What is Dehydration (Deficient Fluid Volume)?

Deficient fluid volume is a health condition where the amount of fluid lost surprises the amount taken. The body proportionally loses electrolytes and water from the ECF. The major fluid loss causes are polyuria, gastrointestinal tract and hyperhidrosis. Deficient fluid volume has the following risk factors: dysfunctional liver, burns, insufficient adrenal, excess bleeding, nausea, vomiting, reduced intake, sweating, diarrhea, fluid access inability, increased urination, coma, ascites and GI suctioning. This might be a chronic or severe health condition that is manageable at a home, hospital or outpatient center.

Causes of Dehydration

Fluid deficit volume is caused by the following:

• Bleeding
• Diarrhea
• Increased metabolism
• Abnormal drainage
• Reduced fluid intake
• Insufficient fluid intake
• Diuresis
• Third space fluid movement
• Unusual fluid loss by the kidney, GI tract and skin.

Signs and symptoms

Dehydrated patients present the following signs and symptoms.

• Poor skin turgor.
• Orthostatic hypotension.
• Mental state alterations.
• Thirst that might/ might not be accompanied by tachyarrhythmia or a low pulse
• Weakness
• Loss of weight.
• Hemoconcentration and reduced blood pressure.
• Tachyarrhythmia and low pulse
• Sunken eyeballs and dry mucosa
• Reduced urination and increased urine concentration.

Goals and Outcomes

Fluid volume deficit goals and outcomes include;

• A patient has a normal blood volume.
• The patient demonstrates lifestyle changes to prevent dehydration advancement.
• The patient knows behaviors and causing factors crucial in correcting fluid deficit.
• The patient explains the measures used to prevent and treat fluid volume loss.
• Symptoms showing the necessity to seek medical assistance are described by the patient.

Nursing Assessment and Rationales for Fluid volume Deficit.

In order to identify problems that may cause fluid volume deficit, a nursing assessment is very important.

Nursing assessment.	Rationale
Vital signs (BP & HR) monitoring and documentation.	A decreased blood circulation can cause tachycardia and hypotension. Cardiac output is maintained through a  mechanism called alteration HR. Electrolyte imbalance causes irregular and weak pulse.
Evaluating skin turgor and oral mucosa	Dehydration signs are easily detected through the skin. Skin turgor shows skin elasticity. The inner thighs of elderly patients should be assessed since older adults lose skin elasticity. Endoscopic ultrasonography on a patient might reveal longitudinal furrows all over the tongue.
For orthostatic changes, patients’ BP and HR should be monitored.	A common sign of fluid loss usually manifests by a drop in systolic blood pressure by 20mm Hg and diastolic blood pressure by 10mm Hg. Older people have a higher risk of getting postural hypotension, and they should be alert if they start experiencing fluid loss symptoms so that they can seek professional help.
Sensorium/ mental alterations such as agitation, confusion and slowed responses should be assessed.	Major causes of sensorium and mental alteration are; electrolyte abnormalities, development of hypoxia, reduced cerebral perfusion, high/low glucose and acidosis. Patients who are not attentive and responsive are at a higher aspiration risk despite the underlying cause of impaired consciousness.
Urine amount and color should be assessed. If a patient passes urine less than 30ml per hour for two consecutive hours, report to a physician	Normal urine passed by a patient should not be less than 30ml/hr. If a patient has concentrated urine, they are experiencing a fluid deficit.
Body temperature should be monitored and documented.	A high body temperature of 37.2°c means the patient has fluid loss through perspiration and is experiencing fast breathing.
In relation to the patient’s dietary intake, monitor fluid intake.	The body gets fluids from the foods, drinks, and the water formed after food is oxidized.
The presence of fever, nausea and vomiting should be noted.	Route of replacement, fluid intake and the need to take fluids are largely influenced by fever, nausea and vomiting.
Auscultation of the heat should be performed, noting and documenting rhythm, rate and other findings that may seem abnormal.	Electrolyte imbalance, commonly known as hypovolemia, can cause dysrhythmia.
Urine osmolarity and serum electrolytes should be monitored, and a report on abnormal values should be done.	High blood urea nitrogen levels in a patient indicate that she/he has a fluid deficit. High levels of blood urea nitrogen also increase urine-specific gravity.
Parenteral therapy should be initiated after finding out whether the patient has any heart problems.	Small changes in fluid volume make elderly patients prone to dehydration and fluid volume deficit. They are also at risk of developing too much fluid in the lungs.
Weigh the patient using the same scale every day and at the same time.	Fluid volume imbalance can be assessed best by weighing the patients. Gaining 2 lbs in a week by the patient is said to be normal.
Possible fluid imbalance causes should be identified.	In order to have personalized and accurate care of the patients, a database with patient history should be established.
Active fluid loss from bleeding, diarrhea, wound drainage, vomiting and tubes should be monitored. Accurate records, both input and output, should be maintained.	Dehydration can result from decreased fluid volume, which is caused by fluid loss from bleeding, diarrhea, wound drainage, vomiting and tubes.

Nursing interventions for fluid volume deficit.

Fluid volume deficit nursing interventions include:

Nursing interventions	Rationale
The patient should be urged to take the required amount of fluid.	Oral fluid replacement is a cost-friendly approach in mild fluid deficit replacement treatment. Elderly patients should be reminded to take fluids since they rarely get thirsty. Patients can also be given oral hydrating solutions.
Help patients who cannot feed themselves by asking family members and SO to assist them.	Dehydrated patients are usually very weak and may find it difficult to take the required amount of food by themselves.
Preferred oral fluid should be given to the patient. Straws and fresh fluids should be placed near the bed where the patient can easily access them.	Since patients rarely get thirsty, they should be constantly reminded to take fluids.
The importance of oral hygiene should be emphasized.	A dry and sticky mouth can result from fluid deficit volume. A feeling of discomfort in the dry mucous membrane can be reduced by practicing good oral hygiene. Increased drinking interest will be promoted by oral hygiene.
Cover patients with light sheets in order to create a cozy environment.	Overheating causes fluid loss, and in order to prevent more fluid loss, any situation that may lead to overheating should be dropped.
Patient’s daily activities should be planned. activities	Planning the patient’s daily activities will help conserve the patient’s energy.

Severe hypovolemia interventions are as follows.

Nursing Intervention	Rationale
Iv catheter should be inserted to have IV access.	In order to treat and to prevent hypovolemia complications, parenteral therapy is used.
Parenteral fluids should be given as prescribed. Patients whose vital signs are abnormal should have an IV fluid infusion.	The fluids maintain the hydration status of a patient. The patient’s clinical status will determine the type, fluid amount supposed to be replaced, and infusion rate.
Blood products should be administered as prescribed.	Fluid loss from active GI bleeding can be corrected by performing a blood transfusion.
The rate of IV flow should be maintained. Infusion should either be stopped or delayed if there is a fluid overload, and inform the physician.	Most fluid overload cases are common to old patients and require immediate intervention.
Insert the arterial and central venous line as indicated in order to help the physician.	In order to monitor a patient’s blood pressure closely, an arterial line is used. C-line is used to infuse fluids and to monitor fluid status and central venous pressure.
Measures that prevent too much electrolyte loss should be provided.	Such measures include; administering antipyretics and resting the GI tract. Diarrhea causes fluid loss, and antidiarrheal medicines should be used to treat it. Antipyretics drugs can reduce fever and fluid loss from diaphoresis.
Increase diet composition and volume immediately after fluid loss stops.	Foods rich in water helps rehydrate the body and improve the patient’s appetite.
Patients should be encouraged to take plenty of fluids depending on their drinking abilities.	To avoid the risk of being dehydrated, patients should take plenty of fluids even when they are experiencing urinary symptoms, and this will help maintain the patient’s homeostatic reserves.
Interventions used to reduce and to prevent dehydration episodes in future should be listed	If a patient is experiencing conditions that cause fluid deficit, such as fever and diarrhea, it is important for them to understand the significance of taking more fluids.
Patients should have an understanding of the causes and impacts of fluid loss.	Educating patients will help them take part in their daily care plan.
Create awareness of the importance of staying hydrated and maintaining proper patient nutrition.	This will help the patients in managing and preventing fluid loss.
Family members should be taught how to monitor output and intake at home.	Patient fluid status is indicated by measuring an exact fluid intake and output.
Patients should be referred to a private nurse for assistance.	Patients will continue receiving health care at home using community resources.
An emergency plan should be established, and patients should know when to request medical help.	Some fluid volume complications can be deadly and require emergency care since they cannot be treated at home.