FLUID VOLUME DEFICIT

CLINICAL INSTRUCTOR:

IVY MANCERA, RN, CNN, MSN

 INTRODUCTION
• Dehydration occurs when the fluid intake of the body is not sufficient to
meet the fluid needs of the body
• The goal of treatment is to restore fluid volume, replace electrolytes as
needed, and eliminate the cause of the fluid volume deficit
• Types of fluid volume deficits:
• Isotonic dehydration
• Hypertonic dehydration
• Hypotonic dehydration

A Fluid Volume Deficit by: Ivy Mancera, RN, MSN

 ISOTONIC DEHYDRATION
• Water and dissolved electrolytes are lost in equal proportions
• Known as hypovolemia
• Isotonic dehydration is the most common type of dehydration
• Isotonic dehydration results in decreased circulating blood volume and
inadequate tissue perfusion
• Causes:
• Inadequate intake of fluids and solutes
• Fluid shifts between compartments
• Excessive losses of isotonic body fluids
A Fluid Volume Deficit by: Ivy Mancera, RN, MSN
 HYPERTONIC DEHYDRATION
• Water loss exceeds electrolyte loss
• The clinical problems that occur results from alterations in the concentrations of specific plasma
electrolytes
• Fluid moves from the intracellular compartment into the plasma and interstitial fluid spaces,
causing cellular dehydration and shrinkage
• Causes:
• Excessive perspiration
• Hyperventilation
• Ketoacidosis
• Prolonged fever and diarrhea
• Early stage of renal failure
• Diabetes Insipidus
A Fluid Volume Deficit by: Ivy Mancera, RN, MSN
 HYPOTONIC DEHYDRATION
• Electrolyte loss exceeds water loss
• The clinical problems that occur result from fluid shifts between compartments,
causing a decrease in plasma volume
• Fluid moves from the plasma and interstitial fluid spaces into the cells, causing a
plasma volume deficit and causing the cells to swell
• Causes:
• Chronic Illness
• Excessive fluid replacement (hypotonic)
• Renal failure
• Chronic Malnutrition

A Fluid Volume Deficit by: Ivy Mancera, RN, MSN

 CLINICAL MANIFESTATIONS
• Fluid Volume Deficit can develop rapidly and its severity depends on the
degree of fluid loss
• Systemic Approach:
• Cardiovascular
• Respiratory
• Neuromuscular
• Renal
• Integumentary
• Gastrointestinal

B
Fluid Volume Deficit by: Ivy Mancera, RN, MSN
 CARDIOVASCULAR S/SX
• Thready and increased pulse rate
• Decreased blood pressure and orthostatic (postural)
hypotension
• Flat neck and hand veins in dependent positions
• Diminished peripheral pulses

B Fluid Volume Deficit by: Ivy Mancera, RN, MSN

 RESPIRATORY &
NEUROMUSCULAR S/SX
• Respiratory:
• Increased rate and depth of respirations
• Neuromuscular:
• Decreased central nervous system activity from lethargy to coma
• Fever

B Fluid Volume Deficit by: Ivy Mancera, RN, MSN

 RENAL & INTEGUMENTARY
S/SX
• Renal
• Decreased Urine Output
• Increased Urinary specific gravity
• Integumentary
• Dry skin
• Poor skin turgor, tenting present
• Dry Mouth
B Fluid Volume Deficit by: Ivy Mancera, RN, MSN
 GASTROINTESTINAL S/SX
• Decreased motility and diminished bowel sounds
• Constipation
• Thirst
• Decreased body weight

B Fluid Volume Deficit by: Ivy Mancera, RN, MSN

 MUSCULOSKELETAL S/SX
HYPOTONIC DHN HYPERTONIC DHN
• Skeletal muscle weakness • Hyperactive deep tendon
reflexes
• Pitting Edema

B Fluid Volume Deficit by: Ivy Mancera, RN, MSN

 DIAGNOSTIC FINDINGS
• Increased serum osmolality
• Increased hematocrit
• Increased creatinine
• Increased Blood Urea Nitrogen (BUN)
• Increased serum sodium level

C Fluid Volume Deficit by: Ivy Mancera, RN, MSN

 NURSING INTERVENTIONS
• Monitor cardiovascular, respiratory, neuromuscular, renal, integumentary, and
gastrointestinal status
• Prevent further fluid losses and increase fluid compartment volumes to normal
ranges
• Provide oral rehydration therapy if possible and intravenous (IV) fluid replacement if
dehydration is severe
• Administer medications as prescribed such as antidiarrheal, antimicrobial,
antiemetic, and antipyretic medications to correct the cause and treat symptoms
• Administer oxygen as prescribed
• Monitor electrolyte values and prepare to administer medication to treat an
imbalance, if present.
D Fluid Volume Deficit by: Ivy Mancera, RN, MSN
 NURSING INTERVENTIONS
• Monitor I&O
• Isotonic dehydration is treated with isotonic fluid solutions (0.9%
NaCl, Lactated Ringer’s solutions, D5W)
• Hypertonic dehydration is treated with hypotonic fluid solutions
(0.45% NaCl)
• Hypotonic dehydration is treated with hypertonic fluid solutions (D5 in
0.9% normal saline and D5 in lactated ringers, 3% NaCl)

D Fluid Volume Deficit by: Ivy Mancera, RN, MSN

 WATER AND ELECTROLYTE
SOLUTIONS

D Fluid Volume Deficit by: Ivy Mancera, RN, MSN

 “ THANK YOU,
THIS ENDS OUR FLUID
VOLUME DEFICIT
(DEHYDRATION) TOPIC.
”
UP NEXT: FLUID VOLUME EXCESS
Fluid Volume Deficit by: Ivy Mancera, RN, MSN
FLUID VOLUME EXCESS

CLINICAL INSTRUCTOR:
IVY M. MANCERA, RN, CNN, MSN
 INTRODUCTION
• Fluid intake or fluid retention exceeds the fluid needs in the body
• Fluid volume excess is also called overhydration or fluid overload
• The goal of treatment is to restore fluid balance, correct electrolyte
imbalances if present, and eliminate or control the underlying cause
of the overload
• Types of overhydration
• Isotonic overhydration
• Hypertonic overhydration
• Hypotonic overhydration
A Fluid Volume Deficit by: Ivy Mancera, RN, MSN
 ISOTONIC OVERHYDRATION
• Known as hypervolemia, isotonic overhydration results from excessive fluid in the
extracellular fluid compartment
• Only the extracellular fluid compartment is expanded, and fluid does not shift
between the extracellular and intracellular compartments
• Isotonic overhydration causes circulatory overload and interstitial edema; when
severe or when it occurs in a client with poor cardiac function, congestive heart
failure and pulmonary edema can result
• Causes:
• Inadequate controlled IV therapy
• Renal failure
• Long – term corticosteroid therapy
A Fluid Volume Deficit by: Ivy Mancera, RN, MSN
HYPERTONIC OVERHYDRATION
• Occurrence of hypertonic overhydration is rare and is caused by
an excessive sodium intake
• Fluid is drawn from the intracellular fluid compartment; the
extracellular fluid volume expands, and the intracellular fluid
volume contracts
• Causes:
• Excessive sodium ingestion
• Rapid infusion of hypertonic saline
• Excessive sodium bicarbonate therapy
A Fluid Volume Deficit by: Ivy Mancera, RN, MSN
 HYPOTONIC OVERHYDRATION
• Hypotonic overhydration is known as water intoxication
• The excessive fluid moves into the intracellular space, and all body fluid
compartments expand
• Electrolyte imbalances occur as a result of dilution
• Causes:
• Early renal failure
• Congestive heart failure
• Syndrome of inappropriate antidiuretic hormone secretion
• Inadequately controlled IV therapy
• Replacement of isotonic fluid loss with hypotonic fluids
• Irrigation of wounds and body cavities with hypotonic fluids

A Fluid Volume Deficit by: Ivy Mancera, RN, MSN

 CLINICAL MANIFESTATIONS
• FVE may be related to simple fluid overload or diminished function of the
homeostatic mechanism responsible for regulating fluid balance
• Contributing factors can include heart failure, kidney injury, liver cirrhosis and
too much consumption of table salt
• Hypotonic overhydration results in the following:
• Polyuria, Diarrhea, Nonpitting edema, Dysrhythmias, Projectile vomiting
• Systemic Approach:
• Cardiovascular
• Respiratory
• Neuromuscular
• Integumentary
B Fluid Volume Deficit by: Ivy Mancera, RN, MSN
 CARDIOVASCULAR S/SX
• Bounding, increased pulse rate
• Elevated blood pressure
• Distended neck and hand veins
• Elevated central venous pressure

B Fluid Volume Deficit by: Ivy Mancera, RN, MSN

 RESPIRATORY S/SX
• Increased respiratory rate (shallow respirations)
• Dyspnea
• Moist crackles on auscultation

B Fluid Volume Deficit by: Ivy Mancera, RN, MSN

 NEUROMUSCULAR S/SX
• Altered level of consciousness
• Headache
• Visual disturbances
• Skeletal muscle weakness
• Paresthesia

B Fluid Volume Deficit by: Ivy Mancera, RN, MSN

 INTEGUMENTARY S/SX
• Pitting edema in dependent
areas
• Pale skin
• Cold clammy skin
• Ascites

B Fluid Volume Deficit by: Ivy Mancera, RN, MSN

 DIAGNOSTIC FINDINGS
• Decreased serum osmolality
• Decreased hematocrit
• Decreased BUN level
• Decreased serum sodium level
• Decreased urine specific gravity

C Fluid Volume Deficit by: Ivy Mancera, RN, MSN

 MEDICAL MANAGEMENT
• Management of FVE is directed at the causes, and if related
to excessive administration of sodium – containing fluids,
discontinuing the infusion may be all that is needed
• Medical approach
• Pharmacologic therapy
• Dialysis
• Nutritional therapy

D Fluid Volume Deficit by: Ivy Mancera, RN, MSN

 PHARMACOLOGIC THERAPY
• Diuretics
• Thiazide diuretics – blocks sodium reabsorption in the distal tubule
• Prescribed for mild to moderate hypervolemia
• Hydrochlorothiazide (Microzide)
• Loop diuretics – cause a greater loss of both water and sodium
• Prescribed for severe hypervolemia
• Furosemide (Lasix), Torsemide (Demadex)
• Potassium Sparing Diuretics – to increase the amount of fluid passed from the
body in urine while preventing potassium being lost with it
• Must not be prescribed to patients with renal failure due to the risk of hyperkalemia
• Spironolactone (Aldactone), Amiloride (Midamor)
D Fluid Volume Deficit by: Ivy Mancera, RN, MSN
 DIALYSIS &
NUTRITIONAL THERAPY
• Hemodialysis of peritoneal dialysis may be used to
remove nitrogenous wastes
• Control potassium
• Maintain acid-base balance
• To effectively remove excess sodium and water in
the blood
• Sodium – restricted diet
• Caution on salt substitutes to patients taking
potassium sparing diuretics and renal patients

D Fluid Volume Deficit by: Ivy Mancera, RN, MSN

 NURSING INTERVENTIONS
• Monitor cardiovascular, respiratory, neuromuscular, renal, integumentary and
gastrointestinal status
• Prevent further fluid overload, and restore normal fluid balance
• Administer diuretics; osmotic diuretics typically are prescribed first to prevent severe
electrolyte imbalances
• Restrict fluid and sodium intake
• Monitor I&O
• Weight monitoring
• Monitor electrolyte values, and prepare to administer medication to treat an
imbalance if present
E Fluid Volume Deficit by: Ivy Mancera, RN, MSN
 “ THANK YOU,
THIS ENDS OUR FLUID
VOLUME EXCESS
(OVERHYDRATION) TOPIC.
”
UP NEXT:
ELECTROLYTE IMBALANCES: SODIUM IMBALANCES
Fluid Volume Deficit by: Ivy Mancera, RN, MSN