Risk for Deficient Fluid Volume | Nursing Diagnosis for Renal Failure

Nursing diagnosis: risk for deficient Fluid Volume

Risk factors may include
Excessive loss of fluid (diuretic phase of ARF, with rising urinary volume and delayed return of tubular reabsorption capabilities)

Possibly evidenced by
(Not applicable; presence of signs and symptoms establishes an actual diagnosis)

Desired Outcomes/Evaluation Criteria—Client Will
Fluid Balance
Display I&O near balance, good skin turgor, moist mucous membranes, palpable peripheral pulses, stable weight and vital signs, and electrolytes within normal range.

Nursing intervention with rationale:
1. Measure I&O accurately. Weigh daily. Calculate insensible fluid losses.
Rationale: Helps estimate fluid replacement needs. Fluid intake should approximate losses through urine, nasogastric (NG) or wound drainage, and insensible losses—diaphoresis and metabolism. Note: Some sources believe that fluid replacement should not exceed two-thirds of the previous day’s output to prevent prolonging the diuresis.

2. Encourage fluid intake. Provide allowed fluids throughout 24-hour period.
Rationale: Diuretic phase of ARF may revert to oliguric phase if fluid intake is not maintained or nocturnal dehydration occurs.

3. Monitor BP, noting postural changes, and heart rate.
Rationale: Orthostatic hypotension and tachycardia suggest hypovolemia.

4. Note signs and symptoms of dehydration, such as dry mucous membranes, thirst, dulled sensorium, and peripheral vasoconstriction.
Rationale: In diuretic or postobstructive phase of renal failure, urine output can exceed 3 L/day. Extracellular fluid (ECF) volume depletion activates the thirst center, and sodium depletion causes persistent thirst, unrelieved by drinking water. Continued fluid losses and inadequate replacement may lead to hypovolemic state.

5. Control environmental temperature; limit bed linens, as indicated.
Rationale: May reduce diaphoresis, which contributes to overall fluid losses.

6. Monitor laboratory studies, such as sodium.
Rationale: In nonoliguric ARF or in diuretic phase of ARF, large urine losses may result in sodium wasting, while elevated urinary sodium acts osmotically to increase fluid losses. Restriction of sodium may be indicated to break the cycle.