Wednesday, May 21, 2014

Nursing Care Plan for Deficient Fluid Volume (Hypovolemia)

Definition

Extracellular Fluid Volume Deficient or hypovolemia (FVD) is isotonic body fluid loss, which is accompanied by loss of sodium and water in the same relative amount. Volume deficits often termed isotonic dehydration that should be used for conditions of relatively pure water loss resulting in hypernatremia.



Etiology

Factors that affect the body's fluid and electrolyte balance, among others:

Age:

Fluid intake needs vary depending on age, because age affects the surface area of the body, metabolism, and weight. Infant and children are more susceptible to interference than the fluid balance adulthood. In old age often occurs due to fluid balance disorders with impaired renal function or heart.

Climate:

People who live in areas that are hot (high temperature) and low air humidity has an increased loss of body fluids and electrolytes through sweat. While someone who indulge in a hot environment can lose up to 5 L of fluid per day.

Stress:

Stress can increase cell metabolism, blood glucose, and the breakdown of muscle glykogen. This mechanism can increase sodium and water retention so that when prolonged can increase blood volume.

Diet:

Diet affects the intake of fluids and electrolytes. When inadequate nutritional intake, the body will burn protein and fat so it will spare protein and serum albumin will be decreased even though both are indispensable in the process fluid balance so that this will lead to edema.



Clinical manifestations

Clinical signs and symptoms which may be obtained on the client with hypovolemia include: dizziness, weakness, fatigue, syncope, anorexia, nausea, vomiting, thirst, mental confusion, constipation, oliguria. Depending on the type of fluid loss. Hypovolemia may be accompanied by acid-base imbalance, or osmolar electrolyte. Depletion (CES) severe, can lead to hypovolemic shock.

Compensatory mechanisms of the body on the condition of hypovolemia, is to be an increase in the sympathetic nervous system stimulation (increased frequency of heart, inotropic [contraction of the heart] and vascular resistance), thirst, release of antidiuretic hormone [ADH], and the release of aldosterone. The condition can lead to hypovolemia long acute renal failure.



Complication
  • Loss of abnormal GI: vomiting, NG suction, diarrhea, intestinal drainage.
  • Abnormal skin loss: excessive diaphoresis secondary to fever or exercise, burns, cystic fibrosis.
  • Abnormal kidney loss: diuretic therapy, diabetes insipidus, osmotic diuresis (polyuria form), adrenal insufficiency, osmotic diuresis (uncontrolled diabetes, post-use of contrast agents.
  • Spasium third or plasma to interstitial fluid displacement: peritonitis, intestinal obstruction, burns, acites.
  • Hemorragia.
  • Changes in input: coma, lack of fluids.


Nursing Care Plan for Deficient Fluid Volume (Hypovolemia)

Assessment
  • Intake-output.
  • Weight.
  • Breath sounds.
  • Edema.
  • Check skin turgor.


Nursing Diagnosis
  1. Deficient Fluid Volume: less than body requirements related to diarrhea, gastric fluid loss, diaphoresis, polyuria.
  2. Impaired skin integrity related to dehydration and or edema.



Outcomes:

Individuals will:
  1. Increasing fluid intake of at least 2000 ml / day (unless contraindicated).
  2. Telling the need to increase fluid intake during stress or heat.
  3. Maintain urine specific gravity within normal limits.
  4. Showed no signs and symptoms of dehydration.


Interventions:

  1. Assess the preferred and non-preferred; give a favorite drink in the diet limits.
  2. Plan objectives fluid intake (eg, 1000 ml during the morning, afternoon 800 ml, and 200 ml of the evening).
  3. Assess individual understanding of the reasons to maintain adequate hydration and methods to achieve goals fluid intake.
 

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