Fluid overload

During tiie ongoing assessment, tiie nurse assesses the respiratory status every 4 hours and whenever tiie drug is administered. The nurse notes the respiratory rate, lung sounds, and use of accessory muscles in breathing, hi addition, tiie nurse keeps a careful record of the intake and output and reports any imbalance, which may indicate a fluid overload or excessive diuresis. It is important to monitor any patient with a history of cardiovascular problems for chest pain and changes in the electrocardiogram. The primary health care provider may order periodic pulmonary function tests, particularly for patients with emphysema or bronchitis, to help monitor respiratory status. 

If there is evidence of fluid overload (elevated jugular venous pressure, edema, rales)... 

Bccesave dosage is manifested as water intoxication (fluid overload). Symptoms of water intoxication include drowsiness, listlessness confusion, and headache (which may precede convulsions and coma). If sgns of excessive dosage occur, the nurse should notify the primary health care provider before the next dose of the drug is due because a change in the dosage, the restriction of oral or IV fluids and the administration of a diuretic may be necessary. 

Instructs in signs and symptoms of fluid overload and the need to notify health care provider should any occur. 

Administration of oxytocin may result in fetal bradycardia, uterine rupture, uterine hypertonicity, nausea, vomiting, cardiac arrhythmias, and anaphylactic reactions. Serious water intoxication (fluid overload, fluid volume excess) may occur, particularly when the drug is administered by continuous infusion and the patient is receiving fluids by mouth. When used as a nasal spray, adverse reactions are rare. 

The nurse immediately reports any signs of water intoxication or fluid overload (eg, drowsiness, confusion, headache, listlessness, and wheezing, coughing, rapid breathing) to the primary health care provider. 

When oxytocin is administered IV, there is a danger of a fluid volume excess (water intoxication) because oxytocin has an antidiuretic effect. The nurse measures the fluid intake and output. In some instances, hourly measurements of the output are necessary. The nurse observes die patient for signs of fluid overload (see Chap. 58). If any of these signs or symptoms is noted, die nurse should immediately discontinue die oxytocin infusion and run die primary IV line at die rate prescribed by die primary healtii care provider until the primary health care provider examines die patient. 

One adverse reaction common to all solutions administered by the parenteral route is fluid overload, that is, the administration of more fluid than the body is able to... 

The nurse observes patients receiving IV solutions at frequent intervals for signs of fluid overload. If signs of fluid overload (see Display 58-1) are observed, the nurse slows the IV infusion rate and immediately notifies the primary health care provider. 

The expected outcomes of the patient may include an optimal response to therapy, prevention of fluid overload, correction of the fluid volume deficit (where appropriate), improved oral nutrition (where appropriate), and an understanding of the administration procedure... 

Older adults are at increased risk for fluid overload because of the increased incidence of cardiac disease and decreased renal function that may accompany old age. Careful monitoring for signs and symptomsof fluid overload (see Table 58-2) isextremely important when administering fluids to older adults... 

Heart failure is a clinical syndrome characterized by a history of specific signs and symptoms related to congestion and hypoperfusion. As HF can occur in the presence or absence of fluid overload, the term heart failure is preferred over the former term congestive heart failure. Heart failure results from any structural or functional cardiac disorder that impairs the ability of the ventricle to fill with or eject blood.1 Many disorders such as those of the pericardium, epicardium, endocardium, or great vessels may lead to HF, but most patients develop symptoms due to impairment in left ventricular (LV) myocardial function. 

Side effects from crystalloids primarily involve fluid overload and electrolyte disturbances of sodium, potassium, and chloride.23 Dilution of coagulation factors can also occur resulting in a dilutional coagulopathy.24 Two clinically significant reasons LR is different from NS is that LR contains potassium and has a lower sodium content (130 versus 154 mEq/L or mmol/L). Thus, LR has a greater potential than NS to cause... 

Generally, the major adverse effects associated with colloids are fluid overload, dilutional coagulopathy, and anaphy-lactoid/anaphylactic reactions.24,32 Although derived from pooled human plasma, there is no risk of disease transmission from commercially available albumin or PPF products since they are heated and sterilized by ultrafiltration prior to distribution.24 Because of direct effects on the coagulation system with the hydroxyethyl starch and dextran products, they should be used cautiously in hemorrhagic shock patients. This is another reason why crystalloids maybe preferred in hemorrhagic shock. Furthermore, hetastarch can result in an increase in amylase not associated with pancreatitis. As such, the adverse-effect profiles of the various fluid types should also be considered when selecting a resuscitation fluid. 

Is there any evidence of adverse events from the resuscitation therapies employed such as fluid overload, electrolyte disturbances, transfusion reactions, and/or alterations in coagulation If yes, manage the particular adverse event accordingly. 

Fluid restriction is generally unnecessary as long as sodium intake is controlled. The thirst mechanism remains intact in CKD to maintain total body water and plasma osmolality near normal levels. Fluid intake should be maintained at the rate of urine output to replace urine losses, usually fixed at approximately 2 L/day as urine concentrating ability is lost. Significant increases in free water intake orally or intravenously can precipitate volume overload and hyponatremia. Patients with stage 5 CKD require renal replacement therapy to maintain normal volume status. Fluid intake is often limited in patients receiving hemodialysis to prevent fluid overload between dialysis sessions. 

Exacerbation of diabetes mellitus from glucose load Fluid overload... 

The tonicity of crystalloid solutions is directly related to their sodium concentration. The most commonly used crystalloids include normal saline, hypertonic saline, and lactated Ringer s solution. Excessive administration of any fluid replacement therapy, regardless of tonicity, can lead to fluid overload, particularly in patients with cardiac or renal insufficiency. 

The clinical scenario and the severity of the volume abnormality dictate monitoring parameters during fluid replacement therapy. These may include a subjective sense of thirst, mental status, skin turgor, orthostatic vital signs, pulse rate, weight changes, blood chemistries, fluid input and output, central venous pressure, pulmonary capillary wedge pressure, and cardiac output. Fluid replacement requires particular caution in patient populations at risk of fluid overload, such as those with renal failure, cardiac failure, hepatic failure, or the elderly. Other complications of IV fluid therapy include infiltration, infection, phlebitis, thrombophlebitis, and extravasation. 

Owing to its ability to cause widespread T cell lysis after the first dose, OKT-3 has several severe adverse effects that manifest within 3 hours after administration.10,11,14 These adverse reactions often are referred to as the first-dose effect and usually are secondary to cytokine release. The adverse-reaction profile of OKT-3 includes fever (77%), chills (43%), dyspnea (16%), nausea (32%), vomiting (25%), diarrhea (37%), and tachycardia (26%). One of the major complications of OKT-3 is the development of severe pulmonary edema.11,15,16 In reported cases of this complication, patients were fluid overloaded at the time of the initial dose. Another problematic adverse reaction is the development of nephropathy.11,17... 

Multiple pharmacologic interventions are available for the treatment of hypercalcemia (Table 96-10). Furosemide 20 to 40 mg/day may be added to hydration once rehydration has been achieved to avoid fluid overload and enhance renal excretion of calcium. Although effective in relieving symptoms, hydration and diuretics are temporary measures that are useful until the onset of antiresorptive therapy thus hydration and antiresorptive therapy should be initiated simultaneously. 

Calciuric therapy Intravenous normal saline 200-500 mlZhour 24-48 hours 2-3 days 0.5-2 mg/dL Avoid fluid overload, monitor electrolytes. 

Patients may develop edema, fluid overload, and oliguria that may progress to anuria with acute renal failure. 

For patients with fluid deficits, it is safer and more cost-effective to correct fluid abnormalities using standard intravenous fluids (e.g., sodium chloride 0.9% in water, dextrose 5% in water, and lactated Ringer s solution). Minimizing fluid volume in PN may be indicated in patients with fluid overload, such as critically ill patients who receive large-volume resuscitation fluids, patients with oliguric (urine output less than 400 mL/day) or anuric (urine output less than 50 mL/day) renal failure, and those with congestive heart failure. It is reasonable to... 

Enteral feeding formulas can be categorized based on caloric density. Standard caloric density is 1 to 1.3 kcal/mL. More calorically dense formulas containing 1.5 to 2 kcal/mL are also available and have a higher osmolality. When choosing an EN formula, the patient s fluid status should dictate the caloric density selected. Fluid-overloaded patients may benefit from more calorically dense formulas. It should be recognized that... 

Metabolic complications of EN most commonly include disorders of fluid and electrolyte homeostasis and hyperglycemia. More severely ill patients require more frequent monitoring than those who are more stable (see Table 98-9). Both dehydration and fluid overload can occur with tube feeding. Careful monitoring of fluid inputs and outputs as well as body weight is important. Dehydration may be due either to excessive fluid... 

Hammer, J., Pruckmayer, M., Bergmann, H., Rletter, K., Gangl, A., The distal colon provides reserve storage capacity during colonic fluid overload, Gut, 1997, 41, 658—663. 

Fluid overload can result in pulmonary congestion and peripheral edema. Nonspecific symptoms may include fatigue, nocturia, hemoptysis, abdominal pain, anorexia, nausea, bloating, ascites, poor appetite, ascites, mental status changes, and weight gain. 

Appropriate management of decompensated HF is aided by determination of whether the patient has signs and symptoms of fluid overload ( wet HF) or low cardiac output ( dry HF) (Fig. 8-2). 

Evaluate and optimize chronic therapy D/C meds that worsen HF Assess for signs/symptoms of fluid overload and/or low cardiac output syndrome... 

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