Fluid Volume Deficit/Dehydration
Risk factors for FVD are as follows: vomiting, diarrhea, GI suctioning, sweating, decreased intake, nausea, inability to gain access to fluids, adrenal insufficiency, osmotic diuresis, hemorrhage, coma, third-space fluid shifts, burns, ascites, and liver dysfunction. Fluid volume deficit may be an acute or chronic condition managed in the hospital, outpatient center, or home setting.
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. 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.”
In other words, it is the water intake/excretion (rather than Na+ handling) that regulates the ECF sodium concentration. It also appears that although some students have knowledge of the different fluid compartments, they fail to apply their knowledge to real life cases. A number of students have a skewed understanding of body fluid compartments and harbour various misconceptions, the most common of which is erroneously referring to “ECF volume depletion” or “intravascular volume depletion” as “dehydration”. The vast majority of doctors appreciate that patients who present with profuse diarrhoea and vomiting and are consequently hypotensive and tachycardic are intravascularly depleted. They also very appropriately resuscitate these patients with 0.9% NS rather than D5W infusion. However, when presenting such a case during the ward round, they say “this patient was severely dehydrated and resuscitated with 0.9% NS”. So, although they correctly identify and treat the clinical syndrome of intravascular volume depletion, they use imprecise terminology (Freda BJ, Davidson MB, 2004).
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