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Deficient Fluid Volume — Diabetes

Deficient Fluid Volume Diabetes Mellitus Nursing Care Plan

Nursing Diagnosis: Deficient Fluid Volume
May be related to
  • Osmotic diuresis (from hyperglycemia)
  • Excessive gastric losses: diarrhea, vomiting
  • Restricted intake: nausea, confusion
Possibly evidenced by:
  • Increased urinary output, dilute urine
  • Weakness; thirst; sudden weight loss
  • Dry skin/mucous membranes, poor skin turgor
  • Hypotension, tachycardia, delayed capillary refill
Desired Outcomes:
  • Demonstrate adequate hydration as evidenced by stable vital signs, palpable peripheral pulses, good skin turgor and capillary refill, individually appropriate urinary output, and electrolyte levels within normal range.
Nursing Interventions Actions
Obtain history from patient/SO related to duration/intensity of symptoms such as vomiting, excessive urination. Assists in estimation of total volume depletion. Symptoms may have been present for varying amounts of time (hours to days). Presence of infectious process results in fever and hypermetabolic state, increasing insensible fluid losses.
Monitor vital signs:

  • Note orthostatic BP changes;
  • Respiratory pattern, e.g., Kussmaul’s respirations, acetone breath;
  • Respiratory rate and quality; use of accessory muscles, periods of apnea, and appearance of cyanosis;
  • Temperature, skin color/moisture.
Hypovolemia may be manifested by hypotension and tachycardia. Estimates of severity of hypovolemia may be made when patient’s systolic BP drops more than 10 mm Hg from a recumbent to a sitting/standing position. Note: Cardiac neuropathy may block reflexes that normally increase heart rate.Lungs remove carbonic acid through respirations, producing a compensatory respiratory alkalosis for ketoacidosis. Acetone breath is due to breakdown of acetoacetic acid and should diminish as ketosis is corrected.Correction of hyperglycemia and acidosis will cause the respiratory rate and pattern to approach normal. In contrast, increased work of breathing; shallow, rapid respirations; and presence of cyanosis may indicate respiratory fatigue and/or that patient is losing ability to compensate for acidosis.Although fever, chills, and diaphoresis are common with infectious process, fever with flushed, dry skin may reflect dehydration.
Assess peripheral pulses, capillary refill, skin turgor, and mucous membranes. Indicators of level of hydration, adequacy of circulating volume.
 Monitor I&O; note urine specific gravity. Provides ongoing estimate of volume replacement needs, kidney function, and effectiveness of therapy.
 Weigh daily. Provides the best assessment of current fluid status and adequacy of fluid replacement.
Maintain fluid intake of at least 2500 mL/day within cardiac tolerance when oral intake is resumed. Maintains hydration/circulating volume.
Promote comfortable environment. Cover patient with light sheets. Avoids overheating, which could promote further fluid loss.
Investigate changes in mentation/sensorium. Changes in mentation can be due to abnormally high or low glucose, electrolyte abnormalities, acidosis, decreased cerebral perfusion, or developing hypoxia. Regardless of the cause, impaired consciousness can predispose patient to aspiration.
Insert/maintain indwelling urinary catheter. Provides for accurate/ongoing measurement of urinary output, especially if autonomic neuropathies result in neurogenic bladder (urinary retention/overflow incontinence). May be removed when patient is stable to reduce risk of infection.