Nursing Diagnosis help with Deficient Fluid Volume

not enough information to help you with this...

Is the patient on IV fluids? If so, fluid volume might not be deficient.

Etiology is what causes the condition...that is the job of the physician.

If she has nausea and vomiting without fluid replacement, that is contributing to your fluid loss much more than the NPO. If she is vomiting, then she can't keep liquids down.

So you need to focus on how you are going to replace the fluids.

She is also at risk for fluid and electrolyte imbalance.

Decreased blood pressure doesn't cause dehydration...it is a symptom of dehydration.

So because of the variable B/P you are assuming a pt on IV fluid replacement is "actively loosing fluid r/t being NPO" maybe it is just me but you may want to look at this again...I am not sure your pt is that depleted...what else could be going on here??

Do you have to use that nursing diagnosis? Was anything done about the bowel obstruction? What?

how about Potential for Fluid Volume Deficit or whatever wording is "official" these days... related to active fluid loss as evidenced by vomiting? Look up fluid volume deficit or whatever official wording there is, and see which parts fit your patient.

I'm resistant to telling you more because I don't feel I know the patient well enough, AND it's your assignment and you don't learn if we give you the answers...

the rationale for the etiology on physiologically based nursing diagnoses (which is what deficient fluid volume is) has to be based on the pathophysiology of the underlying medical diseases or conditions.

are you saying your nursing diagnostic statement is deficient fluid volume r/t active fluid volume loss from dehydration secondary to npo amb active fluid volume loss from dehydration secondary to npo? i see problems with the construction of this diagnostic statement.

a nursing diagnostic statement follows this format:

• problem - this is the nursing diagnosis. a nursing diagnosis is actually a label. to be clear as to what the diagnosis means, read its definition in a nursing diagnosis reference or a care plan book that contains this information. the appendix of taber's cyclopedic medical dictionary has this information.
• etiology - also called the related factor by nanda, this is what is causing the problem and resulting in the symptoms. pathophysiologies of the patient's medical conditions need to be examined to find these etiologies. it is considered unprofessional to list a medical diagnosis so a medical condition must be stated in generic physiological terms. you can sneak a medical diagnosis in by listing a physiological cause and then stating "secondary to (the medical disease)" if your instructors will allow this. etiologies, if they are other than of a medical source, are often the focus of outcomes and long term goals.
• symptoms - also called defining characteristics by nanda, these are the abnormal data items that are discovered during the patient assessment. they could be signs and symptoms of the medical disease the patient has, their responses to their disease, problems accomplishing their adls. they are evidence that prove the existence of the problem. if you are unsure that a symptom belongs with a problem, refer to a nursing diagnosis reference. these symptoms will be the focus of your nursing interventions and goals.

let me break down your diagnosis. . .deficient fluid volume r/t active fluid volume loss from dehydration secondary to npo amb active fluid volume loss from dehydration secondary to npo

• problem: deficient fluid volume. the definition of this diagnosis is decreased intravascular, interstitial, and/or intracellular fluid. this refers to dehydration, water loss alone without change in sodium (page 84, nanda international nursing diagnoses: definitions and classifications 2009-2011). so, it is dehydration.
• etiology: active fluid volume loss from dehydration secondary to npo. while active fluid volume loss is the reason for the patient's dehydration, it doesn't really tell the reader of your diagnostic statement what has caused it. these listings in the nursing diagnosis references are broad suggestions and you, the nurse, need to supply more specific information. to add "loss from dehydration" is redundant to the diagnosis since deficient fluid volume is referring to dehydration anyway. and, npo is a treatment modality ordered by the physician and has nothing to do with the physiology of why this patient became dehydrated. not being mean here, but it shouldn't even be mentioned as an etiology because you are saying the doctor has dehydrated the patient and (1) that is not true and (2) it is unprofessional to take pot shots at the doc, especially in writing. what is going on here is that the patient has a small bowel obstruction which means she has a paralytic ileus, the reason for her nausea and vomiting. her immediate loss of fluids was because of the vomiting. as the bowel obstruction and ileus continues, the inactive bowel fills with fluids which become trapped in her intestinal track and lost, never able to be reabsorbed by the body (you may have noticed her abdomen getting distended and having hypoactive bowel sounds. that was due to her ileus and build up of fluids and gas in her intestines.). that is the source of her fluid loss. this is etiology your instructor was looking for you to discover and reflect in your nursing diagnostic statement. these webpages will help explain the pathophysiology of what is happening to this patient:
  
  • http://www.merck.com/mmpe/sec02/ch011/ch011h.html - intestinal obstruction
  • http://www.fpnotebook.com/surgery/gi/mchnclils.htm - small bowel obstruction
  • http://www.merck.com/mmpe/sec02/ch011/ch011g.html - ileus
  • http://www.merck.com/mmpe/sec19/ch276/ch276b.html - dehydration
• symptoms: inadequate active fluid volume loss from dehydration secondary to npo. your symptoms cannot be the same as your related factors. they must be the evidence that proves the existence of the problem. inadequate active fluid volume loss merely restates the nursing problem (deficient fluid volume). the remainder of that (from dehydration secondary to npo) makes no sense as a sign and symptom. evidence (manifestations) of deficient fluid volume, or dehydration, would be things such as a low blood pressure, low urine outputs, concentrated urine, dry mucous membranes, high temperatures, complaints of thirst, and weakness. things like being npo and having an ngt are treatments (medical interventions ordered by the physician for a medical problem) and not symptoms of a medical condition.

your diagnostic statement should read deficient fluid volume r/t fluids lost in the bowel amb [patient's symptoms of dehydration]. your nursing interventions will be to treat the signs and symptoms. the doctor will treat the dehydration (he already has ordered npo and the ngt). if there is iv therapy this would be an appropriate place to have those interventions. nursing interventions are of four types:

• assess/monitor/evaluate/observe (to evaluate the patient's condition)
• care/perform/provide/assist (performing actual patient care)
• teach/educate/instruct/supervise (educating patient or caregiver)
• manage/refer/contact/notify (managing the care on behalf of the patient or caregiver)

for more information on the writing of care plans, determining nursing diagnoses and to see other examples of how this is done, see this thread on the student forums: http://allnurses.com/general-nursing...ns-286986.html - help with care plans