Fluid Overload (Nursing)

00:01 Now we're going to talk about patients who have too much fluid or who are fluid overloaded.

00:08 So what is fluid overload exactly? Fluid overload is hyperkalemia, or too much fluid in the body system.

00:17 So this can happen when you have normal or increased intake.

00:21 It can cause some abnormal electrolytes, and might also happen if you have decreased output.

00:29 So, if you are unable to urinate, then you're retaining that fluid and can become fluid overloaded.

00:35 So, some additional reasons for fluid overload include patients who have heart failure.

00:41 Patients that have any kind of kidney injury, but especially acute kidney injury are likely to become fluid overloaded.

00:48 Chronic kidney disease can cause fluid overload.

00:52 Sepsis can also cause fluid overload.

00:56 Mostly because we are giving additional fluids to sepsis patients.

01:01 If you have had surgery, you're likely to get additional fluids during that procedure.

01:06 So you can become fluid overloaded.

01:08 And occasionally, we hear the term over resuscitation.

01:12 So as in the example with sepsis, we know we're going to have to give those patients fluid.

01:17 And often the volume of fluid that we have to give those patients is quite high.

01:22 I do want to be very clear that the patients need that fluid.

01:27 If you have a septic patient and their blood pressure is low and their heart is not working correctly, then we need to put fluid in those blood vessels so that the heart has something to work with.

01:38 Eventually, we're going to have to deal with the consequences of all the fluid that we've given.

01:43 But it is still necessary to give that fluid to the patient.

01:48 So, what are some signs and symptoms of fluid overload? You're going to see swelling, often in the hands and feet, and independent areas.

01:58 So lungs are an area that have has a tendency to see a lot of fluid.

02:03 The genital areas, also another area that sees a lot of swelling.

02:08 You might notice a differences in the lung sounds.

02:11 And you might see increased respiratory distress, especially in infants.

02:16 So, as we've mentioned before, when fluid leaks out of those blood vessels, it really kind of likes to settle in the lungs, and the lungs get a little bit on the soggy sides.

02:26 So, you'll notice that in the increased respiratory distress.

02:30 And you might hear crackles when you listen to the patient.

02:34 You might also notice an increase in blood pressure.

02:38 So your patient might actually be hypertensive.

02:42 There are some laboratory values that can also help you know if your patient is fluid overloaded, or doesn't have enough fluid for that matter.

02:51 But in this case, this graph is going to give you an idea of some of those labs and what you would expect to see.

02:58 So, for the serum osmolality.

03:01 Normally, you would expect that to be between 285 and 295.

03:06 In fluid overload or or hyperkalemia, you're going to expect to see that to decrease.

03:14 In hypovolemia, you would expect to see it increase.

03:17 So, this graph really covers both of those.

03:21 Urine specific gravity.

03:23 You would expect the normal to be 1.003 to 1.030.

03:30 And then again, in hypervolemia, you would expect that to decrease.

03:36 In hypovolemia, you would expect it to increase.

03:39 For urine osmolality.

03:41 Your normals going to be anywhere from 200 to 1200.

03:44 So there's kind of a wide normal range.

03:46 And if it's less than 200, you might expect that your patient has too much volume, so hyperkalemia.

03:54 And if it's really high, then that indicates that your patient might not have enough fluid and that's hypovolemia.

04:03 So, what are we going to do about fluid overload? One of the first things we can do is restrict fluid.

04:09 So, you're not going to allow your patient to drink as much.

04:13 You might not be giving them as much IV fluids.

04:16 In a previous presentation we discussed, how to calculate maintenance IV fluids? It might be that you have to cut that rate in half or even cut it down to a third.

04:26 Your provider will help you decide how much you would need to cut those rays.

04:31 But you would have the patient take less fluid in.

04:36 Additionally, fluid overload can cause some electrolyte imbalances.

04:40 So when you're treating fluid overload, we would be checking those electrolytes and we would be correcting any of those imbalances.

04:48 You might be giving your patients diuretics.

04:50 So diuretics will help the kidneys really force fluid out of the body.

04:56 It's also important when you're giving diuretics to follow those electrolytes because you can have some electrolyte imbalances with the diuretics as well.

05:04 While your patient is experiencing the fluid overload, their heart is going to be working really hard.

05:09 So you might be giving medications to support that heart function.

05:14 And in extreme cases, when there is a lot of fluid, and maybe diuretics aren't working, or it's not getting fluid off quickly enough to just restrict fluid, you might have to institute dialysis for your patients.

05:28 So you might have to start dialysis.

05:30 And dialysis can help really take some extra fluid off the patient.

05:35 And then it's really important to remember that you've got to treat the underlying cause of the fluid overload.

05:41 If it's heart failure, then we want to be treating that.

05:45 If it's kidney injury, we want to be helping those kidneys out.

05:48 Otherwise, you'll just continue to accumulate fluid.