Deficient fluid volume, or hypovolemia, results from a loss of body fluid or fluid shift, causing the fluid output to surpass fluid intake. In this process (acute or chronic), the body loses fluid volume and electrolytes. The source for this condition can be gastrointestinal, renal, or even metabolic.
- Inadequate food and fluid intake
- Acid-base imbalance
- Electrolyte imbalance
- Compromised regulatory mechanisms (diabetes insipidus)
- Compromised physical mechanisms (impaired swallowing, facial trauma)
- Blood loss
- Fistulas/ Severe wounds
- Fluid shifts (Third spacing)
- Medications( diuretics, laxatives)
Subjective Data: patient’s feelings, perceptions, and concerns. (Symptoms)
- Expresses feeling thirsty
- Verbalizes feelings of weakness
- States feeling dizzy/lightheaded, especially when changing position
- Complains about an inability to focus
- Complains of headaches
- Describes feeling of fast heartbeat
Objective Data: assessment, diagnostic tests, and lab values. (Signs)
- Altered mental status
- Decreased blood pressure/orthostasis
- Weak/thready peripheral pulses
- Flat neck veins
- Dry skin
- Dry mucous membranes
- Non-elastic skin turgor
- Decreased urine output (less than 30ml/hour)
- Concentrated urine
- Increased hematocrit
- The patient will be euvolemic
- The patient’s vital signs will be within the normal range (normal blood pressure, heart rate, and temperature)
- The patient will maintain adequate fluid intake
- The patient will maintain an elastic skin turgor and moist mucous membranes
- The patient will name measures to stay hydrated
- The patient will be able to recognize signs and symptoms of fluid volume loss/dehydration
Nursing Assessment for Deficient Fluid Volume
|Obtain a thorough history to find probable causes for fluid loss. |
This information helps guide interventions. For example, treatment for chronic anemia will be different than for fluid loss from inadequate oral intake. Causes for fluid volume can differ significantly and warrant specific treatment. If risk factors (vomiting, diarrhea, diabetes mellitus, fever, diuretic treatment) can be identified early, treatment can be initiated and possibly decrease complications.
|Monitor blood pressure and heart rate frequently. |
Low blood volume in the intravascular space causes low blood pressure. Consequently, heart rate may be increased as this is a compensatory mechanism to maintain a sufficient cardiac output.
|Assess for postural/orthostatic hypotension. |
Orthostatic hypotension is a significant drop in blood pressure with position changes. To assess orthostatic hypotension, the nurse obtains blood pressure in the supine, sitting, and standing positions. Orthostasis is considered positive if there is a 20mmHg drop in systolic pressure or a 10mmHg in diastolic pressure.
|Monitor fluid intake and output at least every four hours or every hour in an acute care setting. |
Urine output of at least 30ml per hour indicates adequate perfusion of the kidneys. Less than that may indicate insufficient fluid volume.
|Monitor urine color and specific gravity. |
Urine dark in color with an increased specific gravity may mark an increased urine concentration and volume deficit.
|Assess the patient’s dietary and fluid intake. |
Most patients do not keep track of the daily amount of fluid they consume. Some patients, especially elderly patients, may simply forget about drinking enough water throughout the day. Others might not drink a lot of water because they are on fluid restriction. Therefore, tracking accurate intake and output is essential to guide appropriate treatment.
|Monitor for changes in the patient’s mental status. |
Loss of blood volume and dehydration can cause irritability, fatigue, restlessness, and confusion. Consider these changes, especially for the older population.
|Assess for these clinical signs and symptoms of dehydration: |
Non-elastic skin turgor
Dry, cracked mucous membranes
Such signs indicate a state of dehydration. Check skin turgor on areas of the body that does not have loose skin, such as the forehead or shins. Consider, however, that decreased skin turgor might be the baseline in older adults because the skin loses elasticity with age.
Assessment for the critically ill patient
|Implement hemodynamic monitoring. Monitor |
Central venous pressure (CVP)
Pulmonary artery pressure (PAP)
Pulmonary capillary wedge pressure (PCWP)
These continuous hemodynamic parameters provide information about treatment response and can help guide therapy. In addition, this sensitive monitoring is beneficial for patients with cardiac and renal problems or patients with a septic profile.
Nursing Interventions for Deficient Fluid Volume
|Weigh the patient daily at the same time each day (early AM).|
Sudden weight loss may be indicating a loss of water weight, especially in the presence of other symptoms pointing to volume loss, such as decreasing urine output.
|Provide oral fluids as prescribed throughout the day. |
Distribute the amount of fluids throughout the entire day. Provide 2/3 of the fluids prescribed during the day and 1/3 at night. For example, offer 1000ml during the day shift and 500ml on the night shift for a total of 1500ml prescribed.
|Ask about oral fluid preferences and provide preferred fluids within the ordered restriction. |
Patients are more likely to increase their fluid intake if they like the flavor and temperature of the beverage. Consider popsicles and fruit juices to supplement fluid intake.
|Offer assistance with eating and drinking if necessary. |
Patients often may be too weak to feed themselves and become frustrated because they need help. This could be demotivating for the patient and worsen the situation of decreased fluid intake.
|Provide mouth care at least every four hours and as needed. |
Dehydration can cause the mouth to feel dry and tacky. Frequent oral hygiene makes it more comfortable and enjoyable to eat and drink.
|Place the beverage within view and close reach at the bedside table. |
Fluids within the patient’s visual field serve as a constant reminder to take in fluids. Sometimes water pitchers are too heavy for patients to lift. In that case, provide a glass of water, which will be easier to lift. Also, provide a straw if needed. Easy access to fluids promotes increased fluid intake.
|Administer appropriate medication as ordered. |
Administer antidiarrheals, antipyretics, and antiemetics to reduce fluid loss, if the patient experiences ongoing diarrhea and vomiting.
|Avoid caffeine-containing beverages. |
Caffeine has diuretic properties and may contribute to fluid volume loss and electrolyte imbalances.
Interventions for the critically ill patient
|Anticipate the need for IV, central line, arterial line, and possibly pulmonary artery catheter placement.|
Intravenous fluid replacement therapy is sometimes necessary to maintain an appropriate fluid balance if oral intake is not possible or insufficient. Central lines with central venous pressure (CVP)monitoring and pulmonary artery catheters provide information about the patient’s fluid status. Arterial lines allow for continuous blood pressure monitoring.
|Start parenteral fluid therapy per order and perform a fluid challenge if ordered. |
Intravenous fluids ensure more consistent hydration than oral fluid intake. Physicians perform fluid challenges to see if the patient has a preload reserve that can be used to improve cardiac function and fluid status.
|Monitor lab values such as hematocrit, creatinine, specific gravity, BUN, and osmolality.|
Trending such tests allows the healthcare team to monitor whether treatment is effective or if other strategies need to be considered.
|Monitor for electrolyte imbalances. |
Electrolyte levels can change drastically with fluid volume loss, whether it be blood loss or losing volume due to vomiting and diarrhea. Decreased electrolyte levels can cause dysrhythmias, muscle spasms, and fatigue.
|Insert an indwelling urinary catheter for accurate measurements. |
This way, the nurse can measure urine output hourly and detect a decrease in urine output early. Hourly urine output should be at least 30mL.
Interventions for the elderly population
Older patients experience physiological changes that can affect fluid balance.
|Frequently remind the patient to drink fluids. |
Thirst sensation is decreased in older patients. Therefore, repeated offers to drink fluids are essential for fluid replacement therapy in older patients.
|Assess skin turgor on the forehead or the shin in older adults. |
Skin loses elasticity with age; therefore, older adults commonly have decreased baseline skin turgor.
|Remind patients with cognitive impairment to drink fluids regularly. |
Patients with impaired mentation may not be able to maintain a necessary fluid balance. Therefore, assistance with fluid intake and frequent reminders are essential.
Patient Education about Deficient Fluid Volume
|Teach the patient and family about the importance of appropriate food and fluid intake. |
Providing a rationale promotes compliance and helps prevent the issue.
|Teach patients and family members how to measure intake and output accurately. |
The patient needs to know cup and ounces measurements to be able to track fluid intake.
|Educate about signs and symptoms of dehydration and conditions that increase the likelihood of becoming dehydrated. These conditions include vomiting, diarrhea, excessive sweating, and fever. |
Knowledge about these manifestations allows the patient and family to be proactive, recognize states of fluid loss early, and when to contact the healthcare provider.
More Care Plans:
Potter, P., & Perry, A. (2013). Fundamentals of nursing (8th ed.). Elsevier.
Ackley, B., & Ladwig, G. (2014). Nursing diagnosis handbook (10th ed). Maryland Heights: Mosby Elsevier.