Fluid Volume (FVE and FVD)

Fluid Volume Deficit (FVD)

• Not taking enough fluids from conditions like:

  • Gastric suctioning

  • Sweating

  • 3rd interstitial space (From burns or ascites)

  • Diabetes Insipidus

  • Vomiting

  • Diarrhea

  • Decreased Fluid intake

FVD Contributing factors

• Strenuous exercise

• Increase alcohol or caffeine intake

• Living in high elevations

• Diminished thirst reflex

• Loss of muscle mass due to muscles holding water

FVD Symptoms

• Rapid weight loss
  Decreased skin turgor

• Oliguria

• Thirst

• Concentrated Urine

• Postural Hypotension

• Rapid weak pulse (Thready)

• Increased Temperature

• Clammy skin

• Lassitude

• Nausea

• Muscle weakness, Muscle cramps

• Tachycardia

• Tachypnea

• Confusion

• Weakness

FVD Laboratory Findings

• Increased BUN

• Increased Hematocrit

• Specific gravity is > 1/030

• Hypernatremia: Increased insensible losses and DI

• Hyponatremia: Increased Thirst and Increased ADH release

• Serum osmolality > 295

• Hypokalemia: GI and Renal Losses

• Hyperkalemia: Adrenal Insufficiency

Pharmacological Treatment for FVD

• Not severe: Oral fluids like water, if nauseous give antiemetics with

• Severe: Isotonic Electrolyte solutions like lactated ringers 0.9% NaCl, then once BALANCED give hypotonic solutions like 0.45% NaCl

FVD important assessments

I/O every 8 hours, daily weight, Vitals, Skin/Tongue turgor, Urine output, Mental status, body temperature (Lower unless there is an active infection)

Nursing Management FVD

• Nurse observing for weak rapid pulse (Thready) and orthostatic hypotension (Decrease in SBP exceeding 20mmHg when moving from lying to sitting)

• Monitoring daily weight for weight loss

• Minimizing weight loss

• Fixing underlying problems (eg. diarrhea = antidiarrhea meds)

Fluid Volume Excess (FVE)

• Fluid overload via retention of fluid

• Diminished homeostatic mechanism

• Issues with kidneys that causes it to be unable to excrete OR kidneys is compensating due to CHF

FVE Contributing Factors

• HF

• Renal failure

• Cirrhosis of liver

• Overdose of sodium concentrated fluids
  Fluids shifts due to burns

• Prolonged use of corticosteroids

• Hyperaldosteronism

• Excessive dietary sodium or sodium containing IV solution

FVE Clinical manifestations:

• Edema

• Distended Neck vein

• Abnormal lung sounds

• Tachycardia

• Bounding pulse

• Increased BP

• Increased weight

• Increased urine output

• SOB and Wheezing

• Peripheral edema

• Weakness

• Headache

• AMS

• Ascites

FVE Labs

• Decreased Hematocrit and Hemoglobin

• Decreased Serum and Urine osmolality

• Decreased BUN

• CXR shows Pulmonary Congestion

Assessment for FVE

• Monitor I/O

• Daily weight

• Peripheral edema

• Na restricted diet

• Encourage rest

• If patient is receiving diuretic make sure to monitor closely

• Monitor serum Na and K levels

• Tell patient to notify HCP if gaining 1 to 2lbs of weight in 24 hours

• Educate about low sodium and fluid restriction diet

Pharmacological Treatment for FVE

• Sodium restriction not enough? give Diuretics

• Thiazide: Blocks sodium and water reabsorption at distal tubule

• Potassium sparring: when giving make sure to watch for hyperkalemia

Nursing Management for FVE

• restriction of fluids and sodium

• Prescribing diuretics

• Educate about nutritional therapy where diet should include less than 2000mg of sodium everyday

• Semi-fowler position to prevent dyspnea and orthopnea

• Turning patient

• Assess breath sounds

• Weighing patient

• Check for edema and rank

• Discuss avoiding OTC unless discussed with PCP