Fluid Volume Excess Lecture

Introduction

• Speaker: Nurse Sarah from RegisteredNurseRN.com
• Topic: Fluid Volume Excess, also known as fluid volume overload, overhydration, hypervolemia, or water intoxication.
• Main Idea: Excessive fluid in the body can disrupt normal physiological functions, leading to specific signs and symptoms.

Fluid Compartments

1. Intracellular Compartment:
   • Fluid inside cells.
   • Accounts for two-thirds of body water.
2. Extracellular Compartment:
   • Fluid outside cells.
   • Accounts for one-third of body water.
   • Divided into:
     • Interstitial Compartment: Fluid around cells.
     • Intravascular Compartment: Blood plasma, accessed frequently by nurses.
     • Transcellular Compartment: Smallest, includes fluid around joints and organs like the heart/lungs.

Fluid Movement and Osmosis

• Osmosis: Movement of water from low osmolarity (solute concentration) to high osmolarity areas.
• Osmolarity influence: The concentration of solutes dictates fluid movement.

Types of Fluid Volume Overload

1. Hypertonic Fluid Volume Overload:
   • Water moves from intracellular to extracellular compartment.
   • Causes: High sodium intake, excessive hypertonic IV solutions.
2. Hypotonic Fluid Volume Overload:
   • Also called water intoxication.
   • Water moves from extracellular to intracellular compartment.
   • Causes: Excessive free water intake, psychogenic polydipsia, SIADH (syndrome of inappropriate antidiuretic hormone).
3. Isotonic Fluid Volume Overload:
   • No water movement between compartments.
   • Causes: Heart failure, kidney failure, excessive isotonic IV administration, corticosteroid overuse.

Signs and Symptoms

Neurological

• Brain swelling leading to confusion, headache, mental status changes.

Cardiovascular

• Bounding pulse, hypertension, jugular venous distension, sinus tachycardia.

Respiratory

• Pulmonary edema, shortness of breath, crackles, increased respiratory rate, dry or productive cough.

Peripheral

• Swelling and edema in extremities (pitting edema), cool skin, ascites, nausea, weight gain.

Laboratory and Diagnostic Findings

• Decreased levels: Hemoglobin, hematocrit, sodium, serum osmolality, urine specific gravity.
• Chest X-ray: Possible pulmonary edema.

Nursing Interventions (DRAIN mnemonic)

1. D - Diuretics:

   • Administer to promote urination and fluid removal.

2. R - Restrict Fluids and Sodium:

   • Limit fluid intake (1-2 liters/day).
   • Low sodium diet to prevent water retention.

3. A - Assess Daily Weight:

   • Track weight for fluid status changes (1 kg = 1 liter of fluid).
   • Monitor edema.

4. I - Intake and Output Monitoring:

   • Measure oral and IV intake against urine output.

5. N - Sodium Level Monitoring:

   • Track electrolytes to prevent imbalances like hyponatremia and hypokalemia.

Conclusion

• Importance of balancing fluid removal without causing fluid volume deficit.
• Ongoing monitoring of electrolytes and fluid status is crucial.

Additional Resources

• Further videos can be accessed via the described YouTube link.