Nanda Nursing Diagnoses Fluid Volume Deficit

Hypovolemia; Dehydration

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

Fluid volume deficit, or hypovolemia, occurs from a loss of body fluid or the shift of fluids into the third space, or from a reduced fluid intake. Common sources for fluid loss are the gastrointestinal (GI) tract, polyuria, and increased perspiration. Fluid volume deficit may be an acute or chronic condition managed in the hospital, outpatient center, or home setting. The therapeutic goal is to treat the underlying disorder and return the extracellular fluid compartment to normal. Treatment consists of restoring fluid volume and correcting any electrolyte imbalances. Early recognition and treatment are paramount to prevent potentially life-threatening hypovolemic shock. Elderly patients are more likely to develop fluid imbalances.

Defining Characteristics
  • Decreased urine output
  • Concentrated urine
  • Output greater than intake
  • Sudden weight loss
  • Decreased venous filling
  • Hemoconcentration
  • Increased serum sodium
  • Hypotension
  • Thirst
  • Increased pulse rate
  • Decreased skin turgor
  • Dry mucous membranes
  • Weakness
  • Possible weight gain
  • Changes in mental status

Related Factors
  • Inadequate fluid intake
  • Active fluid loss (diuresis, abnormal drainage or bleeding, diarrhea)
  • Failure of regulatory mechanisms
  • Electrolyte and acid-base imbalances
  • Increased metabolic rate (fever, infection)
  • Fluid shifts (edema or effusions)

NOC Outcomes (Nursing Outcomes Classification)
Suggested NOC Labels
  • Fluid Balance
  • Hydration

NIC Interventions (Nursing Interventions Classification)
Suggested NIC Labels
  • Fluid Monitoring
  • Fluid Management
  • Fluid Resuscitation

Expected Outcomes
  • Patient experiences adequate fluid volume and electrolyte balance as evidenced by urine output greater than 30 ml/hr, normotensive blood pressure (BP), heart rate (HR) 100 beats/min, consistency of weight, and normal skin turgor.
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