Na:fluid volume deficit

MD: sepsis neonatorum

Short term goal: at the end of our 8 hour shift, the parents will verbalize understanding of having adequate fluid volume
Long term goal: at the end of hospitalization the patient will maintain fluid volume at functional level as evidence by individually
adequate urinary output, stable vital signs, moist mucus membranes, good skin turgor.

cues Problem scientific rationale Interventions rationale evaluation

s-“Di na siya fluid volume deficit decrease Evaluate nutritional - to assess causative Goal met, patient’s
masyadong intravascular, status, noting and precipitating relative verbalized
nagtatae” as interstitial, and/or current intake, factors understanding of the
verbalized by the intracellular fluid. weight changes, precaution needed
patient’s mother. This refers to problems with oral to reduce the risk of
dehydration with intake, use of fluid volume
o--(+) dob changes in sodium. supplements, deficite
-(+) vomiting measure
-(+)diarrhea subcutaneous
-(+) sunken eyes fat/muscle
-irritable and crying
-febrile (38.1 C) Note presence of -to evaluate degree
-(+) crackles physical signs(e.g., of fluid deficit.
dry mucous
membranes, poor
skin turgor, delayed
capillary refill.).

Establish 24 hour - correct/replace

replacement needs fluid losses to
and routes to be reverse
used. pathophysiological
mechanisms