How to Diagnose Fluid Volume Deficit: Signs and Care Plan

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Looking for information about fluid volume deficit? We’ve got you covered!

In this article, we’ll explain the fluid volume deficit nursing diagnosis (AKA deficient fluid volume) and describe the causes, symptoms, and signs. We’ll also provide guidance on creating a fluid volume deficit care plan.

 

What Is Fluid Volume Deficit?

Fluid volume deficit (also known as deficient fluid volume or hypovolemia) describes the loss of extracellular fluid from the body. Extracellular fluid is the body fluid not contained within individual cells. It constitutes about 20% of our body weight and includes blood plasma, lymph, spinal cord fluid, and the fluid between cells. Importantly, this fluid isn’t just water—it also contains electrolytes and other essential solutes.

Fluid volume deficit is often used interchangeably with the term “dehydration,” but they aren’t exactly the same thing. Dehydration refers specifically to the loss of body water as opposed to body fluid. What’s the difference? Electrolytes. If a patient has just lost water but no electrolytes, they’ll have slightly different issues—and require slightly different treatment—than a patient who has lost wholesale body fluids, which contains water and electrolytes.

 

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Well, some of these things are electrolytes.

 

What Causes Fluid Volume Deficit?

There are a number ways the body can lose fluid. Here are some major causes of deficient fluid volume:

  • Blood loss from cuts/wounds
  • Through the gastrointestinal system: vomiting and diarrhea
  • Abnormally excessive urination (polyuria); can be caused by excessive intake of diuretic substances or medications or from renal disorder.
  • Excessive sweating; typically sweating is more likely to cause dehydration than fluid volume deficit because the body generally expels far more water than electrolytes, but sweating can also cause deficient fluid volume in some cases.
  • Bleeding disorders
  • Burns (because the skin no longer protects against excessive fluid loss)

The fluids in the body also constantly need to be replenished. Patients can experience deficient fluid volume if they aren’t taking in enough fluid. This is particularly an issue with infant and elderly patients.

Patients can also experience fluid volume deficit if they are losing body fluids to a place inside the body where the fluid is not easily accessed by other organs and body systems; e.g. from edema or internal bleeding caused by trauma or as a complication of surgery. This is known as third spacing.

 

Types of Fluid Volume Deficit

While fluid volume deficit refers to the loss of both water and solutes from the body, there are three major types of fluid volume deficit:

  • Isotonic: Caused by losing fluids and solutes about equally; solute concentration in the remaining extracellular fluid then remains relatively unchanged
  • Hypertonic: Caused by losing more fluids than solutes, leading to increased solute concentration in the remaining fluid.
  • Hypotonic: Caused by losing more solutes than fluid leading to decreased solute concentration in remaining fluid. This is the rarest type.

The type of fluid volume deficit (as determined through lab work) may inform care, especially what fluids are offered to the patient to replace the lost fluid/solutes.

 

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She doesn’t look very happy to be getting IV therapy.

 

Signs and Symptoms of Fluid Volume Deficit

There are a variety of fluid volume deficit signs and symptoms to check for. First we’ll discuss what major symptoms the patient may experience, and then address some ways to determine it the fluid volume deficit nursing diagnosis applies.

Major Fluid Volume Deficit Signs

  • Dizziness (orthostatic/postural hypotension)
  • Decreased urination (oliguria)
  • Dry mouth, dry skin
  • Thirst and/or nausea
  • Weight loss (except in third spacing, where the fluid will still be in the body but inaccessible)
  • Muscle weakness and lethargy

If fluid volume deficit is severe (more than 20% of body fluid volume is lost), the patient may go into hypovolemic shock. The more fluids that are lost, the more severe the symptoms will become. The following shock symptoms may manifest:

  • Very pale skin
  • Cool, clammy extremities (from the body trying to conserve blood flow to essential systems)
  • Confusion and anxiety
  • Rapid, weak pulse
  • Fast, shallow breathing
  • Unusual sweating
  • Loss of consciousness
  • Coma

 

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Get this tired dog some fluids, stat!

 

How to Diagnose Fluid Volume Deficit

There are a variety of indicators you can use to diagnose deficient fluid volume. (Well before the patient reaches coma stage!)

 

Vital Signs

  • Increased heart rate: with less fluid available to the circulatory system, the heart pumps faster to bring oxygen to the body. However, the pulse will also feel weaker than usual.
  • Decreased blood pressure: in adults, lower fluid volume means lower pressure in the veins. However, note that children may still maintain high blood pressure when experiencing fluid volume deficit.
  • You may also want to take the patient’s orthostatic vital signs (vital signs in both supine/lying down and standing positions). A decrease in the systolic blood pressure of 20 mmHg or more or in the diastolic blood pressure of 10mmHg or more when standing indicates fluid deficit. So does an increase in the heart rate of 20 bpm or more.

 

Other Fluid Volume Deficit Signs and Symptoms

  • Decreased skin turgor/tenting. If you pinch the patient’s skin on the back of the hand or forearm and it and “tents” for a moment before returning to normal instead of immediately snapping back into position, this is a sign of decreased fluid volume. However, because elderly individuals already have low skin elasticity, this is not a reliable test of fluid volume deficit for those patients.
  • If you examine the tongue, you’ll most likely see several small furrows instead of the usual one main furrow.
  • With severe fluid volume deficit, you will see signs of decreased tissue perfusion: the nail will take more than three seconds to return to normal coloration when pressed in a capillary refill nail test. Patient’s eyes may appear sunken. Skin may be pale.
  • Neck veins will appear flat when the patient is laying back in a supine position.

 

Lab Results

Depending on the cause of the deficient fluid volume, you may also see:

  • Hypokalemia (decreased potassium in the bloodstream) is commonly caused by vomiting, diarrhea, excessive sweating, or renal (kidney) disorder.
  • Hyponatremia (decreased sodium in blood) OR hypernatremia (increased sodium in the blood) could be present depending on the types of fluid lost.
  • An increase in vasopressin/antidiuretic hormone may also occur as the body constricts the blood vessels and retains remaining body fluid to maintain blood pressure.

 

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The other kind of lab!

 

Potential Complications of Fluid Volume Deficit

When left untreated, severe fluid volume deficit can lead to:

  • Renal failure
  • Heart failure
  • General organ failure (from lack of oxygen)
  • Death

Even if patient’s life is saved through fluid infusion, if they reach the point of organ failure they may experience irreversible damage to some body systems.

 

Fluid Volume Deficit Care Plan

A nursing care plan is a written document that tracks what you have done and will do to take care of a particular patient’s individual needs. Nursing students generally need to create fairly detailed care plans fully from scratch at part of their training in order to learn nursing best practices and to practice the analytical skills critical for good nursing. However, if you are a working nurse, your place of work probably has a computer system that partially generates a care plan based on the input of the relevant nursing diagnoses.

We’ll go through the four parts of a nursing care plan (the diagnosis, goals for patient recovery, nursing orders or interventions, and evaluation) tailored to fluid volume deficit. We also have links to useful examples of completed fluid volume deficit care plans.

 

Diagnosis

First, you’ll identify the relevant nursing diagnosis or diagnoses. Unlike medical diagnoses, which typically identify the specific medical condition at issue (i.e. diabetes, bronchitis, celiac disease), nursing diagnoses describe the more immediate and ongoing physical and psychological needs of the patient.

According to the standards set by NANDA International, a nursing diagnosis is typically written in a three-part manner: first the diagnosis, then what the diagnosis is related to (its direct cause), and finally the evidence for that diagnosis. You can reference the common direct causes and diagnostic signs and symptoms of fluid volume deficit as noted above for help creating your diagnostic statement.

An example fluid volume deficit nursing diagnosis statement might look something like this: “Fluid volume deficit related to diarrhea and vomiting secondary to gastroenteritis as evidenced by decreased skin turgor, low blood pressure, and decreased urine output.”

“Risk for fluid volume deficit” or “risk for deficient fluid volume” is a slightly different nursing diagnosis that can be used to describe patients who, while not yet exhibiting serious signs of fluid volume deficit, are at particular risk of developing the issue. A risk nursing diagnosis only has two parts: the diagnosis (“risk for fluid volume deficit”) is related to whatever the cause of the potential future issue is (“diarrhea and vomiting”). So the risk diagnosis would be “risk for fluid volume deficit related to diarrhea and vomiting.”

The patient may also have other nursing diagnoses in addition to fluid volume deficit. These should be included in the care plan. Any other diagnoses you made would be specific to the patient and based on a head-to-toe assessment (coming soon).

 

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I diagnose this owl with incredible cuteness.

 

Goals

The overall goal of a nursing care plan for a stable patient with deficient fluid volume is to safely restore fluids and necessary electrolytes to the body, but you’ll want to be more specific than that. Good goals for your care plan should be specific to the patient and measurable (so you can definitively assess whether the goal has been met).

Depending on the patient, here are some example goals that might be appropriate for treating fluid volume deficit.

Patient is no longer deficient in fluid volume as evidenced by:

  • Urine output of at least 30 mL/hour (720 mL/day)
  • Systolic blood pressure restored to patient baseline (or 90 mmHg)
  • Patient heart rate of 60-100 bpm (or patient baseline)
  • Improved skin turgor
  • Normal BUN and hematocrit lab values

 

Orders/Interventions

While the particular interventions you choose in your care plan should be tailored to the patient and the severity of their condition, here are some potentially appropriate nursing interventions for fluid volume deficit. Note that some of these deficient fluid volume interventions are not highly specific because they would need to be tailored to the individual patient. If you do use these interventions in a care plan, be sure to select appropriate benchmarks for the patient and add more information.

  • Administer intravenous fluid therapy as prescribed; monitor fluid replacement levels closely to ensure patient does not experience fluid overload
  • Administer blood transfusion products as prescribed
  • Offer electrolyte-rich oral fluids (like a sports drink) if tolerated/appropriate; assist patient in drinking if necessary
  • Assess patient mental state for signs of confusion/agitation
  • Provide oral hygiene to patient at least two times a day (so patient can respond to the sensation of thirst)
  • Maintain record of patient intake and output of fluids
  • Weigh patient daily in the same clothes on the same scale
  • Monitor lab values: hematocrit (assess every 30 mins to 4 hours as appropriate); BUN to creatinine; others as appropriate
  • Monitor skin turgor and moisture of mucous membranes
  • Monitor vital signs (blood pressure and heart rate), including orthostatic vital signs
  • Assess amount, color, and osmolality of urine
  • Provide necessary education about maintaining appropriate hydration to patient
  • Patient can name fluid volume deficit symptoms that indicate a need to seek medical care

Evaluation

In your fluid volume deficit care plan, you’ll use this section to track what interventions and orders were successfully implemented, assess patient progress towards the goals, and evaluate whether each of the fluid volume deficit interventions (and interventions for any other diagnoses you made) described in the plan should be ceased, continued, or revised.

 

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Well, this dog seems pretty happy with how everything is going.

 

Example Fluid Volume Deficit Care Plans

There are several sources of example care fluid volume deficit care plans. Here are some you may find useful:

 

Prenhall Nursing Care Plan – Deficient Fluid Volume

This example nursing plan is free supplemental material from a Prentice Hall nursing textbook. It offers a detailed case study with a nursing care plan for fluid volume deficit tailored to the particular patient.

 

Nursing Concept Blogspot – Deficient Fluid Volume

This care plan is quite detailed and offers explanations and rationale for lots of different potential nursing interventions for fluid volume deficit. Additionally, it segments out which interventions might be appropriate for different patient populations.

 

Nurses Labs Deficient Fluid Volume Care Plan

This is a very detailed care plan with detailed suggestions for nursing assessment and nursing interventions, along with rationales. It could be a helpful resource for students who need to write rationales for their care plans.

 

Nurses Labs – Hypovolemic Shock Care Plan

This care plan is specifically for addressing hypovolemic shock caused by fluid volume deficit, with specific interventions.

 

RN Speak Hypovolemia Nursing Management

This isn’t a complete care plan, but it does offer lots of specific assessment and interventions that could be incorporated into a fluid volume deficit nursing care plan.

 

RN Central Fluid Volume Deficit Care Plan

This care plan is laid out similarly to the computer care plans generated in hospitals, where the nurse simply selects the relevant components of the diagnosis, outcome, and interventions. It’s not very detailed but it gives a good idea of how quick care plans are generated in the field.

 

Delmar Learning Fluid Volume Concept Map

This isn’t laid out like a traditional care plan. However, nursing students may find it helpful as it lays out how all of the different parts of the fluid volume deficit care plan are conceptually related to each other.

 

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Plans are very important!

 

Key Takeaways: Fluid Volume Deficit

“Fluid volume deficit” (which is the same as “deficient fluid volume” or hypovolemia) is a nursing diagnosis that describes a loss of extracellular fluid from the body.

Gastrointestinal issues, blood loss (internal or external), inadequate fluid intake, and renal disorder are all things that can place a patient at risk for fluid volume deficit.

There are a variety of signs and symptoms of fluid volume deficit you can look for, including dizziness, dry mouth and skin, thirst and/or nausea, low blood pressure, and an increased heart rate.

If the fluid loss is very serious, the patient will go into hypovolemic shock and you might see the following severe fluid volume deficit symptoms: Pallor, confusion, cool/clammy extremities, fainting, and even coma.

Deficient fluid volume can be diagnosed through a combination of observation and assessment of patient body systems, vital signs, and lab work.

Finally, we also discussed how to make a fluid volume deficit care plan and listed potential goals, outcomes, and nursing intervention. The main deficient fluid volume interventions are to monitor the patient’s fluid levels and safely restore the lost fluid.

 

What’s Next?

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