NCM 112: Fluids & Electrolytes

1st Semester A/Y 2020-2021

Fluid Volume Deficit

Evaluation

A.
1. Why does FVD occur?

Dehydration or Fluid Volume Deficit is a state where the fluid intake is not enough to meet the
body’s need. It occurs either when there is excess fluid loss, electrolytes loss, or when the body loses both
water and electrolytes from the ECF in similar proportions.

2. What do the elderly, infants, and obese individuals have in common that makes them
vulnerable to FVD?

Elderly, infants, and obese individuals do not have the capacity to absorb water as normal adults
do, that is why they are vulnerable FVD.

Fluid balance in many elderly clients is often marginal at best because of certain physiologic
changes associated with the aging process.

The bodies of infants and young children contain more water than those of adults. They have a
larger surface area in relation to weight, which allows for greater water loss through the skin. Additionally,
since their kidneys are not fully mature, children excrete more diluted urine, which means they lose more
water than they retain. (nestle-waters.com)

Obese individuals have more adipose tissues in their body which does not hold water. With this,
they need more fluid intake than those with normal BMI to prevent dehydration.

3. How does the endocrine system compensate for FVD?

As discussed in the previous lesson, there are 3 hormones that play key roles in regulating fluid
and electrolyte balance namely antidiuretic hormone (ADH), aldosterone, and atrial natriuretic peptide
(ANP). ADH is released from the posterior pituitary gland and acts by promoting water reabsorption in the
distal convoluted tubules of the kidneys, thus, there is a decreased urine output. This mechanism retains
water then increases blood volume or the amount of plasma in the circulation. Next is the aldosterone
which also regulates body fluid and secreted by the adrenal cortex. The result of its production is to
conserve sodium. Because sodium attracts water (when sodium is retained in the body, then so is water),
this may also lead to water retention when ADH is present. Lastly, ANP is a hormone that promotes both
fluid and sodium loss by the kidneys. It suppresses serum renin levels, releases ADH and aldosterone, and
increase glomerular filtration. As a result, there is less reabsorption of water from the renal tubules, thus
urine production is increased.

4. Does RAAS occur in FVD? How?

Yes. To regulate fluid and electrolyte balance in the body, aldosterone is produced. This
mechanism is made possible through the renin-angiotensin-aldosterone system. When there is decreased
blood flow to the kidneys, less oxygen is delivered to the glomeruli or there is an altered renal tissue
perfusion. This signals the juxtaglomerular cells to release renin into the bloodstream. Renin travels to the
liver and converts angiotensinogen to angiotensin I. Then, angiotensin I proceeds to the lungs and gets
converted to angiotensin II by Angiotensin-converting enzyme (ACE). Angiotensin II travels to the adrenal
glands then stimulates to produce aldosterone. The aldosterone is released into the bloodstream and
promotes reabsorption of water, sodium, and chloride from the renal tubules. In conclusion, aldosterone
production causes an increase in salt and water reabsorption into the bloodstream from the kidney
thereby increasing the blood volume, restoring salt levels and blood pressure.

5. Explain cardiopulmonary compensation for FVD.

Through the compensatory mechanism of the cardiopulmonary system, the body tries to maintain
cardiac output (the amount of blood that is pumped by the heart to the body). The body increases the
heart rate (tachycardia) when the amount of fluid in the intravascular space is decreased. It also makes
blood vessels constrict to increase blood pressure and blood flow to the vital organs of the body.

6. Why does oliguria occur in FVD?

Oliguria literally means “reduced” urine volume that is less than 400 mL daily in adults. When
there is a deficiency of fluid in the body (through diarrhea, vomiting, excessive use of diuretics, etc.), the
glomerular filtration rate is reduced. Urine output is decreased because there are not enough fluids to be
excreted and no perfusion or no passage of blood through the vessels in the kidneys.

7. How does FVD affect the level of consciousness of a person?

When we lose more fluid than we take in, our body won't have enough fluid to function normally.
So when the level of dehydration increases, the coping mechanism of the cardiovascular system begins to
fail. The normal function of the heart is to pump blood throughout the body and into vital organs to deliver
oxygen and nutrients. In a body with FVD, blood volume decreases, which causes the blood pressure to
drop. So, if the body is not getting as much blood and oxygen as normal (due to decreased fluid to pump),
the level of consciousness will be affected due to the brain's lack of oxygen.

8. What is the role of serum osmolality in water intoxication and cellular dehydration?

Water intoxication is brought about by the decrease in serum osmolality (when there is too much
fluid in the blood) and the net movement of fluid from the interstitial fluid space into the intracellular
compartment. While in cellular dehydration, the serum osmolality increases, therefore causing the fluids
to shift from intracellular to the extracellular compartments of the cell and shrinks the cell.

When osmolality increases, it triggers our body to make antidiuretic hormone (ADH). This
hormone tells our kidneys to keep more water inside our blood vessels and our urine becomes more
concentrated. When osmolality decreases, our body doesn't make as much ADH. Our blood and urine
become more diluted. (urmc.rochester.edu)

9. Explain the changes that occur in vital signs as a result of FVD?

To compensate with the excess fluid loss, there would be an increase in heart rate (tachycardia)
wherein the heart pumps faster to bring oxygen to throughout the body. However, the pulse will also feel
weaker than usual since there is not enough fluid volume going through the vascular spaces. Additionally,
there is decreased blood pressure because lower fluid volume means lower pressure in the veins. Increase
in temperature will also occur because when the body doesn't have enough fluids, it's hard to maintain a
regular body temperature and this can lead to hyperthermia and fever-like symptoms including chills

10. Give one (1) nursing diagnosis for FVD and give its scientific basis.

Nursing Dx: Deficient Fluid Volume related to nausea, vomiting, and diarrhea as evidenced by
decreased urine output, decreased skin/tongue turgor, dry mucous membranes, weak pulse, and
increased pulse rate.

Scientific basis: The body may lose too much fluid due to nausea, vomiting, and diarrhea. The
following manifestations are observed in a person with FVD:

• Decreased urine output – Loss of fluids also decreases urine output because there is not
enough fluid to excrete
• Decreased skin turgor – The elastic property of the skin is partially dependent on
interstitial fluid volume. In a person with FVD, the skin flattens more slowly after the pinch
is released.
• Dry mucous membrane – the salivary glands in the mouth can't produce enough saliva
which causes dry mouth/mucous membrane
• Weak pulse – since there is not enough fluid volume going through the vascular spaces,
there will be difficulty feeling a person’s pulse.
• Tachycardia – the pulse rate is going to increase to compensate for not having enough
fluid
B. Develop a Nursing Care Plan for Mr. Santos

You are taking care of Mr. Santos, a 65-year-old male. Upon assessment, you notice dry mucous
membrane and longitudinal furrows in his tongue, a weak and thready pulse, and the out-going nurse told
you he had only 100 mL of urine output for the whole shift.
 NURSING CARE PLAN
Name: Mr. Santos Sex: Male
Age: 65

ASSESSMENT NURSING SCIENTIFIC EXPLANATION PLAN INTERVENTION RATIONALE EVALUATION

DIAGNOSIS
Objective: Deficient fluid When an individual After 3 days of Independent: After 3 days of
• Dry mucous volume r/t doesn’t have enough fluid nursing Assess weight, V/S,To determine when nursing
membrane dehydration aeb in the body, the salivary intervention, the central venous therapy should be intervention, the
• Longitudinal dry mouth, fissured glands in the mouth can't following will be pressure, LOC, skinslowed to avoid following was
furrows in the tongue, weak and produce enough saliva observed: turgor, and breath volume overload. observed:
tongue which causes dry • Relatively flat sounds q1hr • Relatively flat
thready pulse, and
mouth/mucous tongue and tongue and
• Weak & thready decreased urine
membrane. diminished Monitor and record Provides information diminished
pulse output.
fissures fluid intake and about adequacy of fissures
• Urine O: 100 mL Tongue is swollen in a • Moist mucous output fluid volume and • Moist mucous
dehydrated state and the membrane replacement needs.
pressure causes cracking. membrane
• Regular heart
(rdhmag.com) Oral fluid • Regular heart
rhythm and
replacement is rhythm and HR:
rate between Promote fluid
Since there is not enough 60-100 bpm intake orally indicated for mild 87 bpm
fluid volume going
• Increased fluid deficit and is a • Increased urine
through the vascular cost-effective output: 1000
urine output
spaces, there will be method for
between 800 mL/day
difficulty feeling a person’s replacement
pulse. 2,000 mL/day treatment.
(if 2L/day was
Loss of fluids also taken) Dehydrated patients
decreases urine output may be weak and
because there is not Assist client with unable to meet
enough fluid to excrete feedings, as
necessary
and no perfusion prescribed intake
happening on the kidneys. independently.

Dependent: To correct fluid

Administer IV fluids deficiency if the
as ordered
client cannot eat or
drink orally