Fluid imbalances: overhydration







Overhydration (too much fluid in the body from ineffective removal or excessive intake)
o Hemodilution (blood cells, electrolytes seem lower)
o Hypervolemia (excessive sodium intake causes certain body parts to retain water)
o at risk for pulmonary edema and congestive heart failure
o reduced kidney functions
Causes of hypervolemia
o compromised regulatory systems (heart failure kidney disease and cirrhosis)
o overdose of fluids, fluid shifts from burns, severe stress
o prolonged use of corticosteroids, hyper aldosteronism
causes of overhydration
o water without electrolyte replacement
o syndrome of inappropriate anti diuretic hormone SIADH
o excessive IV D5W, hypotonic irrigation
Findings, fluid volume overload
o VITAL signs: tachycardia, bounding pulse, hypertension, tachypnea, increased central
venous pressure
o neuromuscular: weakness, visual changes, parenthesias, seizures,
o respiratory: crackles, cough, dyspnea
o Other signs: peripheral edema, weight gain, distended neck veins, urine output increase,
skin cool to touch
Laboratory tests
o decreased the magic crit and hemoglobin
o decrease blood osmolarity and urine sodium
o decrease BUN
Nursing care
o I&O, daily weight, breath sounds, monitor edema, restricted sodium diet, Fowler semi
Fowler position to prevent tissue breakdown, use pressure reducing mattress, monitor
blood sodium and potassium levels
Complications
pulmonary edema
o manifestations include anxiety, tachycardia, vein distention, premature ventricular
contractions, dyspnea at rest, consciousness change, restlessness, lethargy, ascending
crackles, cough productive of frothy pink sputum
 actions for edema
 high fowlers to maximize ventilation
 administer oxygen, positive airway pressure and or intubation
 morphine nitrates diuretics if blood pressure is adequate