Susceptible to experiencing decreased intracellular and/or extracellular fluid, not including blood

• Difficulty obtaining fluids
• Impaired physical mobility
• Inadequate fluid intake
• Inadequate knowledge about fluid needs
• Inadequate muscle mass
• Ineffective medication self-management
• Malnutrition

• Active fluid loss
• Deviations affecting fluid absorption
• Deviations affecting fluid elimination
• Deviations affecting fluid intake
• Excessive fluid loss through normal route
• Extensive surgical procedures
• Fluid loss through abnormal route
• Pharmaceutical preparations
• Prolonged duration of surgical procedure
• Treatment regimen

• Age
• Vital signs
• Respiratory status, including increased respiratory rate
• Level of consciousness
• History of problems that can cause fluid loss, such as vomiting, diarrhea, indwelling tubes, and hemorrhage
• Pulse, blood pressure, respirations, and temperature
• Fluid and electrolyte status, including weight, intake and output, urine specific gravity, skin turgor, and mucous membranes
• Laboratory studies, including serum electrolyte, blood urea nitrogen, and hemoglobin (Hb) levels and hematocrit (HCT)

• Patient's vital signs will remain stable.
• Patient will maintain urine output of at least ____ mL/hour.
• Patient's electrolyte values will remain within normal range.
• Patient will maintain intake at ____ mL/24 hours.
• Patient's intake will equal or exceed output.
• Patient will express understanding of need to maintain adequate fluid intake.
• Patient will demonstrate skill in weighing himself or herself accurately and recording weight.
• Patient will measure and record own intake and output.
• Patient will return to appropriate diet.

Suggested NOC Outcomes

• Monitor and record vital signs every 4 hours. Fever, tachycardia, dyspnea, or hypotension may indicate hypovolemia.
• Maintain accurate record of intake and output to aid estimation of patient's fluid balance.
• Measure urine output every hour. Record and report an output of less than ____ mL/hour. Decreased urine output may indicate reduced fluid volume.
• Measure and record drainage from all tubes and catheters to take such losses into account when replacing fluid.
• When copious drainage appears on dressings, weigh dressings every 8 hours, and record with other output sources. Excessive wound drainage causes significant fluid imbalances (1 kg dressing equals about 1 L of fluid).
• Test urine specific gravity each shift. Monitor laboratory values and report abnormal findings to physician. Increased urine specific gravity may indicate dehydration. Elevated hematocrit and hemoglobin level also indicate dehydration.
• Monitor serum electrolyte levels and report abnormalities. Fluid loss may cause significant electrolyte imbalance.
• Obtain and record patient's weight at the same time every day to help ensure accurate data. Daily weighing helps estimate body fluid status.
• Monitor skin turgor each shift to check for dehydration; report any decrease in turgor. Poor skin turgor is a sign of dehydration.
• Examine oral mucous membranes each shift. Dry mucous membranes are a sign of dehydration.
• Cover wounds to minimize fluid loss and prevent skin excoriation.
• Determine patient's fluid preferences to enhance intake.
• Keep oral fluids at bedside within patient's reach and encourage patient to drink. This gives patient some control over fluid intake and supplements parenteral fluid intake.
• Instruct patient in maintaining appropriate fluid intake, including recording daily weight, measuring intake and output, and recognizing signs of dehydration. This encourages patient and caregiver participation and enhances patient's sense of control.
• Force oral fluids when possible and indicated to enhance replacement of lost fluids. (Bowel sounds should be present and patient awake before giving oral fluids.)
• Administer parenteral fluids as prescribed to replace fluid losses. Maintain parenteral fluids or blood transfusions at prescribed rate to prevent further fluid loss or overload.
• Progress patient to appropriate diet as prescribed to help achieve fluid and electrolyte balance.

Suggested NIC Interventions

• Patient's temperature, pulse rate, blood pressure, and respirations are within set limits (specify).
• Patient's urine output remains at specified volume.
• Patient's electrolyte values remain normal.
• Patient's daily fluid intake remains within established limits (specify).
• Patient's cumulative intake equals or exceeds cumulative output.
• Patient demonstrates understanding of importance of maintaining fluid balance.
• Patient weighs himself or herself with same scale at same time each day and records results.
• Patient maintains weight.
• Patient measures fluid intake and output; records are reviewed to ensure accuracy.
• Patient returns to normal, appropriate diet.

• Observations of physical findings
• Intake and output
• Weight (recorded daily)
• Drainage from indwelling tubes and catheters, including amount, color, and consistency
• Skin turgor, mucous membranes, vital signs, and other physical findings
• Urine specific gravity and other laboratory values
• Amount, color, and odor of drainage on dressings
• Patient teaching about fluid intake and diet
• Patient's response to interventions
• Evaluations for expected outcomes

• Li, J. S. C., Chan, J. Y. H., Tai, M. M. Y., Wong, S. M., Pang, S. M., Lam, F. Y. F., … Chak, W. L. (2018). Hydration and nutritional status in patients on home-dialysis—A single centre study. Journal of Renal Care, 44(3), 142-151.
• Paulis, S. J. C., Everink, I. H. J., Halfens, R. J. G., Lohrmann, C., & Schols, J. M. G. A. (2018). Prevalence and risk factors of dehydration among nursing home residents: A systematic review. Journal of the American Medical Directors Association, 19(8), 646-657.
• Shells, R., & Morrell-Scott, N. (2018). Prevention of dehydration in hospital patients. British Journal of Nursing, 27(10), 565-569.
• Suminski, R. R., Poston, W. S. C., Day, R. S., Jitnarin, N., Haddock, C. K., Jahnke, S. A., & Dominick, G. M. (2019). Steady state hydration levels of career firefighters in a large, population-based sample. Journal of Occupational & Environmental Medicine, 61(1), 47-50.