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.
