Deficient Fluid Volume... Dehydration... and haemorrhage?

[Seike]

Hello everyone!

It truly gets confusing when Nanda is used for diagnosis purposes, due to lack of explanation on the book.

Since the NDx definition for "Deficient Fluid Volume" says it is only about dehydration (water movement), it cannot be used for haemorrhage. And haemorrhage is volume loss, too!!

For haemorrhage, I use "Decreased Cardiac Output" related to "Altered Afterload". This is my rationale.

• Afterload is "the amount of resistance to ejection of blood from the ventricle". And that resistance could be systemic and pulmonary.
  
• Haemorrahge implies blood vessels breaking, and the vessels could be systemic and/or pulmonary.
  
• If there are broken blood vessels, then the resistance will be diminished.
  
• If there is diminished resistence, or altered resistance, then there is Altered Afterload.
  

"Altered Afterload" has defining characteristics found in haemorrhage, such as:

• Abnormal skin color (pale)
  
• Alteration in blood pressure
  
• Clammy skin (if blood loss led to hypovolemic shock)
  
• Decrease in peripheral pulses
  
• Decrease in pulmonary vascular resistance (PVR) (if blood loss is on that area)
  
• Decrease in systemic vascular resistance (SVR)
  
• Dyspnea
  
• Oliguria
  
• Prolonged capillary refill
  

Please, let me know your comments.

Thank you!