{
  "name": "Fluid Volume Excess (Hypervolemia)",
  "slug": "fluid-volume-excess",
  "url": "https://nursingplex.com/care-plans/fluid-volume-excess",
  "category": "Endocrine & Metabolic",
  "summary": "Fluid overload with edema and crackles; diuresis, sodium restriction and daily weights.",
  "nursing_diagnoses": [
    "Excess fluid volume",
    "Impaired gas exchange",
    "Risk for impaired skin integrity"
  ],
  "overview": [
    "Fluid volume excess is retention of isotonic fluid in the intravascular and interstitial compartments, seen in heart failure, renal failure, cirrhosis, nephrotic syndrome, excessive sodium intake and over-aggressive IV therapy.",
    "Excess volume raises hydrostatic pressure, forcing fluid into the interstitium and alveoli. The result is weight gain, dependent edema, jugular venous distention, crackles and, when pulmonary edema develops, severe dyspnea with pink frothy sputum — a medical emergency.",
    "Nursing care revolves around accurate weights and intake–output records, diuretic therapy with electrolyte surveillance, sodium and fluid restriction, and protection of edematous skin."
  ],
  "key_facts": [
    {
      "label": "Weight is the gold standard",
      "text": "A 1 kg gain equals roughly 1 liter of retained fluid; report 2–3 lb in a day or 5 lb in a week."
    },
    {
      "label": "Pulmonary edema",
      "text": "Sudden severe dyspnea, orthopnea and pink frothy sputum require immediate upright positioning, oxygen and provider notification."
    },
    {
      "label": "Diuretic watch",
      "text": "Loop diuretics waste potassium and magnesium; monitor levels and renal function."
    },
    {
      "label": "Skin",
      "text": "Edematous tissue is fragile and perfused poorly — inspect and offload pressure points."
    }
  ],
  "nursing_priorities": [
    "Restore fluid balance and relieve dyspnea.",
    "Monitor diuretic response and electrolytes.",
    "Enforce prescribed sodium and fluid limits.",
    "Protect skin integrity in edematous areas.",
    "Treat the underlying cardiac, renal or hepatic problem."
  ],
  "assessment": {
    "subjective": [
      "Reports of shortness of breath, orthopnea or waking breathless at night",
      "Complaints of swollen legs, tight rings or shoes",
      "Reports of rapid weight gain",
      "Reports of fatigue and reduced exercise tolerance"
    ],
    "objective": [
      "Weight gain, positive fluid balance on intake and output records",
      "Dependent or sacral pitting edema, ascites, periorbital puffiness",
      "Crackles, decreased oxygen saturation, S3 gallop, jugular venous distention",
      "Hypertension, bounding pulses",
      "Dilutional hyponatremia, low hematocrit, elevated BNP"
    ],
    "related_factors": [
      "Heart failure with reduced renal perfusion and RAAS activation",
      "Renal failure with reduced excretion",
      "Hypoalbuminemia from cirrhosis or nephrotic syndrome",
      "Excessive sodium or IV fluid administration",
      "Corticosteroid therapy"
    ]
  },
  "goals": [
    "The client will lose fluid weight at the prescribed rate.",
    "The client will demonstrate clear lung sounds and adequate oxygen saturation.",
    "The client will show decreased peripheral edema.",
    "The client will describe the sodium and fluid restriction plan."
  ],
  "interventions": [
    {
      "title": "Monitor fluid status",
      "points": [
        "Weigh daily at the same time in the same clothing before breakfast.",
        "Maintain strict intake and output; measure abdominal girth if ascites is present.",
        "Auscultate lungs and assess edema, JVD and oxygen saturation each shift.",
        "Track electrolytes, renal function and BNP."
      ]
    },
    {
      "title": "Diuresis and positioning",
      "points": [
        "Administer diuretics as ordered, preferably in the morning, and evaluate urine response.",
        "Replace potassium and magnesium as prescribed and watch for hypokalemia with digoxin.",
        "Position semi- to high-Fowler to ease breathing and elevate dependent limbs when at rest.",
        "Give oxygen for hypoxemia and notify the provider immediately for pulmonary edema signs."
      ]
    },
    {
      "title": "Restriction and skin care",
      "points": [
        "Enforce ordered fluid restriction, spacing allowances across the day.",
        "Provide a low-sodium diet and teach label reading; offer ice chips and mouth care for thirst.",
        "Inspect edematous skin daily, reposition every two hours and avoid tape and tight devices.",
        "Use pressure-redistribution surfaces and heel offloading."
      ]
    }
  ],
  "patient_teaching": [
    "Teach daily weights and the specific thresholds at which to call the provider.",
    "Review low-sodium eating: avoid canned soups, processed meats, restaurant food and the salt shaker.",
    "Explain how to space fluid allowance and manage thirst.",
    "Report increasing swelling, breathlessness at night or a persistent cough."
  ]
}