Fluid volume deficit happens when the body loses more fluid than it takes in, from vomiting, diarrhea, bleeding, fever, or poor intake. It can lead to low blood pressure, kidney injury, and shock. Your priorities are replacing fluids, tracking intake and output, and treating the cause.
Each care plan below follows the nursing process (ADPIE).
Deficient Fluid Volume
- Vomiting, diarrhea, or bleeding
- Poor oral intake
- Fever and increased fluid loss
- Tachycardia and low BP
- Dry mucous membranes and poor skin turgor
- Dark, concentrated urine and low output
- Weight loss and high BUN
- Urine output of at least 30 mL/hr within 8 hours
- Heart rate and BP move toward baseline
- Client maintains fluid balance with moist mucous membranes and stable weight
- Strict intake and output
- Daily weight
- Vital signs, including orthostatic BP
- BUN, creatinine, sodium, and urine specific gravity
| INTERVENTION | RATIONALE |
|---|---|
| Give IV fluids as ordered | IV fluids replace volume quickly when the client cannot drink enough. |
| Offer oral fluids often in small amounts | Small sips are easier to keep down and add up over time. |
| Give antiemetics or antidiarrheals as ordered | Stopping the losses keeps the deficit from getting worse. |
| Report urine output below 30 mL/hr | Low output can be an early sign of kidney injury. |
EVALUATION
- Urine output meets the goal and is lighter in color
- Vital signs are back near baseline
- Mucous membranes are moist
Risk for Injury
- Orthostatic hypotension and dizziness
- Confusion from dehydration
- Weakness
- Client remains free of falls and injury while fluids are replaced
- Client recognizes early dehydration signs and stays free of injury at home
- Mental status every shift
- Orthostatic vital signs
- Fall risk score
| INTERVENTION | RATIONALE |
|---|---|
| Use fall precautions and assist with ambulation | Low volume can cause dizziness when standing. |
| Teach slow position changes | This gives BP time to adjust. |
| Teach early signs of dehydration like thirst, dark urine, and dizziness | Early fluids at home can prevent another admission. |
EVALUATION
- Client has no falls
- Client is alert and oriented
- Client lists signs of dehydration
Practice this in Everyday RN
Manage a full med-surg shift that includes a dehydrated client on IV fluids.
Play Everyday RNQuick answers
Which finding best shows fluid replacement is working?
Urine output of at least 30 mL/hr, along with a heart rate and BP returning toward baseline.
Who is at highest risk for fluid volume deficit?
Older adults and young children, because they have less fluid reserve and may not sense or express thirst.
For learning only. Individualize every care plan to your client, and follow your program, current guidelines, provider orders, and facility policy.