FLUID OVERLOAD

I. FLUID OVERLOAD
Hurst Review's Step by Step Approach to NCLEX® Success

A. Fluid Volume Excess/Hypervolemia:

• Define: Too much fluid in the ___________________ ________________.

1. Causes:

a. Heart Failure (HF): Heart is __________, Cardiac Output _______,

Kidney perfusion _____________, Urinary Output __________.
*The volume stays in the ____________________ ________________.

b. Renal Failure (RF): Kidneys aren’t ____________________________.

c. Three things with a lot of sodium:

Rx 1) Effervescent soluble medications
2) Canned/processed foods
Rx 3) IVF with sodium

2. Hormonal Regulation of Fluid Volume:

Rx a. Aldosterone (steroid, mineralocorticoid):

• Where is aldosterone found? ______________ ___________

• Normal action: When blood volume gets low (vomiting,

hemorrhage, etc.)
Aldosterone secretion increases  retain sodium/water
blood volume goes _________.
**Diseases with too much aldosterone:
__________________________________________
__________________________________________
**Disease with too little aldosterone:
__________________________________________

b. Anti-diuretic Hormone (ADH):

• Normally makes you retain or diurese? ____________________

• Retain __________________________

A CLINICAL JUDGMENT APPROACH | STUDENT MANUAL 1

 TWO ADH PROBLEMS

Too Much ADH Not Enough ADH

FLUID OVERLOAD

Retain _________________________ Lose (diurese) _______________

Fluid Volume ___________________ Fluid Volume ________________
SIADH DI _________________________
Syndrome of Inappropriate ADH Diabetes Insipidus
Secretion
(TOO MANY ________________,
TOO MUCH _________________)
Urine ______________________ Urine _______________________
Blood ______________________ Blood ______________________

*Concentrated makes the #s go up

Urine specific gravity, sodium,
and hematocrit
*Dilute makes the #s go down

• ADH is found in the ______________.

• Key words to make you think potential ADH problem:

craniotomy, head injury, sinus surgery, transsphenoidal
hypophysectomy, or any condition that can lead to an
increased ICP can lead to an ADH problem.

• Trans-______________________________, sphenoid _______________,

hypophysis ______________, ectomy _____________________________

Rx *Another name for anti-diuretic hormone (ADH) is vasopressin

(Pitressin®). The drug vasopressin (Pitressin®) or desmopressin
acetate (DDAVP®) may be utilized as an ADH replacement in
diabetes insipidus.

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 3. Signs/Symptoms of FVE:

a. Distended neck veins/peripheral veins: Vessels are ___________.

FLUID OVERLOAD
b. Peripheral edema/third spacing: Vessels can’t hold
any more, so they start to ___________________.
CVP NORMAL:
2-6 mmHg
Rx c. Central Venous Pressure (CVP): measured where? 5-10 cmH2O
___________ _____________; number goes ____ in FVE. *Depending on
measuring device
More ___________________ More _________________ used*

d. Lungs sound:_________________

e. Polyuria: Kidneys are trying to help you ________________________.

f. Pulse: ____________________________

• Your heart only wants fluid to go _____________.

• If the fluid doesn’t go forward, it’s going to go ________________

_into the lungs. Can lead to heart failure and then pulmonary edema.

• Palpate vein or artery?____________________________

• Feels __________________ and _____________________

g. BP: ______________; more volume, more ______________.

h._Weight: _____________________. Any acute gain or loss isn’t fat; it’s fluid.

4. Treatment: TESTING
STRATEGY
a. Low sodium diet/ restrict fluids
Fluid Retention:
Think Heart
b. I & O and Daily __________ Problems FIRST

Rx c. Diuretics:

Rx • Loop: Example: _______________________________

Bumetanide (Bumex®) may be given when

furosemide (Lasix®) doesn’t work.

Rx • hydrochlorothiazide (Thiazide®): Watch lab work with all diuretics for

dehydration and electrolyte problems.

Rx • Potassium sparing: Example: ______________________

A CLINICAL JUDGMENT APPROACH | STUDENT MANUAL 3

 d. Bed rest induces __________________________________
by the release of _______________, and  production of
FLUID OVERLOAD

________________.

e. Physical assessment

• Focus on the pertinent signs and symptoms.

f. Give IVFs slowly to the elderly and very _ ____________,

Rx
and clients with a history of ___________________ or
_________________ problems.

TESTING
STRATEGY
Anytime you see
assessment or
evaluation on
the NCLEX®, you
should be looking
for the presence
or absence of the
pertinent signs
and symptoms.

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