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Fluid Volume Deficit
Fluid Volume Deficit
(_)Actual (_) Potential
| (_)
Excessive urinary output. (_) Inadequate fluid intake. (_) Abnormal drainage. (_) Excessive emesis. (_) Difficulty in swallowing. (_) Medication:________________________ (_) Diarrhea (_) Shock (_) Hemorrhage (_) Fever (_) Burns (_) Other:_____________________________ ____________________________________ ____________________________________ |
| 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.:
(_) Other: |
(_)
Asses:
(_) 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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