Overview
This lecture covers fluid volume excess (fluid overload), its causes, clinical manifestations, complications, and nursing interventions to manage and prevent further complications.
Fluid Volume Excess (Fluid Overload)
- Fluid overload, or overhydration, is an excess of body fluid due to intake or retention exceeding the body's needs.
- Most issues arise from excess fluid in the vascular space or dilution of electrolytes and blood components.
- The most common type is hypervolemia, which involves excessive fluid in the extracellular fluid (ECF) space.
- Causes include excessive fluid replacement, SIADH, psychiatric polydipsia, heart failure, corticosteroid use, water intoxication, and late-phase kidney failure.
Clinical Manifestations
- Cardiovascular: increased pulse, bounding pulse, elevated BP, decreased pulse pressure, distended veins, weight gain.
- Respiratory: increased rate, shallow breaths, shortness of breath, moist crackles on auscultation.
- Skin/Mucous Membranes: pitting edema, cool and pale skin, risk of skin breakdown.
- Neuromuscular: altered consciousness, headache, visual disturbances, muscle weakness, paresthesia.
- Gastrointestinal: increased motility, enlarged liver.
Assessment and Diagnosis
- Assess at least every 2 hours for signs of pulmonary edema.
- Pitting edema graded by severity and location.
- Hemodilution may cause decreased hemoglobin, hematocrit, and serum protein levels.
- Laboratory values for sodium and potassium may indicate electrolyte dilution.
Nursing Interventions and Priorities
- Patient safety is the top priority to prevent complications like pulmonary edema and heart failure.
- Use the DRAIN mnemonic: Diuretics, Restrictions (fluids/salt), Assessment (weights, intake/output), Intake/Output monitoring, Sodium monitoring.
- Diuretics remove excess fluid if kidney function allows; alternatives (e.g., conivaptan, tolvaptan) used for SIADH.
- Nutrition therapy includes fluid and sodium restriction.
- Daily weight is the best indicator of fluid retention.
- Teach patients and families to monitor and record daily weights; notify HCP if >3 lb/week or >2 lb/24hr gain.
Key Terms & Definitions
- Fluid Overload (Hypervolemia) — Excess body fluid, especially in the vascular/ECF space.
- SIADH — Syndrome of inappropriate antidiuretic hormone secretion, causing fluid retention.
- Pitting Edema — Swelling that leaves an indentation when pressed.
- Hemodilution — Decreased concentration of blood components due to excess water.
- Diuretics — Medications that promote urine output to reduce fluid overload.
Action Items / Next Steps
- Create drug cards for furosemide, conivaptan, and tolvaptan.
- Assess patient regularly for signs of worsening overload.
- Teach and reinforce patient/family education on daily weights and sodium monitoring.
- Monitor lab values for sodium and potassium.