{
  "name": "Fluid Volume Deficit (Dehydration)",
  "slug": "fluid-volume-deficit",
  "url": "https://nursingplex.com/care-plans/fluid-volume-deficit",
  "category": "Endocrine & Metabolic",
  "summary": "Loss of intravascular volume; replacement therapy with intake/output and perfusion monitoring.",
  "nursing_diagnoses": [
    "Deficient fluid volume",
    "Decreased cardiac output",
    "Risk for electrolyte imbalance"
  ],
  "overview": [
    "Fluid volume deficit is a decrease in intravascular, interstitial or intracellular fluid. Isotonic loss (hypovolemia) removes water and sodium together, as in hemorrhage, vomiting, diarrhea and burns; pure water loss (dehydration) raises serum sodium and osmolality, pulling water out of cells.",
    "Compensation begins with tachycardia and vasoconstriction, so blood pressure may remain normal until 20–30% of volume is lost. Older adults, infants and patients on diuretics decompensate soonest because of blunted thirst and lower reserve.",
    "Nursing care replaces fluid at a rate matched to severity, corrects the underlying loss, and monitors for both under-resuscitation (shock, renal injury) and over-correction (overload, rapid sodium shifts)."
  ],
  "key_facts": [
    {
      "label": "Best bedside indicators",
      "text": "Daily weight, urine output and orthostatic vital signs — 1 kg equals about 1 liter."
    },
    {
      "label": "Urine output",
      "text": "Less than 0.5 mL/kg/hour indicates inadequate renal perfusion."
    },
    {
      "label": "Sodium correction",
      "text": "Correct chronic hypernatremia slowly — no faster than about 0.5 mEq/L per hour — to avoid cerebral edema."
    },
    {
      "label": "First-line fluid",
      "text": "Isotonic crystalloid (0.9% saline or lactated Ringer's) for hypovolemia."
    }
  ],
  "nursing_priorities": [
    "Restore circulating volume and tissue perfusion.",
    "Identify and stop ongoing losses.",
    "Correct electrolyte and acid–base disturbances safely.",
    "Protect renal function.",
    "Prevent falls and injury from orthostatic hypotension."
  ],
  "assessment": {
    "subjective": [
      "Reports of thirst, dry mouth, weakness or dizziness on standing",
      "History of vomiting, diarrhea, fever, poor intake or diuretic use",
      "Reports of decreased urination or dark urine",
      "Complaints of confusion or headache"
    ],
    "objective": [
      "Tachycardia, orthostatic hypotension, weak thready pulse",
      "Dry mucous membranes, poor skin turgor, sunken eyes, flat neck veins",
      "Acute weight loss and decreased urine output with high specific gravity",
      "Elevated BUN-to-creatinine ratio, hemoconcentration, high sodium or osmolality",
      "Prolonged capillary refill, cool extremities, altered mental status"
    ],
    "related_factors": [
      "Vomiting, diarrhea, nasogastric suction or fistula losses",
      "Hemorrhage or third spacing (burns, ascites, sepsis)",
      "Excessive diuresis, hyperglycemia or diabetes insipidus",
      "Fever, diaphoresis and insensible losses",
      "Inadequate intake from illness, immobility or impaired thirst"
    ]
  },
  "goals": [
    "The client will maintain blood pressure and heart rate within normal limits.",
    "The client will produce urine output above 0.5 mL/kg/hour with normal specific gravity.",
    "The client will show moist mucous membranes and normal skin turgor.",
    "The client will maintain electrolytes within normal limits."
  ],
  "interventions": [
    {
      "title": "Assess and monitor",
      "points": [
        "Weigh daily on the same scale and record strict intake and output.",
        "Check orthostatic vital signs and capillary refill each shift.",
        "Monitor electrolytes, BUN, creatinine, osmolality and urine specific gravity.",
        "Assess level of consciousness as a perfusion marker."
      ]
    },
    {
      "title": "Replace fluids",
      "points": [
        "Administer isotonic IV fluids at the prescribed rate using a pump.",
        "Encourage oral fluids or oral rehydration solution when the patient can drink safely.",
        "Offer preferred fluids hourly and keep them within reach.",
        "Reassess after each bolus for improvement or signs of overload — crackles, dyspnea, JVD."
      ]
    },
    {
      "title": "Treat cause and prevent harm",
      "points": [
        "Control vomiting and diarrhea with prescribed antiemetics and antidiarrheals.",
        "Hold or adjust diuretics and nephrotoxic drugs in consultation with the provider.",
        "Institute fall precautions and teach slow position changes.",
        "Provide frequent oral care to relieve dryness."
      ]
    }
  ],
  "patient_teaching": [
    "Teach daily weights and how much fluid to drink each day.",
    "Explain increasing fluids during fever, heat and exercise.",
    "Review signs to report: dizziness, dark scanty urine, confusion, rapid heartbeat.",
    "Teach use of oral rehydration solutions for gastroenteritis at home."
  ]
}