Fluid Volume Deficit

Fluid Volume Deficit

(_)Actual (_) Potential

Related To:
[Check those that apply]
(_) Excessive urinary output.
(_) Inadequate fluid intake.
(_) Abnormal drainage.
(_) Excessive emesis.
(_) Difficulty in swallowing.
(_) Medication:________________________
(_) Diarrhea (_) Shock (_) Hemorrhage (_) Fever (_) Burns
(_) Other:_____________________________
____________________________________
____________________________________

As evidenced by:
[Check those that apply]
Major:
(
Must be present)
(_) Output greater than intake.
(_) Dry skin/mucous membranes.
Minor:
(
May be present)
(_) Increased serum sodium. (_) Increased pulse from baseline.
(_) Decreased or excessive urine output. (_) Concentrated urine.
(_) Urinary frequency. (_) Decreased fluid intake. (_) Poor skin tugor.
(_) Thirst/nausea/anorexia.

Date &
Sign.
Plan and Outcome
[Check those that apply]
Target
Date:
Nursing Interventions
[Check those that apply]
Date
Achieved:
The patient will:

(_) Demonstrate adequate fluid balance A.E.B.:

  • Moist mucous membranes.
  • Balanced intake and output.
  • Normal lab values.
  • Improved skin turgor.

(_) Other:

(_) Asses:
  • Moistness of mucous membrane and skin turgor and chart findings.
  • Intake and output q___ hours.
  • Orthostatic hypotension QD.
  • Daily weights each _____ am/pm using same scale.
  • Labs: HCT, BUN, Specific gravity, Sodium, Other:______

(_) Encourage fluid intake of ____ cc/day; ____.

(_) Assist patient with drinking if necessary.

(_) Explore patient's understanding of etiological factors and provide necessary teaching.

(_) Other:________________
________________________
________________________
________________________

__________________________
Patient/Significant other signature

__________________________
RN signature

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