03.04 Fluid Volume Overload

Overview

  1. Fluid volume overload
    1. Bloodstream
    2. Other fluid compartments

Nursing Points

General

  1. Too much fluid volume in bloodstream
    1. Excessive fluid intake
      1. Oral
      2. Intravenous
    2. Excessive intake of sodium
    3. Complications
      1. High blood pressure
      2. Increased hydrostatic pressure -> fluid leaks out of vessels
      3. Buildup of fluid around organs
      4. Fluid in lungs
      5. Hyponatremia
    4. Disease processes
      1. Kidney failure -> less or no urine output
      2. Congestive heart failure
        1. Stretched/weakend heart chambers ->Back up of blood
        2. Fluid leaks out of vessels
      3. Liver failure
        1. Increased pressure in liver ->fluid leakage
        2. Low albumin
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Assessment

  1. Presentation
    1. High blood pressure
    2. Jugular venous distention
    3. Edema
    4. Weight gain
    5. Lung crackles
    6. Shortness of breath
  2. Doctor orders
    1. Labs
      1. ProBNP level
        1. Shows stretching of the heart
      2. Albumin level
      3. Liver studies
      4. Bun & creatinine ->kidney function
      5. Sodium Level
    2. Chest XRAY
      1. Show pulmonary congestion/effusions (fluid overload)

Therapeutic Management

  1. Monitor intake and output
  2. Daily weight
  3. Doctor orders
    1. IV fluids
      1. Hypotonic-> push fluid back into cells
    2.  Diuretics
      1. Increase urine output
      2. Removes fluid
    3. Dialysis
      1. Remove fluid and solutes

Nursing Concepts

  1. Cellular regulation
    1. Affected by fluid overload causing damage
  2. Fluid & electrolyte balance
    1. Too much fluid
    2. Imbalanced electrolytes
  3. Lab values
    1. Sodium levels
    2. ProBNP
    3. BUN & creatinine
    4. Liver studies
    5. Albumin

Patient Education

  1. Follow doctor orders
    1. Fluid restriction
    2. Sodium restriction
    3. Take medications as prescribed
  2. Monitor weight

Reference Links

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Video Transcript

Hey guys! Welcome to the lesson on fluid volume overload where we will discuss how the body gets overloaded with fluid and what to do about it. 

So fluid overload is when there is too much fluid in the body inside or outside of the vessels. This can be caused by drinking too much fluid or receiving large amounts of IV fluids. Excessive intake of sodium or not enough sodium can also affect fluid volume in the body. Where salt goes, water goes, so increased sodium in the bloodstream will pull water out of the cells, causing the cells to shrink and increased fluid in the bloodstream. Contrary to this, not enough sodium will cause the fluid to shift into the cells causing the cells to swell. Next let’s explore faulty processes in the body that occur due to disease processes. 

Now let’s go over a few disease processes that cause fluid overload. When the kidneys fail, they aren’t able to filter the blood and release urine from the body. They may have less or no urine output, so as you can imagine fluid continues to collect in the body. Congestive heart failure is where the heart chambers are too stretched and fail to effectively pump the blood, resulting in the back up of blood. When the blood backs up in these vessels before the heart, fluid leaks out from all the hydrostatic pressure. Liver failure causes increased pressure in the liver causing fluid leakage into the abdomen called ascites where they have big hard bellies. They also have low albumin which causes further shifting because albumin helps keep the fluid from leaking out from the vessels into the interstitial space. Now let’s talk about how this complicates the body processes. 

So the fluid is building up in the vessels causing increased blood pressure. That increased hydrostatic pressure on the vessel walls causes the fluid to leak out of the vessels, allowing for fluid build-up around the organs. Remember in heart failure how the fluid is backed up? Well this can back up into the lungs vessels, leak out of the vessels and cause fluid in the lungs. Also imagine with too much fluid in the vessels, the sodium will be diluted causing hyponatremia. Let’s discuss what this patient may look like. 

The patient with fluid overload will have high blood pressure causing jugular venous distention. That increased pressure will cause vascular leakage and show as edema causing the patient to gain weight from that excess fluid hanging out in the interstitial areas of the body. Now remember how I said the back up of fluid from a weakened heart can back up into the lungs? Well this is going to make it hard for the patient to breath and you can listen to the lungs and heart the coarse crackles from the fluid in the lungs. The patient might even cough up this frothy pink stuff which is a sign of fluid overload in the lungs. Next let’s talk about doctor orders to assess the patient’s status. 

So the doctor will order lab work to assess the body’s status. ProBNP levels show if the heart is stretching, like in fluid overload and heart failure. Albumin levels and liver studies will help to diagnose liver failure as a cause of the fluid overload. Bun and creatinine levels can help diagnose kidney failure as the cause of fluid overload. A sodium level will be drawn as well to help determine treatment. The doctor may order a chest XRAY  if the patient is having pulmonary symptoms like shortness of breath, which will show if there is congestion or effusions in the lungs indicating fluid overload. Alright, now let’s explore how to manage fluid overload. 

It’s very important to monitor and chart the intake and output of the patient with fluid overload to make sure that they aren’t retaining extra fluid in the body. Daily weights help watch for fast weight gains which indicate fluid retainment in the body. The doctor might have to order IV fluids. I know, this sounds nuts, why would we give fluid if they are in fluid overload, but hear me out. Remember how I said increased sodium levels in the blood cause fluid to move out of the cells leaving them dehydrated? Well we need to move that fluid back in, which is best done with hypotonic IV fluids that have less solutes than fluid in them like half normal saline. The doctor will order diuretics along with this fluid to remove fluid from the body. WIthout sodium issues, the doctor won’t need to order any IV fluids, but the patient will on fluid restrictions and diuretics to get rid of some of the fluid. Dialysis may be necessary to remove fluid like in kidney failure where the patient does not urinate. Okay, now let’s move on to patient education. 

Our patient with fluid volume overload needs to be educated based on what the cause of the fluid overload is. For example, if they have CHF they will need to restrict fluid and monitor their weight. Patients with high sodium levels will need to restrict their sodium intake. We need to advise our patients to continue taking their medications daily as ordered. I have had so many patients just stop taking their diuretics because it makes them pee too much, so then they end up in the hospital with fluid overload. 

So our priority nursing concepts for the patient with fluid volume overload are cellular regulation, fluid and electrolyte balance, and lab values. 

Alright, now let’s review the key points. Fluid volume overload is where there is too much fluid inside or outside the blood vessels. This could happen when a patient drinks too much or eats too much salt. Congestive heart failure causes the back up of blood that leaks out of the vessels. Kidney failure leads to fluid retention from the decreased or absent urine output. Liver failure causes vascular leakage in the liver and low albumin levels furthering the leakage creating ascites where the abdomen is super big and hard full of fluid. The complications include high blood pressure, increased hydrostatic pressure, and fluid leakage to interstitial spaces. The patient with fluid volume overload may present with edema from vascular leakage, jugular distention from increased blood pressure, and weight gain from the excess fluid. The patient could have pulmonary symptoms like crackles or shortness of breath from fluid leakage into the lungs or pressure from fluid buildup surrounding the lungs. Fluid overload is managed by monitoring intake and output, checking daily weights, and restricting fluid. Hypotonic fluids may be needed to push fluid back into the cells in cases of hypernatremia. Diuretics are super important to take fluid off of the body through urine output. If the patient cannot urinate like in kidney failure, they may need dialysis for fluid removal. 

Guys, thanks so much for listening about fluid volume overload. Now go out and be your best self today, and as always, happy nursing. 

Read more

  • Question 1 of 5

The healthcare provider ordered furosemide 40 mg PO BID for a client. The nurse knows that the client has which of the following diagnosis? Select all that apply.

  • Question 2 of 5

The nurse assesses a client and notices that the lungs have coarse crackles and the client is struggling to breath, and the client’s legs are edematous. The nurse should implement which of the following orders first?

  • Question 3 of 5

A client is admitted for fluid volume overload. The nurse is about to assess the client and knows to expect which of the following symptoms?

  • Question 4 of 5

The client admitted with COPD has a history of congestive heart failure (CHF). During shift change, the client complains of shortness of breath. Vital signs were as follows: Blood pressure 154/74 HR 67 Respirations 24 Temperature 99.1F Pulse oximeter 78% on room air The nurse auscultates crackles in the lungs and knows that which of the following orders is not a priority at this time?

  • Question 5 of 5

A nurse is assessing a client for fluid volume overload. The nurse knows that which of the following orders should be implemented to determine if the client is in fluid overload?