Hypervolemia: This is a condition in which the ECF compartment becomes expanded, and there is a surplus of circulating fluid with normal or near normal proportions of electrolytes.
Causes 1. Inability of the kidneys to excrete excess water and electrolytes as seen in chronic renal disease, chronic liver disease congestive heart failure, or administration of oral or parenteral fluids at a rate beyond renal capacity for excretion.
2 Administration of intravenous fluids at a rate beyond renal capacity for exrection espectialy in patients with impaired kidney functio, in infants or elderly people.
3 Fluild retention following administration of large doses of corticsteroids resulting from the increased level of aldosterone.
Clinical manifestations:
These are due to expanded exracellular volume
1. If excess fluids is in the vascular space there will be elevated BP, bounding pulse, distended neck veins, weight gain, dyspnea, crackles (rales), and pretibial and sacral oedema. If overload becomes sufficiently severe to exceed the pumping capacity of the left ventricle, pulmonary edema will result. 2. Laboratory findings are variable. Serum osmolality usually remains unchanged. Serum sodium values are not often affected, although they may be low. Hematocrit may be decreased.
Medical management:
The treatment is according to severity but the goal is to obtain a definitive diagnosis of the underlying cause to determine appropriate treatment.
1. Restrict fluids and sodium intake.
2. Administer diuretics e.g. Lasix to eliminate excess fluids.
3. Replace potassium losses secondary to diuretic therapy.
4. Administer dialysis for patients with renal failure or life-threatening hypervolemia.
Nursing diagnosis:
Fluid volume excess, edema related to surplus of circulating fluid.
Nursing Objective:
Patient’s vital signs, physical findings, and laboratory values are within acceptable limits.
Interventions:
1. Assess vital signs and monitor input and output; measure weight daily. Watch out for an irregular pulse, which can be indicative of dangerous hypokalemia.
2. Observe for and report edema, which may not be clinically evident until 5 – 10 pounds of fluid have been retained. Check sacral areas in patients on bed rest. Look for oedema in the ankles and pretibial areas of ambulatory patients.
3. Maintain fluid and sodium restrictions as prescribed.
4. Administer diuretics as prescribed.
5. Monitor lab values; be especially alert to decreased potassium in patients on diuretics.
6. Monitor for clinical indicators of potassium depletion during diuretic therapy. These include muscle weakness, cramping, nausea, anorexia, and cardiac dysrhythmias.
7. Replace potassium losses by administering potassium supplements as prescribed.
8. Teach patient about foods high in potassium, including oranges, tomatoes, and bananas.
Nursing diagnoses:
Impaired gas exchange related to tissue hypoxia secondary to pulmonary oedema.
Nursing Objective: Patient does not exhibit signs of respiratory dysfunction.
Interventions 1. Monitor character, rate, and depth of respirations; auscultate lung fields for adventitious breath sounds.
2. Keep patient in semi-Fowler’s position to facilitate respirations.
3. Teach patient deep-breathing exercises to enhance gas exchange.
Causes 1. Inability of the kidneys to excrete excess water and electrolytes as seen in chronic renal disease, chronic liver disease congestive heart failure, or administration of oral or parenteral fluids at a rate beyond renal capacity for excretion.
2 Administration of intravenous fluids at a rate beyond renal capacity for exrection espectialy in patients with impaired kidney functio, in infants or elderly people.
3 Fluild retention following administration of large doses of corticsteroids resulting from the increased level of aldosterone.
Clinical manifestations:
These are due to expanded exracellular volume
1. If excess fluids is in the vascular space there will be elevated BP, bounding pulse, distended neck veins, weight gain, dyspnea, crackles (rales), and pretibial and sacral oedema. If overload becomes sufficiently severe to exceed the pumping capacity of the left ventricle, pulmonary edema will result. 2. Laboratory findings are variable. Serum osmolality usually remains unchanged. Serum sodium values are not often affected, although they may be low. Hematocrit may be decreased.
Medical management:
The treatment is according to severity but the goal is to obtain a definitive diagnosis of the underlying cause to determine appropriate treatment.
1. Restrict fluids and sodium intake.
2. Administer diuretics e.g. Lasix to eliminate excess fluids.
3. Replace potassium losses secondary to diuretic therapy.
4. Administer dialysis for patients with renal failure or life-threatening hypervolemia.
Nursing diagnosis:
Fluid volume excess, edema related to surplus of circulating fluid.
Nursing Objective:
Patient’s vital signs, physical findings, and laboratory values are within acceptable limits.
Interventions:
1. Assess vital signs and monitor input and output; measure weight daily. Watch out for an irregular pulse, which can be indicative of dangerous hypokalemia.
2. Observe for and report edema, which may not be clinically evident until 5 – 10 pounds of fluid have been retained. Check sacral areas in patients on bed rest. Look for oedema in the ankles and pretibial areas of ambulatory patients.
3. Maintain fluid and sodium restrictions as prescribed.
4. Administer diuretics as prescribed.
5. Monitor lab values; be especially alert to decreased potassium in patients on diuretics.
6. Monitor for clinical indicators of potassium depletion during diuretic therapy. These include muscle weakness, cramping, nausea, anorexia, and cardiac dysrhythmias.
7. Replace potassium losses by administering potassium supplements as prescribed.
8. Teach patient about foods high in potassium, including oranges, tomatoes, and bananas.
Nursing diagnoses:
Impaired gas exchange related to tissue hypoxia secondary to pulmonary oedema.
Nursing Objective: Patient does not exhibit signs of respiratory dysfunction.
Interventions 1. Monitor character, rate, and depth of respirations; auscultate lung fields for adventitious breath sounds.
2. Keep patient in semi-Fowler’s position to facilitate respirations.
3. Teach patient deep-breathing exercises to enhance gas exchange.
