Fluid volume excess (FVE)/ Hypervolemia

 Refers to an isotonic
expansion of the ECF
caused by the
abnormal retention of
water & sodium.
 Fluid moves out of
ECF into cells and
cells swell
 Causes
• Cardiovascular – Heart failure
• Urinary – Kidney injury
• Cirrhosis of the liver
• Others – high sodium intake,
protein malnutrition
• Excessive administration of
sodium containing fluids in a
client with impaired
regulatory mechanisms
• Prolonged corticosteroid
therapy
 Assessment of Patient w/
Hypervolemia:
- Acute Weight gain
- Peripheral edema &
ascites
- Distended jugular veins

- Crackles and shortness

of breath
- Elevated CVP
- Increased BP, bounding
pulse & cough
- Increased RR
- Increased urine output
 Nursing Diagnosis for patient s w/
Hypervolemia:
• Actual fluid volume
excess due to
significant  in water
& Na resulting in a
circulatory overload
• Ineffective breathing
pattern related to 
bronchial secretions &
pulmonary edema
• Anxiety related to
development of
pulmonary edema 2o
to circulatory overload
 Diagnostic Findings:
Lab data
– ↓ Hgb & Hct (plasma
dilution, low CHON
intake & anemia)
– ↓ serum & urine
osmolality
- Decreased Na &
specific gravity
- Chest x-ray-
pulmonary congestion
 Interventions
• Sodium restriction
(foods/water high in sodium)
• Fluid restriction, if necessary
• Closely monitor IVF
• If dyspnea or orthopnea >
Semi-Fowler’s
• Strict I & O, lung sounds,
daily weight, degree of
edema, reposition q 2 hr
• Promote rest and diuresis
(diuretics)
 Sources of water
• Oral liquids- 1300ml/day
• Water in foods – 1000ml/day
– Meats and vegetables - 60-90% water
• Water from oxidation - 300ml/day
– 10ml/cal of food metabolized
• Parenteral fluids
• Enteral feedings
 Medical Interventions:
• Restriction of Na & Fluids
• Promoting urine output – diuretics
Fluid Volume Deficit/
Hypovolemia
 Hypovolemia/ FVD
- occurs when loss of ECF
volume exceeds the
intake of fluid
 Hypovolemia/ FVD
Causes of Hypovolemia
1. Lack of fluid intake
due to:
- cognitive
impairment
- physical impairment
- impaired thirst
mechanism
 Hypovolemia/ FVD
2. Excess fluid losses
due to:
- unmonitored use of
potent diuretics
- severe vomiting &
diarrhea
- diaphoresis
- GI suction
- hemorrhage
- Diarrhea
- Burns
 Hypovolemia/ FVD
Assessment of Patient w/
Hypovolemia:
- Flat/ collapsed neck
veins
- Postural BP drop
- Oliguria/ anuria
- Shock
- No thirst unless
severe
- Normal to decreased
serum Na
Signs & symptoms of Hypovolemia
• Acute weight loss
• Decreased skin turgor
• Concentrated urine
• Weak, rapid pulse (
blood volume)
• Capillary filling time
prolonged ( O2 carrying
capacity)
• Orthostatic hypotension
• muscle cramps
• Sunken eyes
Decreased skin turgor
Signs of hypovolemic shock (SEQUELAE)

1. diminished sensorium (lethargy- a pathological state

of sleepiness or deep unresponsiveness & inactivity)

2. Lack of urine output

3. Cool moist extremities
4. A rapid and feeble pulse
5. Decreased BP
6. Peripheral cyanosis
7. DEATH.
 Labs for Hypovolemia
• Increased BUN &
creatinine
• Increased serum &
urine osmolality and
Increased specific
gravity
• Decreased urine
volume, dark color
 Interventions for Hypovolemia
• Major goal is to prevent or correct abnormal
fluid volume status before ARF occurs
• Encourage fluids
• IV fluids
– Isotonic solutions (0.9% NS or LR) until BP
back to normal, then hypotonic (0.45% NS)
• Monitor I & O, urine specific gravity, daily
weights
 Nursing Diagnoses for Patient w/
Hypovolemia:
• Potential of injury due to postural
hypotension related to hypovolemia
• Actual fluid volume deficit due to large
losses of Na & water resulting from diarrhea
& vomiting
• Alteration in urinary elimination patterns
due to  plasma volume w/ resulting  in
blood flow to kidney
• Alteration in cardiac output due to
inadequate blood volume
 Nursing Interventions Patient w/
Hypovolemia
• Assess VS q 1-4 hours
• Assess peripheral vein filling, it should have
venous refill in 3-5 seconds
• Monitor I&O, daily weights
• Monitor plasma Na, BUN, glucose & hct levels
• Determine history of chronic illness to help
eliminate possible causes
• Assess oral cavity, check for dryness of mucous
membrane & tongue (oral care)
• Check for skin turgor – forearm & sternum
• Restore oral fluid intake
 Nursing Interventions for hypovolemia

• Monitor skin turgor

• Monitor VS and mental status
• Evaluation
– Normal skin turgor, increased urinary
output with normal specific gravity,
normal VS, clear sensorium, good oral
intake of fluids, labs within normal limits