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Excess Fluid Volume — Hemodialysis

HD-Excess Fluid Volume

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NURSING DIAGNOSIS: Fluid Volume, risk for excess

Risk factors may include

  • Rapid/excessive fluid intake: IV, blood, plasma expanders, saline given to support BP during dialysis

Possibly evidenced by

  • [Not applicable; presence of signs and symptoms establishes an actual diagnosis.]

DESIRED OUTCOMES/EVALUATION CRITERIA—PATIENT WILL:
Fluid Balance (NOC)

  • Maintain “dry weight” within patient’s normal range; be free of edema; have clear breath sounds and serum sodium levels within normal limits.

Nursing Interventions & Rationale

Nursing Interventions Rationale
 Measure all sources of I&O. Weigh routinely.  Aids in evaluating fluid status, especially when compared with weight. Weight gain between treatments should not exceed 0.5 kg/day.
 Monitor BP, pulse.  Hypertension and tachycardia between hemodialysis runs may result from fluid overload and/or HF.
 Note presence of peripheral/sacral edema, respiratory rales, dyspnea, orthopnea, distended neck veins, ECG changes indicative of ventricular hypertrophy.  Fluid volume excess due to inefficient dialysis or repeated hypervolemia between dialysis treatments may cause/exacerbate HF, as indicated by signs/symptoms of respiratory and/or systemic venous congestion.
 Note changes in mentation. Fluid overload/hypervolemia may potentiate cerebral edema (disequilibrium syndrome).
 Monitor serum sodium levels. Restrict sodium intake as indicated. High sodium levels are associated with fluid overload, edema, hypertension, and cardiac complications.
 Restrict PO/IV fluid intake as indicated, spacing allowed fluids throughout a 24-hr period.  The intermittent nature of hemodialysis results in fluid retention/overload between procedures and may require fluid restriction. Spacing fluids helps reduce thirst.
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