Susceptible to rapid shift from one to the other of intracellular and/or extracellular fluids, not including blood

• Difficulty obtaining fluids
• Excessive fluid intake
• Excessive sodium intake
• Inadequate fluid intake
• Inadequate knowledge about fluid needs
• Inadequate muscle mass
• Ineffective medication self-management
• Malnutrition

• Active fluid volume loss
• Deviations affecting fluid absorption
• Deviations affecting fluid elimination
• Deviations affecting fluid intake
• Deviations affecting vascular permeability
• Excessive fluid loss through normal route
• Fluid loss through abnormal route
• Pharmaceutical preparations
• Treatment regimen

• Cardiovascular status including heart rate and rhythm, blood pressure, peripheral pulses
• Fluid and electrolyte status, weight, intake and output, urine specific gravity, skin turgor, mucous membranes, jugular vein distention
• Results of laboratory studies including serum electrolytes, blood urea nitrogen, hemoglobin, hematocrit
• History of cardiovascular, renal, gastrointestinal dysfunction

• Patient will remain hemodynamically stable.
• Patient will not experience electrolyte imbalance.
• Patient will maintain adequate urine output.
• Patient will identify risk factors contributing to possible imbalanced fluid volume.

Suggested NOC Outcomes

• Assess for conditions that may contribute to imbalanced fluid volume. Prompt treatment of underlying cause may prevent serious complications of fluid imbalance.
• Monitor vital signs and other assessment parameters frequently. Changes in heart rate and rhythm, blood pressure, and breath sounds may indicate altered fluid status.
• Collect and evaluate urine output frequently. Measure urine specific gravity as indicated. Decreased urine volume and elevated urine specific gravity indicate hypovolemia.
• Collect and evaluate serum electrolyte levels. Fluid alterations may affect electrolyte levels.
• Administer intravenous fluids as indicated. Proactive fluid management may prevent serious imbalances.
• Educate patient and family regarding fluid restrictions or need for increased fluids, depending on the underlying condition. Knowledge will enhance feeling of participation and sense of control.
• Provide encouragement and support for cooperation with prescribed treatment regimen. Positive reinforcement will promote compliance.
• Coordinate care with other members of the health care team to effectively manage underlying medical condition and prevent any alteration in fluid balance.

Suggested NIC Interventions

• Patient remains hemodynamically stable.
• Electrolytes remain within acceptable limits.
• Patient has no electrolyte imbalances as a result of altered fluid status.
• Patient has adequate urine output.
• Patient states risk factors contributing to altered fluid status.

• Patient's intake and output measurements
• Patient's vital signs and physical assessment findings
• Relevant lab results
• Patient's understanding of behaviors that promote fluid balance
• Evaluations for expected outcomes

• Davies, H., Leslie, G. D., & Morgan, D. (2017). A retrospective review of fluid balance control in CRRT. Australian Critical Care, 30(6), 314-319.
• Li, C., Wang, H., Liu, N., Jia, M., Hou, X., Zhang, H., & Xi, X. (2018). Early negative fluid balance is associated with lower mortality after cardiovascular surgery. Perfusion, 33(8), 630-637.
• Samransamruajkit, R., Saelim, K., Hantragool, S., Deerojanawong, J., Sritippayawan, S., & Prapphal, N. (2017). A comparison of NSS vs balanced salt solution as a fluid resuscitation and impact of fluid balance on clinical outcomes in pediatric septic shock. Critical Care & Shock, 20(3), 68-75.
• Van Regenmortel, N., Verbrugghe, W., Roelant, E., Van den Wyngaert, T., & Jorens, P. G. (2018). Maintenance fluid therapy and fluid creep impose more significant fluid, sodium, and chloride burdens than resuscitation fluids in critically ill patients: A retrospective study in a tertiary mixed ICU population. Intensive Care Medicine, 44(4), 409-417.