Management of Dehydration: Fluid Bolus with Fluid Overload (Nursing)

00:02 Now, in many instances, your patient is going to need more than one fluid bolus.

00:07 And why is that? So under normal conditions, fluid is going to go into the bloodstream and it's going to stay there anywhere from 20 minutes to 1 to 2 hours, That's kind of the half life of the fluid.

00:26 After that fluid has been in the blood vessels for that period of time.

00:30 It is going to start leaking out of the blood vessels and into the space in between the cells.

00:39 So, infants and premature infants often even have a lower plasma oncotic pressure and higher permeability of the capillary wall.

00:48 So what does that mean? That the little gaps in the walls of your blood vessels are even a little bit wider for infants and premature infants.

01:00 And so the fluid that's in those blood vessels is just able to leak out into the tissues around the blood vessels.

01:07 And this can also happen when you're sick, the gaps in your blood vessels widen out a little bit.

01:12 And again, that fluid that's in your blood vessels starts to leak out into the tissues.

01:17 So when you get a fluid bolus, the fluid stays in the blood vessels for a period of time, but eventually, it's going to start leaking out into the tissues surrounding the blood vessels.

01:30 This increases the shift of water from the intravascular space to that interstitial space.

01:37 And really, states like sepsis makes this much worse.

01:43 So when the fluid starts to shift into that interstitial space, that is what is known as third spacing.

01:50 So you'll hear that term third spacing quite often when you are talking about ill and sick patients.

01:59 So, third spacing, when that fluid starts shifting into that interstitial space, it really starts to cause a lot of edema.

02:08 What does that mean? Hands and feet, dependent areas start to really swell.

02:14 Genitals is also an area where fluid has a tendency to collect.

02:20 Lungs are an area where fluid has a tendency to collect.

02:24 And if you are lying in a bed, anything that is low has a tendency to collect fluids.

02:31 So the back of your head, sometimes the back of your body, and definitely hands and feet are all areas that might become quite quite swollen.

02:41 And it's really good to kind of warn parents and caregivers that this might happen, because it can be quite shocking for them to see their child as they start swelling with these fluid boluses.

02:54 So most importantly, if you are going to perform an intervention like giving a fluid bolus, just remember to assess your patient assess them before, during, and after that intervention.