Hypervolemia & Hypovolemia (Fluid Imbalances) Nursing Care Plans


Learn about hypervolemia and hypovolemia nursing care plans and nursing diagnosis. This guide will help you understand the causes, signs, and symptoms of hypervolemia and hypovolemia and provide you with effective nursing interventions and care plans.

Fluid Balance: Hypervolemia and Hypovolemia 

Body fluids have a variety of important functions in the human body: the facilitate transport of nutrients, hormones, proteins, and other molecules into cells; aid in the removal of metabolic waste products; regulate body temperature; lubricate musculoskeletal joints; provide a medium for which cellular metabolism could take place, and act as a component in body cavities.

  • Hypervolemia refers to an isotonic volume expansion of the extracellular fluid (ECF) caused by the abnormal retention of water and sodium in approximately the same proportions in which they normally exist in the ECF.
  • Hypovolemia occurs when the loss of extracellular fluid exceeds the intake of fluid.

Nursing Care Plans

The nursing goals for a patient with fluid imbalance are to restore fluid balance, prevent complications, and promote overall health and wellbeing. This is achieved through careful monitoring of fluid intake and output, administering appropriate medications, and implementing measures to manage underlying conditions that may be causing the fluid imbalance.

Here are two nursing diagnosis for fluid imbalances: hypervolemia and hypovolemia nursing care plans:

  1. Hypervolemia: Excess Fluid Volume
  2. Hypovolemia: Deficient Fluid Volume

Hypervolemia: Excess Fluid Volume

Hypervolemia can occur due to excess fluid or sodium intake, which overwhelms the body’s regulatory mechanisms and leads to an accumulation of fluid in the extracellular space. Compromised regulatory mechanisms, such as impaired kidney function or hormonal imbalances, can also contribute to hypervolemia by reducing the body’s ability to excrete excess fluid and maintain fluid balance.

Nursing Diagnosis

May be related to

  • Excess fluid or sodium intake.
  • Compromised regulatory mechanism.

Possibly evidenced by

  • Ascites.
  • Aphasia, muscle twitching, tremors, seizures.
  • Bounding pulses.
  • Changes in the level of consciousness (lethargy, disorientation, confusion to coma).
  • Crackles.
  • Distended neck and peripheral veins.
  • Edema variable from dependent
  • Elevated central venous pressure.
  • Extra heart sounds S3.
  • Hypertension.
  • Productive cough.
  • Shortness of breath.
  • Sudden weight gain, often in excess of 5% of total body weight.
  • Tachypnea with or without dyspnea, orthopnea.
  • Tachycardia (usually present); bradycardia (a late sign of cardiac decompensation).

Desired Outcomes

  • The client will verbalize understanding of individual dietary and fluid restrictions.
  • The client will demonstrate behaviors to monitor fluid status and prevent or limit recurrence.
  • The client will demonstrate stable fluid volume as evidenced by stable vital signs, balanced intake and output, stable weight, and absence of signs of edema.

Nursing Assessment and Rationales

Thorough nursing assessment is crucial in identifying the underlying causes of hypervolemia, monitoring the patient’s fluid status, and implementing appropriate nursing interventions to promote optimal health outcomes.

1. Monitor vital signs as well as central venous pressure, if available.
Tachycardia and hypertension are common manifestations. Tachypnea is usually present with or without dyspnea. Elevated CVP may be noted before dyspnea and adventitious breath sounds occur. Hypertension may be a primary disorder or occur secondary to other associated conditions such as heart failure.

2. Weigh clients daily. Observe for sudden weight gain.
One liter of fluid retention equals a weight gain of 1 kilogram (2.2 pounds). Daily weight measurement is essential in hypervolemia nursing care plans to detect minor changes in weight and prevent complications, and sudden weight gain should be observed as it may indicate fluid overload, requiring immediate nursing intervention.

3. Note the presence of neck and peripheral vein distention, along with pitting edema, and dyspnea.
These signs indicate fluid overload and can be used to assess the patient’s condition and response to treatment. Neck vein distention is a sign of increased central venous pressure, which can be caused by heart failure or pulmonary hypertension, while peripheral vein distention and pitting edema indicate fluid accumulation in the limbs. Dyspnea is a common symptom in hypervolemia and can be caused by pulmonary congestion or edema. Monitoring and noting these signs is essential in guiding nursing interventions, promoting optimal patient outcomes, and preventing complications such as heart failure and pulmonary edema.

4. Auscultate lung and heart sounds.
Adventitious sounds (crackles) and extra heart sounds (S3) are indicative of fluid excess, possibly returning in the rapid development of pulmonary edema.

5. Monitor intake and output. Note decreased urinary output and positive fluid balance on 24-hour calculations.
Decreased renal perfusion, cardiac insufficiency, and fluid shifts may cause decreased urinary output and edema formation.

6. Assess for the presence and location of edema formation.
Edema can be either a cause or a result of various pathological conditions reflecting four competing forces: blood hydrostatic and osmotic pressures and interstitial fluid hydrostatic and osmotic pressures. The dynamic interaction of these four forces allows fluid to shift from one body compartment to another. Edema may be generalized or localized in dependent areas. Older clients may develop dependent edema with relatively little excess fluid.

7. Monitor laboratory studies, such as sodium, potassium, BUN, and arterial blood gases (ABGs), as indicated.
Extracellular fluid shifts, sodium and water restriction, and renal function all affect serum sodium levels. Potassium deficit may occur with kidney dysfunction or diuretic therapy. BUN may be increased as a result of renal dysfunction. ABGs may reflect metabolic acidosis.

Nursing Interventions and Rationales

Nursing interventions are crucial for managing hypervolemia by improving fluid balance, preventing complications, and promoting health, and may include monitoring fluid, administering diuretics, and managing underlying conditions.

1. Monitor infusion rate of parenteral fluids closely; May use infusion pump, as necessary.
Rapid fluid bolus or prolonged excessive administration potentiates volume overload and the risk of cardiac decompensation.

2. Administer oral fluids with caution. Do a 24-hour schedule fluid intake if fluids are restricted.
Fluid restrictions, as well as extracellular shifts, can aggravate the drying of mucous membranes, and the client may desire more fluids that are prudent.

3. Encourage adequate bed rest.
Limited cardiac reserves result in fatigue and activity intolerance. Rest, particularly lying down, favors diuresis and reduction of edema.

4. Encourage deep breathing and coughing exercises.
Pulmonary fluid shifts potentiate respiratory complications.

5. Turn or reposition, and provide skin care at regular intervals.
Decreases pressure and friction on edematous tissue, which is more prone to breakdown than normal tissue.

6. Maintain semi-Fowler’s position if dyspnea or ascites is present.
Gravity improves lung expansion by lowering the diaphragm and shifting fluid to the lower abdominal cavity.

7. Provide safety measures as indicated such as putting the bed in a low position, providing soft restraints, and using side rails.
Fluid shifts may cause cerebral edema and changes in mentation, especially in the geriatric population.

8. Replace potassium losses, as indicated.
A potassium deficit may occur, especially if the client is receiving a potassium-wasting diuretic. This can cause lethal cardiac dysrhythmias if untreated.

9. Provide a balanced protein, low-sodium diet. Restrict fluids, as indicated.
If serum proteins are low because of malnutrition or gastrointestinal (GI) losses, intake of dietary proteins can enhance colloidal osmotic gradients and promote a return of fluid to the vascular space. Restriction of sodium or water decreases extracellular fluid retention.

10. Administer diuretics as indicated: loop diuretics such as furosemide (Lasix), potassium-sparing diuretics such as spironolactone (Aldactone), and Thiazide diuretics such as hydrochlorothiazide (Microzide).
To achieve the excretion of excess fluid, either a single thiazide diuretic or a combination of agents may be selected, such as thiazide and spironolactone. The combination can be particularly helpful when two drugs have different sites of action, allowing more effective control of fluid excess.

11. Prepare for and assist with dialysis or ultrafiltration, if indicated.
May be done to rapidly reduce fluid overload, especially in the presence of severe cardiac or renal failure.


Recommended Resources

Recommended nursing diagnosis and nursing care plan books and resources.

Disclosure: Included below are affiliate links from Amazon at no additional cost from you. We may earn a small commission from your purchase. For more information, check out our privacy policy.

Ackley and Ladwig’s Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning Care
We love this book because of its evidence-based approach to nursing interventions. This care plan handbook uses an easy, three-step system to guide you through client assessment, nursing diagnosis, and care planning. Includes step-by-step instructions showing how to implement care and evaluate outcomes, and help you build skills in diagnostic reasoning and critical thinking.

Nursing Care Plans – Nursing Diagnosis & Intervention (10th Edition)
Includes over two hundred care plans that reflect the most recent evidence-based guidelines. New to this edition are ICNP diagnoses, care plans on LGBTQ health issues and on electrolytes and acid-base balance.

NANDA International Nursing Diagnoses: Definitions & Classification, 2021-2023
The definitive guide to nursing diagnoses is reviewed and approved by the NANDA International. In this new version of a pioneering text, all introductory chapters have been rewritten to provide nurses with the essential information they need to comprehend assessment, its relationship to diagnosis and clinical reasoning, and the purpose and application of taxonomic organization at the bedside. A total of 46 new nursing diagnoses and 67 amended nursing diagnostics are presented.

Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions, and Rationales
Quick-reference tool includes all you need to identify the correct diagnoses for efficient patient care planning. The sixteenth edition includes the most recent nursing diagnoses and interventions from NANDA-I 2021-2023 and an alphabetized listing of nursing diagnoses covering more than 400 disorders.

Nursing Diagnosis Manual: Planning, Individualizing, and Documenting Client Care 
Identify interventions to plan, individualize, and document care for more than 800 diseases and disorders. Only in the Nursing Diagnosis Manual will you find for each diagnosis…. subjectively and objectively – sample clinical applications, prioritized action/interventions with rationales – a documentation section, and much more!

All-in-One Nursing Care Planning Resource – E-Book: Medical-Surgical, Pediatric, Maternity, and Psychiatric-Mental Health 
Includes over 100 care plans for medical-surgical, maternity/OB, pediatrics, and psychiatric and mental health. Interprofessional “patient problems” focus familiarizes you with how to speak to patients.

See also

Other recommended site resources for this nursing care plan:

Other nursing care plans related to endocrine system and metabolism disorders:


Matt Vera, a registered nurse since 2009, leverages his experiences as a former student struggling with complex nursing topics to help aspiring nurses as a full-time writer and editor for Nurseslabs, simplifying the learning process, breaking down complicated subjects, and finding innovative ways to assist students in reaching their full potential as future healthcare providers.

1 thought on “Hypervolemia & Hypovolemia (Fluid Imbalances) Nursing Care Plans”

  1. Thank you for sharing this informative article about hypervolemia and hypovolemia. As a nurse instructor, I would like to add some tips for caring for patients with these conditions. When caring for a patient with hypervolemia, it is important to monitor their fluid intake and output closely and implement interventions to reduce fluid overload, such as diuretic therapy and dietary modifications. On the other hand, for patients with hypovolemia, it is crucial to identify the underlying cause and administer appropriate fluid resuscitation while monitoring for signs of fluid overload. Thank you again for highlighting these important topics in nursing care.


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