Fluid Volume Deficit/Excess

NCLEX Review Guide: Fluid, Electrolyte & Acid-Base Balance

Fluid Volume Deficit (Hypovolemia)

Assessment & Clinical Manifestations

Decreased skin turgor - skin tents when pinched and returns slowly to normal position
Orthostatic hypotension - BP drops ≥20 mmHg systolic or ≥10 mmHg diastolic when changing positions
Increased heart rate, weak thready pulse, decreased urine output (<0.5 mL/kg/hr)
Dry mucous membranes, sunken eyes, decreased tear production
Concentrated urine (specific gravity >1.030), increased BUN and creatinine

Clinical Scenario

Mrs. Johnson, 75 years old, presents with diarrhea for 3 days. VS: BP 90/60 (baseline 130/80), HR 110, skin tenting present. Priority nursing action: Establish IV access and begin fluid replacement

Key Points

Monitor I&O strictly - output should be ≥30 mL/hr
Daily weights - 1 kg = 1 liter of fluid
Replace fluids gradually to prevent fluid overload

Fluid Volume Excess (Hypervolemia)

Assessment & Clinical Manifestations

Peripheral edema - starts in dependent areas (feet, ankles, sacrum in bedridden patients)
Pulmonary edema signs - crackles, dyspnea, pink frothy sputum
Jugular vein distention (JVD), bounding pulse, hypertension
Weight gain >2 lbs in 24 hours or >5 lbs in one week
Decreased hematocrit and BUN due to hemodilution

Critical Alert: Acute pulmonary edema is a medical emergency - position patient upright, administer oxygen, prepare for diuretics

Key Points

Restrict sodium and fluid intake as ordered
Monitor for signs of heart failure and pulmonary edema
Administer diuretics and monitor electrolytes closely

Commonly Confused Points

Fluid Volume Deficit	Fluid Volume Excess
Skin turgor: Tenting	Skin: Edema, tight
Pulse: Weak, thready	Pulse: Bounding, strong
Urine: Concentrated, dark	Urine: Dilute, pale
Weight: Rapid loss	Weight: Rapid gain

Study Tips & Memory Aids

Memory Aid: "DRY vs WET"

DRY (Deficit): Decreased BP, Rapid pulse, Yucky concentrated urine

WET (Excess): Weight gain, Edema, Tight skin

Priority Nursing Actions

Assess vital signs and level of consciousness
Monitor intake and output hourly
Obtain daily weights at same time, same scale, same clothing
Assess skin turgor and mucous membranes
Monitor laboratory values (electrolytes, BUN, creatinine)

Common Pitfalls

Don't confuse dehydration with fluid volume deficit - they're different conditions
Remember: Elderly patients may not show classic signs due to decreased skin elasticity
Always check skin turgor over the sternum or forehead in elderly patients

Quick Check Self-Assessment

☐ Can you identify 3 signs of fluid volume deficit?
☐ Do you know the priority intervention for suspected fluid overload?
☐ Can you explain why daily weights are more accurate than I&O?
☐ Do you understand the difference between dependent and pitting edema?
☐ Can you list 3 causes each of fluid deficit and excess?

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Fluid Volume Deficit/Excess

NCLEX Review Guide: Fluid, Electrolyte & Acid-Base Balance

Fluid Volume Deficit (Hypovolemia)

Assessment & Clinical Manifestations

Clinical Scenario

Key Points

Fluid Volume Excess (Hypervolemia)

Assessment & Clinical Manifestations

Key Points

Commonly Confused Points

Study Tips & Memory Aids

Memory Aid: "DRY vs WET"

Priority Nursing Actions

Common Pitfalls

Quick Check Self-Assessment

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Fluid Volume Deficit/Excess

NCLEX Review Guide: Fluid, Electrolyte & Acid-Base Balance

Fluid Volume Deficit (Hypovolemia)

Assessment & Clinical Manifestations

Clinical Scenario

Key Points

Fluid Volume Excess (Hypervolemia)

Assessment & Clinical Manifestations

Key Points

Commonly Confused Points

Study Tips & Memory Aids

Memory Aid: "DRY vs WET"

Priority Nursing Actions

Common Pitfalls

Quick Check Self-Assessment