Risk for Deficient Fluid Volume — AIDS

Nursing Diagnosis: Risk for Deficient Fluid Volume

Risk factors may include

• Excessive losses: copious diarrhea, profuse sweating, vomiting
• Hypermetabolic state, fever
• Restricted intake: nausea, anorexia; lethargy

Desired outcomes

• Maintain hydration as evidenced by moist mucous membranes, good skin turgor, stable vital signs, individually adequate urinary output.

Nursing Interventions	Rationale
Monitor vital signs, including CVP if available. Note hypotension, including postural changes.	Indicators of circulating fluid volume.
Note temperature elevation and duration of febrile episode. Administer tepid sponge baths as indicated. Keep clothing and linens dry. Maintain comfortable environmental temperature.	Fever is one of the most frequent symptoms experienced by patients with HIV infections (97%). Increased metabolic demands and associated excessive diaphoresis result in increased insensible fluid losses and dehydration.
Assess skin turgor, mucous membranes, and thirst.	Indirect indicators of fluid status.
Measure urinary output and specific gravity. Measure/estimate amount of diarrheal loss. Note insensible losses.	Increased specific gravity/decreasing urinary output reflects altered renal perfusion/circulating volume. Note:Monitoring fluid balance is difficult in the presence of excessive GI/insensible losses.
Weigh as indicated.	Although weight loss may reflect muscle wasting, sudden fluctuations reflect state of hydration. Fluid losses associated with diarrhea can quickly create a crisis and become life-threatening.
Monitor oral intake and encourage fluids of at least 2500 mL/day.	Maintains fluid balance, reduces thirst, and keeps mucous membranes moist.
Make fluids easily accessible to patient; use fluids that are tolerable to patient and that replace needed electrolytes	Enhances intake. Certain fluids may be too painful to consume (e.g., acidic juices) because of mouth lesions.
Eliminate foods potentiating diarrhea	May help reduce diarrhea. Use of lactose-free products helps control diarrhea in the lactose-intolerant patient.
Encourage use of live culture yogurt or OTC Lactobacillus acidophilus(lactaid).	Antibiotic therapies disrupt normal bowel flora balance, leading to diarrhea. Note: Must be taken 2 hr before or after antibiotic to prevent inactivation of live culture.
Administer fluids/electrolytes via feeding tube/IV, as appropriate.	May be necessary to support/augment circulating volume, especially if oral intake is inadequate, nausea/vomiting persists.
Monitor laboratory studies as indicated, e.g.: Serum/urine electrolytes; BUN/Cr; Stool specimen collection.	Alerts to possible electrolyte disturbances and determines replacement needs. Evaluates renal perfusion/function. Bowel flora changes can occur with multiple or single antibiotic therapy.
Maintain hypothermia blanket if used.	May be necessary when other measures fail to reduce excessive fever/insensible fluid losses.