Pediatric Case: Fluid Overload (Nursing)

00:01 So we want you to think about this question, in the next couple of slides.

00:06 Would you ever give fluid to a patient that is already fluid overloaded? Think about that for a moment.

00:20 So, we're going to think about this in terms of a patient case.

00:23 I want you to imagine these patient assessments.

00:27 You have a patient that for the last 24 hours is up one liter of fluid.

00:34 So they're positive one liter in their fluid balance, When you look back at their eyes and nose over the last three days there positive five liters of fluid.

00:44 And remember, in pediatric patients, who can be quite small, a five liters of fluid is a large amount.

00:52 The urine output for your patient today was only 0.4 milligrams per kilo per hour.

00:58 Now yesterday, it seemed to be pretty adequate, it was one milliliter per kilo per hour.

01:05 Your patient is six-years-old. Their blood pressure is 78/45.

01:10 What do you think about that blood pressure? You notice that they have edema in their hands and feet.

01:16 Their hands and feet are swollen. Their heart rate is 123.

01:20 You look at their capillary refill, and it's three seconds.

01:23 That's fairly normal. Their lung sounds are clear.

01:26 So based on this patient assessment, I want you to think for a moment about would you give fluid to this patient? So, the answer is yes.

01:42 Now, I know that they have some extra fluid on board.

01:45 And there are some things that indicate that this patient is pretty fluid overloaded.

01:51 But why would you give this patient fluid? So, in our patient assessment, there were a few clues and a few cues that you should have picked up on that said that this patient is third spacing, but that they didn't have enough fluid in their blood vessels.

02:09 Some of those clues included, their blood pressure was a little on the low side.

02:14 78/45 is low for a six-year-old child.

02:18 And that heart rate is a little bit elevated.

02:21 123 is a little higher than you would expect a six-year-old child to have.

02:26 We would generally expect their heart rate to be less than 100.

02:30 So, those clues tell me that even though the patient has extra fluid on board, they have some swelling in their hands and feet, that their blood vessels don't quite have enough fluid to give a good blood pressure and our hearts working a little bit harder than we want it to.

02:49 And that's why it's elevated.

02:51 So, in this instance, we would give a fluid bolus.

02:55 So, you might hear the term that our patient is functionally fluid down.

03:00 So the patient isn't actually fluid down, they have too much fluid on board, but we call them functionally fluid down because that fluids not in the right place.

03:10 It's not in the blood vessels.

03:13 So when might something like this happen? If you have a sick patient, a patient especially with sepsis, they have a high inflammatory status.

03:25 Maybe the patient has low albumin in the case of often chronic kidney patients have low albumin states, then fluid might leak out into that third space.

03:36 And in this instance, how would you give that fluid? Do you need to rush to give a very rapid bolus or can you take a little bit more time? I would say probably for this patient that you could give that fluid a little more conservatively, perhaps over 30 minutes and time to assess your patient before and after that bolus is given.

03:59 So when you think about fluid overload, it's really important to remember that we generally try not to give extra fluid to fluid overloaded patients and goal of treatment is to get that fluid off and make sure that the patient becomes more balanced.

04:17 But the most important thing to remember is that you have to assess your patient and sometimes it does end up being necessary to give fluid to a fluid overloaded patient.