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Extracellular fluid volume excess

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Khushi Devgan

ECFVE, or extracellular fluid volume excess, occurs when there is increased retention of sodium and water in the intravascular and interstitial spaces. This most commonly results from renal or heart disorders that impair sodium regulation. Symptoms include dyspnea, edema, neck vein engorgement, and crackles in the lungs. Treatment involves diuretics and a low-sodium diet to promote sodium and water excretion and reduce fluid overload. Patients must be carefully monitored for changes in vital signs, edema, and lab values to ensure fluid balance is restored.

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PRESENTED BY:- KHUSHNASIB
ECFVE is increased fluid retension in the intravascular & interstitial spaces. When sodium and water are retained in the same proportions, the condition is referred to as iso- osmolar fluid volume excess. The serum sodium level may be withthe normal range even though the actual sodium level is increased because of excess water retension.
ECFVE frequently occurs in cases of heart disease in which there is pump failure. Excess fluid volume and coronary insufficiency due to heart pump failure usually lead to congestive heart failure. ETIOLOGY:- ECFVE usually results from an increase in total body sodium content. Causes of ECFVE include:-
- Renal disorders - Cirrhosis of liver - Increased ingestion of foods that contain high amounts of sodium - Excessive tap water enemas - Excessive amounts of intravenous fluids that contain sodium.
Heart, kidney or liver disease are prone to sodium and water retension. - Clients with hyperaldosteronism or Cushing syndrome - Using glucocorticoids - Use of hypotonic fluids to irrigate NG tubes. - Men undergone transurethral resection of prostate gland with sodium free irrigation during and after surgery.
Increased hydrostatic pressure in arterial end of capillary ↓ Increased peripheral Fluid movement Vascular resistance into tissues ↓ Increased left ventricular Edema Pressure ↓
Pulmonary edema Decreased Lymphatic Increased Production obstruction capillary Of plasma decreases permeability Protiens absorption of interstitial fluid ↓
Decreased Decreased Movement Capillary transportation of plasma Oncotic of capillary protiens Pressure filtered into tissues ↓ ↓ ↓ Edema Increased Increased tissue oncotic tissue oncotic pressure which pressure pulls fluid towards it ↓ ↓ Edema Edema
 Dyspnea  Engorged neck and hand veins  Bounding pulse  Moist crackles in the lungs  Edema of extremities Respiratory symptoms:- - Constant irritating cough - Dyspnea - Crackles in lungs
- Cyanosis Cardiovascular symptoms:- - Neck vein engorgement in semi Fowler’s position - Hand vein engorgement - Bounding pulse, elevated blood pressure - S3 gallop sounds - Pitting edema of lower extremities - Sacral edema
- Weight gain Neurologic symptoms:- - Change in level of consciousness PATHOPHYSIOLOGIC BASIS:- - Fluid accumulation in the alveolar sacs due to hypervolemia - Due to fluid congestion in lungs - Alveoli are congested with fluid owing to increased hydrostatic pressure.
- A late symptom of pulmonary edema that results from impaired oxygen transport due to capillaries being filled with fluid. - Due to fluid overload and delayed right sided heart emptying/filling. - Due to peripheral vascular fluid overload. - Due to delayed ventricular filling and overdistension of ventricles from rapid filling during early diastole.
- Osmotic pressure in the venous end of the capillary exceeds interstitial pressure and fluid contain return to blood stream. - Dependent edema in the supine patient occurs in sacral hollow rather than in feet and legs, because the sacrum in the lowest place on the body. - Due to fluid retension, for every 1 Kg gained 1L body fluid is retained. - Malaise, confusion, headache and lethargy
are due to cerebral edema. - Indicates a diluted body fluid in which there are few solutes in proportion to the water volume. - Depending on the amount of sodium retension or water retension, the serum sodium level may be normal, decreased or elevated. - Due to hemodilution. - Solvent in urine exceeds solute.
 Serum osmolality<275 mOs/Kg.  Serum sodium <135 mEq/L to 145>mEq/L(Low, normal or high value).  Decreased hematocrit.  Specific gravity below 1.010 MEDICAL MANAGEMENT:- Diagnosis is determined by a clinical history of contributing and causative factors, history of drug use, signs & symptoms of fluid overload,
& laboratory findings. (The presence of pulmonary edema is a medical emergency requiring immidiate intervention to prevent further respiratory distress). PHARMACOLOGIC MANAGEMENT:- Loop & potassium wasting diuretics and a digitalis preperation and frequently described for the treatment of ECFVE. These potent diuretics cause potassium to be excreted along with the sodium and water. To preserve potassium, a combination of potassium
& potassium sparing diuretics is frequently prescribed. Digoxin, a digitalis preperation is ordered to increase the force of myocardial contraction or to slow the heart rate if the heart failure is the cause of ECFVE. DIETARY MANAGEMENT:- A low sodium diet.
ASSESSMENT:- - Frequent assessment of breathe sound. - Palpation of lower extremities for pitting edema. - Observation for hand and neck vein engorgement and observation of changes in vital signs are used to determine the presence of fluid volume excess. When checking for neck vein engorgement, the nurse should note whether the jugular vein remains engorged
When the client is in semi fowler’s position. Engorgement of neck veins in this position may indicate fluid overload. To check for hand vein engorgement , the nurse has the client lower the hand until the peripheral veins are engorged. The client then raises the hand above the level of heart and the nurse observes the time it takes for the veins to flatten. If the veins do not flatten within 3-5 seconds, fluid overload should be suspected.
 Serum electrolyte values should be checked for abnormalities when the child is recieving diuretics. If the client is taking digoxin and a potassium wasting diuretic, the client should be observed for signs and symptoms of digitalis toxicity and hypokalemia. Nsg dsis:- Fluid volume excess r/t compromised regulatory mechanisms or hypervolemia  Expected outcomes:- Fluid balance will be within normal limits, as evidenced by the
Absence of dyspnea, clear chest sounds, absence of dependent edema, flat neck veins, the peripheral vein emptying in 3-5 seconds, decreased body weight and the urine output exceeding intake. IMPLEMENTATION:- - Vital signs should be monitored for bounding pulse or an elevated blood pressure every 4-8 hours. - The nurse should auscultate breathe sounds
Every 4-8 hours for crackles, noting changes and the location of adventitious sounds. The physician should be notified if there is an increase in crackles. - Assess neck vein engorgement every 8 hours and monitors daily weights. Edema does not usually occurs unless there are 3 L or more of excess fluids. - Intake & output should be evaluated every 4-8 hours in cases of fluid excess, and once every shift in cases of severe fluid excess, and once
every shift in cases of severe fluid excess. - Assess for level of consciousness and palpates lower extremities and sacrum for pitting edema each morning. - Assess for laboratory values include serum osmolarity, sodium, hematocrit and potassium levels, and specific gravity of urine. - Restrict fluid and sodium in diet. - Oral medications should be scheduled at the
time meals are eaten, this will decrease the chance of extra fluids being used to swallow medications. Provide cold fluids. - Provide oral care - Skin care if generalised edema is present.
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Extracellular fluid volume excess

  • 2. ECFVE is increased fluid retension in the intravascular & interstitial spaces. When sodium and water are retained in the same proportions, the condition is referred to as iso- osmolar fluid volume excess. The serum sodium level may be withthe normal range even though the actual sodium level is increased because of excess water retension.
  • 3. ECFVE frequently occurs in cases of heart disease in which there is pump failure. Excess fluid volume and coronary insufficiency due to heart pump failure usually lead to congestive heart failure. ETIOLOGY:- ECFVE usually results from an increase in total body sodium content. Causes of ECFVE include:-
  • 4. - Renal disorders - Cirrhosis of liver - Increased ingestion of foods that contain high amounts of sodium - Excessive tap water enemas - Excessive amounts of intravenous fluids that contain sodium.
  • 5. Heart, kidney or liver disease are prone to sodium and water retension. - Clients with hyperaldosteronism or Cushing syndrome - Using glucocorticoids - Use of hypotonic fluids to irrigate NG tubes. - Men undergone transurethral resection of prostate gland with sodium free irrigation during and after surgery.
  • 6. Increased hydrostatic pressure in arterial end of capillary ↓ Increased peripheral Fluid movement Vascular resistance into tissues ↓ Increased left ventricular Edema Pressure ↓
  • 7. Pulmonary edema Decreased Lymphatic Increased Production obstruction capillary Of plasma decreases permeability Protiens absorption of interstitial fluid ↓
  • 8. Decreased Decreased Movement Capillary transportation of plasma Oncotic of capillary protiens Pressure filtered into tissues ↓ ↓ ↓ Edema Increased Increased tissue oncotic tissue oncotic pressure which pressure pulls fluid towards it ↓ ↓ Edema Edema
  • 9.  Dyspnea  Engorged neck and hand veins  Bounding pulse  Moist crackles in the lungs  Edema of extremities Respiratory symptoms:- - Constant irritating cough - Dyspnea - Crackles in lungs
  • 10. - Cyanosis Cardiovascular symptoms:- - Neck vein engorgement in semi Fowler’s position - Hand vein engorgement - Bounding pulse, elevated blood pressure - S3 gallop sounds - Pitting edema of lower extremities - Sacral edema
  • 11. - Weight gain Neurologic symptoms:- - Change in level of consciousness PATHOPHYSIOLOGIC BASIS:- - Fluid accumulation in the alveolar sacs due to hypervolemia - Due to fluid congestion in lungs - Alveoli are congested with fluid owing to increased hydrostatic pressure.
  • 12. - A late symptom of pulmonary edema that results from impaired oxygen transport due to capillaries being filled with fluid. - Due to fluid overload and delayed right sided heart emptying/filling. - Due to peripheral vascular fluid overload. - Due to delayed ventricular filling and overdistension of ventricles from rapid filling during early diastole.
  • 13. - Osmotic pressure in the venous end of the capillary exceeds interstitial pressure and fluid contain return to blood stream. - Dependent edema in the supine patient occurs in sacral hollow rather than in feet and legs, because the sacrum in the lowest place on the body. - Due to fluid retension, for every 1 Kg gained 1L body fluid is retained. - Malaise, confusion, headache and lethargy
  • 14. are due to cerebral edema. - Indicates a diluted body fluid in which there are few solutes in proportion to the water volume. - Depending on the amount of sodium retension or water retension, the serum sodium level may be normal, decreased or elevated. - Due to hemodilution. - Solvent in urine exceeds solute.
  • 15.  Serum osmolality<275 mOs/Kg.  Serum sodium <135 mEq/L to 145>mEq/L(Low, normal or high value).  Decreased hematocrit.  Specific gravity below 1.010 MEDICAL MANAGEMENT:- Diagnosis is determined by a clinical history of contributing and causative factors, history of drug use, signs & symptoms of fluid overload,
  • 16. & laboratory findings. (The presence of pulmonary edema is a medical emergency requiring immidiate intervention to prevent further respiratory distress). PHARMACOLOGIC MANAGEMENT:- Loop & potassium wasting diuretics and a digitalis preperation and frequently described for the treatment of ECFVE. These potent diuretics cause potassium to be excreted along with the sodium and water. To preserve potassium, a combination of potassium
  • 17. & potassium sparing diuretics is frequently prescribed. Digoxin, a digitalis preperation is ordered to increase the force of myocardial contraction or to slow the heart rate if the heart failure is the cause of ECFVE. DIETARY MANAGEMENT:- A low sodium diet.
  • 18. ASSESSMENT:- - Frequent assessment of breathe sound. - Palpation of lower extremities for pitting edema. - Observation for hand and neck vein engorgement and observation of changes in vital signs are used to determine the presence of fluid volume excess. When checking for neck vein engorgement, the nurse should note whether the jugular vein remains engorged
  • 19. When the client is in semi fowler’s position. Engorgement of neck veins in this position may indicate fluid overload. To check for hand vein engorgement , the nurse has the client lower the hand until the peripheral veins are engorged. The client then raises the hand above the level of heart and the nurse observes the time it takes for the veins to flatten. If the veins do not flatten within 3-5 seconds, fluid overload should be suspected.
  • 20.  Serum electrolyte values should be checked for abnormalities when the child is recieving diuretics. If the client is taking digoxin and a potassium wasting diuretic, the client should be observed for signs and symptoms of digitalis toxicity and hypokalemia. Nsg dsis:- Fluid volume excess r/t compromised regulatory mechanisms or hypervolemia  Expected outcomes:- Fluid balance will be within normal limits, as evidenced by the
  • 21. Absence of dyspnea, clear chest sounds, absence of dependent edema, flat neck veins, the peripheral vein emptying in 3-5 seconds, decreased body weight and the urine output exceeding intake. IMPLEMENTATION:- - Vital signs should be monitored for bounding pulse or an elevated blood pressure every 4-8 hours. - The nurse should auscultate breathe sounds
  • 22. Every 4-8 hours for crackles, noting changes and the location of adventitious sounds. The physician should be notified if there is an increase in crackles. - Assess neck vein engorgement every 8 hours and monitors daily weights. Edema does not usually occurs unless there are 3 L or more of excess fluids. - Intake & output should be evaluated every 4-8 hours in cases of fluid excess, and once every shift in cases of severe fluid excess, and once
  • 23. every shift in cases of severe fluid excess. - Assess for level of consciousness and palpates lower extremities and sacrum for pitting edema each morning. - Assess for laboratory values include serum osmolarity, sodium, hematocrit and potassium levels, and specific gravity of urine. - Restrict fluid and sodium in diet. - Oral medications should be scheduled at the
  • 24. time meals are eaten, this will decrease the chance of extra fluids being used to swallow medications. Provide cold fluids. - Provide oral care - Skin care if generalised edema is present.