Learn about a condition that can occur in the body called fluid volume excess. Learn about how it looks, feels and sounds in the body as well as the actions nurses take in treatment.
Introduction to Fluid Volume Excess
Fluid is very important to have in our bodies. It makes up the blood that transports oxygen and nutrients to organs, hydrates our tissues and carries waste products outside our body when we urinate, breathe and sweat. In order to stay healthy, you must have the right amount of fluid in your body.
When a person has too much fluid, the condition is called fluid volume excess.
Think about how a dry sponge looks in its original shape compared to when it’s filled with water. Just like the sponge, people who have fluid volume excess look swollen and puffy. This is because the excess fluid in their bodies has leaked into the tissues right beneath the skin. The medical term edema describes this appearance. You commonly see this in the legs, ankles and feet.
However, it can appear anywhere there is tissue, such as the arms, abdomen, face and around the eyes.In some cases, a person may have another form of edema, called pitting edema. This occurs when the body part is so full of fluid you can press your fingertips into the skin and make indentations that slowly disappear.
Sometimes the skin is extremely stretched to where it appears shiny. There can also be excess fluid in the abdomen that makes it look round and protruded. This is called distention.
Just like a water-filled sponge, the skin feels squishy.
In severe situations, the skin feels moist or wet from the fluid leaking out. When feeling the pulse in the wrist, it can feel very strong and forceful, which is called a bounding pulse. The person may complain about a heaviness in his or her body, particularly in the chest, arms and legs. Other complaints include headache, difficulty breathing, heart palpitations, fatigue and confusion.
A stethoscope is the instrument used to listen to the heart and lungs.
When there is excess fluid in the body, these organs can sound a specific way. The heart may beat with an irregular rhythm or faster than normal (tachycardia). The lungs may have a rattling sound when inhaling and exhaling, called rales or crackles.
As a nurse, it is important to identify fluid volume excess so that specific interventions can be performed.Like any liquid, the fluid in the body has weight. The nurse weighs the patient every day at the same time, usually in the morning. The patient should have on the same amount of clothes when weighed on a standing scale or have the same amount of covers removed when weighed on a bed scale. A weight measurement is a good indicator of how much fluid is in the body when comparing the readings from day to day.Nurses measure the amounts of fluids going in and out of the body over a period of time.
The intake includes the fluid that goes in the body. Here are some examples:
- Beverages (water, juice, milk, soda, coffee and tea)
- Liquid foods (broth and soup)
- Foods that become liquid at room temperature (ice chips, ice cream, gelatin and popsicles)
- Fluids received through an intravenous line (saline, multivitamins, blood transfusion)
- Nutritional supplements received through a feeding tube
The output is the fluid that goes out of the body. Urine is the most common type of output the nurse measures. Other examples are the fluids from vomiting, diarrhea and bleeding.
Excess fluid in the body can gather in the arms and legs and lead to edema when the limbs are in downward positions.
Positioning the limbs above the heart facilitates fluid circulation back into the body. If the patient is in bed, the foot of the bed can be elevated to help relieve fluid from the legs and feet, while pillows are used to elevate the arms. The nurse might also encourage walking around, since moving the legs moves fluid from the lower limbs.Water likes to go where there is sodium. So, when there are elevated levels of sodium in the body, it holds on to water, leading to excess fluid. To help prevent this, the nurse can encourage the patient to avoid foods that contain high amounts of salt, such as those that are fried, processed, packaged and canned.
There are special medications called water pills or diuretics that help rid the body of excess fluid. Diuretics work by making the kidneys put more sodium into the urine. These can be taken orally, though in severe cases of fluid volume excess, they are given intravenously. As you’ve learned already, water likes to go where sodium is located, so it also goes into the urine.One way the nurse checks to see that diuretics are working is by observing an increased amount of urine the patient puts out. The nurse should also monitor the side effects of the diuretics, because some can cause dizziness, low potassium levels and a sudden drop in blood pressure.
Fluid volume excess is when the body has too much fluid in the body. There are many symptoms people can experience. The skin if often swollen, puffy, moist and shiny. The abdomen can look distended.
The person can have a bounding pulse, feel heaviness in the body, or complain of difficulty breathing, heart palpitations, fatigue and confusion. Rattling sounds may be heard in the lungs.Specific nursing interventions include taking the patient’s weight everyday to determine the amount of excess fluid in the body, monitoring intake and output of fluids, positioning the body to facilitate the draining of fluids, encouraging a low-sodium diet and administering diuretics.Medical Disclaimer: The information on this site is for your information only and is not a substitute for professional medical advice.
Fluid volume excess – a condition which occurs when a person has too much fluid in their bodyEdema – the swollen, puffy appearance of body parts that have fluid volume excessPitting edema – a form of edema when the body part is so full of fluid you can press your fingertips into the skin and make indentations that slowly disappearDistention – excess fluid in the abdomen that makes it look round and protrudedBounding pulse – a very strong and forceful pulseTachycardia – when the heart beats with an irregular rhythm or faster than normalIntake – the fluids or other substances that enter the bodyOutput – the fluids or other substances that exit the bodyDiuretics – pills which help rid the body of excess fluid
Study the lesson until you feel ready to:
- Identify the symptoms of fluid volume excess
- Describe appropriate nursing interventions for people experiencing fluid volume excess