2 Disorders of Water Balance: Hypovolemia and Hypervolemia

1.     Dehydration or hypovolemia

Nursing diagnosis: Fluid Volume deficit

Rationale:  Water loss is greater than water intake and the body is in negative fluid balance

Causes

              Hemorrhage

              Severe burns

              Prolonged vomiting and diarrhea

              Profuse sweating

              Water deprivation

             Diuretic abuse

Signs and Symptoms

             Cottonmouth

             Thirst

             Dry flushed skin

             oliguria

Consequence

             Weight loss

             Fever

             Mental confusion

             If severe:

          Hypovolemic shock and loss of electrolytes

Intervention

·                Encourage oral fluids

·                IV fluids  -isotonic solutions (0.9% NS or LR) until  

             BP back to normal, then hypotonic (0.45% NS)

·                Monitor I&O, urine specific gravity and  daily

                  weight

·                Monitor skin turgor, VS and mental status

Evaluation

          Normal:

·               Skin turgor

·               Specific gravity

·               VS

      Increased UOP

      Clear sensorium

           Good oral intake of fluids, labs WNL

2.     Hypervolemia

Nursing Diagnosis:  Fluid Volume excess

Rationale:  Fluid moves out of ECF into cells and cells swell.  It may be due to abnormal retention of water and sodium.

Causes

              Cardiovascular:  Heart Failure

               Urinary:  Renal Failure

               Hepatic: Liver failure, cirrhosis

               Other:  Cancer, thrombus, PVD, drug therapy

                          (corticosteroids), high sodium intake,

                     protein malnutrition

Signs and Symptoms

               Physical assessment:

·             Weight gain

·             Distended neck veins

·             Periorbital edema

·             Pitting edema

·             Adventitious lung sounds (mainly crackles)

·             Dyspnea

·             Mental status changes

·             Generalized or dependent edema

               VS

·             High CVP/PAWP

·             ↑cardiac output

               Laboratory data:

·             ↓Hct (dilutional)

·             ↓BUN (dilutional)

·             ↓serum osmolality

·             ↓specific gravity

              Radiography:

·             Pulmonary vascular congestion

·             Pleural effusion

·             Pericardial effusion

·             Ascites

Intervention

·               Sodium restriction (foods and water

               high in sodium)

·               Fluid restriction if necessary

·              Closely monitor IVF

·               If dyspnes or orthopnea felt: Position in

               semi fowler’s

·               Strict I&O

·               Check lung sounds, daily weight, degree

                of  edema

·                Reposition q2hrs

·                Promote rest and dieresis

          Check and monitor electrolyte composition of body fluids