Fluid Volume Deficit related to Dehydration

Dehydration occurs when water or fluids out of the body more than the incoming fluid, so that the body is not able to function as it should. If the fluid needs are not immediately met, then the body will become dehydrated.

The initial signs of dehydration include:

• Feeling thirsty.
• Dizziness.
• Dark yellow urine color.
• Frequency of urination less than usual.

The most obvious indicator to determine the body dehydration / less fluid is to look at the color of urine: if bright and clear, the body hydrated, and if the yellow - dark red then it is almost certainly a sign of dehydration.

Dehydration mild - moderate effect and can cause the following symptoms:

• Dry mouth and sticky.
• Tired and sleepy.
• Thirst.
• The quantity of urine is reduced.
• Dry skin.
• Constipation.
• Headache.

In children, they usually become less active than usual when dehydrated.

Severe dehydration

If left unchecked, the body that dehydration can cause dehydration worse. Severe dehydration is an emergency medical condition, and must be given treatment.

Symptoms of severe dehydration can include:

• Very thirsty.
• Mouth, skin, and mucous membranes are very dry.
• Confusion and irritability.
• Not urinating more than 8 hours.
• Urine is very dark, and few in number.
• Eyes look sunken, heavy, dry and sore.
• Rapid heartbeat.
• Low blood pressure.
• Low level of awareness to a fever.

Fluid Volume Deficit related to excessive output, less input. (Doenges, 1999)

Goal: Adequate fluid volume, so the lack of fluid volume can be resolved.

Expected outcomes:

• Maintaining fluid balance.
• Vital signs (pulse = 80-100 x / min, temperature = 36-37 ° C)
• Capillary refill less than 3 seconds.
• Acral warm.
• Urine output is 1-2 cc / kg body weight / hour.

Action Plan

1) Monitor vital signs, capillary refill, status mucous membranes, turgor.
Rationale: circulation volume adequacy indicator, the data hypotension occurs with risk of injury after the change of position.

2) Monitor the amount and type of fluid intake, urine output measure accurately.
Rational: Patients should not consume fluids at all lead to dehydration, or changing caloric intake of fluids to affect electrolyte balance.

3) Discuss strategies to stop vomiting and use of laxatives / diuretics.
Rationale: Helping patients received the feeling that as a result of vomiting and / or use of laxatives / diuretics prevent further loss.

4) Identification of a plan to improve / maintain optimal fluid balance. For example: fluid intake schedule.
Rationale: Involving the patient in a plan to correct the imbalance.

5) Assess function test results electrolyte / kidney.
Rationale: The transfer fluids / electrolytes, renal function decline may extend affect healing.

6) Provide / supervise administration of IV fluids.
Rationale: Emergency measures to correct the imbalance of fluid.

7) Additional potassium, oral or N as indicated.
Rationale: It can prevent cardiac dysrhythmias.

Signs and Symptoms of Dehydration - (Mild, Moderate and Severe)

Dehydration occurs when water or fluids out of the body more than the incoming fluid, so that the body can not perform its functions properly. If the fluid needs are not immediately met, then the body will become dehydrated.

Dehydration is generally caused due to lack of drinking water, or when the body fluid that comes out is not immediately replaced. The weather, the level and frequency of physical activity and poor diet can also cause dehydration.

A person also can become dehydrated as a result of the disease being suffered, such as vomiting and diarrhea, sweating out while fever, and when doing activity in hot weather.

Signs and Symptoms of Dehydration

Early signs of dehydration include:

• Feel thirsty.
• Dizziness.
• Dark yellow urine.
• Frequency of urination is reduced than usual.

To know clearly the body hydrated is to look at the color of urine: if the color is bright and clear, the body well hydrated, and if yellow - dark red then it is almost certainly a sign of dehydration.

Dehydration (mild - moderate) can cause effects and symptoms as follows:

• Dry mouth and sticky.
• Tired and sleepy.
• Thirst.
• The quantity of urine is reduced.
• Dry skin.
• Constipation.
• Headache.

In children, they usually become less active than usual when dehydrated.


Severe dehydration

If left unchecked, the body fluid deficiency, can lead to severe dehydration. Severe dehydration is an emergency medical condition, and must be given treatment.

Symptoms of severe dehydration can include:

• Very thirsty.
• Mouth, skin, and mucous membranes are very dry.
• Confusion and irritability.
• Not urinating more than 8 hours.
• Very dark-colored urine, and few in number.
• The eyes look sunken, heavy, dry and sore.
• Rapid heartbeat.
• Low blood pressure.
• Low levels of awareness to a fever.

The best way to treat the dehydration is quickly replacing lost body fluids, ie with plenty of water, white water, milk, or fruit juice.

Sweet drinks can be used to replace the shortage of sugar in the body, and a snack or light meal can be used to replace body salts.

To prevent dehydration, it is recommended to drink at least 8 glasses of water each day. And drinking more than usual when the activity in hot weather, after exercising or sweating, and before going to bed and after waking.

Pediatric Nursing Management for Dehydration

Definition of Dehydration :

1. Dehydration is a condition where a person who did not undergo fasting experiencing or at risk of dehydration vascular, interstitial or intra-vascular (Lynda Jual Carpenito, 2000 : 139).
2. Dehydration is a lack of body fluids due to the amount of fluid that comes out more than the amount of fluid intake (Sri Ayu Ambarwati, 2003).
3. Dehydration is a disturbance in fluid balance, along with the output exceeds intake, so the amount of water in the body is reduced (Drs. Syaifuddin, 1992: 3).

Based on the above notions, it can be concluded that dehydration is the lack of extra cellular fluid which resulted in the migration of fluids or lost from the body.


3 Types Classification of Dehydration :

a. Isotonic dehydration
Isotonic dehydration is an equal loss of water and sodium. Isotonic means that the number of particles contained on one side of a permeable membrane is the same as on the other side, thus there is no fluid shift in either direction. The amount of intracellular and extracellular water remains in balance. This can be caused by a complete fast, vomiting, and diarrhea.

b. Hypotonic dehydration
Hypotonic dehydration is the loss of water and sodium at the same time but lack of water than sodium, serum sodium lower than the normal range of extracellular fluid was hypotonic body status to reduce the secretion of antidiuretic hormone, so that the water in the renal tubular reabsorption decrease in urine output to increase from an increase in extracellular osmotic pressure.

c. Hypertonic dehydration
Hypertonic dehydration is the loss of water and sodium at the same time, but the lack of sodium than water, it is higher than the normal range of serum sodium, extracellular fluid status was hypertonic. When lack of water than sodium, the increase in extracellular osmotic pressure, increased secretion of antidiuretic hormone, renal tubular reabsorption of water increased, reduced urine output.


Etiology of Dehydration

Various types cause dehydration (According to Donna D. Ignatavicus, 1991: 253).

1. Dehydration

• bleeding
• vomitus
• diarrhea
• hypersalivation
• fistula
• Ileustomy (cuts colon)
• diaporesis (excessive sweating)
• burn
• fasting
• therapy hypotonic
• suction gastrointestinal (stomach wash)

2. Hypotonic dehydration

• DM disease
• excess fluid rehydration
• severe malnutrition and chronic

3. Hypertonic dehydration

• hyperventilation
• water diarrhea
• diabetes insipidus (ADH hormones decreased)
• excessive fluid rehydration
• dysphagia
• Impaired sense of thirst
• disorders of consciousness
• systemic infection: increased body temperature.

Clinical Manifestations of Dehydration

The following symptoms or signs of dehydration by level (Nelson, 2000):

1. Mild dehydration (loss of fluids 2-5%, of its original weight)

• thirsty, restless
• pulse: 90 -110 x / min, normal breath
• normal skin turgor
• urine output (1300 ml / day)
• good awareness
• heart rate increased

2. Moderate dehydration (fluid loss of 5%, of its original weight)

• increased thirst
• rapid and weak pulse
• dry skin turgor, dry mucous membranes
• reduced urine output
• increased body temperature

3. Severe dehydration (loss of fluids 8%, of its original weight)

• loss of consciousness
• weak, lethargic
• tachycardia
• sunken eyes
• no urine output
• hypotension
• pulse rapid and smooth
• cold extremities

Management of Dehydration

Management in patients with dehydration (Doenges & Sylvia Anderson):

1. Antiemetic drugs (To overcome vomiting)

2. Antidiarrheal drugs
Spending excessive feces may be given anti-diarrhea medications.

3. Provision of drinking water
Provision of drinking water containing sodium sufficient to address the imbalance that occurs.

4. Intravenous fluid administration
In the severe dehydration, intravenous fluid administration is needed. Isotonic saline solution (0.9%) were intravenous fluids chosen for cases with near-normal sodium levels, as it will increase the plasma volume. Soon after reaching normotensive patients, half of normal saline solution (0.45%) is given to provide water to the cells and helps the disposal of metabolic waste products.

5. IV fluid bolus administration
Initial IV bolus administration of fluid in a fluid load test, to determine whether to increase the flow of urine, which showed normal renal function.