Deficient Fluid Volume | Nursing Care Plan for Diabetes Mellitus Nursing diagnosis: deficient Fluid Volume related

to Osmotic diuresis from hyperglycemia, Excessive gastric lossesdiarrhea, vomiting, Restricted intakenausea, confusion Possibly evidenced by Increased urinary output, dilute urine Weakness, thirst, sudden weight loss Dry skin and mucous membranes, poor skin turgor Hypotension, tachycardia, delayed capillary refill Desired Outcomes/Evaluation CriteriaClient Will Fluid Balance 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 intervention with rationale: 1. Obtain history from client and significant other (SO) related to duration and intensity of symptoms, such as vomiting and excessive urination. Rationale: Helps estimate total volume depletion. Symptoms may have been present for varying amounts of timehours to days. Presence of infectious process results in fever and hypermetabolic state, increasing insensible fluid losses. 2. Monitor vital signs: Note orthostatic BP changes Rationale: Hypovolemia may be manifested by hypotension and tachycardia. Estimates of severity of hypovolemia may be made when clients systolic BP drops more than 10 mm Hg from a recumbent to a sitting or standing position. Note: Cardiac neuropathy may block reflexes that normally increase heart rate. 3. Assess peripheral pulses, capillary refill, skin turgor, and mucous membranes. Nursing intervention: Indicators of level of hydration and adequacy of circulating volume. 4. Monitor intake and output (I&O); note urine specific gravity. Rationale: Provides ongoing estimate of volume replacement needs, kidney function, and effectiveness of therapy. 5. Weigh daily. Rationale: Provides the best assessment of current fluid status and adequacy of fluid replacement. 6. Maintain fluid intake of at least 2,500 mL/day within cardiac tolerance when oral intake is resumed. Rationale: Maintains hydration and circulating volume. 7. Promote comfortable environment. Cover client with light sheets. Rationale: Avoids overheating, which could promote further fluid loss. 8. Investigate changes in mentation and sensorium. Rationale: 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 client to aspiration. 9. Administer fluids, as indicated: Isotonic (0.9%) or lactated Ringers solution without additives Rationale: Type and amount of fluid depends on degree of deficit and individual client response. Note: Client with DKA is often severely dehydrated and commonly needs 5 to 10 L of isotonic saline, 2 to 3 L within first 2 hours of treatment. 10. Administer potassium and other electrolytes intravenously (IV) or by oral route, as indicated. Rationale: Potassium should be added to the IV as soon as urinary flow is adequate, to prevent hypokalemia. Note: Potassium phosphate may be drug of choice when IV fluids contain sodium chloride in order to prevent chloride overload. Phosphate concentrations tend to decrease with insulin therapy.