Water imbalances in the body

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