In this article, we give an overview of fluid volume deficit and fluid volume excess, including the pathophysiology, risk factors, symptoms, diagnosis and treatment options. This disease is covered in our Medical-Surgical Flashcards (Cardiovascular system).
Medical-Surgical Nursing - Flashcards
Fluid volume deficit
In fluid volume deficit, the body's fluid output exceeds the body's fluid intake, which causes hypovolemia.
Fluid volume deficit risk factors
Risk factors associated with fluid-volume deficit include GI losses, such as excess vomiting, diuretics, hemorrhaging, diabetes insipidus, as well as hyperventilation.
Fluid volume deficit signs/symptoms
A lack of fluid volume causes blood pressure to drop, which can result in hypotension. The body will try to compensate for this hypotension by increasing the respiration rate and heart rate. This can lead to tachypnea and tachycardia.
Fluid volume deficit can also cause weak, thready pulses. The patient may feel weak and thirsty. It can also result in prolonged capillary refill time, and oliguria (decreased urine). This is pretty easy to remember for your nursing exams—If the patient is dehydrated or lacking in fluid volume, they're not going to be peeing a lot.
Fluid volume deficit can also result in flattened jugular veins.
Fluid volume deficit labs/diagnostics
A patient with fluid volume deficit may have concentrated blood and concentrated urine, which can result in an increase in urine specific gravity and urine osmolarity, an increase in hematocrit, serum osmolarity, and BUN.
Fluid volume deficit treatment
Treatment for fluid volume deficit includes providing the patient with IV fluid replacement.
Fluid volume deficit nursing care
Nursing care for a patient with fluid volume deficit includes monitoring their input and output, because if their urine output drops below 30 mL/hr, then it can be indicative of hypovolemic shock. Notify the provider if the urine output falls below 30 mL/hr.
Also, implement fall precautions as the physical weakness increases the likelihood of falling.
Fluid volume excess
Fluid volume excess is excessive intake of fluid, or inadequate excretion of fluid, which causes hypervolemia.
Fluid volume excess risk factors
Risk factors for fluid volume excess include kidney dysfunction. The kidneys are supposed to help with excretion of excess fluid and electrolytes. If the kidneys aren't working properly, then that fluid can back up into the body.
Heart failure is another key risk factor for fluid volume excess. If the heart is not beating effectively, then fluid can back up. Other risk factors include corticosteroids and cirrhosis.
Fluid volume excess signs/symptoms
Signs and symptoms of fluid volume excess can include weight gain, edema, hypertension, bounding pulses, as well as jugular vein distension.
Fluid volume excess can also cause tachycardia because the heart is being overwhelmed with all this excess fluid. So it will try to beat faster to compensate. The fluid can also back up into the lungs, and that can cause dyspnea as well as crackles and tachypnea.
Fluid volume excess labs/diagnostics
Fluid volume excess is the opposite of fluid volume deficit, which we covered previously. So the labs and diagnostics you need to know for fluid volume excess are the same as fluid volume deficit, but in the opposite direction.
Labs and diagnostics include: decrease in hemoglobin, decrease in hematocrit, decrease in serum osmolarity, diluted urine, and a decrease in urine specific gravity.
Fluid volume excess treatment
The go-to treatment for fluid volume excess is diuretics. There are loop diuretics (furosemide), thiazide diuretics (hydrochlorothiazide), osmotic diuretics (mannitol), and potassium sparing diuretics (spironolactone).
These medications are covered in our Pharmacology Flashcards for Nursing Students.
Fluid volume excess nursing care
Nursing care for a patient with fluid volume excess includes weighing the patient daily. In this article's video, Cathy emphasizes, "not once a week, not every other day, every single day."
If the patient has a weight gain of 1 - 2 lbs within a 24-hour period, or a weight gain of 3+ lbs within a week, then notify the provider.
Sit the patient up, and oxygen may need to be provided to make it easier to breathe.
Take great care with the patient's skin, because their skin will be very fragile if they have a lot of excess fluid. As Cathy describes in the video, their skin can be almost like tissue paper if the edema is really severe
Restricting fluid and sodium intake
You will likely need to restrict the patient's fluid and sodium intake, per provider's orders. This will likely be difficult for the patient, and, as Cathy shares from experience in the video, the patient may try to ask anybody who walks in the room to get more fluids.
This is very normal. Water is our most essential survival need, so feeling like you don't have enough water can feel like a crisis. But it is important for patient safety to follow the provider's orders for fluid intake As the bedside nurse, write on the whiteboard if the patient is on fluid restrictions, and share that information with the care team as well.
Monitor for complications
If you have a patient with fluid volume excess, monitor for complications, including pulmonary edema, (because of the backup of fluid on the lungs) as well as heart failure. Heart failure can cause fluid volume excess; it can also be a complication of fluid-volume excess.