss are the gastrointestinal tract, polyuria, and increased perspiration. Risk factors for FVD
are as follows: vomiting, diarrhea, GI suctioning, sweating, decreased intake, nausea, inability to gain
access to fluids, adrenal insufficiency, osmotic diuresis, hemorrhage, coma, third-space fluid shifts,
burns, ascites, and liver dysfunction. Fluid volume deficit may be an acute or chronic condition
managed in the hospital, outpatient center, or home setting.

Appropriate management is vital to prevent potentially life-threatening hypovolemic shock. Older

patients are more likely to develop fluid imbalances. The goals of management are to treat the
underlying disorder and return the extracellular fluid compartment to normal, to restore fluid volume,
and to correct any electrolyte imbalances.

Contents [hide]
 1 Related Factors
2 Defining Characteristics
3 Goals and Outcomes
4 Nursing Assessment
5 Nursing Interventions
6 See also
7 External Resources

Related Factors
Here are some factors that may be related to Deficient Fluid Volume:

Active fluid loss (abnormal drainage or bleeding, diarrhea, diuresis)

Electrolyte and acid-base imbalances
Failure of regulatory mechanisms
Fluid shifts (edema or effusion)
Inadequate fluid intake
Increased metabolic rate (fever, infection)

Defining Characteristics
Deficient Fluid Volume is characterized by the following signs and symptoms:

Alterations in mental state

Concentrated urine
Decreased skin turgor
Decreased urine output (less than 30mL/hr)
Decreased venous filling pressures (preload)
Dry mucous membranes
Hemoconcentration
Hypotension/orthostasis
Sudden weight loss
Tachycardia/weak, rapid HR
Thirst
Weakness

Goals and Outcomes

The following are the common goals and expected outcomes for Deficient Fluid Volume:

Patientis normovolemic as evidenced by systolic BP greater than or equal to 90 mm HG (or

patients baseline), absence of orthostasis, HR 60 to 100 beats/min, urine output greater than 30
mL/hr and normal skin turgor.
Patient demonstrates lifestyle changes to avoid progression of dehydration.
Patient verbalizes awareness of causative factors and behaviors essential to correct fluid
deficit.
Patient explains measures that can be taken to treat or prevent fluid volume loss.
Patient describes symptoms that indicate the need to consult with health care provider.

Nursing Assessment
Assessment is necessary in order to identify potential problems that may have lead to Deficient Fluid
Volume as well as name any episode that may occur during nursing care.

Assessment
Monitor and document vital signs especially BP
and HR.
Assess skin turgor and oral mucous
membranes for signs of dehydration.
Rationales
Decrease in circulating blood volume can cause
hypotension and tachycardia. Alteration in HR is
a compensatory mechanism to maintain
cardiac output. Usually, the pulse is weak and
may be irregular if electrolyte imbalance also
occurs. Hypotension is evident in hypovolemia.
Signs of dehydration are also detected through
the skin. Skin of elderly patients losses
elasticity, hence skin turgor should be assessed
over the sternum or on the inner thighs.
Longitudinal furrows may be noted along the
tongue.
A common manifestation of fluid loss is
postural hypotension. It is manifested by a 20-
mm Hg drop in systolic BP and a 10 mm Hg
drop in diastolic BP. The incidence increases
with age. Note the following orthostatic
hypotension significance:

Monitor BP for orthostatic changes (changes

seen when changing from supine to standing
position). Monitor HR for orthostatic changes.
Assess alteration in mentation/sensorium
(confusion, agitation, slowed responses)
Assess color and amount of urine. Report urine
output less than 30 ml/hr for 2 consecutive
hours.
Monitor and document temperature.
Monitor fluid status in relation to dietary intake.
Note presence of nausea, vomiting and fever.
Auscultate and document heart sounds; note
rate, rhythm or other abnormal findings.
Monitor serum electrolytes and urine
osmolality, and report abnormal values.
Greater than 10 mm Hg drop: circulating
blood volume is decreased by 20%.
Greater than 20 to 30 mm Hg drop:
circulating blood volume is decreased by
40%.
Orthostatic hypotension caused by volume
depletion is associated with a compensatory
increase in HR (more than 20 beats/min).
Alteration in mentation/sensorium may be
caused by abnormally high or low glucose,
electrolyte abnormalities, acidosis, decreased
cerebral perfusion, or developing hypoxia.
Impaired consciousness can predispose patient
to aspiration regardless of the cause.
A normal urine output is considered normal not
less than 30ml/hour. Concentrated urine
denotes fluid deficit.
Febrile states decrease body fluids by
perspiration and increased respiration. This is
known as insensible water loss.
Most fluid comes into the body through
drinking, water in food, and water formed by
oxidation of foods. Verifying if the patient is on
a fluid restraint is necessary.
These factors influence intake, fluid needs, and
route of replacement.
Cardiac alterations like dysrhythmias may
reflect hypovolemia and/or electrolyte
imbalance, commonly hypocalcemia. Note: MI,
pericarditis, and pericardial effusion with/
without tamponade are common
cardiovascular complications.
Elevated blood urea nitrogen suggests fluid
deficit. Urine specific gravity is likewise
increased.

Ascertain whether the patient has any related
heart problem before initiating parenteral
therapy.
Weigh daily with same scale, and preferably at
the same time of day.
Identify the possible cause of the fluid
disturbance or imbalance.
Monitor active fluid loss from wound drainage,
tubes, diarrhea, bleeding, and vomiting;
maintain accurate input and output record.
During treatment, monitor closely for signs of
circulatory overload (headache, flushed skin,
tachycardia, venous distention, elevated central
venous pressure [CVP], shortness of breath,
increased BP, tachypnea, cough) during
treatment.
Monitor and document hemodynamic status
including CVP, pulmonary artery pressure
(PAP), and pulmonary capillary wedge pressure
(PCWP) if available in hospital setting.
Monitor for the existence of factors causing
deficient fluid volume (e.g., gastrointestinal
losses, difficulty maintaining oral intake, fever,
uncontrolled type II diabetes mellitus, diuretic
therapy).
Nursing Interventions
The following are the therapeutic nursing interventions for Deficient Fluid Volume:
Interventions
Cardiac and older patients are often susceptible
to fluid volume deficit and dehydration as a
result of minor changes in fluid volume. They
also are susceptible to the development of
pulmonary edema.
Weight is the best assessment data for
possible fluid volume imbalance. An increased
in 2 lbs a week is consider normal.
Establishing a database of history aids accurate
and individualized care for each patient.
Fluid loss from wound drainage, diarrhea,
bleeding, and vomiting cause decreased fluid
volume and can lead to dehydration.
Close monitoring for responses during therapy
reduces complications associated with fluid
replacement.
These direct measurements serve as optimal
guide for therapy.
Early detection of risk factors and early
intervention can decrease the occurrence and
severity of complications from deficient fluid
volume. The gastrointestinal system is a
common site of abnormal fluid loss.
Rationales
Oral fluid replacement is indicated for mild fluid

Urge the patient to drink prescribed amount of
fluid.
Aid the patient if he or she is unable to eat
without assistance, and encourage the family or
SO to assist with feedings, as necessary.
If patient can tolerate oral fluids,give what
oralfluids patient prefers. Provide fluid and
straw at bedside within easy reach. Provide
fresh water and a straw.
Emphasize importance oforal hygiene.
Provide comfortable environment by covering
patient with light sheets.
Plan daily activities.
For more severe hypovolemia:
Insert and IV catheter to have IV access.
Administer parenteral fluids as prescribed.
Consider the need for an IV fluid challenge with
immediate infusion of fluids for patients with
abnormal vital signs.
Administer blood products as prescribed.
Maintain IV flow rate. Stop or delay the infusion
if signs of fluid overload transpire, refer to
physician respectively.
deficit and is a cost-effective method for
replacement treatment. Older patients have a
decreased sense of thirst and may need
ongoing reminders to drink. Being creative in
slecting fluid sources (e.g., flavored gelatin,
frozen juice bars, sports drink) can facilitate
fluid replacement. Oral hydrating solutions (e.g.,
Rehydralyte) can be considered as needed.
Dehydrated patients may be weak and unable to
meet prescribed intake independently.
Most elderly patients may have reduced sense
of thirst and may require continuing reminders
to drink.
Fluid deficit can cause a dry, sticky mouth.
Attention to mouth care promotes interest in
drinking and reduces discomfort of dry mucous
membranes.
Dropsituations where patient can experience
overheating to prevent further fluid loss.
Planning conserves patients energy.
Parenteral fluid replacement is indicated to
prevent or treat hypovolemic complications.
Fluids are necessary to maintain hydration
status. Determination of the type and amount
of fluid to be replaced and infusion rates will
vary depending on clinical status.
Blood transfusions may be required to correct
fluid loss from active gastrointestinal bleeding.
Most susceptible to fluid overload are elderly
patients and require immediate attention.
A central venous line allows fluids to be infused
 Assist the physician with insertion of central
venous line and arterial line, as indicated.
Provide measures to prevent excessive
electrolyte loss (e.g., resting the GI tract,
administering antipyretics as ordered by the
physician).
Begin to advance the diet in volume and
composition once ongoing fluid losses have
stopped.
Encourage to drink bountiful amounts of fluid
as tolerated or based on individual needs.
Educate patient about possible cause and
effect of fluid losses or decreased fluid intake.
Enumerate interventions to prevent or minimize
future episodes of dehydration.
Emphasize the relevance of maintaining proper
nutrition and hydration.
Teach family members how to monitor output
in the home. Instruct them to monitor both
intake and output.
Refer patient to home health nurse or private
nurse in able to assist patient, as appropriate.
Identify an emergency plan, including when to
ask for help.
See also
Related posts from the site:
centrally and for monitoring of CVP and fluid
status. An arterial line allows for the continuous
monitoring of BP.
Fluid losses from diarrhea should be
concomitantly treated with antidiarrheal
medications, as prescribed. Antipyretics can
decrease fever and fluid losses from
diaphoresis.
Addition of fluid-rich foods can enhance
continued interest in eating.
Patient may have restricted oral intake in an
attempt to control urinary symptoms, reducing
homeostatic reserves and increasing risk of
dehydration or hypovolemia.
Enough knowledge aids the patient to take part
in his or her plan of care.
Patient needs to understand the value of
drinking extra fluid during bouts of diarrhea,
fever, and other conditions causing fluid
deficits.
Increasing the patients knowledge level will
assist in preventing and managing the problem.
An accurate measure of fluid intake and output
is an important indicator of patients fluid
status.
Continuity of care is facilitated through the use
of community resources.
Some complications of deficient fluid volume
cannot be reversed in the home and are life-
threatening. Patients progressing toward
hypovolemic shock will need emergency care.
 Nursing Care Plans

External Resources
Recommended books and resources:

1. Nursing Care Plans: Diagnoses, Interventions, and Outcomes

2. Nurses Pocket Guide: Diagnoses, Prioritized Interventions and Rationales
3. Nursing Diagnoses 2015-17: Definitions and Classification

8 36 SHARES
a 0 Facebook d 0 f 3 h 33 s v
ADVERTISEMENT

Gil Wayne, RN
https://nurseslabs.com

Gil Wayne is a registered nurse and a contributor at Nurseslabs.com. Prefers writing, traveling and discovering stuffs. Not a
fan of working in a hospital, but enjoys exploring nursing outside its walls! I like the color gray, but cant imagine myself in gray
scrubs... lol!