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Tip of the Week– Fluid Volume Excess Assessment and Recognition

Fluid volume excess (FVE), or hypervolemia, occurs from an increase in total body sodium content and an increase in total body water. This fluid excess usually results from compromised regulatory mechanisms for sodium and water as seen in congestive heart failure (CHF), kidney failure, and liver failure.

FVE may also be caused by excessive intake of sodium from foods, low protein intake, hormonal disturbances, overload from intravenous (IV) solutions, medications (antidiuretics, steroids), pregnancy, and inflammatory processes.

Defining characteristics are edema and weight gain together with symptoms of the underlying cause of fluid volume excess.

Edema is observable swelling which is the result of the accumulation of excess fluid under the skin in the spaces within the tissues. It is most commonly seen in the feet and legs (peripheral edema).

Other kinds of edema can occur depending on where the excess fluid is stored. If it occurs in the alveoli in the lungs, it is called pulmonary edema and if it is in the peritoneal cavity in the abdomen, it is called ascites. A more severe case, anasarca or generalized edema, is the widespread accumulation of fluid in all  tissues and interstitial spaces of the body at the same time.

Edema is further classified into two types – pitting and non-pitting edema. Pitting edema is assessed by pressing a finger onto the swollen area, an indentation occurs and persists even after relieving pressure. Non-pitting edema does not cause a persistent indentation upon the application of pressure.

Other clinical manifestations of hypervolemia include:

  • Bounding pulses
  • Shortness of breath; orthopnea
  • Abnormal breath sounds: crackles (rales)
  • Change in respiratory pattern
  • Increased blood pressure
  • Jugular vein distension
  • Specific gravity changes

Assessment of patient outcomes comprise of taking daily weight, monitoring intake and output, measurement of edematous extremities and abdominal girth, and assessment of severity and location of edema.

Though specific treatments are aimed at resolving the cause of fluid volume excess, the following nursing interventions can be done to relieve symptoms of edema.

  • instruct patient regarding fluid restrictions
  • restrict sodium intake as prescribed
  • instruct to avoid medications that cause fluid retention (OTC NSAIDs, steroids)
  • administration of prescribed diuretics
  • elevation of edematous extremities
  • reduce constriction of blood vessels (appropriate garments, avoid crossing legs)
  • instruct use of anti-embolic stockings or bandages as ordered

Disorders of Fluid Volume from Merck Manuals

Edema by MedicineNet.com

Fluid Volume Excess by RNcentral


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